Housing Managers' Education Series by Care Providers of Minnesota

Care Providers of Minnesota presents one of its most popular and longest-running programs:

HOUSING MANAGERS’ EDUCATION SERIES

While this signature certificate series is now a virtual experience, the quality of education and presenters upholds Care Providers of Minnesota’s high standards. Each module will be presented live, and participants have the opportunity to engage with presenters. In addition, each module will be archived and available for 30 days after live presentation.

HOUSING MANAGERS’ EDUCATION SERIES

FEBRUARY 25-APRIL 8, 2021 21 hours | 13 modules* | 12 speakers | 1 great learning opportunity The HOUSING MANAGERS’ EDUCATION SERIES is a virtual certificate program designed for housing professionals trying to manage the multitude of tasks they face every day, nursing facility administrators considering expansion into senior housing, nurses looking for a greater understanding of the role of the housing manager, and other interested staff.

COMPREHENSIVE LEARNING EXPERIENCES & CAREER INVESTMENT—VIRTUAL EDITIONS

*Seven modules are shared with the Nurse Managers’ Education Series

Housing Managers’ Education Series February 25 – April 8 | Virtual Event

FEBRUARY Thursday, February 25 10:00 AM

AGENDA Fundamentals of Landlord/Tenant Law Michelle Klegon, Attorney, Klegon Law Office

MARCH Tuesday, March 2 1:00 PM Thursday, March 4 10:00 AM Wednesday, March 10 10:00 AM Wednesday, March 17 9:00 AM Thursday, March 18 1:00 PM Tuesday, March 23 10:00 AM Wednesday, March 24 1:00 PM Wednesday, March 31 1:00 PM

New Laws Affecting Assisted Living**

Jill Schewe, Director of Assisted Living, Housing & Home Care, Care Providers of Minnesota

Quality Initiatives in Senior Housing

Karen Ruda, Director of Customer Experience, North Shore Healthcare

Growing a Healthy Relationship—Housing Managers & Nurse Managers**

Amanda Johnson, Vice President of Clinical Operations, Tealwood Senior Living

Legal Issues for Housing & Nurse Managers**

Rebecca K. Coffin, Attorney/Partner, Voigt, Rodè & Boxeth & Coffin Robert Rodè, Attorney/Partner, Voigt, Rodè, Boxeth & Coffin

Senior Housing & Emergency Planning

Jill Schewe, Director of Assisted Living, Housing & Home Care, Care Providers of Minnesota

Show Me the Money—Payment Sources

Todd Bergstrom, Director of Research & Data Analysis, Care Providers of Minnesota

Addressing Concerns & Complaints: When, How, & Why?**

April J. Boxeth, Attorney/Partner, Voigt, Rodè, Boxeth & Coffin Rebecca K. Coffin, Attorney/Partner, Voigt, Rodè & Boxeth & Coffin

Leadership Beyond COVID-19: Re-Ignite the Passion Within**

Lisa Thomson, Chief Marketing & Strategy Officer, Pathway Health

APRIL Thursday, April 1 1:00 PM Tuesday, April 6 1:00 PM 3:00 PM Thursday, April 8 9:00 AM

Selling & Marketing Senior Housing: Art & Science

Peggy Scoggins, Owner, Adept Selling

Survey Preparation & Success**

Doug Beardsley, Vice President of Member Services, Care Providers of Minnesota

Electronic Monitoring **

Doug Beardsley, Vice President of Member Services, Care Providers of Minnesota

Human Resource Management

Jennifer Edwards, Regional Director of Human Resources, The Waters Senior Living

**Session is shared between the two signature education series

CARE PROVIDERS OF MINNESOTA 7851 Metro Parkway, Suite 200 Bloomington, MN 55425

www.careproviders.org 1-952-854-2844 MN Toll-Free 1-800-462-0024

facebook.com/CPofMN twitter.com/CPofMN linkedin.com/company/CPofMN youtube.com/user/careprovidersofMN

2021 Housing Managers' Education Series

CARE PROVIDERS OF MINNESOTA 2021 HOUSING MANAGER EDUCATION SERIES

FUNDAMENTALS OF LANDLORD-TENANT LAW Michelle R. Klegon Klegon Law Office, Ltd. (763) 546-1109 MKlegon@klegonlaw.com

INTRODUCTIONS

Michelle Klegon, Attorney, Klegon Law Office, Ltd. Michelle Klegon is an attorney at Klegon Law Office. She practices in the areas of health law and employment law and has been representing nursing facility, home care, and housing with services providers since 1991. Ms. Klegon advises nursing facility and home care providers on survey and other regulatory matters and assists housing with services providers with fair housing issues, contract drafting and review, and conflict resolution. She also advises employers regarding discrimination issues, policy and procedure drafting, conflict resolution, and a variety of other employment law matters. Ms. Klegon regularly conducts provider trainings on all of these topics.

2021 Housing Managers' Education Series

THE LANDLORD/TENANT RELATIONSHIP

GENERAL PROVISIONS UNDER MINNESOTA LANDLORD/TENANT LAW

2021 Housing Managers' Education Series

MINNESOTA STATUTES §504B: LANDLORD-TENANT LAW 

When is a lease required?



Definitions



Mandatory lease provisions



Duties of Landlord & Tenant

GENERAL PROVISIONS OF §504B 

A Landlord with 12 or more residential units must have a written lease for each unit rented to a residential Tenant  



Must identify the specific unit to be occupied First page must identify the start date, the end date and any pro-rated rents

A Landlord must give each Tenant a copy of his or her written lease A Landlord may obtain from a Tenant a signed and dated receipt of the written lease

2021 Housing Managers' Education Series

GENERAL PROVISIONS OF §504B 

In the event of nonpayment, a Landlord may bring action against a Tenant to recover possession of the leased premises 



Address partial payment issues in lease

If a Tenant pays the rent due after the Landlord has initiated legal action, the Tenant may then be restored to possession of the leased premises Rent paid by a Tenant after the initiation of action by a Landlord must first be applied to the oldest balance claimed in the Complaint, unless the Court finds the claim for earlier rent has been waived

GENERAL PROVISIONS OF §504B 



If the building in which the leased premises is deemed unfit for occupancy and such unfitness is not the Tenant's fault, the Tenant cannot be held liable for the payment of rent unless the same is expressly provided for in a written agreement with the Landlord If a Tenant abandons or otherwise vacates the leased unit without providing the Landlord with at least three (3) days notice, the Tenant is guilty of a misdemeanor 



Applies in cold weather months only (Nov. 15th – Apr. 15th)

If a Tenant dies, either the Landlord or the personal representative of the Tenant’s estate may terminate the lease upon two (2) months written notice 

If lease is month-to-month, termination notice period would be 30 days to end on last day of month

2021 Housing Managers' Education Series

SPECIFIC PROVISIONS OF § 504B

PAYMENT OF RENT (MINN. STAT. §504B.118) 

Landlord must provide Tenant with receipt if Tenant pays rent with cash Provide at time of payment if paid in person  Provide within three (3) business days if paid by mail 

2021 Housing Managers' Education Series

RECOVERY OF ATTORNEYS’ FEES (MINN. STAT. §504B.172) 

If a lease entitles Landlord to recover its attorneys’ fees when it wins a legal action, Tenant is entitled to recover his or her fees if he or she wins Type of action must be identified in lease agreement  Tenant’s action must be of the same type as Landlord’s, under the same circumstances and to the same extent as specified in lease for Landlord 

APPLICANT SCREENING FEE (MINN. STAT. §504B.173) 

Fee charged by landlord to cover costs of processing application for tenancy Credit checks  Criminal background checks 



Limitations on Landlord Can’t charge fee when Landlord knows no unit available Can’t collect or hold fee without providing prospective Tenant with receipt  Can’t use, cash or deposit fee until all prior applicants have either:  

 

Been screened and rejected; or Offered a unit and declined the same

2021 Housing Managers' Education Series

APPLICANT SCREENING FEE (MINN. STAT. §504B.173) 

Disclosures by Landlord ◦ ◦ ◦ ◦ ◦



Only apply if Landlord charges applicant screening fee Must be made prior to Landlord accepting applicant screening fee Must be in writing Must identify name, address and number of screening service, if applicable Criteria on which decision to rent to applicant will be based

Landlord must notify Tenant within 14 days of rejecting application Landlord must identify criteria applicant failed to meet

APPLICANT SCREENING FEE (MINN. STAT. §504B.173) 

Landlord must return fee if: Applicant is rejected for any reason not listed in Landlord’s disclosure  Prior applicant is offered and accepts a unit 



Landlord must return portion of fee not used for reference checks, credit reports or applicant screening reports

2021 Housing Managers' Education Series

APPLICANT SCREENING FEE (MINN. STAT. §504B.173) 

Remedies 

Landlord who violates status is liable to applicant for: Amount of screening fee  Civil penalty up to $100  Civil court filing costs  Reasonable attorneys’ fees 



Applicant who provides materially false information or omits material information is liable to Landlord for: Landlord’s damages Civil penalty up to $500  Civil court filing costs  Reasonable attorneys’ fees  

LATE FEES (MINN. STAT. §504B.177) 

Landlord may not charge late fee if rent is paid after due date unless Landlord and Tenant agree in writing to include late fee 



Landlord may not charge late fees of more than 8% of overdue rent 



Written agreement must identify when late fee will be incurred

A late fee is different than interest

Subsidized housing with conflicting federal rules regarding late fees will follow the federal rules 

Landlord of federally-subsidized tenancy program can only charge late fees consistent with laws and rules governing program

2021 Housing Managers' Education Series

SEPARATE UTILITY BILLING (MINN. STAT. § 504B.215) 

If Landlord bills utility charges separate from the rent, Landlord must: Provide prospective Tenants with notice of utility costs  Predetermine and put in writing for all leases the formula used to calculate the utilities and how often Landlord bills for utilities  Include in lease Landlord will provide copy of utility bills paid during Tenant’s tenancy upon request 

SEPARATE UTILITY BILLING (MINN. STAT. § 504B.215) 



If Landlord bills for gas and electric charges separately from rent, must inform Tenants in writing of possible availability of energy assistance for low income by September 30 of each year Landlord must follow entire law on division of utility charges or is liable to the Tenant for triple the damages or $500.00, whichever is greater

2021 Housing Managers' Education Series

ABANDONED PROPERTY (MINN. STAT. § 504B.271) 



Landlord must hold property left behind by Tenant for 28 days Prior to sale, Landlord must provide 14-day prior written notice of the sale by personal service in writing or send written notice by first-class and certified mail 

If Landlord notifies Tenant by mail, the 14-day period is deemed to start the day the notice is mailed in the U.S. mail

ABANDONED PROPERTY (MINN. STAT. § 504B.271) 

If Landlord fails to give notice, Tenant may recover punitive damages in an amount not to exceed twice the actual damages or $1,000.00, whichever is greater.

2021 Housing Managers' Education Series

REMOVAL/STORAGE OF PROPERTY (MINN. STAT. § 504B.365)



The court hearing the eviction action retains jurisdiction regarding removal and/or of personal property

MORE PROVISIONS OF § 504B

2021 Housing Managers' Education Series

PROMISES BY LANDLORD  The

leased premises and all common areas are fit for the use intended by the parties

 The

Landlord will keep the leased premises in reasonable repair during the term of the lease, unless the disrepair of the premises is caused by the Tenant

PROMISES BY LANDLORD  The

Landlord will make the premises reasonably energy efficient

 The

Landlord will maintain the leased premises in compliance with applicable health and safety laws of the State of Minnesota

2021 Housing Managers' Education Series

PROMISES BY LANDLORD & TENANT  Neither

party will:



Unlawfully allow controlled substances on the leased premises



Allow prostitution or prostitution-related activity to occur on the premises or in the common areas



Allow the unlawful use or possession of a firearm on the premises or in the common areas



Allow stolen property or property obtained by robbery in the premises or in the common areas

PROMISES BY LANDLORD & TENANT  The

common area will not be used by the Landlord, the Tenant, or by any other person acting under the control of either party, to manufacture, sell, give away, barter, deliver, exchange, distribute, purchase or possess a controlled substance in violation of any criminal provision

2021 Housing Managers' Education Series

PROMISES BY LANDLORD & TENANT  Neither

Landlord nor Tenant will commit an act of:  Domestic abuse;  Criminal sexual conduct; or  Harassment against another tenant or authorized occupant

A

breach of these promises by the Tenant voids the Tenant's right to possess the leased unit

RIGHT OF ENTRY

A Landlord may enter the premises rented by a Tenant only for a reasonable business purpose and only after making a good faith effort to give the Tenant reasonable notice under the circumstances of its intent to enter

2021 Housing Managers' Education Series

“REASONABLE PURPOSE” INCLUDES: 

    



Showing the leased unit to a prospective buyer or Tenant Performing maintenance work Allowing government inspections Investigating a possible disturbance or lease violation Performing prearranged housekeeping work Determining whether the unit is occupied by someone without the legal right to possess Determining whether Tenant has vacated the unit

EXCEPTIONS TO NOTICE REQUIREMENT  The

Landlord reasonably suspects that immediate entry is necessary to prevent injury to persons or property 

Must relate to building maintenance, security or law enforcement

 The

Landlord reasonably suspects that immediate entry is necessary to determine a Tenant's safety

2021 Housing Managers' Education Series

EXCEPTIONS TO NOTICE REQUIREMENT



The Landlord reasonably suspects that immediate entry is necessary to comply with local ordinances regarding unlawful activity occurring within a Tenant's premises If the Landlord substantially violates this provision of the law, the Tenant may use a tenants’ remedy action to enforce Minnesota law

EXCEPTIONS TO NOTICE REQUIREMENT

 The

Tenant can ask the Court for:

Rent reduction  A full rescission of the lease  Recovery of any damage deposits  Up to a $100 civil penalty 

2021 Housing Managers' Education Series

POLL QUESTION Staff can go through a tenant’s cupboards and drawers to see if any drugs are being kept on the premises. True  False 

DEPOSITS & FEES

2021 Housing Managers' Education Series

PRE-LEASE DEPOSIT (MINN. STAT. §504B.175) 

Payment given to Landlord from prospective tenant   



Lease not yet entered into Different than applicant screening fee Often used with buildings under construction

Deposit must be given pursuant to written agreement between Landlord and prospective tenant  

Identify circumstances under which deposit will be returned Deposit must be returned within 7 days of occurrence of identified “trigger” event



Upon move-in, landlord must apply deposit to security deposit or rent



Landlord can be liable for amount of deposit plus 50% 

Exclusive of any other available remedies for violation of law

SECURITY DEPOSITS (MINN. STAT. § 504B.178) 

Security deposits not required under landlord-tenant law 



If Landlord chooses to collect security deposit, Landlord must follow law

Purpose of security deposit is to secure Tenant’s performance under lease agreement Not advance payment of rent Held by Landlord until end of lease term  Earns interest at rate of 1% per year  



By definition, security deposits are refundable 

Can’t call it something else to avoid returning deposit

2021 Housing Managers' Education Series

SECURITY DEPOSITS (MINN. STAT. § 504B.178) 

Landlord must return proper amount of security deposit within 3 weeks of tenancy ending 



If building condemned, must be returned within 5 days of Tenant moving out

Penalty equal to amount of deposit withheld plus interest Punitive damages up to $500 if Landlord withholds funds in bad faith (increased from $200)  Penalty is in addition to return of withheld funds 

SECURITY DEPOSITS (MINN. STAT. § 504B.178) 

Landlord may withhold monies from the security deposit To pay unpaid rent or other funds due to Landlord from Tenant pursuant to agreement  To restore the leased premises to their original condition, ordinary wear and tear excepted 



Landlord must provide Tenant with written statement identifying amounts withheld and reasons for same

2021 Housing Managers' Education Series

COMMUNITY FEE 

Not identified in MN landlord-tenant law



Can mean different things to different landlords Security deposit in disguise  Supplement operations expenses  Pay for special projects  Tenant directed 



Can help provider cash flow

COMMUNITY FEE 



Legal vs. practical: Will you be able to collect a community fee from tenants receiving public assistance? Best practice: Be thoughtful when structuring a community fee Make sure it isn’t a security deposit with another name  Segregate funds if used for special projects or tenant-directed  “Safest” community fee is one used for the benefit of the community 

2021 Housing Managers' Education Series

PET DEPOSITS/PET FEES 

Is it a deposit or a fee?  



If treated as additional security deposit, must follow MN security deposit law 



Deposit implies refundable Fee implies one-time, non-refundable payment

Return at end of lease term with 1% interest

MN landlord-tenant law doesn’t address pet deposits or fees If HUD property, HUD limits amount of deposit

PET DEPOSITS/PET FEES 

Is it a pet, a service animal or an emotional support animal? Okay to charge deposit or fee for pet  Not okay to charge deposit or fee for service or emotional support animal 



Service and emotional support animals are allowed as reasonable accommodation Service animals must be trained as such (per ADA)  Emotional support animals do not need to be trained 

2021 Housing Managers' Education Series

PET DEPOSITS/PET FEES 

Emotional support animals must be medically prescribed to treat an identified disability Prescriber must be able to speak to Tenant’s emotional and social needs  There must be a relationship between the Tenant’s disability and the assistance the animal provides  If no identified disability, no right to accommodation 

EVICTION ACTIONS

2021 Housing Managers' Education Series

REMOVAL FROM PROPERTY

 No

force allowed  Peaceful recovery  Physical removal by sheriff Nonpayment and lease violations can be pursued simultaneously

EVICTION ACTIONS GENERALLY  If

no material violation of lease has occurred but rent is due, a Tenant has up to 7 additional days to pay the outstanding rent

 The

Court must hear an eviction action within 7-14 days from the date on which the Court issued its Summons

2021 Housing Managers' Education Series

ACTION TO RECOVER (MINN. STAT. § 504B.291)



Rebuttable presumption rent has been paid if Tenant provides one or more copies of money orders or one or more original receipt stubs showing the purchase of money orders and: The total amount of the rent paid  A date or dates approximately corresponding with the date rent was due  In the case of copies of money orders, they are payable to Landlord 

ACTION TO RECOVER (MINN. STAT. § 504B.291)



Landlord can rebut this presumption by producing a business record that shows Tenant has not paid rent Landlord can introduce other evidence to rebut this presumption

2021 Housing Managers' Education Series

COMPLAINT  The

specific facts of the grounds for eviction  Dates and times of alleged violations  Specific lease provisions violated  Names of persons allegedly living on the property  Names of neighbors stating complaints, and the precise nature of those complaints  A copy of the lease

DEFENSES TO EVICTION ACTIONS 1. Retaliation or penalty for enforcing rights under lease or under Federal or State Law 2. Retaliation or penalty for Tenant’s good faith report to a governmental authority of the Landlord's violation of any health, safety, housing or building codes or ordinances

2021 Housing Managers' Education Series

DEFENSES TO EVICTION ACTIONS 3. The Landlord increased rent or decreased services offered as a penalty for any lawful act of the Tenant as described in 1 and 2 above 4. There is a statutory presumption of retaliation if a notice to terminate a Tenant’s lease is served within 90 days of an event described in 1 and 2 above

COURT PROCESS 

 



The Landlord files the Complaint with the Court Administrator, along with a filing fee The Court Administrator prepares a Summons The Court Administrator forwards the Summons to the Landlord The Landlord must arrange to serve the defendant (Tenant) with the summons at least 7 days before the initial hearing  Landlord can use either personal or substitute service

2021 Housing Managers' Education Series

COURT PROCESS  The

Tenant may answer the Complaint

 In

most courts, the initial court hearing serves as an arraignment 

In Hennepin and Ramsey Counties, a referee presides over the arraignment

 Only

a principal or licensed attorney is allowed to appear in Housing Court unless Power of Authority is attached to the Complaint at the time of filing

COURT PROCESS  In

many counties, a corporation is required to be represented by an attorney in an eviction action

 If

the defendant (Tenant) does not appear, the Court will find for the plaintiff (Landlord) and issue a Writ of Recovery and Order to Vacate

 If

the defendant (Tenant) appears and disputes the action, the court usually schedules a trial for another day

2021 Housing Managers' Education Series

COURT PROCESS  If

the defendant (Tenant) appears and does not dispute the action, the Court will rule for the plaintiff (Landlord), but could delay the issuance of a Writ for 7 days

 At

trial, the Landlord has the burden of proving breach of contract and the Tenant may raise numerous defenses

 If

the Tenant prevails, the Landlord may not evict the Tenant at that time 

Tenant may be able to have record expunged

COURT PROCESS 

If the Landlord prevails, the Court may: Immediately issue a Writ of Recovery and Order to Vacate;  Issue a 24-hour eviction notice; or  Delay issuance of the Writ for up to seven days 



The Landlord will arrange for the sheriff or police to deliver the Writ of Recovery and Order to Vacate If the Tenant does not move, the Landlord must schedule an eviction of the Tenant with the sheriff or police

2021 Housing Managers' Education Series

COURT PROCESS  Either

party may appeal within 15 days from the entry of judgment

 If

a referee heard the case (Hennepin and Ramsey counties), a party may seek a judge’s review of a decision recommended by the referee

 The

Landlord is required to store the Tenant's property for up to 28 days 

Can store either on site or with a storage company

HWS & HOME CARE ISSUES

2021 Housing Managers' Education Series

TERMINATIONS & DISCLOSURES

POLL QUESTION Which of the following statements is/are correct? Evictions aren’t allowed for any reason because of the pandemic  Evictions aren’t allowed but this doesn’t apply to senior housing providers  It’s okay to terminate someone’s housing for nonpayment  It’s okay to issue a termination notice but housing providers can’t proceed with an eviction  None of the above 

2021 Housing Managers' Education Series

TERMINATION REQUIREMENTS: HOUSING WITH SERVICES  Must

provide written notice of termination of housing

 Termination

information

notice must contain specific

 Applies

only to Tenants who are also assisted living clients

TERMINATION NOTICE: HOUSING WITH SERVICES  Effective  Section

date of termination of lease

of lease authorizing termination

 Explanation

that:  AL client must vacate apartment and remove personal property by termination date  Failure to vacate may result in eviction action in which AL client may present a defense  AL client may seek legal advice in connection with termination notice

2021 Housing Managers' Education Series

TERMINATION NOTICE: HOUSING WITH SERVICES  Affirmative

offer to meet with assisted living client or client representative within 5 business days of date of notice

 Statement

that reasonable accommodation is available to AL client with respect to termination notice

 Name

and contact information of HWS provider representative with whom AL client may discuss notice of termination

TERMINATION REQUIREMENTS: HOME CARE 



Applies only to non-Medicare certified home care providers Must provide 30-day written notice of termination of services unless exceptions apply Termination notice must contain specific information Termination notice must include copy of home care bill of rights

2021 Housing Managers' Education Series

TERMINATION REQUIREMENTS: HOME CARE  30-day

unless: 



notice of termination of services required

Client’s behavior changes the terms and conditions of employment of the caregiver as identified in an employment agreement OR creates an abusive or unsafe work environment A client’s emergency or significant change in condition results in a need for services beyond what home care provider can offer Nonpayment (10-day notice)

TERMINATION NOTICE: HOME CARE  Effective  Reason

date of termination of services

for termination of services

 Affirmative

offer to meet with assisted living client or client representative within 5 business days of date of notice

 Contact

information for reasonable number of other home care providers in area

2021 Housing Managers' Education Series

TERMINATION NOTICE: HOME CARE  Statement

that home care provider will participate in coordinated transfer of care to another provider per Minn. Stat. §144A.44

 Name

and contact information of home care provider representative with whom client may discuss notice of termination

 Statement

that termination notice from home care provider does not constitute termination of housing with services contract with housing with services provider

 Attach

copy of home care bill of rights

HOME CARE INFORMATION: HWS CONTRACT  Services

available through home care agency

 Charges

for available services

2021 Housing Managers' Education Series

HOME CARE INFORMATION: PROSPECTIVE HWS TENANTS  Name,

mailing address and telephone number of arranged home care provider

 Name

and mailing address of at least one natural person authorized to accept service of process of behalf of arranged home care provider

HOME CARE INFORMATION: PROSPECTIVE HWS TENANTS 



Description of the process through which a home care service plan between a housing with services tenant/home care client and arranged home care provider may be modified, amended or terminated Arranged home care provider’s billing and payment procedures and requirements Any limits to services available from arranged home care provider

2021 Housing Managers' Education Series

HOME CARE INFORMATION: PROSPECTIVE HWS TENANTS  Must

be delivered either before a contract is signed or before move-in, whichever is earlier

 Home

care provider and housing with services provider can determine specifics of how information is delivered and by whom

HWS CONTRACT CHECKLIST

2021 Housing Managers' Education Series

WHAT IS HOUSING WITH SERVICES?  Sleeping  80%

accommodations for one or more adults

are 55 years of age or older

 One

or more regularly scheduled health-related services

 Two

or more regularly scheduled supportive services

HWS CONTRACT REQUIREMENTS  Building's

name, street address and mailing address  Owner's name, mailing address and business entity type  Managing agent's name and mailing address  Name and address of Owner's authorized agent  Registration and licensure status  Name and registration/licensure status of providers providing health-related and/or supportive services pursuant to arrangement with HWS establishment

2021 Housing Managers' Education Series

HWS CONTRACT REQUIREMENTS  Term

of contract  Description of basic services offered and delineation of charges  Description and cost of additional services offered  Method by which contract may be modified, amended or terminated 

Include whether Tenant will have to move to different or shared apartment or room if Tenant cannot pay current rent

 Explanation

of complaint resolution process, including toll-free number of Ombudsman’s office

HWS CONTRACT REQUIREMENTS  Name

of Tenant’s designated representative  Explanation of referral procedures upon contract termination  Residency requirements  Procedures for billing and payment  Statement regarding outside service providers  Statement regarding availability of public funds for payment of rent and/or services  Statement regarding availability of and contact information for long-term care consultation services 78

2021 Housing Managers' Education Series

HWS CONTRACT REQUIREMENTS Statements regarding:  Ability

to furnish and decorate unit

 Right

to access food at any time

 Right

to choose visitors and times of visits

 Right

to choose roommate if sharing a unit

 Right

to have and use a lockable door

OTHER HWS REQUIREMENTS 



As part of registration process with MDH, HWS establishments must identify whether services are included in the base rate to be paid by tenant (Minn. Stat. §144D.03) Must provide existing and prospective Tenants with information contained in the Uniform Consumer Information Guide (Minn. Stat. §144D.08) When terminating a lease, written notice must include contact information for the Ombudsman for Long-Term Care and a statement of how to request problem-solving assistance from that office (Minn. Stat. §144D.09)

2021 Housing Managers' Education Series

OTHER HWS REQUIREMENTS 

HWS providers are prohibited from entering into a lease with a Tenant until the Landlord receives verification that the Tenant has undergone a long-term care consultation through the Senior LinkAge Line (Minn. Stat. §256B.0911, subd. 3c)  Exceptions for:  Lease-only arrangements in subsidized housing  Previous receipt of LTCC assessment  Receipt of or evaluation for hospice services  Receipt of financial planning and creation of long-term care plan

AUDITING YOUR HWS CONTRACT & LEASE

 



Breakdown of rent and services included in base rate Ability to move Tenant into different unit based on ability to pay rent Ability to terminate agreement based on inability to meet rent obligations Remember to keep health-related issues out of lease!

2021 Housing Managers' Education Series

DEMENTIA CARE & CONSUMER PROTECTION

DEMENTIA CARE LAW (MINN. STAT. §144D.065) 

Applies to providers marketing or otherwise promoting services for persons with Alzheimer’s disease or related disorders 



BUT, 2014 changes to law also included assisted living providers who do not have special care unit

All staff must be trained in dementia care Direct care staff and their supervisors must receive 8 hours of initial training and 2 hours every year thereafter  Non-direct care staff must receive 4 hours of initial training and 2 hours every year thereafter 

2021 Housing Managers' Education Series

DEMENTIA CARE LAW (MINN. STAT. §144D.065)  Training    

Explanation of Alzheimer’s disease and related disorders Assistance with activities of daily living Problem solving with challenging behaviors Communications skills

 Home    

must include:

care agency must provide consumers with:

Description of training program Categories of employees trained Frequency of training Basic topics covered

DEMENTIA CARE LAW (MINN. STAT. §144D.065) Special Care Units/Programs for Dementia: Position:

Amount of Training:

Supervisors of direct care staff 8 hrs within 120 working hrs of start date; 2 hrs annually thereafter Direct care staff

Non-direct care staff

8 hrs within 160 working hrs of start date; 2 hrs annually thereafter 4 hrs within 160 working hrs of start date; 2 hrs annually thereafter

2021 Housing Managers' Education Series

DEMENTIA CARE LAW (MINN. STAT. §144D.065) HWS Establishments Providing AL Services: Position:

Amount of Training:

Supervisors of direct care staff 4 hrs within 120 working hrs of start date; 2 hrs annually thereafter Direct care staff

Non-direct care staff

4 hrs within 160 working hrs of start date; 2 hrs annually thereafter 4 hrs within 160 working hrs of start date; 2 hrs annually thereafter

CONSUMER PROTECTION LAWS  Uniform

Deceptive Trade Practices Act

(Minn. Stat. §325D.43 - §325D.48)  False

Statement in Advertisement Act

(Minn. Stat. §325F.67)  Deceptive

Acts Perpetrated Against Senior Citizens or Handicapped Persons (Minn. Stat. §325F.71)

 Disclosure

of Special Care Status

(Minn. Stat. §325F.72)

2021 Housing Managers' Education Series

DISCLOSURE OF SPECIAL CARE STATUS (MINN. STAT. §325F.72)

Who Must Make Disclosures? 89

“SPECIAL CARE UNIT” PROVIDERS MUST

MAKE

DISCLOSURES

HWS establishments that: 



Secure, segregate, or provide a special program or special unit for residents with a diagnosis of probable Alzheimer's disease or a related disorder; or Advertise, market, or otherwise promote the establishment as providing specialized care for Alzheimer's disease or a related disorder

2021 Housing Managers' Education Series

TO WHOM IS DISCLOSURE REQUIRED? 

The Commissioner of Health, if requested



The Office of Ombudsman for Long-Term Care



Each person seeking placement within a residence, or the person's authorized representative, before an agreement to provide the care is entered into

CONTENTS OF DISCLOSURE 1. A statement of the overall philosophy and how it reflects the special needs of residents with Alzheimer's disease or other dementias 2. The criteria for determining who may reside in the special care unit 3. The process used for assessment and establishment of the service plan or agreement, including how the plan is responsive to changes in the resident's condition

2021 Housing Managers' Education Series

CONTENTS OF DISCLOSURE 4.

Staffing credentials, job descriptions, and staff duties and availability, including any training specific to dementia

Physical environment as well as design and security features that specifically address the needs of residents with Alzheimer's disease or other dementias

Frequency and type of programs and activities for residents of the special care unit

CONTENTS OF DISCLOSURE 7.

Involvement of families in resident care and availability of family support programs

Fee schedules for additional services to the residents of the special care unit

A statement that residents will be given a written notice 30 days prior to changes in the fee schedule

2021 Housing Managers' Education Series

OTHER INFORMATION  Duty 

to Update

Substantial changes to disclosures must be reported at the time the change is made

 Remedy 



The Attorney General may seek the remedies set forth in Minn. Stat. §8.31 for repeated and intentional violations of disclosure act No private right of action may be maintained

QUESTIONS???

2021 Housing Managers' Education Series

CARE PROVIDERS OF MINNESOTA 2021 HOUSING MANAGER EDUCATION SERIES

FUNDAMENTALS OF LANDLORD-TENANT LAW Michelle R. Klegon Klegon Law Office, Ltd. (763) 546-1109 MKlegon@klegonlaw.com

State of Minnesota

District Court

County of:

Judicial District: Court File Number: Housing

Case Type:

EVICTION ACTION COMPLAINT (Minn. Stat. §504B.321)

Plaintiff #1 (Landlord)

Plaintiff #2 (Landlord)

Name:

Address:

City/State/Zip

City/State/Zip:

Defendant #1 (Tenant)

Defendant #2 (Tenant)

VS.

Name:

Address:

City/State/Zip:

City/State/Zip

Check box if there are more than two plaintiffs or more than two defendants. List the information for the other parties on the Additional Litigants Form (HOU125). 1. Rental Agreement Landlord leased or rented property located at: Apartment #

in the city of

Zip Code

, in the county of

does

, the state of Minnesota, and

does not include a garage. and ending

The agreement for the property, beginning from is an

ORAL or

WRITTEN agreement and is for:

(Check all that apply)

Payment of Rent. The current rent due and payable under this agreement each month is due on the

day of each month.

Exchange of Services. The agreement for exchange of services was: (explain in detail)

2. Notice of Right of Possession by Landlord for Residential Leases

HOU102

State

ENG

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Landlord having present right of possession of the residential property, has followed Minn. Stat. §504B.181 by: (You must check either A and B, or C) a. informing the Tenant, either in the rental agreement or otherwise in writing, before the beginning of the tenancy the name and address of: i. the person authorized to manage the property AND ii. a landlord or agent authorized by the landlord to accept service of process and receive and give receipt for notices and demands AND b. Posting in an obvious place on the property a printed or typewritten notice that includes the information above. Explain where the notice is posted:

OR c. The Tenant knew of the name and address of the person authorized to manage the property and accept and give receipt for notices and demands, at least 30 days before the filing of this action because:

3. Grounds for Eviction Landlord seeks to have the Tenant evicted for the following reasons: (Check all that apply) a. The Tenant is still in possession of the premises and has failed to pay the rent for the month(s) of

in the amount of per month payable on the

day of each month for a total due of

b. The Tenant failed to vacate the property after written notice was given: (Check all that apply) Landlord gave written notice to tenant on property by

. Tenant has failed to vacate the property.

Tenant gave written notice to Landlord on

HOU102

State

ENG

to vacate the

Rev 5/19

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that they would

Page 2 of 4

vacate the property by

. Tenant has failed to vacate the property.

c. The Tenant has broken the terms of the rental agreement with property landlord by: (be specific)

d. The Tenant has breached the covenants at stated in Minn. Stat. §504B.171 by: (be specific)

e. The Tenant defaulted on the mortgage and the property has been sold at a Sheriff's sale. The Redemption period has expired and Plaintiff is entitled to possession. f. The Tenant defaulted on a Contract for Deed and is holding over after proper cancellation of the contract. 4. The Landlord seeks judgment against the above Tenants for restitution of said premises plus costs and disbursements. 5. Tenant #1 date of birth

Unknown;

Tenant #2 date of birth

Unknown;

If a tenant is a business, leave this section blank for that tenant. 6. Military status for Tenant: Tenant # 1

is in the military service

is not in the military service

Unknown

Tenant # 2

is in the military service

is not in the military service

Unknown

If a tenant is a business, leave this section blank for that tenant. I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. § 358.116. ****Notice: A licensed attorney must sign the Complaint and appear in court on behalf of a corporation or LLC. ****

HOU102

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Dated: Signature Name: County and State where signed

Address: City/State/Zip: Telephone: E-mail address:

HOU102

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INSTRUCTIONS Eviction Action Complaint Forms you will need for your Eviction case: • • • •

Instructions (HOU101); Eviction Action Complaint (HOU102); Affidavit of Service (HOU106); and Additional Litigants Form (HOU125) – if needed. Overview of Steps in an Eviction Case

1. Fill out and sign the Eviction Action Complaint, following all of the steps in these instructions. 2. Make copies of the signed Eviction Action Complaint. 3. File your forms (electronically or at the courthouse), and pay the filing fee (or ask for a fee waiver if you cannot afford to pay the fee). They will issue you a Summons. 4. Have someone (not you) serve a copy of the Complaint and Summons on each tenant. No later than 3 days before the court hearing, file proof with the Court that each tenant was served. Steps for personal service are explained in greater detail in Step 5 below. 5. Go to the court hearing. Each “step” is explained below in detail. Important Notices and Resources The Court has forms and instructions, for some types of cases, as a general guide to the court process. These instructions explain the steps in more detail and answer common questions, but are not a full guide to the law. Court employees may be able to give general information on court rules and procedures, but they cannot give legal advice. Got a question about court forms or instructions? • Visit www.MNCourts.gov/SelfHelp • Call the MN Courts Self Help Center at (651) 435-6535 Not sure what to do about a legal issue or need advice? • Talk with a lawyer • Visit www.MNCourts.gov/Find-a-Lawyer.aspx

Helpful materials may be found at your public county law library. For a directory, see http://mn.gov/lawlibrary/research-links/county-law-libraries.jsp . For more information, contact your court administrator or call the Minnesota State Law Library at 651-297-7651.

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General Information about Eviction Action Complaints Minn. Stat. § 504B.321

Use the Eviction Action Complaint (HOU102) to ask the Court to evict a tenant from residential or commercial rental property. Carefully read through the steps laid out in these instructions to complete the forms to file. The information in these instructions is a general guide to you to explain the legal process for filing for an eviction. If you do not understand any of the following steps or do not know if these forms are right for your situation, you should speak with an attorney for legal advice. Court staff cannot give legal advice. To evict a tenant, the landlord must have a valid reason for the eviction under Minnesota law, and the landlord must properly complete all the steps for the eviction, as required by Minnesota Statutes Chapter 504B and the Minnesota Rules of Civil Procedure. In Hennepin and Ramsey Counties, eviction cases are heard in “Housing Court” governed by General Rules of Practice for District Courts, Rules 601-612. There may be other legal requirements in City Ordinances, Minnesota Statutes and Rules, or Federal law affecting your eviction action.

Step 1 Fill Out the Eviction Action Complaint (HOU102) The Eviction Action Complaint form is broken up into sections below with guided numbers to help you fill out the form. This guide is not meant to be legal advice. If you have questions on how to fill out a question you should speak with an attorney for legal advice.

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A State of Minnesota County

Judicial District: Court File Number: Case Type:

2 District Court 3 Housing

EVICTION ACTION COMPLAINT (Minn. Stat. § 504B.321) Plaintiff #1 (Landlord)

Plaintiff #2 (Landlord)

Name Address

City/State/Zip

Defendant #1 (Tenant) Name Address

vs.

City/State/Zip

Defendant #2 (Tenant) Name Address City/State/Zip

Check Box if there are more than two plaintiffs or more than two defendants. List the information for the other parties on the Additional Litigants Form, HOU125.

A – Caption 1.

In the upper left corner, fill in the county where the property is located.

In the upper right corner, fill in the Judicial District number.

Leave the Case File Number blank for now.

On the line marked “Plaintiff #1,” write the name and address of the property owner (or the person entitled to possession). The plaintiff is a person, or the legal entity that is the owner (corporation, partnership, or sole proprietor) or a court-appointed receiver or fiduciary. • If there are co-owners, such as a husband and wife, you may list one or both as plaintiffs in “Plaintiff #2” of the caption. • If business is conducted using an assumed name, list the owner’s name followed by the assumed name. Example: John Jones, doing business as Lakeview Apartments. Note: Minn. Stat. § 333.01 requires a commercial business to file a certificate of assumed name with the MN Secretary of State before conducting business using the assumed name. • A property management company or property manager that does not own the property should not be listed as the plaintiff.

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•

If you have questions about who to list as a plaintiff, read Minnesota Statutes Chapter 504B or ask an attorney for advice. You can also visit the LandlordTenant Help Topics page for information to laws and rules at http://www.mncourts.gov/Help-Topics/Landlord-and-Tenant-Issues.aspx .

On the line marked “Defendant #1,” write the name and address of the tenant. Include all adults on the lease, and any other adults known to be living there. If there are more than two tenants, you should use the Additional Litigants Form (HOU125). If unknown persons are living there, you can list “John Doe” or “Mary Roe” along with the known persons.

If you have more than two landlords or two tenants, then check this box and be sure to fill out the Additional Litigants Form (HOU125) with their information.

B – Rental Agreement 7.

Fill in the street address, apartment, city, zip code and county where the property is located. Check if the property “does” or “does not” include a garage.

Write in the beginning and end date of the agreement. Check if the agreement was an “Oral” or “Written” agreement.

Check the box if the agreement was for payment of rent. Write in the amount of rent and on which day of the month rent is due.

10.

Check the box if the agreement was for an exchange of services. Note: an agreement can be both for payment of rent and an exchange of services (for example, an agreement for reduced rent if the tenant cleans the common areas of building). Explain in detail the agreement on services to be provided by the tenant.

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Is your situation different? The Eviction Action Complaint form was created for use in the typical situation where a tenant agrees to pay rent each month to landlord. An eviction can also be filed if there is an agreement for an exchange of services instead of rent, or if unlawful activities are occurring at the property that are covered in Minn. Stat. § 504B.171. If this is not your situation, talk with an attorney for advice on what steps you may take to evict someone.

C – Notice of Right of Possession by Landlord for Residential Leases This section only applies to residential property only (not commercial leases) where there is an agreement to pay rent. You cannot file an eviction unless A and B are true, or C is true. See Minn. Stat. § 504B.181, Subd.4. If you have not given the tenant the required information at this point, speak with an attorney for legal advice. 11.

Before the tenant moves in and pays rent, the landlord must give the tenant certain information in writing AND must post the information on the property. Read Paragraphs 3 (a) and (b). If both are true, check both boxes and fill in the line at (b) explaining where the information was posted.

12.

If you are not able to check both box A and B, then you must check box C and explain, in detail, how the tenant knew this information at least 30 days ago.

NOTE: You cannot file an eviction unless A and B are true, or C is true. If you have not given the tenant the required information in writing at this point, talk with an attorney for legal advice.

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3. Grounds for Eviction Landlord seeks to have the Tenant evicted for the following reasons: (check all that apply)  a. The Tenant is still in possession of the premises and has failed to pay rent for the month(s) of in the amount 13 of $ per month payable on the day of each month for a total due of $ .  b. The Tenant failed to vacate the property after written notice was given: (check all that apply)  Landlord gave written notice to Tenant on ______________ (date) to vacate the property by _____________________ (date). Tenant has failed to vacate the property. 14  Tenant gave written notice to Landlord on _____________ (date) that they would vacate the property by___________________ (date). Tenant has failed to vacate the property.  c. The Tenant has broken the terms of the rental agreement with property landlord by: (be specific) 15 _____.  d. The Tenant has breached the covenants as stated in Minn. Stat. §504B.171 by: (be specific): 16 ____________.  e. The Tenant defaulted on the mortgage and the property has been sold at a Sheriff’s sale. The Redemption period has expired and Plaintiff is entitled to possession.

 f. The Tenant defaulted on a Contract for Deed and is holding over after proper cancellation of the contract.

D – Grounds for Eviction 13. Check box A if the reason for the eviction is that the tenant did not pay the rent. • • • •

State which months are unpaid (such as Jan, Feb). State the amount of rent that is unpaid per month (such as $500 for Jan, and $900 for Feb). Fill in the day of the month when rental payments are due. Fill in the total rent owed at the time the Complaint is signed.

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NOTE: Tenant may be able to redeem or “pay and stay” if the only reason for filing the eviction action is nonpayment of rent, and they bring to the court hearing the amount of rent that is past due (plus interest), the costs of the court action, and an attorney’s fee (not greater than $5), and performs any other agreements of the lease. If the rent is paid by the day of court, the Judge can give the tenant up to 7 more days to pay the other costs. See Minn. Stat. § 504B.291, Subd. 1. For purposes of “pay and stay” court costs include only the court filing fee and reasonable service of process fees. Court costs do not include management fees, or fees paid to an agent. If the total amount due on the Complaint includes utilities or late fees, the Judge will decide if these amounts must be paid by the tenant to “pay and stay.” 14. Check box B if tenant failed to move out (vacate) after notice was given. • Landlord gave notice to Tenant - Check the first box if the landlord asked the tenant to move out. First write in the date you gave the notice to the tenant and then write in the date they were to move out of the property. • Tenant gave notice to Landlord – Check the second box if the tenant gave notice that they would be moving out. First write in the date notice was given and then write in the date they were to move out of the property. NOTE: If landlord asked tenant to move, a copy of the letter telling tenant to move out should be attached to the Complaint.

Common Problems with evictions for failure to move out : Improper Notice to Vacate: In general, a full rental period’s notice must be given. If you have a written lease, read the lease to see if some other notice period is required. If the property was foreclosed, other notice periods may apply. An eviction case may be dismissed for improper service. Speak with an attorney for legal advice if this was not done. Example 1: If rent is due on the 1st of the month and you want the tenant to move out by March 1, you must deliver the notice to vacate on or before January 31. Example 2: If you give the tenant a notice to vacate letter on April 10, the earliest date the notice can tell the tenant to leave is May 31, so you have given notice of a full rental period (the month of May) Filing the Eviction Action Complaint before the vacate date: If tenant was asked to move out by January 1, do not file the Complaint until after January 1, even if the court date will be after January 1. The tenant must be in violation of the request to move out at the time you file the Complaint. If the tenant tells the landlord they do not plan to move out by January 1, landlord still must wait until after January 1 to file the Complaint.

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Waiting to File if tenant fails to pay rent: Generally, if the tenant gives or is given a notice to move out, the tenant must still pay rent through the move-out date. An exception to this rule is if the lease allows tenant to apply a damage deposit as the last month’s rent, or a specific law allows it, such as with mortgage foreclosures. If the tenant must pay the last month’s rent and does not pay by the due date, landlord can file an eviction case for non-payment of rent. Landlord does not have to wait until tenant fails to move out per the Notice to Vacate. Failure to pay rent creates a separate reason to file for eviction. 15. Check box C if tenant violated the rental agreement (for something other than not paying rent.) •

Describe the dates and specific details of how the tenant broke the terms of the rental agreement. The breach of lease should be material, meaning something that is significant.

•

If the agreement was for an exchange of services and tenant did not perform those services as part of the agreement, explain in detail what was not done. NOTE: A copy of the lease should be attached to the Complaint. Be sure to read Minn. Stat. § 504B.115 to see if you are required to give the tenant a copy of the written lease before filing an eviction action. 16. Check box D if the tenant has violated Minn. Stat. § 504B.171 (drugs, prostitution, guns, stolen property at the rental property) • Be sure to read Minn. Stat. § 504B.171 before deciding if this ground for eviction applies to your situation. You must be detailed about the alleged unlawful activities. Attach a copy of any police report(s) to the Complaint. 17. Check box E if the tenant defaulted on the mortgage and the property has been sold at a Sheriff’s sale. • This should only be done if the redemption period has expired and Plaintiff has right to possession. Read Minn. Statute §504B.285 subd. 1(a) for more information and requirements. If you are not sure if this applies to your situation, talk with an attorney for legal advice. 18 . Check Box F if Contract for Deed was cancelled and the tenant is still living in property. • Please read Minn. Stat. §504B.285 subd. 1(b) to be sure you have followed all of the steps for notice and meet the requirements. If you are not sure if this applies to your situation, talk with an attorney for legal advice.

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E – Date of Birth and Military Status

E 19 5. Tenant #1 date of birth: ____________/  Unknown; Tenant #2 date of birth: ______________/  Unknown. If a tenant is a business, leave this section blank for that tenant. 6. Military status for Tenant: 20 Tenant # 1  is in the military service /  is not in the military service /  Unknown Tenant # 2  is in the military service /  is not in the military service /  Unknown If a tenant is a business, leave this section blank for that tenant.

19.

Fill in the tenant’s birthdate, if known. If unknown, check “unknown.” If the tenant is a business, you can leave this question blank.

20.

Check whether the tenant, to the best of your knowledge, is in the military service. If you do not know whether they are in the military service, check “unknown.” If a tenant is in the military, special laws may apply. Talk with an attorney for legal advice before signing the Complaint. If a tenant is a business, leave this section blank for that tenant.

Step 2 Sign the Eviction Action Complaint 1. Sign the Complaint under penalty of perjury. By signing the Complaint under penalty of perjury, you are stating that the information in the document is true to the best of your knowledge. Perjury is the crime of intentionally lying or misrepresenting the truth. 2. The Complaint must be signed by the owner, a licensed attorney, or the person entitled to possession of the property. 3. Print your name, title if filing on behalf of a plaintiff, and fill in your address, city, state, zip, daytime phone number, and e-mail address. E-mail addresses are required if documents are served or filed using electronic means. NOTE: If the owner of the property is a business, an attorney must sign the Complaint and appear in court with the owner or owner’s agent. There is an exception in filing in Hennepin County Housing Court. You can read the Housing Court Rules online. See Step 6 for more information on attorneys representing businesses in court.

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Step 3 Make Copies of the Eviction Action Complaint Make a copy of the signed Complaint with attachments, if any, for each tenant named in the Complaint. You should be sure to make a copy for yourself as well.

Step 4 Bring the Eviction Action Complaint to the Court Administrator File the following documents with the Court Administrator: • The Eviction Action Complaint, and any attachments such as a copy of the written lease, a copy of the Notice to Vacate, Power of Authority (used only in Hennepin County), or police report. • If needed, be sure to also file the Additional Litigants Form (HOU125). • Pay the court filing fee . If you have a low income and cannot afford to pay the filing fee, you can use Form IFP102 and IFP104 to ask that a judge waive the fee. Court administration cannot accept your Complaint for filing without the fee or a request to waive the fee. If the filling fee is not waived you are then required to pay the fee before the Court can take any action. Interpreter Needed? If you need an interpreter at the hearing, tell court administration when you file. If you think your tenant needs an interpreter, consider asking the tenant to call court administration. Generally, 48 hours (2 full days) notice is needed, not including weekends and holidays, to schedule an interpreter. Less notice may cause a delay or a rescheduling of the hearing. The Court will create a Summons. A Summons is a written notice telling the tenant that a legal action has been filed and will be heard in court on a certain day. It also states that if the tenant disagrees with the action or wants to tell a different side of the story, they must appear in court at the time of the hearing. You will need a copy of the Summons for each tenant.

Step 5 Serve the Summons and Eviction Action Complaint on the Tenant •

You (the plaintiff) cannot be the person who serves the Summons and Complaint. If you gave Power of Authority to an agent, do not ask the agent to serve the papers. It is best not to

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ask the building manager to serve papers. Use a neutral person who is over the age of 18, or pay a service of process agency or the Sheriff to serve the papers. •

Service of the Summons and Complaint must be completed at least 7 days before the hearing date. Example: If court is on Friday, the last day to serve is Friday of the week before.

•

A Summons and Complaint cannot be served on a legal holiday.

•

Each named tenant must be served. Example: if there are 3 tenants, each tenant must be served with a separate copy of the Summons and Complaint. If there is a husband and wife and 2 children, the husband and wife must each be served with a separate copy of the Summons and Complaint. Minor children should not be named as defendants or served.

•

A separate Affidavit of Service for each tenant must be filed with the Court at least 3 days before the court hearing (when counting the 3 days, don’t count Saturdays, Sundays, or legal holidays). There is more information about the Affidavit of Service below.

•

If Section 8 is involved, the contract between the landlord and the Housing Authority may require the landlord to serve a copy of the Summons and Complaint on the Housing Authority at the same time the papers are served on each tenant.

PERSONAL SERVICE OF THE SUMMONS & COMPLAINT

Personal Service:

An adult who is not involved with the case may act as the server and may hand the Summons and Complaint directly to the tenant at least seven days before the court date.

Substitute Service:

An adult who is not involved with the case may “serve” the Summons and Complaint by leaving a copy of the documents with a responsible person who lives with the tenant. This person is then responsible for delivering the Summons and Complaint to the tenant. Example: Joe and John are adult roommates. If only Joe is home, the server can leave 2 copies of the Summons and Complaint with Joe, one for Joe and one for John.

The server fills out one Affidavit of Service for each tenant. The server must sign the Affidavit of Service under penalty of perjury. Perjury is the crime of intentionally lying or misrepresenting the truth. The Affidavits of Service are your proof that you had the tenant served. File the completed Affidavits with the court at least 3 days before the hearing (not counting Saturdays, Sundays, or legal holidays).

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It is always best if the tenant is personally served with the Summons and Complaint. However, if you cannot find the tenant, you may be able to have the tenant served in another way called mailing and posting.

1. Tenants cannot be found in the county AND

MAILING AND POSTING of the SUMMONS & COMPLAINT

Use this method of service when:

2. Personal or substitute service has been tried at least twice on different days with at least one of the attempts at service made between 6 and 10 p.m. If the property is commercial instead of residential, the attempts to serve are not required. Instead, there must be proof that the commercial property is not occupied.

See the form Instructions – Service by Mail and Post (HOU107) for instructions on using this form of service.

Step 6 Go to the Hearing The plaintiff, the plaintiff’s attorney, or the plaintiff’s agent with power of authority (in Hennepin County only), must attend the hearing. If the plaintiff is a business, the plaintiff must have an attorney in court. There is one exception to this rule. In Hennepin County, an officer or agent with power of authority may appear and represent the corporation without a lawyer in Housing Court. If a decision is appealed to a judge or appellate court, however, then an attorney will be required. Many eviction cases settle at court. The landlord and tenant should try to work out an agreement. In some counties, if a trial with witnesses and evidence is needed, the trial will be scheduled for a separate date. In other counties, you may be expected to have your witnesses ready at the first hearing date. For more information about what to expect at an eviction hearing, contact court administration for the county where you are filing, and/or look at the court’s website at http://www.mncourts.gov/Find-Courts.aspx and then pick your district/county.

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Other Information Requesting an Interpreter

If you need interpreter services for the hearing, call court administration right away. The court generally needs 48 hours notice (2 full days), excluding weekends and holidays, to provide an interpreter.

Expedited Hearing

If tenant’s behavior is seriously endangering the property or safety of other residents or the owner, landlord can request that the eviction court date be scheduled within 5 to 7 days, rather than 7 to 14 days. An additional affidavit is required, and a judicial officer must preapprove the request before court administration sets the date. A landlord can be fined up to $500 for abuse of the expedited hearing process. See Minn. Stat. §504B.321 Subd.2. An eviction action decides if the tenant must move. It does not include a judgment for rent or other money owed.

Collecting the Rent

Claims for rent and other money issues cannot be brought in housing court with the eviction complaint and must be brought separately in either conciliation court or district court. Claims that are less than $15,000 can be brought in Conciliation Court. Claims over $15,000 must be filed in District Court. A “Writ of Recovery of Premises and Order to Vacate” is a legal notice ordering the tenant to move and authorizing the sheriff to take certain actions if the tenant does not move voluntarily. It is issued by the court if the landlord wins an eviction action in court, the landlord asks for the Writ, and pays a Writ fee.

Eviction Notice (Writ of Recovery of Premises and Order to Vacate)

Landlord takes the Writ to the sheriff. If the sheriff cannot find the tenants to serve the Writ, the sheriff may post it in a noticeable place at the property. The Tenant has 24 hours to remove all property and turn in keys. If the Tenant ignores the notice, Landlord may contact the sheriff to schedule a “move out” time. For more information, read Minn. Stat. § 504B.365 (Unlawful exclusion or removal; action for recovery of possession).

Tenant’s Personal Property

Minn. Stat. § 504B.271 covers what the landlord can do with property a tenant leaves behind after moving out. For more information, see links to booklets published by the Attorney General and other agencies at www.mncourts.gov/selfhelp/?page=415

Instructions – Eviction Action Complaint HOU101 State ENG Rev 1/20

www.mncourts.gov/forms

Page 13 of 13

01/04/21

REVISOR

This Document can be made available in alternative formats upon request

JSK/CH

21-01030

State of Minnesota

HOUSE OF REPRESENTATIVES NINETY-SECOND SESSION 01/28/2021 02/11/2021

H. F. No.

Authored by Her, Edelson, Vang, Long, Hassan and others The bill was read for the first time and referred to the Committee on Housing Finance and Policy Adoption of Report: Re-referred to the Committee on Judiciary Finance and Civil Law

1.1

A bill for an act

1.2 1.3 1.4 1.5

relating to housing; prohibiting landlords from imposing certain fees; restricting entry by a landlord and amending fees for improper entry; amending Minnesota Statutes 2020, section 504B.211, subdivisions 2, 6; proposing coding for new law in Minnesota Statutes, chapter 504B.

1.6

1.7

399

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. [504B.120] PROHIBITED FEES.

1.8

Subdivision 1. Prohibited fees. Except for actual services rendered for an optional

1.9

service offered by the landlord, a landlord shall not charge a tenant any nonrefundable fee

1.10

in relation to a residential tenancy.

1.11

Subd. 2. Penalties. A landlord who violates this section is liable to the residential tenant

1.12

for each unenforceable fee for three times the amount of each fee imposed that was not for

1.13

an actual optional service or $500, whichever is greater, and the court may award the tenant

1.14

reasonable attorney's fees.

1.15 1.16

1.17

EFFECTIVE DATE. This section applies to leases signed before, on, or after August 1, 2021. Sec. 2. Minnesota Statutes 2020, section 504B.211, subdivision 2, is amended to read:

1.18

Subd. 2. Entry by landlord. Except as provided in subdivision 4, a landlord may enter

1.19

the premises rented by a residential tenant only for a reasonable business purpose and after

1.20

making a good faith effort to give the residential tenant reasonable notice under the

1.21

circumstances of not less than 24 hours in advance of the intent to enter. The notice must

1.22

specify a time of entry that does not exceed four hours and the landlord may only enter

Sec. 2.

01/04/21

REVISOR

JSK/CH

21-01030

2.1

between the hours of 8:00 a.m. and 8:00 p.m. A residential tenant may not waive and the

2.2

landlord may not require the residential tenant to waive the residential tenant's right to prior

2.3

notice of entry under this section as a condition of entering into or maintaining the lease.

2.4

Sec. 3. Minnesota Statutes 2020, section 504B.211, subdivision 6, is amended to read:

2.5

Subd. 6. Penalty. If a landlord substantially violates subdivision 2 this section, the

2.6

residential tenant is entitled to a penalty which may include a rent reduction up to full

2.7

rescission of the lease, recovery of any damage deposit less any amount retained under

2.8

section 504B.178, and up to a $100 civil penalty for each violation. If a landlord violates

2.9

subdivision 5, the residential tenant is entitled to up to a $100 civil penalty for each violation

2.10

damages not less than an amount equal to one month's rent and reasonable attorney fees. A

2.11

residential tenant shall may follow the procedures in sections 504B.381, 504B.385, and

2.12

504B.395 to 504B.471 to enforce the provisions of this section. A violation of this section

2.13

by the landlord is a violation of section 504B.161.

2.14 2.15

EFFECTIVE DATE. This section applies to matters commenced on or after August 1, 2021.

Sec. 3.

01/20/21

REVISOR

This Document can be made available in alternative formats upon request

JSK/CH

21-01910

State of Minnesota

HOUSE OF REPRESENTATIVES NINETY-SECOND SESSION 02/01/2021 02/08/2021

1.1 1.2 1.3 1.4 1.5 1.6

1.7

H. F. No.

566

Authored by Fischer and Johnson The bill was read for the first time and referred to the Committee on Human Services Finance and Policy Adoption of Report: Re-referred to the Committee on Judiciary Finance and Civil Law without further recommendation

A bill for an act relating to housing; permitting a landlord to require a tenant to provide documentation supporting the tenant's need for a service or support animal; amending Minnesota Statutes 2020, sections 256C.02; 363A.09, subdivision 5; proposing coding for new law in Minnesota Statutes, chapter 504B. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. Minnesota Statutes 2020, section 256C.02, is amended to read:

1.8

256C.02 PUBLIC ACCOMMODATIONS.

1.9

People who are blind or people with a visual or physical disability have the same right

1.10

as the able-bodied to the full and free use of the streets, highways, sidewalks, walkways,

1.11

public buildings, public facilities, and other public places; and are entitled to full and equal

1.12

accommodations, advantages, facilities, and privileges of all common carriers, airplanes,

1.13

motor vehicles, railroad trains, motor buses, boats, or any other public conveyances or

1.14

modes of transportation, hotels, lodging places, places of public accommodation, amusement,

1.15

or resort, and other places to which the general public is invited, subject only to the conditions

1.16

and limitations established by law and applicable alike to all persons.

1.17

Every person who is totally or partially blind, or person who is deaf, or person with a

1.18

physical disability, or any person training a dog to be a service dog shall have the right to

1.19

be accompanied by a service dog in any of the places listed in section 363A.19. The person

1.20

shall be liable for any damage done to the premises or facilities by such dog. The service

1.21

dog must be capable of being properly identified as from a recognized school for seeing

1.22

eye, hearing ear, service, or guide dogs.

Section 1.

01/20/21

2.1 2.2

REVISOR

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21-01910

Sec. 2. Minnesota Statutes 2020, section 363A.09, subdivision 5, is amended to read: Subd. 5. Real property full and equal access. It is an unfair discriminatory practice

2.3

for a person to deny full and equal access to real property provided for in sections 363A.08

2.4

to 363A.19, and 363A.28, subdivision 10, to a person who is totally or partially blind, deaf,

2.5

or has a physical or sensory has a disability and who uses a service animal, if the service

2.6

animal can be properly identified as being from a recognized program which trains service

2.7

animals to aid persons who are totally or partially blind or deaf or have physical or sensory

2.8

disabilities. The person may not be required to pay extra compensation for the service animal

2.9

but is liable for damage done to the premises by the service animal.

2.10 2.11 2.12 2.13 2.14 2.15

Sec. 3. [504B.113] SERVICE AND SUPPORT ANIMAL DOCUMENTATION. Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given. (b) "Service animal" has the meaning given in Code of Federal Regulations, title 28, section 36.104, as amended. (c) "Support animal" means an animal that: (1) provides emotional support that alleviates

2.16

one or more identified symptoms or effects of a person's disability; and (2) does not need

2.17

to be trained to perform a specific disability-related task.

2.18

(d) "Tenant" means a current tenant or a prospective tenant.

2.19

(e) "Licensed professional" means a provider of care who is:

2.20

(1) a person licensed by the Board of Medical Practice under chapter 147;

2.21

(2) a physician assistant licensed under chapter 147A;

2.22

(3) a nurse, as defined in section 148.171, subdivision 9, licensed under chapter 148;

2.23

(4) a psychologist licensed under chapter 148;

2.24

(5) a mental health professional licensed under chapter 148B;

2.25

(6) a social worker licensed under chapter 148E;

2.26

(7) a counselor licensed under chapter 148F; or

2.27

(8) any professional listed in clauses (1) to (7) who holds a valid license in any other

2.28

state, provided the professional has an existing treatment relationship with the tenant

2.29

requesting a reasonable accommodation.

Sec. 3.

01/20/21

REVISOR

JSK/CH

21-01910

3.1

A licensed professional does not include any person who operates primarily to provide

3.2

certification for a service or support animal.

3.3

(f) "Reasonable accommodation" means the granting of a waiver by a landlord of a

3.4

no-pets or pet-fee policy for a person with a disability consistent with the Fair Housing Act,

3.5

United States Code, title 42, sections 3601 to 3619, as amended, and section 504 of the

3.6

Rehabilitation Act of 1973, United States Code, title 29, section 701, as amended.

3.7

Subd. 2. Request for documentation permitted. (a) A landlord may require a tenant

3.8

to provide supporting documentation for each service or support animal for which the tenant

3.9

requests a reasonable accommodation under any provision of law. A landlord must not

3.10

require supporting documentation from a tenant if the tenant's disability or disability-related

3.11

need for a service or support animal is readily apparent or already known to the landlord.

3.12

(b) Upon a landlord's request, the tenant must provide supporting documentation from

3.13

a licensed professional confirming the tenant's disability and the relationship between the

3.14

tenant's disability and the need for a service or support animal. A landlord must not require

3.15

the tenant to disclose or provide access to medical records or medical providers or provide

3.16

any other information or documentation of a person's physical or mental disability.

3.17

Subd. 3. Additional fees or deposits prohibited. A landlord must not require a tenant

3.18

with a reasonable accommodation under this section to pay an additional fee, charge, or

3.19

deposit for the service or support animal. A tenant is liable to the landlord for any damage

3.20

to the premises caused by the service or support animal.

3.21 3.22 3.23 3.24

Subd. 4. Prohibited conduct. A tenant must not, directly or indirectly through statements or conduct, knowingly: (1) misrepresent themselves as a person with a disability that requires the use of a service or support animal; or

3.25

(2) provide fraudulent supporting documentation under this section.

3.26

Subd. 5. Penalty. If a tenant violates this section, the landlord may deny the tenant's

3.27

rental application or request for a service or support animal. Nothing in this section shall

3.28

be construed to prohibit an eviction action based on a breach of the lease.

Sec. 3.

12/30/20

REVISOR

This Document can be made available in alternative formats upon request

JSK/KM

21-01000

State of Minnesota

HOUSE OF REPRESENTATIVES NINETY-SECOND SESSION 01/07/2021 02/22/2021

1.5

1.6

Authored by Hassan; Frazier; Xiong, J.; Gomez; Reyer and others The bill was read for the first time and referred to the Committee on Housing Finance and Policy Adoption of Report: Re-referred to the Committee on Judiciary Finance and Civil Law

A bill for an act

1.1 1.2 1.3 1.4

H. F. No.

relating to real property; modifying termination of tenancy at will; requiring residential tenant notice of grounds for eviction before action may be brought; amending Minnesota Statutes 2020, sections 504B.135; 504B.321. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. Minnesota Statutes 2020, section 504B.135, is amended to read:

1.7

504B.135 TERMINATING TENANCY AT WILL.

1.8

(a) A tenancy at will may be terminated by either party by giving notice in writing. The

1.9

time of the notice must be at least as long as the interval between the time rent is due or

1.10

three months, whichever is less.

1.11

(b) If a tenant neglects or refuses to pay rent due on a tenancy at will, the landlord may

1.12

terminate the tenancy by giving the tenant 14 days notice to quit in writing.

1.13

Sec. 2. Minnesota Statutes 2020, section 504B.321, is amended to read:

1.14

504B.321 COMPLAINT AND SUMMONS.

1.15

Subdivision 1. Procedure. (a) To bring an eviction action, the person complaining shall

1.16

file a complaint with the court, stating the full name and date of birth of the person against

1.17

whom the complaint is made, unless it is not known, describing the premises of which

1.18

possession is claimed, stating the facts which authorize the recovery of possession, and

1.19

asking for recovery thereof.

1.20 1.21

Sec. 2.

(b) The lack of the full name and date of birth of the person against whom the complaint is made does not deprive the court of jurisdiction or make the complaint invalid.

12/30/20

2.1 2.2 2.3 2.4 2.5 2.6 2.7

REVISOR

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21-01000

(c) The court shall issue a summons, commanding the person against whom the complaint is made to appear before the court on a day and at a place stated in the summons. (d) The appearance shall be not less than seven nor more than 14 days from the day of issuing the summons, except as provided by subdivision 2. (e) A copy of the complaint shall be attached to the summons, which shall state that the copy is attached and that the original has been filed. (f) If applicable, the person filing a complaint must attach a copy of the written notice

2.8

described in subdivision 1a. The court shall dismiss an action without prejudice for failure

2.9

to provide a notice as described in subdivision 1a and grant an expungement of the eviction

2.10

case court file.

2.11

Subd. 1a. Written notice. (a) Before bringing an eviction action alleging nonpayment

2.12

of rent or other unpaid financial obligation in violation of the lease, a landlord must provide

2.13

written notice to the residential tenant specifying the basis for a future eviction action.

2.14

(b) For an allegation of nonpayment of rent or other unpaid financial obligations in

2.15

violation of the lease, the landlord must include the following in a written notice:

2.16

(1) the total amount due;

2.17

(2) a specific accounting of the amount of the total due that is comprised of unpaid rents,

2.18 2.19 2.20

late fees, or other charges under the lease; and (3) the name and address of the person authorized to receive rent and fees on behalf of the landlord.

2.21

2.22

(1) provide a statement that a low-income residential tenant may be eligible for financial

2.23

assistance from the county;

2.24

(2) provide a description on how to access legal and financial assistance through the

2.25

"Law Help" website at www.lawhelpmn.org and "Minnesota 211" through its website at

2.26

www.211unitedway.org or by calling 211; and

2.27 2.28 2.29 2.30

(3) state that the landlord may bring an eviction action following expiration of the 14-day notice period if the residential tenant fails to pay the total amount due or fails to vacate. (d) The landlord or an agent of the landlord must deliver the notice personally or by first class mail to the residential tenant at the address of the leased premises.

Sec. 2.

12/30/20

REVISOR

JSK/KM

21-01000

3.1

(e) Only if the residential tenant fails to correct the rent delinquency within 14 days of

3.2

the delivery or mailing of the notice, or fails to vacate, the landlord may bring an eviction

3.3

action under subdivision 1 based on the nonpayment of rent.

3.4

(f) Receipt of a notice under this section is an emergency situation under section 256D.06,

3.5

subdivision 2, and Minnesota Rules, chapter 9500. For purposes of chapter 256J and

3.6

Minnesota Rules, chapter 9500, a county agency verifies an emergency situation by receiving

3.7

and reviewing a notice under this section. If a residential tenant applies for financial

3.8

assistance from the county, the landlord must cooperate with the application process by:

3.9 3.10 3.11 3.12

(1) supplying all information and documentation requested by the residential tenant or the county; and (2) accepting or placing into escrow partial rent payments where necessary to establish a residential tenant's eligibility for assistance.

3.13

Subd. 2. Expedited procedure. (a) In an eviction action brought under section 504B.171

3.14

or on the basis that the residential tenant is causing a nuisance or other illegal behavior that

3.15

seriously endangers the safety of other residents, their property, or the landlord's property,

3.16

the person filing the complaint shall file an affidavit stating specific facts and instances in

3.17

support of why an expedited hearing is required.

3.18

(b) The complaint and affidavit shall be reviewed by a referee or judge and scheduled

3.19

for an expedited hearing only if sufficient supporting facts are stated and they meet the

3.20

requirements of this paragraph.

3.21

3.22

than seven days from the date the summons is issued. The summons, in an expedited hearing,

3.23

shall be served upon the residential tenant within 24 hours of issuance unless the court

3.24

orders otherwise for good cause shown.

3.25

(d) If the court determines that the person seeking an expedited hearing did so without

3.26

sufficient basis under the requirements of this subdivision, the court shall impose a civil

3.27

penalty of up to $500 for abuse of the expedited hearing process.

Sec. 2.

HF1060 FIRST ENGROSSMENT This Document can be made available in alternative formats upon request

REVISOR

JSK

State of Minnesota

HOUSE OF REPRESENTATIVES NINETY-SECOND SESSION 02/11/2021 02/22/2021

H1060-1

H. F. No.

1060

Authored by Agbaje, Gomez, Hassan and Youakim The bill was read for the first time and referred to the Committee on Housing Finance and Policy Adoption of Report: Amended and re-referred to the Committee on Judiciary Finance and Civil Law

1.1

A bill for an act

1.2 1.3 1.4 1.5 1.6 1.7 1.8

relating to housing; establishing procedures for eviction and tenant screening reports; amending Minnesota Statutes 2020, sections 504B.001, subdivision 4; 504B.241, subdivision 4; 504B.245; 504B.321; 504B.331; 504B.335; 504B.345, subdivision 1, by adding a subdivision; 504B.361, subdivision 1; 504B.371, subdivisions 1, 4, 5; proposing coding for new law in Minnesota Statutes, chapter 504B; repealing Minnesota Statutes 2020, sections 504B.341; 504B.371, subdivision 7.

1.9

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.10

Section 1. Minnesota Statutes 2020, section 504B.001, subdivision 4, is amended to read:

1.11

Subd. 4. Evict or eviction. "Evict" or "eviction" means a summary court proceeding to

1.12

remove a tenant or occupant from or otherwise recover possession of real property by the

1.13

process of law set out in this chapter.

1.14 1.15

Sec. 2. Minnesota Statutes 2020, section 504B.241, subdivision 4, is amended to read: Subd. 4. Court file information. (a) If a residential tenant screening service includes

1.16

information from a court file on an individual in a residential tenant report, the report must

1.17

provide the full name and date of birth of the individual in any case where the court file

1.18

includes the individual's full name and date of birth, and the outcome of the court proceeding

1.19

must be accurately recorded in the residential tenant report including the specific basis of

1.20

the court's decision, when available.

1.21

(b) If a tenant screening service knows that a court file has been expunged or that the

1.22

court file has not resulted in a writ of recovery of premises and order to vacate, as defined

1.23

in section 504B.001, subdivision 15, the tenant screening service shall delete any reference

1.24

to that file in any data maintained or disseminated by the screening service. Every tenant

Sec. 2.

HF1060 FIRST ENGROSSMENT

REVISOR

JSK

H1060-1

2.1

screening service has an affirmative duty to update and verify the current status of court

2.2

files by accessing the Minnesota Court Information System no more than 24 hours prior to

2.3

issuing a residential tenant screening report. If a file cannot be found, it shall be presumed

2.4

to be expunged and may not be reported.

2.5

2.6

whatever form, the court shall include the full name and date of birth of the individual, if

2.7

that is indicated on the court file or summary, and information on the outcome of the court

2.8

proceeding, including the specific basis of the court's decision, coded as provided in

2.9

subdivision 5 for the type of action, when it becomes available.

2.10

(d) The residential tenant screening service is not liable under section 504B.245 if the

2.11

residential tenant screening service reports complete and accurate information as provided

2.12

by the court, consistent with paragraph (b).

2.13

Sec. 3. Minnesota Statutes 2020, section 504B.245, is amended to read:

2.14

504B.245 TENANT REPORT; REMEDIES.

2.15

The remedies provided in section 8.31 apply to A residential tenant aggrieved by a

2.16

violation of section 504B.241 is entitled to recover damages, together with costs and

2.17

disbursements, including costs of investigation and attorney fees, and receive other equitable

2.18

relief as determined by the court. A residential tenant screening service or landlord in

2.19

compliance with the provisions of the Fair Credit Reporting Act, United States Code, title

2.20

15, section 1681, et seq., is considered to be in compliance with section 504B.241.

2.21

Sec. 4. Minnesota Statutes 2020, section 504B.321, is amended to read:

2.22

504B.321 COMPLAINT AND SUMMONS.

2.23

Subdivision 1. Procedure Complaint. (a) To bring an eviction action, the person

2.24

complaining shall file a complaint with the court, stating the full name and, date of birth,

2.25

telephone number, and e-mail address of the person or persons against whom the complaint

2.26

is made, unless it is not known, describing the premises of which possession is claimed,

2.27

stating the facts which authorize the recovery of possession, and asking for recovery thereof.

2.28

(b) The lack of the full name and date of birth, telephone number, and e-mail address

2.29

of the person against whom the complaint is made does not deprive the court of jurisdiction

2.30

or make the complaint invalid.

2.31 2.32

(c) The court shall issue a summons, commanding the person against whom the complaint is made to appear before the court on a day and at a place stated in the summons.

Sec. 4.

HF1060 FIRST ENGROSSMENT

3.1 3.2 3.3 3.4

REVISOR

JSK

H1060-1

(d) The appearance shall be not less than seven nor more than 14 days from the day of issuing the summons, except as provided by subdivision 2. (e) A copy of the complaint shall be attached to the summons, which shall state that the copy is attached and that the original has been filed.

3.5

Subd. 2. Expedited procedure. (a) In an eviction action brought under section 504B.171

3.6

or on the basis that the tenant is causing a nuisance or other illegal behavior that seriously

3.7

endangers the safety of other residents, their property, or the landlord's property, the person

3.8

filing the complaint shall file an affidavit stating specific facts and instances in support of

3.9

why an expedited hearing is required.

3.10

(b) The complaint and affidavit shall be reviewed by a referee or judge and scheduled

3.11

for an expedited hearing only if sufficient supporting facts are stated and they meet the

3.12

requirements of this paragraph.

3.13

3.14

than seven days from the date the summons is issued. The summons, in an expedited hearing,

3.15

shall be served upon the tenant within 24 hours of issuance unless the court orders otherwise

3.16

for good cause shown.

3.17

(d) If the court determines that the person seeking an expedited hearing did so without

3.18

sufficient basis under the requirements of this subdivision, the court shall impose a civil

3.19

penalty of up to $500 for abuse of the expedited hearing process.

3.20

Subd. 3. Contents of complaint. The person bringing the complaint must:

3.21

(1) attach the current written lease or most recent written lease in existence;

3.22

(2) if alleging nonpayment of rent, attach a detailed ledger or accounting of the amount

3.23 3.24 3.25 3.26 3.27 3.28 3.29

owed; (3) if alleging a breach of lease, identify the clause of the lease which is the basis of the allegation; (4) if alleging a violation of section 504B.171, specify the conduct constituting the alleged violation; (5) if alleging a violation of section 504B.285, subdivision 1, attach a copy of any notice to vacate or notice to quit;

3.30

(6) indicate if the unit receives a federal or state housing subsidy through project-based

3.31

federal assistance payments, the Section 8 program, as defined in section 469.002, subdivision

3.32

24, or the low-income housing tax credit program, or other similar program; and

Sec. 4.

HF1060 FIRST ENGROSSMENT

4.1 4.2

REVISOR

JSK

H1060-1

(7) if known, indicate whether the defendant is a participant in the address confidentiality program under chapter 5B.

4.3

Subd. 4. Summons. (a) The court shall issue a summons, commanding the person against

4.4

whom the complaint is made to appear before the court on a day and at a place stated in the

4.5

summons. A copy of the complaint must be attached to the summons.

4.6

(b) The summons must include, at a minimum:

4.7

(1) the full name of the person against whom the complaint is brought;

4.8

(2) the date, time, and location of the hearing;

4.9

(3) information about the methods for participating in the court appearance, including,

4.10

if applicable, information for appearing by telephone or teleconferencing system and contact

4.11

information for the court regarding remote participation;

4.12

(4) the following statement: You have the right to seek legal help or request a reasonable

4.13

accommodation from the court for the court proceeding. If you can't afford a lawyer, free

4.14

legal help may be available. Contact your local Legal Aid office or visit the LawHelpMN

4.15

website at www.LawHelpMn.org for information and referrals;

4.16

(5) the following statement: To apply for financial assistance, contact your local county

4.17

or tribal social services office or call the United Way toll-free information line by dialing

4.18

2-1-1; and

4.19

(6) notification that a copy of the complaint is attached and has been filed with the court.

4.20

Subd. 5. Hearing. The court appearance described in this section shall not be less than

4.21 4.22 4.23 4.24 4.25

4.26

14 days from the day of issuing the summons, except as provided by subdivision 2. Subd. 6. Defective filing or service. The court must dismiss and expunge the record of any action if the person bringing the action fails to comply with subdivision 1 or 2. Subd. 7. Nonpublic record. An eviction action is not accessible to the public until the court enters a final judgment. Sec. 5. Minnesota Statutes 2020, section 504B.331, is amended to read:

4.27

504B.331 SUMMONS; HOW SERVED.

4.28

(a) The summons and complaint must be served at least seven 14 days before the date

4.29

of the court appearance specified in section 504B.321, in the manner provided for service

4.30

of a summons in a civil action in district court. It may be served by any person not named

4.31

a party to the action.

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5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8

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(b) If the defendant cannot be found in the county, the summons and complaint may be served at least seven 14 days before the date of the court appearance by: (1) leaving a copy at the defendant's last usual place of abode with a person of suitable age and discretion residing there; or (2) if the defendant had no place of abode, by leaving a copy at the property described in the complaint with a person of suitable age and discretion occupying the premises. (c) Failure of the sheriff to serve the defendant is prima facie proof that the defendant cannot be found in the county.

5.9

(d) Where the defendant cannot be found in the county, service of the summons and

5.10

complaint may be made upon the defendant by posting the summons in a conspicuous place

5.11

on the property for not less than one week 14 days if:

5.12

(1) the property described in the complaint is:

5.13

(i) nonresidential and no person actually occupies the property; or

5.14

(ii) residential and service has been attempted at least twice on different days, with at

5.15

least one of the attempts having been made between the hours of 6:00 p.m. and 10:00 p.m.;

5.16

and

5.17 5.18 5.19 5.20 5.21 5.22

(2) the plaintiff or the plaintiff's attorney has signed and filed with the court an affidavit stating that: (i) the defendant cannot be found, or that the plaintiff or the plaintiff's attorney believes that the defendant is not in the state; and (ii) a copy of the summons and complaint has been mailed to the defendant at the defendant's last known address if any is known to the plaintiff.; and

5.23

(iii) the plaintiff or plaintiff's attorney has communicated to the defendant that an eviction

5.24

hearing has been scheduled, including the date, time, and place of the hearing specified in

5.25

the summons by all forms of communication the plaintiff regularly uses to communicate

5.26

with the defendant, including e-mail and text message.

5.27 5.28

(e) If the defendant or the defendant's attorney does not appear in court on the date of the appearance, the trial shall proceed.

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Sec. 6. Minnesota Statutes 2020, section 504B.335, is amended to read:

6.2

504B.335 ANSWER; TRIAL.

6.3

(a) At the court appearance specified in the summons, the defendant may answer the

6.4

complaint, either orally or in writing, and the court shall hear and decide the action, unless

6.5

it grants a continuance of the trial as provided in section 504B.341.:

6.6

(1) dismiss the action;

6.7

(2) approve a settlement between the parties;

6.8

(3) schedule a trial for no fewer than ten days after the appearance; or

6.9

(4) continue the matter for such other hearings the court deems appropriate.

6.10

(b) If any defendant fails to appear at the scheduled court appearance, the court shall

6.11

review the court records and determine whether the complaint was properly served pursuant

6.12

to section 504B.331. The court shall:

6.13

(1) dismiss the case for improper service;

6.14

(2) proceed with a trial on the allegations in the complaint; or

6.15

(3) schedule and provide notice to all parties of the date and time of a trial.

6.16

6.17

the complexity of the matter; the need for parties to obtain discovery; the need for parties

6.18

to secure the presence of witnesses; the opportunity for the defendant to seek legal counsel,

6.19

apply for any emergency financial assistance that may be available, or both; and any

6.20

extenuating factors enumerated under section 504B.171.

6.21 6.22

(d) The parties shall cooperate with reasonable informal discovery requests by another party.

6.23

(b) (e) Either party may demand a trial by jury.

6.24

6.25

provided in sections 504B.281 to 504B.371.

6.26

(d) The court, in scheduling appearances and hearings under this section, shall give

6.27

priority to any eviction brought under section 504B.171, or on the basis that the defendant

6.28

is a tenant and is causing a nuisance or seriously endangers the safety of other residents,

6.29

their property, or the landlord's property.

6.30 6.31

(g) Nothing in this section affects the rights of a landlord under section 504B.321, subdivision 2. Sec. 6.

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(h) The court may not require the defendant to pay any amount of money into court,

7.2

post a bond, or by any other means post security for any purpose prior to final disposition

7.3

of the action, except for appeals as provided in section 504B.371.

7.4

Sec. 7. [504B.337] ENFORCEMENT OF SETTLEMENT AGREEMENTS.

7.5

Subdivision 1. Notice of compliance with settlement agreement. A party who believes

7.6

the other party has failed to comply with a court-approved settlement agreement may seek

7.7

judicial enforcement of the agreement after serving upon the other party an affidavit that

7.8

sets forth the specific facts constituting any documentary evidence supporting the allegation

7.9

of noncompliance. If the alleged noncompliance is not cured or otherwise resolved within

7.10

24 hours of service, the party may file the affidavit with the court.

7.11

Subd. 2. Adjudication. The court must schedule a hearing on the evidence to be held

7.12

at least 72 hours after the affidavit is filed and at least 24 hours after the affidavit has been

7.13

served on all other parties to the action. The court must notify the parties of the date and

7.14

time of the hearing and notify the party alleged to be in noncompliance of the right to dispute

7.15

the allegation at the hearing, either orally or in writing.

7.16 7.17

Subd. 3. Stay of writ of recovery. No writ of recovery shall be issued until the hearing has been held and a judgment on the matter entered.

7.18

Sec. 8. Minnesota Statutes 2020, section 504B.345, subdivision 1, is amended to read:

7.19

Subdivision 1. General. (a) If the court or jury finds for the plaintiff, the court shall

7.20

immediately enter judgment that the plaintiff shall have recovery of the premises, and shall

7.21

tax the costs against the defendant. The court shall issue execution in favor of the plaintiff

7.22

for the costs and also immediately issue a writ of recovery of premises and order to vacate.

7.23

(b) The court shall give priority in issuing a writ of recovery of premises and order to

7.24

vacate for an eviction action brought under section 504B.171 or on the basis that the tenant

7.25

is causing a nuisance or seriously endangers the safety of other residents, their property, or

7.26

the landlord's property.

7.27

7.28

(1) the court shall enter judgment for the defendant, tax the costs against the plaintiff,

7.29 7.30

and issue execution in favor of the defendant; and (2) the court may must expunge the records relating to the action under the provisions

7.31

of section 484.014 or under the court's inherent authority at the time judgment is entered

7.32

or after that time upon motion of the defendant.; and Sec. 8.

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8.1

(3) may order relief as provided in section 504B.425, including retroactive rent abatement.

8.2

(d) Except in actions brought: (1) under section 504B.291 as required by section

8.3

609.5317, subdivision 1; (2) under section 504B.171; or (3) on the basis that the tenant is

8.4

causing a nuisance or seriously endangers the safety of other residents, their property, or

8.5

the landlord's property, upon a showing by the defendant that immediate restitution of the

8.6

premises would work a substantial hardship upon the defendant or the defendant's family,

8.7

the court shall stay the writ of recovery of premises and order to vacate for a reasonable

8.8

period, not to exceed seven days a minimum of seven days. In establishing the period of

8.9

the stay, the court must consider extenuating circumstances or any hardships that would be

8.10

suffered by the defendant.

8.11 8.12

8.13 8.14 8.15

(e) This section applies to any writ of recovery issued at the conclusion of a trial pursuant to section 504B.335, paragraph (a) or (b). Sec. 9. Minnesota Statutes 2020, section 504B.345, is amended by adding a subdivision to read: Subd. 3. Motion to vacate judgment. Notwithstanding any other law to the contrary,

8.16

the defendant may bring a motion to vacate a judgment in an eviction action and may appeal

8.17

an order denying a motion to vacate a judgment to the same extent and under the same

8.18

guidelines as a party to any other civil action.

8.19

Sec. 10. Minnesota Statutes 2020, section 504B.361, subdivision 1, is amended to read:

8.20

Subdivision 1. Summons and writ. The state court administrator shall develop a uniform

8.21

form for the summons and writ of recovery of premises and order to vacate. The summons

8.22

shall conform to the requirements enumerated under section 504B.321, subdivision 3. The

8.23

writ of recovery of premises and order to vacate must include:

8.24

(1) the following statement: If you want to seek legal help and can't afford a lawyer, free

8.25

legal help may be available. Contact your local Legal Aid office or visit the LawHelpMN

8.26

website at www.LawHelpMn.org for information and referrals; and

8.27

(2) the following statement: To apply for financial assistance or other social services,

8.28

contact your local county or tribal social services office or call the United Way toll-free

8.29

information line by dialing 2-1-1.

Sec. 10.

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Sec. 11. Minnesota Statutes 2020, section 504B.371, subdivision 1, is amended to read: Subdivision 1. Statement of intention to appeal. If the court renders judgment against

9.2 9.3

the defendant and the defendant or defendant's attorney informs the court the defendant

9.4

intends to appeal, the court shall issue an order staying the writ for recovery of premises

9.5

and order to vacate for at least 24 hours after judgment, except as provided in subdivision

9.6

9.7 9.8 9.9

9.10

Sec. 12. Minnesota Statutes 2020, section 504B.371, subdivision 4, is amended to read: Subd. 4. Stay pending appeal. After the appeal is taken, all further proceedings in the case are stayed, except as provided in subdivision 7. Sec. 13. Minnesota Statutes 2020, section 504B.371, subdivision 5, is amended to read:

9.11

Subd. 5. Stay of writ issued before appeal. (a) Except as provided in subdivision 7, If

9.12

the court issues a writ for recovery of premises and order to vacate before an appeal is taken,

9.13

the appealing party may request that the court stay further proceedings and execution of the

9.14

writ for possession of premises and order to vacate, and the court shall grant a stay.

9.15 9.16

(b) If the party appealing remains in possession of the premises, that party must give a bond under subdivision 3.

9.17

9.18

served with the order granting the stay, the officer shall cease all further proceedings. If the

9.19

writ for possession of premises and order to vacate has not been completely executed, the

9.20

defendant shall remain in possession of the premises until the appeal is decided.

9.21 9.22

9.23 9.24 9.25

Sec. 14. REPEALER. Minnesota Statutes 2020, sections 504B.341; and 504B.371, subdivision 7, are repealed. Sec. 15. EFFECTIVE DATE. Sections 1 to 14 are effective August 1, 2021, and apply to actions filed on or after that date.

Sec. 15.

APPENDIX Repealed Minnesota Statutes: H1060-1

504B.341 CONTINUANCE OF TRIAL. (a) In an eviction action, the court, in its discretion, may grant a continuance of the trial for no more than six days unless all parties consent to longer continuance. (b) However, in all actions brought under section 504B.285, other than actions on a written lease signed by both parties, the court shall continue the trial as necessary but for no more than three months if the defendant or the defendant's agent or attorney: (1) states under oath that the defendant cannot proceed to trial because a material witness is not present; (2) names the witness; (3) states under oath that the defendant has made due exertion to obtain the witness; (4) states the belief that if the continuance is allowed the defendant will be able to procure the attendance of the witness at the trial or to obtain the witness's deposition; and (5) gives a bond that the plaintiff will be paid all rent that accrues during the pendency of the action and all costs and damages that accrue due to the adjournment. 504B.371 APPEALS. Subd. 7. Exception. Subdivisions 1, 4, and 6 do not apply in an action on a lease, against a tenant holding over after the expiration of the term of the lease, or a termination of the lease by a notice to quit, if the plaintiff gives a bond conditioned to pay all costs and damages if on the appeal the judgment of restitution is reversed and a new trial ordered. In such a case, the court shall issue a writ for recovery of premises and order to vacate notwithstanding the notice of appeal, as if no appeal had been taken, and the appellate court shall issue all needful writs and processes to carry out any judgment which may be rendered in the court.

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This Document can be made available in alternative formats upon request

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21-01003

State of Minnesota

HOUSE OF REPRESENTATIVES NINETY-SECOND SESSION 01/28/2021 02/04/2021 02/11/2021

H. F. No.

Authored by Her, Vang, Long, Hassan and Winkler The bill was read for the first time and referred to the Committee on Judiciary Finance and Civil Law By motion, recalled and re-referred to the Committee on Housing Finance and Policy Adoption of Report: Re-referred to the Committee on Judiciary Finance and Civil Law

1.1

A bill for an act

1.2 1.3 1.4

relating to civil law; landlord and tenant; establishing termination of lease upon infirmity of tenant; proposing coding for new law in Minnesota Statutes, chapter 504B.

1.5

400

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6

Section 1. [504B.266] TERMINATION OF LEASE UPON INFIRMITY OF TENANT.

1.7

Subdivision 1. Definitions. (a) For the purposes of this section, the following terms have

1.8

the meanings given them.

1.9

(b) "Authorized representative" means a person acting as an attorney-in-fact under a

1.10

power of attorney under section 523.24 or a court-appointed conservator or guardian under

1.11

chapter 524.

1.12 1.13

(c) "Disability" means any condition or characteristic that is a physical, sensory, or mental impairment that materially limits one or more major life activity.

1.14

(d) "Medical care facility" means:

1.15

(1) a nursing home, as defined in section 144A.01, subdivision 5;

1.16

(2) hospice care, as defined in section 144A.75, subdivision 8;

1.17

(3) residential hospice facility, as defined in section 144A.75, subdivision 13;

1.18

(4) boarding care, as licensed under chapter 144 and regulated by the Department of

1.19

Health under Minnesota Rules, chapter 4655;

1.20

(5) supervised living facility, as licensed under chapter 144;

1.21

(6) a facility providing assisted living, as defined in section 144G.01, subdivision 2;

Section 1.

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REVISOR

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2.1

(7) an accessible unit, as defined in section 363A.40, subdivision 1, paragraph (b);

2.2

(8) a state facility as defined in section 246.50, subdivision 3;

2.3

(9) a facility providing a foster care for adults program as defined in section 245A.02,

2.4

subdivision 6c; or (10) a facility providing intensive residential treatment services as defined in section

2.5 2.6

256B.0622, subdivision 2, paragraph (n).

2.7

(e) "Medical professional" means:

2.8

(1) a physician who is currently licensed to practice medicine under section 147.02,

2.9

subdivision 1; (2) an advanced practice registered nurse, as defined in section 148.171, subdivision 3;

2.10 2.11 2.12 2.13 2.14

or (3) a mental health professional as defined in sections 245.462, subdivision 18, clauses (1) to (6), and 245.4871, subdivision 27, clauses (1) to (5). Subd. 2. Termination of lease upon infirmity of tenant. (a) A tenant or the authorized

2.15

representative of the tenant may terminate the lease prior to the expiration of the lease in

2.16

the manner provided in subdivision 3 if the tenant has, or if there is more than one tenant,

2.17

all the tenants have, been found by a medical professional to need to move into a medical

2.18

care facility and:

2.19 2.20 2.21 2.22

(1) require assistance with instrumental activities of daily living or personal activities of daily living due to medical reasons or a disability; (2) meet one of the nursing facility level of care criteria under section 144.0724, subdivision 11; or

2.23

(3) have a disability or functional impairment in three or more of the areas listed in

2.24

section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced because of

2.25

a mental illness.

2.26

(b) When a tenant requires an accessible unit as defined in section 363A.40, subdivision

2.27

1, and the landlord can provide an accessible unit in the same complex where the tenant

2.28

currently resides that is available within two months of the request, then the provisions of

2.29

this section do not apply and the tenant may not terminate the lease.

2.30

Subd. 3. Notice. When the conditions in subdivision 2 have been met, the tenant or the

2.31

tenant's authorized representative may terminate the lease by providing at least two months'

2.32

written notice to be effective on the last day of a calendar month. The notice must be either Section 1.

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REVISOR

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3.1

hand-delivered or mailed by postage prepaid, first class United States mail. The notice must

3.2

include: (1) a copy of the medical professional's written documentation of the infirmity;

3.3

and (2) documentation showing that the tenant has been accepted as a resident or has a

3.4

pending application at a location where the medical professional has indicated that the tenant

3.5

needs to move. The termination of a lease under this section shall not relieve the eligible

3.6

tenant from liability either for the payment of rent or other sums owed prior to or during

3.7

the notice period, or for the payment of amounts necessary to restore the premises to their

3.8

condition at the commencement of the tenancy, ordinary wear and tear excepted.

3.9

Subd. 4. Waiver prohibited. Any waiver of the rights of termination provided by this

3.10

section, including lease provisions or other agreements that require a longer notice period

3.11

than those provided for in this section, shall be void and unenforceable.

3.12

EFFECTIVE DATE. This section is effective January 1, 2022, and applies to leases

3.13

entered into or renewed on or after January 1, 2022. For the purposes of this section, estates

3.14

at will shall be deemed to be renewed at the commencement of each rental period.

Section 1.

Emergency Executive Order 20-79; Rescinding Emergency Executive Orders 20-14 and 20-73 Modifying the Suspension of Evictions and Writs of Recovery During the COVID-19 Peacetime Emergency I, Tim Walz, Governor of the State of Minnesota, by the authority vested in me by the Constitution and applicable statutes, issue the following Executive Order: On March 23, 2020, I issued Executive Order 20-14, which suspended evictions, writs of recovery, and tenancy terminations during the peacetime emergency (“Executive Order 20-14”). The purpose of Executive Order 20-14 was to protect the public health by ensuring that Minnesotans were stably housed during the COVID-19 pandemic. On June 5, 2020, I issued Executive Order 20-73, which clarified the application of Executive Order 20-14. The protections provided by Executive Order 20-14 and Executive Order 20-73 have been crucial to protect public health by promoting Minnesotans’ housing stability and preventing displacement during the COVID-19 pandemic. We have continued to slowly and safely reopen Minnesota’s economy and, in line with those actions, recognize that tenants may begin to move more safely. At the same time, I recognize that COVID-19’s economic impact continues to influence the ability of tenants and homeowners to pay their rent and mortgages. Over 800,000 Minnesotans have applied for unemployment insurance since March 16, 2020. Today I approved the release of $100 million in funds for a program to provide housing assistance to prevent evictions and maintain housing stability for Minnesotans in the face of economic challenges due to COVID-19. To continue to strike a balance between the crucial importance of maintaining public health and stability for residential tenants, the economic impacts of the COVID-19 pandemic on tenants, and the interests of housing providers to maintain and protect their properties, I am modifying the eviction protections to allow evictions in additional limited circumstances. In addition, I am requiring landlords to give residential tenants a 7-day notice of intent to file an eviction to help mitigate the impact upon residential tenants and encourage resolutions without court involvement.

For these reasons, I order as follows: 1. Effective August 4, 2020 at 12:00 am, Executive Orders 20-14 and 20-73 are rescinded. Paragraphs 2 through 13 of this Executive Order are effective as of August 4, 2020 at 12:00 am. 2. The ability of property owners, mortgage holders, or other persons entitled to recover residential premises to file an eviction action on the grounds that a residential tenant remains in the property after a notice of termination of lease, after a notice of nonrenewal of a lease, after a material violation of a lease, after the termination of the redemption period for a residential foreclosure, or after nonpayment of rent, is suspended. Nothing in this Executive Order relieves a tenant’s obligation to pay rent. This suspension does not include eviction actions where the tenant: a. Seriously endangers the safety of other residents; b. Violates Minnesota Statutes 2019, section 504B.171, subdivision 1; c. Remains in the property past the vacate date after receiving a notice to vacate or nonrenewal under paragraph 4 of this Executive Order; or d. Materially violates a residential lease by the following actions on the premises, including the common area and the curtilage of the premises: i. Seriously endangers the safety of others; or ii. Significantly damages property. 3. Residential landlords must not issue notices of termination of lease or nonrenewal of lease or terminate residential leases during the pendency of the peacetime emergency unless the termination or nonrenewal is based upon one of the grounds permitted by paragraph 2. 4. Paragraph 3 does not apply to residential landlords who issue a termination of lease or nonrenewal of lease due to the need to move the property owner or property owner’s family member(s) into the property and where the property owner or property owner’s family member(s) move into the property within 7 days after it is vacated by the tenant. 5. All officers who hold a writ of recovery of premises and order to vacate must cease executing such writs as required by Minnesota Statutes 2019, section 504B.365, subdivision 1, with the exception of: a. Writs designated as a priority execution under Minnesota Statutes 2019, section 504B.365, subdivision 2; b. Writs issued as a result of an eviction action judgment entered prior to the enactment of Executive Order 20-14 on March 24, 2020 at 5:00 pm; or 2

c. Writs issued as a result of an eviction action permitted by paragraph 2. 6. All property owners, mortgage holders, or other persons seeking possession on grounds permitted by this Executive Order must provide a written notice of intent to file an eviction action to the tenant at least 7 days prior to filing the action, or the specified notice period included in the lease, whichever is longer. 7. Nothing in this Executive Order is intended to modify the relief available, including exclusion from the dwelling, in an order for protection issued under Minnesota Statutes 2019, section 518B.01, or in a domestic abuse no contact order issued under Minnesota Statutes 2019, section 629.75. 8. Financial institutions holding home mortgages are requested to implement an immediate moratorium on all pending and future foreclosures when the foreclosure arises out of a substantial decrease in income or substantial out of pocket medical expenses caused by the COVID-19 pandemic, or any local, state, or federal governmental response to COVID-19. Financial institutions are also strongly urged not to impose late fees or other penalties for late mortgage payments related to the COVID-19 pandemic. 9. I strongly encourage property owners, mortgage holders, or other persons entitled to recover residential premises to work with tenants to reach amicable resolutions where possible without filing eviction actions. I strongly encourage tenants who are able to pay their rent to continue to do so. 10. Pursuant to Minnesota Statutes 2019, section 12.45, a person who willfully violates paragraphs 2, 3, and 5 of this Executive Order is guilty of a misdemeanor and upon conviction must be punished by a fine not to exceed $1,000, or by imprisonment for not more than 90 days. The Attorney General may also seek any relief available pursuant to Minnesota Statutes 2019, section 8.31. 11. This Executive Order does not apply to properties on federal tribal trust land. 12. Nothing in this Executive Order creates grounds for eviction or lease termination beyond what is provided for by Minnesota Statutes. 13. Nothing in this Executive Order may in any way restrict state or local authority to order any quarantine, isolation, or other public health measure that may compel an individual to remain physically present in a particular residential real property. 14. Executive Order 20-14 and Executive Order 20-73 remain in full force and effect until superseded by this Executive Order according to its terms. Pursuant to Minnesota Statutes 2019, section 4.035, subdivision 2, and section 12.32, this Executive Order is effective immediately upon approval by the Executive Council. It remains in effect until the peacetime emergency declared in Executive Order 20-01 is terminated or until it is rescinded by proper authority.

A determination that any provision of this Executive Order is invalid will not affect the enforceability of any other provision of this Executive Order. Rather, the invalid provision will be modified to the extent necessary so that it is enforceable. Signed on July 14, 2020.

_____________________________________

Tim Walz Governor

Filed According to Law:

_____________________________________

Steve Simon

Secretary of State

Approved by the Executive Council on July 14, 2020:

_____________________________________

Alice Roberts-Davis

Secretary, Executive Council

Filed July 14, 2020 Office of the Minnesota Secretary of State Steve Simon

2021 Housing & Nurse Managers' Education Series

NEW LAWS AFFECTING ASSISTED LIVING March 2, 2021

Jill Schewe, Director of Assisted Living, Housing & Home Care Care Providers of Minnesota, Inc.

Thank you to our sponsor

2021 Housing & Nurse Managers' Education Series

Care Providers of Minnesota Service Corporation, a wholly owned for-profit subsidiary of Care Providers of Minnesota, offers a number of goods and services to Association members. With Service Corporation products you will:

Care Providers of Minnesota

Phone: 952-854-2844 Fax: 952-854-6214 Email: dbeardsley@careproviders.org

7851 Metro Parkway, Suite 200 Bloomington, MN 55425

www.careproviders.org/ServiceCorp

Housing & Nurse Managers’ Education Series

New Laws Affecting Assisted Living JILL SCHEWE

DIRECTOR OF ASSISTED LIVING, HOUSING & HOME CARE

2021 Housing & Nurse Managers' Education Series

INTRODUCTIONS

Jill Schewe, Director of Assisted Living, Housing & Home Care Care Providers of Minnesota, Inc. Jill Schewe has worked in and with assisted living communities her entire career. As a former assisted living manager, her experience was in startup, management, and operations of several assisted living communities. In her current role, Jill works with assisted living providers on any topic they need help with to aid in their success, including: licensing, policy, payment, and operational systems. She understands the needs of older adults and home- and community-based services alike. Jill has a BA in sociology and gerontology from Winona State University and an MA in management from St. Mary’s University of Minnesota.

Agenda Identify who this new licensure applies to and when

Outline the regulatory requirements

Describe the Assisted Living Director licensure process

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing & Nurse Managers' Education Series

Housing & Nurse Managers’ Education Series

Assisted Living Licensure

Who does the new license apply to?  All current providers who currently are a registered HWS establishments and either have their own comprehensive home care license or have an arranged agreement with a comprehensive home care license provider and meet the current definition of Assisted Living  There are a limited number of settings that are excluded licensure built into the statue such as transitional housing, buildings funded in certain ways, residential settings under 245A, and privately-owned communities such as co-ops  But… While there are specific exceptions, the Minnesota Department of Human Services(DHS) has stated that to be “an enrolled provider of customized living services, the setting must obtain an assisted living license”, regardless of whether providers meet the exemption. Handout found here: https://www.careproviders.org/members/2019/ALLicense-DecisionTree.pdf

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing & Nurse Managers' Education Series

Assisted Living Licensure  Providers will choose from one of two types of licensure: 1. Assisted Living License, or 2. Assisted Living with Dementia Care License  The license essentially combines HWS & Comprehensive Home Care and will cover all services, aspects of unit rental, and physical plant requirements (residents will still have the option to receive services from an outside provider).  New licensure fees  Assisted Living Facility license fees - $2,000 per building plus $75.00 per resident.  Assisted Living Facility with Dementia Care fees - $3,000 per building plus $100.00 per resident

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Assisted Living Licensure If you choose to have an ALL with Dementia Care:  Additional requirements are identified for assisted living facilities that advertise, market, or otherwise promote as providing specialized care for individuals with Alzheimer’s disease or other dementias.  An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care.  Facilities with this designation must demonstrate the capacity to manage residents with dementia, comply with the additional staffing and staff training requirements, and provide some specific services as needed by each resident.

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing & Nurse Managers' Education Series

ALL Options

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

When does it go into effect?  The law goes into effect on August 1, 2021. That’s 152 days from today!  Yes – we tried really hard to get it delayed because of the COVID-19 pandemic, but we were unsuccessful.  All ALs will need to apply for the new license, and all licenses will be effective August 1, 2021  The transitioned facilities will then have staggered renewals to distribute facilities throughout the year.  Companies will have the option to stagger their facilities or have them all renew on one date.

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements: Statutes vs. Rules  We’re used to all our regulations being found in statues (the laws passed the Minnesota legislature)  When statues were passed in 2019 for the new Assisted Living Licensure law a handful of areas weren’t fully developed, and the statute outlined a process for some details to be decided through the Rulemaking process (the process by which the legislature gives state agencies, along with stakeholder input, the authority to establish the rules to follow)  Going forward we will have two areas to find regulations in:  State statue 144G – Assisted Living (NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021)

 Assisted Living Rules – not finalized yet Handout found here: https://www.careproviders.org/ItemDetail?iProductCode=800217&Category=RESOURCES

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Regulatory Requirements in Statute There are general expectations of all assisted living facilities – the Minimum Assisted Living Facility Requirements include (many are not new) : 1. Distribute the assisted living bill of rights 2.

Providing service in compliance with the Nurse Practice Act

3. Utilize a person-centered planning and service delivery process 4. Have a system for delegation of health care activities to unlicensed personnel by a registered nurse

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Minimum Assisted Living Facility Requirements include: 5. Provide a means for residents to request assistance for health and safety needs 24 hours per day 6. Allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract 7. Permit resident access to food at any time 8. Allow residents to choose the resident's visitors and times of visits 9. Allow the resident the right to choose a roommate if sharing a unit 10. Notify the resident of the right to have and use a lockable door to the resident's unit

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Regulatory Requirements in Statute Minimum Assisted Living Facility Requirements include: 11. Develop and implement a staffing plan the meets the residents needs

12. Ensuring one or more persons are available 24 hours/day who are awake 13. Offer to provide or make available at least the following services to residents:      

At least three nutritious meals and snacks daily Weekly housekeeping and laundry service Direct or reasonable assistance with arranging for transportation Reasonable assistance with accessing community resources Provide culturally sensitive programs Have a daily program of social and recreational activities

14. Provide staff access to an on-call registered nurse 24 hours per day

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute  Bill of Rights – will need the new version signed by all  Set up meetings with clients/tenants  Significant difference from prior version

 New Contracts for all residents – will need to be signed by all  Two elements in ONE contract  Housing (lease/rent)  Assisted Living Services (Service Plan)

 Consider legal review to comply with new requirements

 Survey Cycle – will you be ready?  Statues and Rules  Every 2-year cycle  Building inspection – New!

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Regulatory Requirements in Statute Contract Terminations & Consumer Appeal Rights  There are new notice and discharge planning requirements for situations that require a contract termination and a new appeals process with the Office of Administrative Hearings for consumers wishing to contest a contract termination  There are separate terms and processes for termination for nonpayment, termination for violations of the contract, and expedited termination where there are health and safety issues involving other residents or facility staff  Emergency relocations are allowed with specific notice requirements; however, a facility shall not refuse to allow a resident to return if a termination of housing has not been given

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Contract Terminations & Consumer Appeal Rights  For situations where a facility just decides not to renew a resident’s housing under a contract, there are requirements that the facility either give 60 days’ notice of the nonrenewal and help with relocation planning or follow the termination procedure.  Regardless of how a resident is moved from the facility (termination, service reduction, planned closure) there are requirements for facilities to help coordinate the move, including development of a relocation plan that includes a “safe location”.

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Regulatory Requirements in Statute Resident Councils

Family Councils

The facility must provide a resident council with space and privacy for meetings, where doing so is reasonably achievable. Staff, visitors, and other guests may attend a resident council meeting only at the council's invitation.

The facility must provide a family council with space and privacy for meetings, where doing so is reasonably achievable. The facility must designate a staff person who is approved by the family council to be responsible for providing assistance and responding to written requests that result from meetings.

The facility must designate a staff person who is approved by the resident council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the resident council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the resident council, take reasonably achievable steps to make residents aware of upcoming meetings in a timely manner.

The facility must consider the views of the family council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the family council, take reasonably achievable steps to make residents and family members aware of upcoming meetings in a timely manner.

2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Physical plant  Existing providers who will transition into licensure will be a legacy provider to most new construction physical plant requirements as long as the physical plant “does not constitute a distinct hazard to life”  Any existing elements that surveyors find to be a “distinct hazard to life” must be corrected

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Regulatory Requirements in Statute Despite being a legacy provider, there are some additional physical plant requirements:  If not fully sprinkled, smoke detection in each occupied room (tested and maintained)  Portable fire extinguishers  A maintenance and repair program to keep the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment in a continuous state of good repair and operation  All-weather roads and walks must be provided within the lot lines to the primary entrance and the service entrance, including employees’ and visitors’ parking at the site  Must have space for outdoor activities for residents

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Other mentionable changes in the new AL requirements :  New construction, significant modifications to space, renovations sot space, alternations to space or changes in the use or additions must meet new physical plant requirements  There are several provisions related to how to handle resident finances and property, including a requirement to provide a final statement and funds within 30 days of a termination or death  The new statue formalizes who a “designated representative” is  New closure requirements  More outlined areas as to when the Office of Ombudsman for Long Term Care is notified

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Regulatory Requirements in Statute A few notables that stay the same in the new AL requirements:  Assessment schedules (within 5, 14, and every 90 day)  Residents can still opt out of having any services

 Medication assessments  Medication and Treatment & Therapy plans  Individualized abuse prevention plans  Resident and employee records

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided : 1. 2. 3. 4.

ADLs for persons with dementia Non-pharmacological practices that are person-centered and evidence-informed Education of residents and family members about transitions of care and communication Choices for meaningful engagement with other residents and the broader community

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Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided :  Each resident must be evaluated to address the following: 1. 2. 3. 4. 5.

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2021 Housing & Nurse Managers' Education Series

Current abilities and skills Emotional and Social needs and patterns Physical abilities and limitations Adaptations necessary for resident participation Identification of activities for behavioral interventions

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An individualized activity plan must be developed, reflecting on resident activity preferences and needs A selection of structured and non-structured activities must be available, including… ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦

Occupation or chore related tasks Scheduled and planned events such as entertainment or outings Spontaneous activities for enjoyment or to diffuse a behavior One-to-One activities Spiritual, creative, and intellectual activities Sensory stimulation activities Physical activities that enhance or maintain ambulation and movement Outdoor activities (Brrr)

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit):  Hazard Vulnerability Assessment completed with hazards mitigated  Must be fully sprinkled no later than August 1, 2029 (start planning now)  Must meeting NFPA Life Safety Code – Health Care (Limited Care) Chapter  Must have an awake staff person at all time physically present in the secured unit  Staff must be dementia-trained staff  Only staff trained in certain topics are permitted to work with dementia residents  Staffing levels must be sufficient, and based on sleep patterns of residents for evening staffing

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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit):  Persons overseeing or providing dementia staff training must have experience and knowledge in the care of individuals with dementia, including:  2 years work experience related to Alzheimer’s disease or related fields  Completed training and passed a skills competency or knowledge test required by MDH  AL Director must complete at least 10 hours of the required annual training in topics related to the care of residents with dementia

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit):  Specific policies regarding dementia are required (10 outlined in statue): 1. Philosophy of program 2. Management of behavior and nonpharmacological practices 3. Wander and egress prevention 4. Medication management 5. Staff training specific to dementia care

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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit):  Specific policies regarding dementia are required continued: 6. Description of life enrichment programs 7. Description of family support programs 8. Limited use of intercoms or paging – for emergencies only 9. Transportation assistance 10. Safekeeping of residents’ possessions

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Rules Hold on – they’re not done yet!  MDH published the draft Rules in December 2020  Public comment period started when the rules were published and ended February 9, 2021  Hearings occurred with an Admistrative Law Judge January 19 and 20, 2021  A rebuttal period started February 10 and ended February 17, 2021  Currently waiting on the Administrative Law Judge to decide on final requirements (she has 30 days from the end of the rebuttal period). As part of the process: Care Providers of Minnesota submitted comments, testified, and submitted rebuttal comments

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Regulatory Requirements in Rules Elements of what’s in the proposed Rule:  Resident assessment/reassessments - your initial assessment is CRITICAL  Must be conducted on prospective residents  Each facility must develop, but must contain minimum identified elements (and there are a lot of them)  Must be able to conduct a nursing assessment on weekends if resident is returning from the hospital  Every 90 days, and changes in condition  Also adds “Individualized Review” for non-AL services (RN need not complete)

 Uniform checklist disclosure of services (MDH to post sample)  Facility to submit their version to MDH at application and each renewal, and each time updated

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2021 Housing & Nurse Managers' Education Series

Regulatory Requirements in Rules Elements of what’s in the proposed Rule:  Contract terminations and Discharge Planning  Emergency Preparedness Plan – CMS Appendix Z (ouch)  Missing Resident Plan  Staffing – No ratios (that goodness). Must have a plan, developed by RN. Must post staffing for the public to see. Staffing must meet the needs of residents.  Two staff must be on duty at all times if any resident requires the assistance of two for scheduled and unscheduled needs.  Call lights must be answered within 10 minutes during evening hours

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Next steps & what you can do  Read the statute and proposed rules to identify what areas or concepts in your current operation will need to change.  Who/What will hold the AL license  What license will you apply for (regular or memory care?)  Who will be the LALD?  Who will be the Clinical Nurse Supervisor?  How and when will you update your contracts to comply with the new requirements?  How and when will you update your uniform assessment tool and disclosure to comply?  Updates to policies and procedures

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2021 Housing & Nurse Managers' Education Series

Housing & Nurse Managers’ Education Series

Licensed Assisted Living Director

Who does the LALD apply to?  All licensed assisted living facilities will have to have a Licensed Assisted Living Director (LALD or ALD)  This person is responsible for the general administration and management of the facility and oversee the day-to-day operations, including:  Ensure that services and support are provided in a manner to protect health, safety and well-being, and consistent with residents’ rights, including the right to refuse services  Ensure facility is in compliance with all applicable laws and regulations  Ensure all required policies, procedures and services are in place  Ensure the building and grounds are well maintained  Ensure proper recruitment, hiring, training and supervision of staff

 You will apply for an ALD licenses through the Minnesota Board of Executives for Long Term Services and Supports (BELTSS)

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2021 Housing & Nurse Managers' Education Series

Routes to become a LALD OPTION 1 (CURRENTLY UNDER DEVELOPMENT) Has completed an approved training course and passed an examination approved by the Board of Executives for Long Term Services and Supports that is designed to test for competence and that includes assisted living facility laws in Minnesota

OPTION 2 (PARTIALLY UNDER DEVELOPMENT) Is a Licensed Nursing Home Administrator or has been validated as a Qualified Health Services Executive by the National Association of Long-Term Care Administrator Boards (NAB) and has a core knowledge of Minnesota Assisted Living laws (how to define and measure core knowledge is still to be determined)

Handout found here: https://www.careproviders.org/members/2019/ALDirector-DecisionTreev2.pdf

Routes to become a LALD OPTION 3 – LEGACY OPTIONS 1. Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance

2. Has completed at least 1,000 hours of a director/executive in training program provided by a licensed assisted living director

3. Has managed a registered housing with services establishment under assisted living title protection for at least three years

4. Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility

Handout found here: https://www.careproviders.org/members/2019/ALDirector-DecisionTreev2.pdf

2021 Housing & Nurse Managers' Education Series

Assisted Living Director How do I get a license if I meet a legacy in option?

• Complete an application (goal to be all online) • Identify one of the requirements to be a legacy • Application will most likely have an attestation you sign that you’ve met the • •

requirements You will submit a resume or like document to show your experience You will submit education transcripts that you’ll have sent directly to BELTSS

• Complete a background check (different from the NetStudy 2.0 study) • Paid a licensing fee (talk has been around $250)

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Assisted Living Director in Residence What if I don’t meet the criteria for a legacy license?

• Don’t panic – you’re NOT necessarily out of a job! • You will apply with BELTSS to be an Assisted Living Director in Residence (ALDIR) within 30 days of the process being open

• Complete a background check (different from the NetStudy 2.0 study) • Paid a licensing fee (talk has been around $250) • You will have 1 year to complete the required elements of licensure (course work, field experience & test)

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2021 Housing & Nurse Managers' Education Series

Assisted Living Director in Residence What if I don’t meet the criteria for a legacy license?

• You must meet one of the following education and work experience requirements: • A high school diploma or equivalent +2 years of work experience in the continuum of LTC, including 1 year in a management or supervisory position, or

•

An Associate’s degree + 6 months of work experience in a management or supervisory position; or

•

A Bachelor’s degree + 6 months work experience in a management or supervisory experience in LTC

• You will need to have a mentor, who is a licensed AL director, oversee you. This person can be anyone who is licensed

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Assisted Living Director in Residence After you’ve received an ALDIR permit – within 1 year you must:

• You will complete a self assessment which will help determine the number of hours you will need to complete (the proposed rule is 320-1000 hours)

• Compete field experience hours under the direction of your mentor • Compete the required course work (still under development) • Pass the required test(s) for licensure (still under development) • Then you will receive your ALD license!!

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2021 Housing & Nurse Managers' Education Series

Assisted Living Director Once you are licensed – then what?

• You need to obtain 7 continuing education hours

within the first year of licensure • Unlike the HWS education requirements, these continuing education credits will need to be approved / accredited

• Licenses will be renewed annually (likely in the fall when LNHA are) • An annual renewal fee will be collected (talk is around $250)

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Assisted Living Director Once you are licensed – then what?

• You must have at least 30 hours of training every two years on topics relevant to the operation of a licensed Assisted Living facility and the needs of the residents.

• If you are managing a licensed Assisted Living with Dementia Care, you must complete and document that at least 10 hours of the required 30 hours of training relate to the care of individuals with dementia. (again, all education, once licensed, needs to be CEU accredited education)

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2021 Housing & Nurse Managers' Education Series

Assisted Living Director Can I oversee more than 1 licensed assisted living setting?

• Yes, you can apply to over see more than one settings if: • You have a license in good standing • You are overseeing more than 5 settings within a 60-mile radius • Each setting has a common management • If you want to apply to over see buildings outside those parameters, you will apply to the board to do so and they will determine approval

• You must maintain sufficient on-site presence to effectively be the director, manage and supervise each facility

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Board of Examiners for Long Term Services and Supports (BELTSS) As a licensed professional – you have new responsibilities!

• You need to follow any direction from BELTSS and communicate with them as required

• There are Code of Ethics expectations (like all other professional licenses) • The BELTSS board has disciplinary actions for failing to uphold the integrity of your license

• There is a complaint process to the board for licensed professional

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2021 Housing & Nurse Managers' Education Series

Board of Examiners for Long Term Services and Supports (BELTSS) Other things to note:

• BELTSS is made up of a volunteer board of directors – currently all licensed nursing home administrators. The new statue adds and Assisted Living Director and an Assisted Living nurse slots to the board's makeup

• You can find more information on the BELTSS website: https://mn.gov/boards/nursing-home/applicants/assisted-living-director/

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When LALD go into effect and what are we waiting for? When does it go into effect? •ALD Licensure goes into effect with “sunrise” of AL licensure on August 1, 2021 •Those eligible to be a legacy ALD’s will need to apply for licensure by July 1, 2021

What are we waiting for? •The BELTSS board is working on: • The application process for legacy licensees • The application process to apply for an ALDIR permit • The process for new applications (not legacy) • Work with educators to approve education content that is accredited for licensure

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2021 Housing & Nurse Managers' Education Series

Next steps & what you can do  There’s not much you can do right now …  Wait to hear how legacy providers will apply for licensure and the more specific details of who’s eligible and who’s not  If you won’t qualify for a ALD license, and you’re currently the director, watch for next steps to apply for an ALDIR  Update your resume or like document – you’ll need it when applying  Round up who and how you request your transcripts from your education institutions – but don’t’ request them yet, until we know where you will have to have them sent to  Hang tight!

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What CPM is working on to help you prepare?  Watch for lots of education to come in the next 6 months!  We’re working on monthly Assisted Living webinars on various consolidated topics  The Assisted Living Summit is being planned for dates TBD in May  We are in the process of writing all new resource manuals for you  Plus, as always, we’re here to answer your individual calls and emails  Watch your weekly ACTION newsletter for details as they come out!

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2021 Housing & Nurse Managers' Education Series

Questions JILL SCHEWE Director of Assisted Living, Housing & Home Care Care Providers of Minnesota jschewe@careproviders.org (952) 851-2484

Do I need an Assisted Living Facility License or an Assisted Living Facility with Dementia Care License? YES

Are you a facility that provides sleeping accommodations to one or more adults

Are you any of the following? An emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home (144A), or a hospital , boarding care home, or licensed supervised living facility (144.50-144.56) A licensed lodging establishment Residential settings licensed under 245A, or adult foster care (245D) A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011

You are not required to have an AL License

YES

Do you provide one or more of the following Assistance with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing Standby assistance Verbal or visual reminders to residents to take regularly scheduled medication(s), which includes bring the resident previously set-up medication(s), medication(s) in original containers, or liquid or food to accompany the medication(s) Verbal or visual reminders to the resident to perform regularly scheduled treatments and/or exercises The preparation of modified diets ordered by a licensed health professional The services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person’s scope of practice Medication management services Hands-on assistance with transfers and mobility Treatments and therapies Assistance for residents with eating when the residents have complicated eating problems Complex or specialty health care services

YES You need an AL

license

Does either of the following apply to your facility? You are required to have an Assisted Living Facility with Dementia Care license

You advertise, market, or otherwise promote yourself an assisted living as providing specialized care for dementia or related disorders.

YES

You have a secured dementia care unit, meaning a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident’s ability to exit, the secured area or setting.

You are required to have an Assisted Living Facility License. You have the option to have an Assisted Living Facility with Dementia Care license.

Assisted Living Director Licensure By August 1, 2021, each Licensed Assisted Living Facility in Minnesota must be managed by a Licensed Assisted Living Director. There are three “routes” available to become a Licensed Assisted Living Director:

OPTION 1 (to be developed)

Has completed an approved training course and passed an examination approved by the Board of Executives for Long Term Services and Supports (formally BENHA) that is designed to test for competence and that includes assisted living facility laws in Minnesota

OPTION 2

Is a Licensed Nursing Home Administrator or has been validated as a Qualified Health Services Executive by the National Association of LongTerm Care Administrator Boards (NAB) and has a core knowledge of Minnesota Assisted Living laws (how to define and measure core knowledge is still to be determined)

OPTION 3

(“legacy” options)

Apply for licensure by July 1, 2021 AND satisfy at least ONE of the following requirements

Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance

Has completed at least 1,000 hours of a director/ executive in training program provided by a licensed assisted living director

Has managed a registered housing with services establishment under assisted living title protection for at least three years

Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility

Assisted Living Director licenses will be managed by the Minnesota Board of Executives for Long Term Services and Supports (formerly the Board of Examiners for Nursing Home Administrators/BENHA). Each Licensed Assisted Living Director must receive at least 30 hours of training every two years on topics relevant to the operation of a Licensed Assisted Living Facility and the needs to its residents. If the Licensed Assisted Living Director is managing a Licensed Assisted Living with Dementia Care, the Director must complete and document that at least 10 hours of the required 30 hours of training relate to the care of individuals with dementia. Care Providers of Minnesota 8/19

Compliance with Minnesota’s §325F.721 “I’m okay” Check Services Statue Are you an unlicensed setting providing sleeping accommodations to one or more adult residents, at least 80% which are 55 years of age or older

YES

Do you, for a fee, offer any of the following supportive services? Assistance with laundry Assistance with shopping Assistance with household chores Housekeeping services Provision or assistance with meals or food preparation Help with arranging for, on arranging transportation to, medical, social, recreational, personal, or social services appointments Provision of social or recreational services

YES

The “I’m okay” statute does not apply to you.

Are you any of the following? Emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home A hospital A certified boarding care home A licensed supervised living facility A licensed lodging establishment Residential settings licensed under 245A Adult foster care An assisted living facility licensed under chapter 144I A setting governed by the standards of 245D A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011

The “I’m okay” statute does not apply to you.

YES

Effective with contracts entered into on or after August 21, 2021, you must comply with the following three requirements:

You must disclose to prospective residents that the facility is not licensed as an assisted living facility under chapter 144I and, notwithstanding any contract for "I'm okay" check services, is not permitted to provide assisted living services, as defined in section 144I.01, subdivision 9, either directly or through a provider under a business relationship or other affiliation with the covered setting. You must prominently disclose in a written contract whether or not your setting itself or through a provider with which the your setting has a business agreement offers "I'm okay" check services. If the resident contracts for "I'm okay" check services, the written contract must detail the nature, extent, and frequency of the provision of these services. © Care Providers of Minnesota 5/19

MINNESOTA STATUTES 2020

CHAPTER 144G ASSISTED LIVING NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021. 144G.01

DEFINITIONS.

144G.51

ARBITRATION.

144G.02

ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION.

144G.52

ASSISTED LIVING CONTRACT TERMINATIONS.

144G.53

NONRENEWAL OF HOUSING.

144G.54

APPEALS OF CONTRACT TERMINATIONS.

144G.55

COORDINATED MOVES.

144G.03

ASSISTED LIVING REQUIREMENTS.

144G.04

RESERVATION OF RIGHTS.

144G.05

REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES.

144G.56

TRANSFER OF RESIDENTS WITHIN FACILITY.

144G.06

UNIFORM CONSUMER INFORMATION GUIDE.

144G.57

PLANNED CLOSURES.

144G.07

RETALIATION PROHIBITED. 144G.60

STAFFING REQUIREMENTS.

STAFFING REQUIREMENTS

ASSISTED LIVING LICENSURE 144G.08

DEFINITIONS.

144G.61

STAFF COMPETENCY EVALUATIONS.

144G.09

COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES.

144G.62

DELEGATION AND SUPERVISION.

144G.63

ORIENTATION AND ANNUAL TRAINING REQUIREMENTS.

144G.64

TRAINING IN DEMENTIA CARE REQUIRED.

144G.70

SERVICES.

144G.71

MEDICATION MANAGEMENT.

144G.72

TREATMENT AND THERAPY MANAGEMENT SERVICES.

144G.10

ASSISTED LIVING FACILITY LICENSE.

144G.11

APPLICABILITY OF OTHER LAWS.

144G.12

APPLICATION FOR LICENSURE.

144G.13

BACKGROUND STUDIES OF LICENSE APPLICANTS.

144G.15

CONSIDERATION OF APPLICATIONS.

144G.16

PROVISIONAL LICENSE.

144G.17

LICENSE RENEWAL.

144G.18

NOTIFICATION OF CHANGES IN INFORMATION.

144G.19

TRANSFER OF LICENSE PROHIBITED.

SERVICES

ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80

ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.81

ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS.

144G.82

ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.83

ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.84

SERVICES FOR RESIDENTS WITH DEMENTIA.

ENFORCEMENT 144G.20

ENFORCEMENT.

SURVEYS, CORRECTION ORDERS, AND FINES 144G.30

SURVEYS AND INVESTIGATIONS.

144G.31

VIOLATIONS AND FINES.

144G.32

RECONSIDERATION OF CORRECTION ORDERS AND FINES.

144G.33

INNOVATION VARIANCE.

OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40

HOUSING AND SERVICES.

144G.401

PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS.

RESIDENT RIGHTS AND PROTECTIONS 144G.90

REQUIRED NOTICES.

144G.91

ASSISTED LIVING BILL OF RIGHTS.

144G.911

RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS.

144G.41

MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS.

144G.42

BUSINESS OPERATION.

144G.43

RESIDENT RECORD REQUIREMENTS.

144G.92

RETALIATION PROHIBITED.

MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS.

144G.93

CONSUMER ADVOCACY AND LEGAL SERVICES.

144G.95

OFFICE OF OMBUDSMAN FOR LONG-TERM CARE.

144G.9999

RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE.

144G.45

CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50

ASSISTED LIVING CONTRACT REQUIREMENTS.

Official Publication of the State of Minnesota Revisor of Statutes

144G.01

MINNESOTA STATUTES 2020

144G.01 DEFINITIONS. Subdivision 1. Scope; other definitions. For purposes of sections 144G.01 to 144G.05, the following definitions apply. In addition, the definitions provided in section 144D.01 also apply to sections 144G.01 to 144G.05. Subd. 2. Assisted living. "Assisted living" means a service or package of services advertised, marketed, or otherwise described, offered, or promoted using the phrase "assisted living" either alone or in combination with other words, whether orally or in writing, and which is subject to the requirements of this chapter. Subd. 3. Assisted living client; client. "Assisted living client" or "client" means a housing with services resident who receives assisted living that is subject to the requirements of this chapter. Subd. 4. Commissioner. "Commissioner" means the commissioner of health. History: 2006 c 282 art 19 s 13; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.02 ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION. Subdivision 1. Protected title; restriction on use. No person or entity may use the phrase "assisted living," whether alone or in combination with other words and whether orally or in writing, to advertise, market, or otherwise describe, offer, or promote itself, or any housing, service, service package, or program that it provides within this state, unless the person or entity is a housing with services establishment that meets the requirements of this chapter, or is a person or entity that provides some or all components of assisted living that meet the requirements of this chapter. A person or entity entitled to use the phrase "assisted living" shall use the phrase only in the context of its participation in assisted living that meets the requirements of this chapter. A housing with services establishment offering or providing assisted living that is not made available to residents in all of its housing units shall identify the number or location of the units in which assisted living is available, and may not use the term "assisted living" in the name of the establishment registered with the commissioner under chapter 144D, or in the name the establishment uses to identify itself to residents or the public. Subd. 2. Authority of commissioner. (a) The commissioner, upon receipt of information that may indicate the failure of a housing with services establishment, the arranged home care provider, an assisted living client, or an assisted living client's representative to comply with a legal requirement to which one or more of the entities may be subject, shall make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved. (b) In addition to the authority with respect to licensed home care providers under section 144A.45 and with respect to housing with services establishments under chapter 144D, the commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which a housing with services establishment is located to compel the housing with services establishment or the arranged home care provider to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment or arranged home care provider is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general

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or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions. History: 2006 c 282 art 19 s 14; 2013 c 108 art 11 s 33; 2014 c 275 art 1 s 134,138; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.03 ASSISTED LIVING REQUIREMENTS. Subdivision 1. Verification in annual registration. A registered housing with services establishment using the phrase "assisted living," pursuant to section 144G.02, subdivision 1, shall verify to the commissioner in its annual registration pursuant to chapter 144D that the establishment is complying with sections 144G.01 to 144G.05, as applicable. Subd. 2. Minimum requirements for assisted living. (a) Assisted living shall be provided or made available only to individuals residing in a registered housing with services establishment. Except as expressly stated in this chapter, a person or entity offering assisted living may define the available services and may offer assisted living to all or some of the residents of a housing with services establishment. The services that comprise assisted living may be provided or made available directly by a housing with services establishment or by persons or entities with which the housing with services establishment has made arrangements. (b) A person or entity entitled to use the phrase "assisted living," according to section 144G.02, subdivision 1, shall do so only with respect to a housing with services establishment, or a service, service package, or program available within a housing with services establishment that, at a minimum: (1) provides or makes available health-related services under a home care license. At a minimum, health-related services must include: (i) assistance with self-administration of medication, medication management, or medication administration as defined in section 144A.43; and (ii) assistance with at least three of the following seven activities of daily living: bathing, dressing, grooming, eating, transferring, continence care, and toileting. All health-related services shall be provided in a manner that complies with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (2) provides necessary assessments of the physical and cognitive needs of assisted living clients by a registered nurse, as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (3) has and maintains a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (4) provides staff access to an on-call registered nurse 24 hours per day, seven days per week; (5) has and maintains a system to check on each assisted living client at least daily;

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MINNESOTA STATUTES 2020

(6) provides a means for assisted living clients to request assistance for health and safety needs 24 hours per day, seven days per week, from the establishment or a person or entity with which the establishment has made arrangements; (7) has a person or persons available 24 hours per day, seven days per week, who is responsible for responding to the requests of assisted living clients for assistance with health or safety needs, who shall be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the housing with services establishment in order to respond within a reasonable amount of time; (iii) capable of communicating with assisted living clients; (iv) capable of recognizing the need for assistance; (v) capable of providing either the assistance required or summoning the appropriate assistance; and (vi) capable of following directions; (8) offers to provide or make available at least the following supportive services to assisted living clients: (i) two meals per day; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the client, reasonable assistance with arranging for transportation to medical and social services appointments, and the name of or other identifying information about the person or persons responsible for providing this assistance; (v) upon the request of the client, reasonable assistance with accessing community resources and social services available in the community, and the name of or other identifying information about the person or persons responsible for providing this assistance; and (vi) periodic opportunities for socialization; and (9) makes available to all prospective and current assisted living clients information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This information must be made available beginning no later than six months after the commissioner makes the uniform format and required components available to providers according to section 144G.06. Subd. 3. Exemption from awake-staff requirement. A housing with services establishment that offers or provides assisted living is exempt from the requirement in subdivision 2, paragraph (b), clause (7), item (i), that the person or persons available and responsible for responding to requests for assistance must be awake, if the establishment meets the following requirements: (1) the establishment has a maximum capacity to serve 12 or fewer assisted living clients; (2) the person or persons available and responsible for responding to requests for assistance are physically present within the housing with services establishment in which the assisted living clients reside; (3) the establishment has a system in place that is compatible with the health, safety, and welfare of the establishment's assisted living clients;

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(4) the establishment's housing with services contract, as required by section 144D.04, includes a statement disclosing the establishment's qualification for, and intention to rely upon, this exemption; (5) the establishment files with the commissioner, for purposes of public information but not review or approval by the commissioner, a statement describing how the establishment meets the conditions in clauses (1) to (4), and makes a copy of this statement available to actual and prospective assisted living clients; and (6) the establishment indicates on its housing with services registration, under section 144D.02 or 144D.03, as applicable, that it qualifies for and intends to rely upon the exemption under this subdivision. Subd. 4. Nursing assessment. (a) A housing with services establishment offering or providing assisted living shall: (1) offer to have the arranged home care provider conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a service plan prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier; and (2) inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier. (b) An arranged home care provider is not obligated to conduct a nursing assessment by a registered nurse when requested by a prospective resident if either the geographic distance between the prospective resident and the provider, or urgent or unexpected circumstances, do not permit the assessment to be conducted prior to the date on which the prospective resident executes a contract or moves in, whichever is earlier. When such circumstances occur, the arranged home care provider shall offer to conduct a telephone conference whenever reasonably possible. (c) The arranged home care provider shall comply with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285, with respect to the provision of a nursing assessment prior to the delivery of nursing services and the execution of a home care service plan or service agreement. Subd. 5. Assistance with arranged home care provider. The housing with services establishment shall provide each assisted living client with identifying information about a person or persons reasonably available to assist the client with concerns the client may have with respect to the services provided by the arranged home care provider. The establishment shall keep each assisted living client reasonably informed of any changes in the personnel referenced in this subdivision. Upon request of the assisted living client, such personnel or designee shall provide reasonable assistance to the assisted living client in addressing concerns regarding services provided by the arranged home care provider. Subd. 6. Termination of housing with services contract. If a housing with services establishment terminates a housing with services contract with an assisted living client, the establishment shall provide the assisted living client, and the legal or designated representative of the assisted living client, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the section of the contract that authorizes the termination;

Official Publication of the State of Minnesota Revisor of Statutes

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MINNESOTA STATUTES 2020

(3) without extending the termination notice period, an affirmative offer to meet with the assisted living client and, if applicable, client representatives, within no more than five business days of the date of the termination notice to discuss the termination; (4) an explanation that: (i) the assisted living client must vacate the apartment, along with all personal possessions, on or before the effective date of termination; (ii) failure to vacate the apartment by the date of termination may result in the filing of an eviction action in court by the establishment, and that the assisted living client may present a defense, if any, to the court at that time; and (iii) the assisted living client may seek legal counsel in connection with the notice of termination; (5) a statement that, with respect to the notice of termination, reasonable accommodation is available for the disability of the assisted living client, if any; and (6) the name and contact information of the representative of the establishment with whom the assisted living client or client representatives may discuss the notice of termination. History: 2006 c 282 art 19 s 15; 2016 c 179 s 17,18; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.04 RESERVATION OF RIGHTS. Subdivision 1. Use of services. Nothing in this chapter requires an assisted living client to utilize any service provided or made available in assisted living. Subd. 2. Housing with services contracts. Nothing in this chapter requires a housing with services establishment to execute or refrain from terminating a housing with services contract with a prospective or current resident who is unable or unwilling to meet the requirements of residency, with or without assistance. Subd. 3. Provision of services. Nothing in this chapter requires the arranged home care provider to offer or continue to provide services under a service agreement or service plan to a prospective or current resident of the establishment whose needs cannot be met by the arranged home care provider. Subd. 4. Altering operations; service packages. Nothing in this chapter requires a housing with services establishment or arranged home care provider offering assisted living to fundamentally alter the nature of the operations of the establishment or the provider in order to accommodate the request or need for facilities or services by any assisted living client, or to refrain from requiring, as a condition of residency, that an assisted living client pay for a package of assisted living services even if the client does not choose to utilize all or some of the services in the package. History: 2006 c 282 art 19 s 16; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.

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MINNESOTA STATUTES 2020

144G.07

144G.05 REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES. Notwithstanding the provisions of this chapter, the requirements for the elderly waiver program's assisted living payment rates under sections 256S.201 and 256S.202 shall continue to be effective and providers who do not meet the requirements of this chapter may continue to receive payment under sections 256S.201 and 256S.202, as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved Elderly Home and Community Based Services Waiver Program (Control Number 0025.91). Providers of assisted living for the community access for disability inclusion (CADI) and Brain Injury (BI) waivers shall continue to receive payment as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved CADI and BI waiver plans. History: 2006 c 282 art 19 s 17; 2012 c 216 art 14 s 2; 2015 c 78 art 6 s 31; 2019 c 54 art 2 s 4; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.06 UNIFORM CONSUMER INFORMATION GUIDE. The commissioner shall adopt a uniform format for the guide to be used by individual providers, and the required components of materials to be used by providers to inform assisted living clients of their legal rights, and shall make the uniform format and the required components available to assisted living providers. History: 2006 c 282 art 19 s 18; 1Sp2010 c 1 art 17 s 5; 2014 c 286 art 7 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.07 RETALIATION PROHIBITED. Subdivision 1. Definitions. For the purposes of this section: (1) "facility" means a housing with services establishment registered under section 144D.02 and operating under title protection under sections 144G.01 to 144G.07; and (2) "resident" means a resident of a facility. Subd. 2. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law;

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MINNESOTA STATUTES 2020

(6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or (9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 3. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; (7) an arbitrary increase in charges or fees; (8) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or (9) any oral or written communication of false information about a person advocating on behalf of the resident. Subd. 4. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination.

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Subd. 5. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 3 within 30 days of an initial action described in subdivision 2, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. History: 2019 c 60 art 3 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 3, section 3, expires July 31, 2021. Laws 2019, chapter 60, article 3, section 3, the effective date. ASSISTED LIVING LICENSURE 144G.08 DEFINITIONS. Subdivision 1. Applicability. For the purposes of this chapter, the terms in this section have the meanings given. Subd. 2. Adult. "Adult" means a natural person who has attained the age of 18 years. Subd. 3. Advanced practice registered nurse. "Advanced practice registered nurse" has the meaning given in section 148.171, subdivision 3. Subd. 4. Applicant. "Applicant" means an individual, legal entity, or other organization that has applied for licensure under this chapter. Subd. 5. Assisted living contract. "Assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services. Subd. 6. Assisted living director. "Assisted living director" means a person who administers, manages, supervises, or is in general administrative charge of an assisted living facility, whether or not the individual has an ownership interest in the facility, and whether or not the person's functions or duties are shared with one or more individuals and who is licensed by the Board of Executives for Long Term Services and Supports pursuant to section 144A.20. Subd. 7. Assisted living facility. "Assisted living facility" means a licensed facility that provides sleeping accommodations and assisted living services to one or more adults. Assisted living facility includes assisted living facility with dementia care, and does not include: (1) emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals, as defined under section 116L.361; (2) a nursing home licensed under chapter 144A; (3) a hospital, certified boarding care, or supervised living facility licensed under sections 144.50 to 144.56; (4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, or under chapter 245D or 245G; (5) services and residential settings licensed under chapter 245A, including adult foster care and services and settings governed under the standards in chapter 245D;

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(6) a private home in which the residents are related by kinship, law, or affinity with the provider of services; (7) a duly organized condominium, cooperative, and common interest community, or owners' association of the condominium, cooperative, and common interest community where at least 80 percent of the units that comprise the condominium, cooperative, or common interest community are occupied by individuals who are the owners, members, or shareholders of the units; (8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593; (9) a setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing; (10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services; (11) rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q; (12) rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56; (13) rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011; or (14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b). Subd. 8. Assisted living facility with dementia care. "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 9. Assisted living services. "Assisted living services" includes one or more of the following: (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; (2) providing standby assistance; (3) providing verbal or visual reminders to the resident to take regularly scheduled medication, which includes bringing the resident previously set up medication, medication in original containers, or liquid or food to accompany the medication; (4) providing verbal or visual reminders to the resident to perform regularly scheduled treatments and exercises; (5) preparing modified diets ordered by a licensed health professional; (6) services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker;

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(7) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; (8) medication management services; (9) hands-on assistance with transfers and mobility; (10) treatment and therapies; (11) assisting residents with eating when the residents have complicated eating problems as identified in the resident record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; (12) providing other complex or specialty health care services; and (13) supportive services in addition to the provision of at least one of the services listed in clauses (1) to (12). Subd. 10. Authority having jurisdiction. "Authority having jurisdiction" means an organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure. Subd. 11. Authorized agent. "Authorized agent" means the person who is authorized to accept service of notices and orders on behalf of the licensee. Subd. 12. Change of ownership. "Change of ownership" means a change in the licensee that is responsible for the management, control, and operation of a facility. Subd. 13. Commissioner. "Commissioner" means the commissioner of health. Subd. 14. Controlled substance. "Controlled substance" has the meaning given in section 152.01, subdivision 4. Subd. 15. Controlling individual. (a) "Controlling individual" means an owner and the following individuals and entities, if applicable: (1) each officer of the organization, including the chief executive officer and chief financial officer; (2) each managerial official; and (3) any entity with at least a five percent mortgage, deed of trust, or other security interest in the facility. (b) Controlling individual does not include: (1) a bank, savings bank, trust company, savings association, credit union, industrial loan and thrift company, investment banking firm, or insurance company unless the entity operates a program directly or through a subsidiary; (2) government and government-sponsored entities such as the U.S. Department of Housing and Urban Development, Ginnie Mae, Fannie Mae, Freddie Mac, and the Minnesota Housing Finance Agency which provide loans, financing, and insurance products for housing sites; (3) an individual who is a state or federal official, a state or federal employee, or a member or employee of the governing body of a political subdivision of the state or federal government that operates one or more

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facilities, unless the individual is also an officer, owner, or managerial official of the facility, receives remuneration from the facility, or owns any of the beneficial interests not excluded in this subdivision; (4) an individual who owns less than five percent of the outstanding common shares of a corporation: (i) whose securities are exempt under section 80A.45, clause (6); or (ii) whose transactions are exempt under section 80A.46, clause (2); (5) an individual who is a member of an organization exempt from taxation under section 290.05, unless the individual is also an officer, owner, or managerial official of the license or owns any of the beneficial interests not excluded in this subdivision. This clause does not exclude from the definition of controlling individual an organization that is exempt from taxation; or (6) an employee stock ownership plan trust, or a participant or board member of an employee stock ownership plan, unless the participant or board member is a controlling individual. Subd. 16. Dementia. "Dementia" means the loss of cognitive function, including the ability to think, remember, problem solve, or reason, of sufficient severity to interfere with an individual's daily functioning. Dementia is caused by different diseases and conditions, including but not limited to Alzheimer's disease, vascular dementia, neurodegenerative conditions, Creutzfeldt-Jakob disease, and Huntington's disease. Subd. 17. Dementia care services. "Dementia care services" means ongoing care for behavioral and psychological symptoms of dementia, including planned group and individual programming and person-centered care practices provided according to section 144G.84 to support activities of daily living for people living with dementia. Subd. 18. Dementia-trained staff. "Dementia-trained staff" means any employee who has completed the minimum training required under sections 144G.64 and 144G.83 and has demonstrated knowledge and the ability to support individuals with dementia. Subd. 19. Designated representative. "Designated representative" means a person designated under section 144G.50. Subd. 20. Dietary supplement. "Dietary supplement" means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars, or metabolites. Subd. 21. Dietitian. "Dietitian" means a person licensed as a dietitian under section 148.624. Subd. 22. Direct contact. "Direct contact" means providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to residents of a facility. Subd. 23. Direct ownership interest. "Direct ownership interest" means an individual or organization with the possession of at least five percent equity in capital, stock, or profits of the licensee, or who is a member of a limited liability company of the licensee. Subd. 24. Facility. "Facility" means an assisted living facility. Subd. 25. Hands-on assistance. "Hands-on assistance" means physical help by another person without which the resident is not able to perform the activity.

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Subd. 26. "I'm okay" check services. "'I'm okay' check services" means having, maintaining, and documenting a system to, by any means, check on the safety of a resident a minimum of once daily or more frequently according to the assisted living contract. Subd. 27. Indirect ownership interest. "Indirect ownership interest" means an individual or legal entity with a direct ownership interest in an entity that has a direct or indirect ownership interest of at least five percent in an entity that is a licensee. Subd. 28. Legal representative. "Legal representative" means one of the following in the order of priority listed, to the extent the person may reasonably be identified and located: (1) a court-appointed guardian acting in accordance with the powers granted to the guardian under chapter 524; (2) a conservator acting in accordance with the powers granted to the conservator under chapter 524; (3) a health care agent acting in accordance with the powers granted to the health care agent under chapter 145C; or (4) an attorney-in-fact acting in accordance with the powers granted to the attorney-in-fact by a written power of attorney under chapter 523. Subd. 29. Licensed health professional. "Licensed health professional" means a person licensed in Minnesota to practice a profession described in section 214.01, subdivision 2. Subd. 30. Licensed practical nurse. "Licensed practical nurse" has the meaning given in section 148.171, subdivision 8. Subd. 31. Licensed resident capacity. "Licensed resident capacity" means the resident occupancy level requested by a licensee and approved by the commissioner. Subd. 32. Licensee. "Licensee" means a person or legal entity to whom the commissioner issues a license for an assisted living facility and who is responsible for the management, control, and operation of a facility. Subd. 33. Maltreatment. "Maltreatment" means conduct described in section 626.5572, subdivision 15. Subd. 34. Management agreement. "Management agreement" means a written, executed agreement between a licensee and manager regarding the provision of certain services on behalf of the licensee. Subd. 35. Manager. "Manager" means an individual or legal entity designated by the licensee through a management agreement to act on behalf of the licensee in the on-site management of the assisted living facility. Subd. 36. Managerial official. "Managerial official" means an individual who has the decision-making authority related to the operation of the facility and the responsibility for the ongoing management or direction of the policies, services, or employees of the facility. Subd. 37. Medication. "Medication" means a prescription or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements. Subd. 38. Medication administration. "Medication administration" means performing a set of tasks that includes the following:

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(1) checking the resident's medication record; (2) preparing the medication as necessary; (3) administering the medication to the resident; (4) documenting the administration or reason for not administering the medication; and (5) reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the resident, or the resident's refusal to take the medication. Subd. 39. Medication management. "Medication management" means the provision of any of the following medication-related services to a resident: (1) performing medication setup; (2) administering medications; (3) storing and securing medications; (4) documenting medication activities; (5) verifying and monitoring the effectiveness of systems to ensure safe handling and administration; (6) coordinating refills; (7) handling and implementing changes to prescriptions; (8) communicating with the pharmacy about the resident's medications; and (9) coordinating and communicating with the prescriber. Subd. 40. Medication reconciliation. "Medication reconciliation" means the process of identifying the most accurate list of all medications the resident is taking, including the name, dosage, frequency, and route, by comparing the resident record to an external list of medications obtained from the resident, hospital, prescriber, or other provider. Subd. 41. Medication setup. "Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the resident or by facility staff. Subd. 42. New construction. "New construction" means a new building, renovation, modification, reconstruction, physical changes altering the use of occupancy, or addition to a building. Subd. 43. Nurse. "Nurse" means a person who is licensed under sections 148.171 to 148.285. Subd. 44. Nutritionist. "Nutritionist" means a person licensed as a nutritionist under section 148.624. Subd. 45. Occupational therapist. "Occupational therapist" means a person who is licensed under sections 148.6401 to 148.6449. Subd. 46. Ombudsman. "Ombudsman" means the ombudsman for long-term care. Subd. 47. Over-the-counter drug. "Over-the-counter drug" means a drug that is not required by federal law to bear the symbol "Rx only."

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Subd. 48. Owner. "Owner" means an individual or legal entity that has a direct or indirect ownership interest of five percent or more in a licensee. For purposes of this chapter, "owner of a nonprofit corporation" means the president and treasurer of the board of directors or, for an entity owned by an employee stock ownership plan, means the president and treasurer of the entity. A government entity that is issued a license under this chapter shall be designated the owner. Subd. 49. Person-centered planning and service delivery. "Person-centered planning and service delivery" means services as defined in section 245D.07, subdivision 1a, paragraph (b). Subd. 50. Pharmacist. "Pharmacist" has the meaning given in section 151.01, subdivision 3. Subd. 51. Physical therapist. "Physical therapist" means a person who is licensed under sections 148.65 to 148.78. Subd. 52. Physician. "Physician" means a person who is licensed under chapter 147. Subd. 53. Prescriber. "Prescriber" means a person who is authorized by section 148.235; 151.01, subdivision 23; or 151.37 to prescribe prescription drugs. Subd. 54. Prescription. "Prescription" has the meaning given in section 151.01, subdivision 16a. Subd. 55. Provisional license. "Provisional license" means the initial license the commissioner issues after approval of a complete written application and before the commissioner completes the provisional license survey and determines that the provisional licensee is in substantial compliance. Subd. 56. Regularly scheduled. "Regularly scheduled" means ordered or planned to be completed at predetermined times or according to a predetermined routine. Subd. 57. Reminder. "Reminder" means providing a verbal or visual reminder to a resident. Subd. 58. Repeat violation. "Repeat violation" means the issuance of two or more correction orders within a 12-month period for a violation of the same provision of a statute or rule. Subd. 59. Resident. "Resident" means a person living in an assisted living facility who has executed an assisted living contract. Subd. 60. Resident record. "Resident record" means all records that document information about the services provided to the resident. Subd. 61. Respiratory therapist. "Respiratory therapist" means a person who is licensed under chapter 147C. Subd. 62. Secured dementia care unit. "Secured dementia care unit" means a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident's ability to exit, the secured area or setting. A secured dementia care unit is not solely an individual resident's living area. Subd. 63. Service plan. "Service plan" means the written plan between the resident and the provisional licensee or licensee about the services that will be provided to the resident. Subd. 64. Social worker. "Social worker" means a person who is licensed under chapter 148D or 148E. Subd. 65. Speech-language pathologist. "Speech-language pathologist" has the meaning given in section 148.512, subdivision 17.

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Subd. 66. Standby assistance. "Standby assistance" means the presence of another person within arm's reach to minimize the risk of injury while performing daily activities through physical intervention or cueing to assist a resident with an assistive task by providing cues, oversight, and minimal physical assistance. Subd. 67. Substantial compliance. "Substantial compliance" means complying with the requirements in this chapter sufficiently to prevent unacceptable health or safety risks to residents. Subd. 68. Supportive services. "Supportive services" means: (1) assistance with laundry, shopping, and household chores; (2) housekeeping services; (3) provision or assistance with meals or food preparation; (4) help with arranging for, or arranging transportation to, medical, social, recreational, personal, or social services appointments; (5) provision of social or recreational services; or (6) "I'm okay" check services. Arranging for services does not include making referrals, or contacting a service provider in an emergency. Subd. 69. Survey. "Survey" means an inspection of a licensee or applicant for licensure for compliance with this chapter and applicable rules. Subd. 70. Surveyor. "Surveyor" means a staff person of the department who is authorized to conduct surveys of assisted living facilities. Subd. 71. Treatment or therapy. "Treatment" or "therapy" means the provision of care, other than medications, ordered or prescribed by a licensed health professional and provided to a resident to cure, rehabilitate, or ease symptoms. Subd. 72. Unit of government. "Unit of government" means a city, county, town, school district, other political subdivision of the state, or agency of the state or federal government, that includes any instrumentality of a unit of government. Subd. 73. Unlicensed personnel. "Unlicensed personnel" means individuals not otherwise licensed or certified by a governmental health board or agency who provide services to a resident. Subd. 74. Verbal. "Verbal" means oral and not in writing. History: 2019 c 60 art 1 s 2,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 2, the effective date. 144G.09 COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES. Subdivision 1. Regulations. The commissioner shall regulate assisted living facilities pursuant to this chapter. The regulations shall include the following:

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(1) provisions to assure, to the extent possible, the health, safety, well-being, and appropriate treatment of residents while respecting individual autonomy and choice; (2) requirements that facilities furnish the commissioner with specified information necessary to implement this chapter; (3) standards of training of facility personnel; (4) standards for the provision of assisted living services; (5) standards for medication management; (6) standards for supervision of assisted living services; (7) standards for resident evaluation or assessment; (8) standards for treatments and therapies; (9) requirements for the involvement of a resident's health care provider, the documentation of the health care provider's orders, if required, and the resident's service plan; (10) standards for the maintenance of accurate, current resident records; (11) the establishment of levels of licenses based on services provided; and (12) provisions to enforce these regulations and the assisted living bill of rights. [See Note.] Subd. 2. Regulatory functions. (a) The commissioner shall: (1) license, survey, and monitor without advance notice assisted living facilities in accordance with this chapter and rules; (2) survey every provisional licensee within one year of the provisional license issuance date subject to the provisional licensee providing assisted living services to residents; (3) survey assisted living facility licensees at least once every two years; (4) investigate complaints of assisted living facilities; (5) issue correction orders and assess civil penalties under sections 144G.30 and 144G.31; (6) take action as authorized in section 144G.20; and (7) take other action reasonably required to accomplish the purposes of this chapter. (b) The commissioner shall review blueprints for all new facility construction and must approve the plans before construction may be commenced. (c) The commissioner shall provide on-site review of the construction to ensure that all physical environment standards are met before the facility license is complete. [See Note.]

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Subd. 3. Rulemaking authorized. (a) The commissioner shall adopt rules for all assisted living facilities that promote person-centered planning and service delivery and optimal quality of life, and that ensure resident rights are protected, resident choice is allowed, and public health and safety is ensured. (b) On July 1, 2019, the commissioner shall begin rulemaking. (c) The commissioner shall adopt rules that include but are not limited to the following: (1) staffing appropriate for each licensure category to best protect the health and safety of residents no matter their vulnerability; (2) training prerequisites and ongoing training, including dementia care training and standards for demonstrating competency; (3) procedures for discharge planning and ensuring resident appeal rights; (4) initial assessments, continuing assessments, and a uniform assessment tool; (5) emergency disaster and preparedness plans; (6) uniform checklist disclosure of services; (7) a definition of serious injury that results from maltreatment; (8) conditions and fine amounts for planned closures; (9) procedures and timelines for the commissioner regarding termination appeals between facilities and the Office of Administrative Hearings; (10) establishing base fees and per-resident fees for each category of licensure; (11) considering the establishment of a maximum amount for any one fee; (12) procedures for relinquishing an assisted living facility with dementia care license and fine amounts for noncompliance; and (13) procedures to efficiently transfer existing housing with services registrants and home care licensees to the new assisted living facility licensure structure. (d) The commissioner shall publish the proposed rules by December 31, 2019, and shall publish final rules by December 31, 2020. History: 2019 c 60 art 1 s 34,41,47 NOTE: Subdivisions 1 and 2, as added by Laws 2019, chapter 60, article 1, section 34, are effective August 1, 2021. Laws 2019, chapter 60, article 1, section 34, the effective date. 144G.10 ASSISTED LIVING FACILITY LICENSE. Subdivision 1. License required. Beginning August 1, 2021, no assisted living facility may operate in Minnesota unless it is licensed under this chapter. The licensee is legally responsible for the management, control, and operation of the facility, regardless of the existence of a management agreement or subcontract. Nothing in this chapter shall in any way affect the rights and remedies available under other law. Subd. 2. Licensure categories. (a) The categories in this subdivision are established for assisted living facility licensure.

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(1) The assisted living facility category is for assisted living facilities that only provide assisted living services. (2) The assisted living facility with dementia care category is for assisted living facilities that provide assisted living services and dementia care services. An assisted living facility with dementia care may also provide dementia care services in a secured dementia care unit. (b) An assisted living facility that has a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 3. Licensure under other law. An assisted living facility licensed under this chapter is not required to also be licensed as a boarding establishment, food and beverage service establishment, hotel, motel, lodging establishment, resort, or restaurant under chapter 157. Subd. 4. Violations; penalty. (a) Operating an assisted living facility without a license is a misdemeanor, and the commissioner may also impose a fine. (b) A controlling individual of the facility in violation of this section is guilty of a misdemeanor. This paragraph shall not apply to any controlling individual who had no legal authority to affect or change decisions related to the operation of the facility. (c) The sanctions in this section do not restrict other available sanctions in law. History: 2019 c 60 art 1 s 3,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 3, the effective date. 144G.11 APPLICABILITY OF OTHER LAWS. Assisted living facilities: (1) are subject to and must comply with chapter 504B; (2) must comply with section 325F.72; and (3) are not required to obtain a lodging license under chapter 157 and related rules. History: 2019 c 60 art 1 s 44,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 44, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 44, the effective date. 144G.12 APPLICATION FOR LICENSURE. Subdivision 1. License applications. Each application for an assisted living facility license, including provisional and renewal applications, must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the business name and legal entity name of the licensee, and the street address and mailing address of the facility; (2) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners, controlling individuals, managerial officials, and the assisted living director;

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(3) the name and e-mail address of the managing agent and manager, if applicable; (4) the licensed resident capacity and the license category; (5) the license fee in the amount specified in section 144.122; (6) documentation of compliance with the background study requirements in section 144G.13 for the owner, controlling individuals, and managerial officials. Each application for a new license must include documentation for the applicant and for each individual with five percent or more direct or indirect ownership in the applicant; (7) evidence of workers' compensation coverage as required by sections 176.181 and 176.182; (8) documentation that the facility has liability coverage; (9) a copy of the executed lease agreement between the landlord and the licensee, if applicable; (10) a copy of the management agreement, if applicable; (11) a copy of the operations transfer agreement or similar agreement, if applicable; (12) an organizational chart that identifies all organizations and individuals with an ownership interest in the licensee of five percent or greater and that specifies their relationship with the licensee and with each other; (13) whether the applicant, owner, controlling individual, managerial official, or assisted living director of the facility has ever been convicted of: (i) a crime or found civilly liable for a federal or state felony level offense that was detrimental to the best interests of the facility and its resident within the last ten years preceding submission of the license application. Offenses include: felony crimes against persons and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; any felonies involving malpractice that resulted in a conviction of criminal neglect or misconduct; and any felonies that would result in a mandatory exclusion under section 1128(a) of the Social Security Act; (ii) any misdemeanor conviction, under federal or state law, related to: the delivery of an item or service under Medicaid or a state health care program, or the abuse or neglect of a patient in connection with the delivery of a health care item or service; (iii) any misdemeanor conviction, under federal or state law, related to theft, fraud, embezzlement, breach of fiduciary duty, or other financial misconduct in connection with the delivery of a health care item or service; (iv) any felony or misdemeanor conviction, under federal or state law, relating to the interference with or obstruction of any investigation into any criminal offense described in Code of Federal Regulations, title 42, section 1001.101 or 1001.201; (v) any felony or misdemeanor conviction, under federal or state law, relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; (vi) any felony or gross misdemeanor that relates to the operation of a nursing home or assisted living facility or directly affects resident safety or care during that period;

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(vii) any revocation or suspension of a license to provide health care by any state licensing authority. This includes the surrender of such a license while a formal disciplinary proceeding was pending before a state licensing authority; (viii) any revocation or suspension of accreditation; or (ix) any suspension or exclusion from participation in, or any sanction imposed by, a federal or state health care program, or any debarment from participation in any federal executive branch procurement or nonprocurement program; (14) whether, in the preceding three years, the applicant or any owner, controlling individual, managerial official, or assisted living director of the facility has a record of defaulting in the payment of money collected for others, including the discharge of debts through bankruptcy proceedings; (15) the signature of the owner of the licensee, or an authorized agent of the licensee; (16) identification of all states where the applicant or individual having a five percent or more ownership, currently or previously has been licensed as an owner or operator of a long-term care, community-based, or health care facility or agency where its license or federal certification has been denied, suspended, restricted, conditioned, refused, not renewed, or revoked under a private or state-controlled receivership, or where these same actions are pending under the laws of any state or federal authority; (17) statistical information required by the commissioner; and (18) any other information required by the commissioner. Subd. 2. Authorized agents. (a) An application for an assisted living facility license or for renewal of a facility license must specify one or more owners, controlling individuals, or employees as authorized agents who can accept service on behalf of the licensee in proceedings under this chapter. (b) Notwithstanding any law to the contrary, personal service on the authorized agent named in the application is deemed to be service on all of the controlling individuals or managerial officials of the facility, and it is not a defense to any action arising under this chapter that personal service was not made on each controlling individual or managerial official of the facility. The designation of one or more controlling individuals or managerial officials under this subdivision shall not affect the legal responsibility of any other controlling individual or managerial official under this chapter. Subd. 3. Fees. (a) An initial applicant, renewal applicant, or applicant filing a change of ownership for assisted living facility licensure must submit the application fee required in section 144.122 to the commissioner along with a completed application. (b) Fees collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. All fees are nonrefundable. Subd. 4. Fines and penalties. (a) The penalty for late submission of the renewal application less than 30 days before the expiration date of the license or after expiration of the license is $200. The penalty for operating a facility after expiration of the license and before a renewal license is issued is $250 each day after expiration of the license until the renewal license issuance date. The facility is still subject to the misdemeanor penalties for operating after license expiration.

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(b) Fines and penalties collected under this subdivision shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 5,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 5, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 5, the effective date. 144G.13 BACKGROUND STUDIES OF LICENSE APPLICANTS. Subdivision 1. Background studies required. (a) Before the commissioner issues a provisional license, issues a license as a result of an approved change of ownership, or renews a license, a managerial official or a natural person who is an owner with direct ownership interest is required to undergo a background study under section 144.057. No person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C. For the purposes of this section, managerial officials subject to the background study requirement are individuals who provide direct contact. Nothing in this section shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) The commissioner shall not issue a license if any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits. Subd. 2. Reconsideration. (a) If the individual requests reconsideration of a disqualification under section 144.057 or chapter 245C and the commissioner sets aside or rescinds the disqualification, the individual is eligible to be involved in the management, operation, or control of the facility. (b) If an individual has a disqualification under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's disqualification is barred from a set aside, and the individual must not be involved in the management, operation, or control of the facility. Subd. 3. Data classification. Data collected under this section shall be classified as private data on individuals under section 13.02, subdivision 12. History: 2019 c 60 art 1 s 7,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 7, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 7, the effective date. 144G.15 CONSIDERATION OF APPLICATIONS. (a) Before issuing a provisional license or license or renewing a license, the commissioner shall consider an applicant's compliance history in providing care in a facility that provides care to children, the elderly, ill individuals, or individuals with disabilities. (b) The applicant's compliance history shall include repeat violation, rule violations, and any license or certification involuntarily suspended or terminated during an enforcement process.

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(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license or impose conditions if: (1) the applicant fails to provide complete and accurate information on the application and the commissioner concludes that the missing or corrected information is needed to determine if a license shall be granted; (2) the applicant, knowingly or with reason to know, made a false statement of a material fact in an application for the license or any data attached to the application or in any matter under investigation by the department; (3) the applicant refused to allow agents of the commissioner to inspect its books, records, and files related to the license application, or any portion of the premises; (4) the applicant willfully prevented, interfered with, or attempted to impede in any way: (i) the work of any authorized representative of the commissioner, the ombudsman for long-term care, or the ombudsman for mental health and developmental disabilities; or (ii) the duties of the commissioner, local law enforcement, city or county attorneys, adult protection, county case managers, or other local government personnel; (5) the applicant has a history of noncompliance with federal or state regulations that were detrimental to the health, welfare, or safety of a resident or a client; or (6) the applicant violates any requirement in this chapter. (d) If a license is denied, the applicant has the reconsideration rights available under section 144G.16, subdivision 4. History: 2019 c 60 art 1 s 10,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 10, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 10, the effective date. 144G.16 PROVISIONAL LICENSE. Subdivision 1. Provisional license. Beginning August 1, 2021, for new assisted living facility license applicants, the commissioner shall issue a provisional license from one of the licensure categories specified in section 144G.10, subdivision 2. A provisional license is effective for up to one year from the initial effective date of the license, except that a provisional license may be extended according to subdivisions 2, paragraph (d), and 3. Subd. 2. Initial survey. (a) During the provisional license period, the commissioner shall survey the provisional licensee after the commissioner is notified or has evidence that the provisional licensee is providing assisted living services to at least one resident. (b) Within two days of beginning to provide assisted living services, the provisional licensee must provide notice to the commissioner that it is providing assisted living services by sending an e-mail to the e-mail address provided by the commissioner. (c) If the provisional licensee does not provide services during the provisional license period, the provisional license shall expire at the end of the period and the applicant must reapply. (d) If the provisional licensee notifies the commissioner that the licensee is providing assisted living services within 45 calendar days prior to expiration of the provisional license, the commissioner may extend

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the provisional license for up to 60 calendar days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits. Subd. 3. Licensure; termination or extension of provisional licenses. (a) If the provisional licensee is in substantial compliance with the survey, the commissioner shall issue a facility license. (b) If the provisional licensee is not in substantial compliance with the initial survey, the commissioner shall either: (1) not issue the facility license and terminate the provisional license; or (2) extend the provisional license for a period not to exceed 90 calendar days and apply conditions necessary to bring the facility into substantial compliance. If the provisional licensee is not in substantial compliance with the survey within the time period of the extension or if the provisional licensee does not satisfy the license conditions, the commissioner may deny the license. Subd. 4. Reconsideration. (a) If a provisional licensee whose assisted living facility license has been denied or extended with conditions disagrees with the conclusions of the commissioner, then the provisional licensee may request a reconsideration by the commissioner. The reconsideration request process must be conducted internally by the commissioner and chapter 14 does not apply. (b) The provisional licensee requesting the reconsideration must make the request in writing and must list and describe the reasons why the provisional licensee disagrees with the decision to deny the facility license or the decision to extend the provisional license with conditions. (c) The reconsideration request and supporting documentation must be received by the commissioner within 15 calendar days after the date the provisional licensee receives the denial or provisional license with conditions. Subd. 5. Continued operation. A provisional licensee whose license is denied is permitted to continue operating during the period of time when: (1) a reconsideration is in process; (2) an extension of the provisional license and terms associated with it is in active negotiation between the commissioner and the licensee, and the commissioner confirms the negotiation is active; or (3) a transfer of residents to a new facility is underway and not all of the residents have relocated. Subd. 6. Requirements for notice and transfer. A provisional licensee whose license is denied must comply with the requirements for notification and the coordinated move of residents in sections 144G.52 and 144G.55. Subd. 7. Fines. The fee for failure to comply with the notification requirements in section 144G.52, subdivision 7, is $1,000. History: 2019 c 60 art 1 s 4,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 4, the effective date. 144G.17 LICENSE RENEWAL. A license that is not a provisional license may be renewed for a period of up to one year if the licensee: (1) submits an application for renewal in the format provided by the commissioner at least 60 calendar days before expiration of the license;

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(2) submits the renewal fee under section 144G.12, subdivision 3; (3) submits the late fee under section 144G.12, subdivision 4, if the renewal application is received less than 30 days before the expiration date of the license or after the expiration of the license; (4) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under section 144G.12, subdivision 1; and (5) provides any other information deemed necessary by the commissioner. History: 2019 c 60 art 1 s 8,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 8, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 8, the effective date. 144G.18 NOTIFICATION OF CHANGES IN INFORMATION. A provisional licensee or licensee shall notify the commissioner in writing prior to a change in the manager or authorized agent and within 60 calendar days after any change in the information required in section 144G.12, subdivision 1, paragraph (a), clause (1), (3), (4), (17), or (18). History: 2019 c 60 art 1 s 9,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 9, the effective date. 144G.19 TRANSFER OF LICENSE PROHIBITED. Subdivision 1. Transfers prohibited. An assisted living facility license may not be transferred to another party. Subd. 2. New license required. (a) A prospective licensee must apply for a license prior to operating a currently licensed assisted living facility. The new license, if issued, shall not be a provisional license. The licensee must change whenever one of the following events occur: (1) the form of the licensee's legal entity structure is converted or changed to a different type of legal entity structure; (2) the licensee dissolves, consolidates, or merges with another legal organization and the licensee's legal organization does not survive; (3) within the previous 24 months, 50 percent or more of the licensee is transferred, whether by a single transaction or multiple transactions, to: (i) a different person; or (ii) a person who had less than a five percent ownership interest in the facility at the time of the first transaction; or (4) any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's responsibility for the facility. (b) The prospective licensee must provide written notice to the department at least 60 calendar days prior to the anticipated date of the change of licensee.

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Subd. 3. Survey required. For all new licensees after a change of ownership, the commissioner shall complete a survey within six months after the new license is issued. History: 2019 c 60 art 1 s 6,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 6, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 6, the effective date. ENFORCEMENT 144G.20 ENFORCEMENT. Subdivision 1. Conditions. (a) The commissioner may refuse to grant a provisional license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the owner, controlling individual, or employee of an assisted living facility: (1) is in violation of, or during the term of the license has violated, any of the requirements in this chapter or adopted rules; (2) permits, aids, or abets the commission of any illegal act in the provision of assisted living services; (3) performs any act detrimental to the health, safety, and welfare of a resident; (4) obtains the license by fraud or misrepresentation; (5) knowingly makes a false statement of a material fact in the application for a license or in any other record or report required by this chapter; (6) denies representatives of the department access to any part of the facility's books, records, files, or employees; (7) interferes with or impedes a representative of the department in contacting the facility's residents; (8) interferes with or impedes ombudsman access according to section 256.9742, subdivision 4; (9) interferes with or impedes a representative of the department in the enforcement of this chapter or fails to fully cooperate with an inspection, survey, or investigation by the department; (10) destroys or makes unavailable any records or other evidence relating to the assisted living facility's compliance with this chapter; (11) refuses to initiate a background study under section 144.057 or 245A.04; (12) fails to timely pay any fines assessed by the commissioner; (13) violates any local, city, or township ordinance relating to housing or assisted living services; (14) has repeated incidents of personnel performing services beyond their competency level; or (15) has operated beyond the scope of the assisted living facility's license category. (b) A violation by a contractor providing the assisted living services of the facility is a violation by the facility.

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Subd. 2. Terms to suspension or conditional license. (a) A suspension or conditional license designation may include terms that must be completed or met before a suspension or conditional license designation is lifted. A conditional license designation may include restrictions or conditions that are imposed on the assisted living facility. Terms for a suspension or conditional license may include one or more of the following and the scope of each will be determined by the commissioner: (1) requiring a consultant to review, evaluate, and make recommended changes to the facility's practices and submit reports to the commissioner at the cost of the facility; (2) requiring supervision of the facility or staff practices at the cost of the facility by an unrelated person who has sufficient knowledge and qualifications to oversee the practices and who will submit reports to the commissioner; (3) requiring the facility or employees to obtain training at the cost of the facility; (4) requiring the facility to submit reports to the commissioner; (5) prohibiting the facility from admitting any new residents for a specified period of time; or (6) any other action reasonably required to accomplish the purpose of this subdivision and subdivision 1. (b) A facility subject to this subdivision may continue operating during the period of time residents are being transferred to another service provider. Subd. 3. Immediate temporary suspension. (a) In addition to any other remedies provided by law, the commissioner may, without a prior contested case hearing, immediately temporarily suspend a license or prohibit delivery of housing or services by a facility for not more than 90 calendar days or issue a conditional license, if the commissioner determines that there are: (1) Level 4 violations; or (2) violations that pose an imminent risk of harm to the health or safety of residents. (b) For purposes of this subdivision, "Level 4" has the meaning given in section 144G.31. (c) A notice stating the reasons for the immediate temporary suspension or conditional license and informing the licensee of the right to an expedited hearing under subdivision 17 must be delivered by personal service to the address shown on the application or the last known address of the licensee. The licensee may appeal an order immediately temporarily suspending a license or issuing a conditional license. The appeal must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the commissioner within five calendar days after the licensee receives notice. If an appeal is made by personal service, it must be received by the commissioner within five calendar days after the licensee received the order. (d) A licensee whose license is immediately temporarily suspended must comply with the requirements for notification and transfer of residents in subdivision 15. The requirements in subdivision 9 remain if an appeal is requested. Subd. 4. Mandatory revocation. Notwithstanding the provisions of subdivision 13, paragraph (a), the commissioner must revoke a license if a controlling individual of the facility is convicted of a felony or gross misdemeanor that relates to operation of the facility or directly affects resident safety or care. The

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commissioner shall notify the facility and the Office of Ombudsman for Long-Term Care 30 calendar days in advance of the date of revocation. Subd. 5. Owners and managerial officials; refusal to grant license. (a) The owners and managerial officials of a facility whose Minnesota license has not been renewed or whose Minnesota license has been revoked because of noncompliance with applicable laws or rules shall not be eligible to apply for nor will be granted an assisted living facility license under this chapter or a home care provider license under chapter 144A, or be given status as an enrolled personal care assistance provider agency or personal care assistant by the Department of Human Services under section 256B.0659, for five years following the effective date of the nonrenewal or revocation. If the owners or managerial officials already have enrollment status, the Department of Human Services shall terminate that enrollment. (b) The commissioner shall not issue a license to a facility for five years following the effective date of license nonrenewal or revocation if the owners or managerial officials, including any individual who was an owner or managerial official of another licensed provider, had a Minnesota license that was not renewed or was revoked as described in paragraph (a). (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend or revoke, the license of a facility that includes any individual as an owner or managerial official who was an owner or managerial official of a facility whose Minnesota license was not renewed or was revoked as described in paragraph (a) for five years following the effective date of the nonrenewal or revocation. (d) The commissioner shall notify the facility 30 calendar days in advance of the date of nonrenewal, suspension, or revocation of the license. Subd. 6. Requesting a stay of adverse actions required by owners and managerial officials restrictions. Within ten business days after the receipt of the notification, the facility may request, in writing, that the commissioner stay the nonrenewal, revocation, or suspension of the license. The facility shall specify the reasons for requesting the stay; the steps that will be taken to attain or maintain compliance with the licensure laws and regulations; any limits on the authority or responsibility of the owners or managerial officials whose actions resulted in the notice of nonrenewal, revocation, or suspension; and any other information to establish that the continuing affiliation with these individuals will not jeopardize resident health, safety, or well-being. Subd. 7. Granting a stay of adverse actions required by owners and managerial officials restrictions. The commissioner shall determine whether the stay will be granted within 30 calendar days of receiving the facility's request. The commissioner may propose additional restrictions or limitations on the facility's license and require that granting the stay be contingent upon compliance with those provisions. The commissioner shall take into consideration the following factors when determining whether the stay should be granted: (1) the threat that continued involvement of the owners and managerial officials with the facility poses to resident health, safety, and well-being; (2) the compliance history of the facility; and (3) the appropriateness of any limits suggested by the facility. If the commissioner grants the stay, the order shall include any restrictions or limitation on the provider's license. The failure of the facility to comply with any restrictions or limitations shall result in the immediate removal of the stay and the commissioner shall take immediate action to suspend, revoke, or not renew the license.

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Subd. 8. Controlling individual restrictions. (a) The commissioner has discretion to bar any controlling individual of a facility if the person was a controlling individual of any other nursing home or assisted living facility in the previous two-year period and: (1) during that period of time the nursing home or assisted living facility incurred the following number of uncorrected or repeated violations: (i) two or more repeated violations that created an imminent risk to direct resident care or safety; or (ii) four or more uncorrected violations that created an imminent risk to direct resident care or safety; or (2) during that period of time, was convicted of a felony or gross misdemeanor that related to the operation of the nursing home or assisted living facility, or directly affected resident safety or care. (b) When the commissioner bars a controlling individual under this subdivision, the controlling individual may appeal the commissioner's decision under chapter 14. Subd. 9. Exception to controlling individual restrictions. Subdivision 8 does not apply to any controlling individual of the facility who had no legal authority to affect or change decisions related to the operation of the nursing home or assisted living facility that incurred the uncorrected violations. Subd. 10. Stay of adverse action required by controlling individual restrictions. (a) In lieu of revoking, suspending, or refusing to renew the license of a facility where a controlling individual was disqualified by subdivision 8, paragraph (a), clause (1), the commissioner may issue an order staying the revocation, suspension, or nonrenewal of the facility's license. The order may but need not be contingent upon the facility's compliance with restrictions and conditions imposed on the license to ensure the proper operation of the facility and to protect the health, safety, comfort, treatment, and well-being of the residents in the facility. The decision to issue an order for a stay must be made within 90 calendar days of the commissioner's determination that a controlling individual of the facility is disqualified by subdivision 8, paragraph (a), clause (1), from operating a facility. (b) In determining whether to issue a stay and to impose conditions and restrictions, the commissioner must consider the following factors: (1) the ability of the controlling individual to operate other facilities in accordance with the licensure rules and laws; (2) the conditions in the nursing home or assisted living facility that received the number and type of uncorrected or repeated violations described in subdivision 8, paragraph (a), clause (1); and (3) the conditions and compliance history of each of the nursing homes and assisted living facilities owned or operated by the controlling individual. (c) The commissioner's decision to exercise the authority under this subdivision in lieu of revoking, suspending, or refusing to renew the license of the facility is not subject to administrative or judicial review. (d) The order for the stay of revocation, suspension, or nonrenewal of the facility license must include any conditions and restrictions on the license that the commissioner deems necessary based on the factors listed in paragraph (b). (e) Prior to issuing an order for stay of revocation, suspension, or nonrenewal, the commissioner shall inform the licensee and the controlling individual in writing of any conditions and restrictions that will be

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imposed. The controlling individual shall, within ten working days, notify the commissioner in writing of a decision to accept or reject the conditions and restrictions. If any of the conditions or restrictions are rejected, the commissioner must either modify the conditions and restrictions or take action to suspend, revoke, or not renew the facility's license. (f) Upon issuance of the order for a stay of revocation, suspension, or nonrenewal, the controlling individual shall be responsible for compliance with the conditions and restrictions. Any time after the conditions and restrictions have been in place for 180 days, the controlling individual may petition the commissioner for removal or modification of the conditions and restrictions. The commissioner must respond to the petition within 30 days of receipt of the written petition. If the commissioner denies the petition, the controlling individual may request a hearing under chapter 14. Any hearing shall be limited to a determination of whether the conditions and restrictions shall be modified or removed. At the hearing, the controlling individual bears the burden of proof. (g) The failure of the controlling individual to comply with the conditions and restrictions contained in the order for stay shall result in the immediate removal of the stay and the commissioner shall take action to suspend, revoke, or not renew the license. (h) The conditions and restrictions are effective for two years after the date they are imposed. (i) Nothing in this subdivision shall be construed to limit in any way the commissioner's ability to impose other sanctions against a licensee under the standards in state or federal law whether or not a stay of revocation, suspension, or nonrenewal is issued. Subd. 11. Mandatory proceedings. (a) The commissioner must initiate proceedings within 60 calendar days of notification to suspend or revoke a facility's license or must refuse to renew a facility's license if within the preceding two years the facility has incurred the following number of uncorrected or repeated violations: (1) two or more uncorrected violations or one or more repeated violations that 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. (b) Notwithstanding paragraph (a), the commissioner is not required to revoke, suspend, or refuse to renew a facility's license if the facility corrects the violation. Subd. 12. Notice to residents. (a) Within five business days after proceedings are initiated by the commissioner to revoke or suspend a facility's license, or a decision by the commissioner not to renew a living facility's license, the controlling individual of the facility or a designee must provide to the commissioner and the ombudsman for long-term care the names of residents and the names and addresses of the residents' designated representatives and legal representatives, and family or other contacts listed in the assisted living contract. (b) The controlling individual or designees of the facility must provide updated information each month until the proceeding is concluded. If the controlling individual or designee of the facility fails to provide the information within this time, the facility is subject to the issuance of: (1) a correction order; and (2) a penalty assessment by the commissioner in rule.

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(c) Notwithstanding subdivisions 21 and 22, any correction order issued under this subdivision must require that the facility immediately comply with the request for information and that, as of the date of the issuance of the correction order, the facility shall forfeit to the state a $500 fine the first day of noncompliance and an increase in the $500 fine by $100 increments for each day the noncompliance continues. (d) Information provided under this subdivision may be used by the commissioner or the ombudsman for long-term care only for the purpose of providing affected consumers information about the status of the proceedings. (e) Within ten business days after the commissioner initiates proceedings to revoke, suspend, or not renew a facility license, the commissioner must send a written notice of the action and the process involved to each resident of the facility, legal representatives and designated representatives, and at the commissioner's discretion, additional resident contacts. (f) The commissioner shall provide the ombudsman for long-term care with monthly information on the department's actions and the status of the proceedings. Subd. 13. Notice to facility. (a) Prior to any suspension, revocation, or refusal to renew a license, the facility shall be entitled to notice and a hearing as provided by sections 14.57 to 14.69. The hearing must commence within 60 calendar days after the proceedings are initiated. In addition to any other remedy provided by law, the commissioner may, without a prior contested case hearing, temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 calendar days, or issue a conditional license if the commissioner determines that there are Level 3 violations that do not pose an imminent risk of harm to the health or safety of the facility residents, provided: (1) advance notice is given to the facility; (2) after notice, the facility fails to correct the problem; (3) the commissioner has reason to believe that other administrative remedies are not likely to be effective; and (4) there is an opportunity for a contested case hearing within 30 calendar days unless there is an extension granted by an administrative law judge. (b) If the commissioner determines there are Level 4 violations or violations that pose an imminent risk of harm to the health or safety of the facility residents, the commissioner may immediately temporarily suspend a license, prohibit delivery of services by a facility, or issue a conditional license without meeting the requirements of paragraph (a), clauses (1) to (4). For the purposes of this subdivision, "Level 3" and "Level 4" have the meanings given in section 144G.31. Subd. 14. Request for hearing. A request for hearing must be in writing and must: (1) be mailed or delivered to the commissioner; (2) contain a brief and plain statement describing every matter or issue contested; and (3) contain a brief and plain statement of any new matter that the applicant or assisted living facility believes constitutes a defense or mitigating factor. Subd. 15. Plan required. (a) The process of suspending, revoking, or refusing to renew a license must include a plan for transferring affected residents' cares to other providers by the facility. The commissioner

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shall monitor the transfer plan. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension, the licensee shall provide the commissioner, the lead agencies as defined in section 256B.0911, county adult protection and case managers, and the ombudsman for long-term care with the following information: (1) a list of all residents, including full names and all contact information on file; (2) a list of the resident's legal representatives and designated representatives and family or other contacts listed in the assisted living contract, including full names and all contact information on file; (3) the location or current residence of each resident; (4) the payor sources for each resident, including payor source identification numbers; and (5) for each resident, a copy of the resident's service plan and a list of the types of services being provided. (b) The revocation, refusal to renew, or suspension notification requirement is satisfied by mailing the notice to the address in the license record. The licensee shall cooperate with the commissioner and the lead agencies, county adult protection and case managers, and the ombudsman for long-term care during the process of transferring care of residents to qualified providers. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension action, the facility must notify and disclose to each of the residents, or the resident's legal and designated representatives or emergency contact persons, that the commissioner is taking action against the facility's license by providing a copy of the revocation, refusal to renew, or suspension notice issued by the commissioner. If the facility does not comply with the disclosure requirements in this section, the commissioner shall notify the residents, legal and designated representatives, or emergency contact persons about the actions being taken. Lead agencies, county adult protection and case managers, and the Office of Ombudsman for Long-Term Care may also provide this information. The revocation, refusal to renew, or suspension notice is public data except for any private data contained therein. (c) A facility subject to this subdivision may continue operating while residents are being transferred to other service providers. Subd. 16. Hearing. Within 15 business days of receipt of the licensee's timely appeal of a sanction under this section, other than for a temporary suspension, the commissioner shall request assignment of an administrative law judge. The commissioner's request must include a proposed date, time, and place of hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 90 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause or for purposes of discussing settlement. In no case shall one or more extensions be granted for a total of more than 90 calendar days unless there is a criminal action pending against the licensee. If, while a licensee continues to operate pending an appeal of an order for revocation, suspension, or refusal to renew a license, the commissioner identifies one or more new violations of law that meet the requirements of Level 3 or Level 4 violations as defined in section 144G.31, the commissioner shall act immediately to temporarily suspend the license. Subd. 17. Expedited hearing. (a) Within five business days of receipt of the licensee's timely appeal of a temporary suspension or issuance of a conditional license, the commissioner shall request assignment of an administrative law judge. The request must include a proposed date, time, and place of a hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 30 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause. The commissioner shall issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. Certified

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mail to the last known address is sufficient. The scope of the hearing shall be limited solely to the issue of whether the temporary suspension or issuance of a conditional license should remain in effect and whether there is sufficient evidence to conclude that the licensee's actions or failure to comply with applicable laws are Level 3 or Level 4 violations as defined in section 144G.31, or that there were violations that posed an imminent risk of harm to the resident's health and safety. (b) The administrative law judge shall issue findings of fact, conclusions, and a recommendation within ten business days from the date of hearing. The parties shall have ten calendar days to submit exceptions to the administrative law judge's report. The record shall close at the end of the ten-day period for submission of exceptions. The commissioner's final order shall be issued within ten business days from the close of the record. When an appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed, the commissioner shall issue a final order affirming the temporary immediate suspension or conditional license within ten calendar days of the commissioner's receipt of the withdrawal or dismissal. The licensee is prohibited from operation during the temporary suspension period. (c) When the final order under paragraph (b) affirms an immediate suspension, and a final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that sanction, the licensee is prohibited from operation pending a final commissioner's order after the contested case hearing conducted under chapter 14. (d) A licensee whose license is temporarily suspended must comply with the requirements for notification and transfer of residents under subdivision 15. These requirements remain if an appeal is requested. Subd. 18. Time limits for appeals. To appeal the assessment of civil penalties under section 144G.31, and an action against a license under this section, a licensee must request a hearing no later than 15 business days after the licensee receives notice of the action. Subd. 19. Relicensing. If a facility license is revoked, a new application for license may be considered by the commissioner when the conditions upon which the revocation was based have been corrected and satisfactory evidence of this fact has been furnished to the commissioner. A new license may be granted after an inspection has been made and the facility has complied with all provisions of this chapter and adopted rules. Subd. 20. Informal conference. At any time, the commissioner and the applicant, licensee, manager if applicable, or facility may hold an informal conference to exchange information, clarify issues, or resolve issues. Subd. 21. Injunctive relief. In addition to any other remedy provided by law, the commissioner may bring an action in district court to enjoin a person who is involved in the management, operation, or control of a facility or an employee of the facility from illegally engaging in activities regulated by this chapter. The commissioner may bring an action under this subdivision in the district court in Ramsey County or in the district in which the facility is located. The court may grant a temporary restraining order in the proceeding if continued activity by the person who is involved in the management, operation, or control of a facility, or by an employee of the facility, would create an imminent risk of harm to a resident. Subd. 22. Subpoena. In matters pending before the commissioner under this chapter, the commissioner may issue subpoenas and compel the attendance of witnesses and the production of all necessary papers, books, records, documents, and other evidentiary material. If a person fails or refuses to comply with a subpoena or order of the commissioner to appear or testify regarding any matter about which the person may be lawfully questioned or to produce any papers, books, records, documents, or evidentiary materials in the matter to be heard, the commissioner may apply to the district court in any district, and the court shall

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order the person to comply with the commissioner's order or subpoena. The commissioner may administer oaths to witnesses or take their affirmation. Depositions may be taken in or outside the state in the manner provided by law for taking depositions in civil actions. A subpoena or other process or paper may be served on a named person anywhere in the state by an officer authorized to serve subpoenas in civil actions, with the same fees and mileage and in the same manner as prescribed by law for a process issued out of a district court. A person subpoenaed under this subdivision shall receive the same fees, mileage, and other costs that are paid in proceedings in district court. History: 2019 c 60 art 1 s 24,38,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 24 and 38, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 24 and 38, the effective dates. SURVEYS, CORRECTION ORDERS, AND FINES 144G.30 SURVEYS AND INVESTIGATIONS. Subdivision 1. Regulatory powers. (a) The Department of Health is the exclusive state agency charged with the responsibility and duty of surveying and investigating all assisted living facilities required to be licensed under this chapter. The commissioner of health shall enforce all sections of this chapter and the rules adopted under this chapter. (b) The commissioner, upon request to the facility, must be given access to relevant information, records, incident reports, and other documents in the possession of the facility if the commissioner considers them necessary for the discharge of responsibilities. For purposes of surveys and investigations and securing information to determine compliance with licensure laws and rules, the commissioner need not present a release, waiver, or consent to the individual. The identities of residents must be kept private as defined in section 13.02, subdivision 12. Subd. 2. Surveys. The commissioner shall conduct a survey of each assisted living facility on a frequency of at least once every two years. The commissioner may conduct surveys more frequently than every two years based on the license category, the facility's compliance history, the number of residents served, or other factors as determined by the commissioner deemed necessary to ensure the health, safety, and welfare of residents and compliance with the law. Subd. 3. Scheduling surveys. Surveys and investigations shall be conducted without advance notice to the facilities. Surveyors may contact the facility on the day of a survey to arrange for someone to be available at the survey site. The contact does not constitute advance notice. The surveyor must provide presurvey notification to the Office of Ombudsman for Long-Term Care. Subd. 4. Information provided by facility. (a) The assisted living facility shall provide accurate and truthful information to the department during a survey, investigation, or other licensing activities. (b) Upon request of a surveyor, assisted living facilities shall within a reasonable period of time provide a list of current and past residents and their legal representatives and designated representatives that includes addresses and telephone numbers and any other information requested about the services to residents. Subd. 5. Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a facility, a managerial official, or an employee of the facility is not in compliance with this chapter. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction.

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(b) The commissioner shall mail or e-mail copies of any correction order to the facility within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the facility and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the facility must document in the facility's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the facility's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed. Subd. 6. Follow-up surveys. The commissioner may conduct follow-up surveys to determine if the facility has corrected deficient issues and systems identified during a survey or complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint investigations, shall be concluded with an exit conference and written information provided on the process for requesting a reconsideration of the survey results. Subd. 7. Required follow-up surveys. For assisted living facilities that have Level 3 or Level 4 violations under section 144G.31, the commissioner shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor shall focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made. Subd. 8. Notice of noncompliance. If the commissioner finds that the applicant or a facility has not corrected violations by the date specified in the correction order or conditional license resulting from a survey or complaint investigation, the commissioner shall provide a notice of noncompliance with a correction order by e-mailing the notice of noncompliance to the facility. The noncompliance notice must list the violations not corrected. History: 2019 c 60 art 1 s 35,36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 35 and 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 35 and 36, the effective dates. 144G.31 VIOLATIONS AND FINES. Subdivision 1. Categories of violations. Correction orders for violations are categorized by both level and scope. Subd. 2. Levels of violations. Correction orders for violations are categorized by level as follows: (1) Level 1 is a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety; (2) Level 2 is a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death; (3) Level 3 is a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death; and (4) Level 4 is a violation that results in serious injury, impairment, or death. Subd. 3. Scope of violations. Levels of violations are categorized by scope as follows:

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(1) isolated, when one or a limited number of residents are affected or one or a limited number of staff are involved or the situation has occurred only occasionally; (2) pattern, when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive; and (3) widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the residents. Subd. 4. Fine amounts. (a) Fines and enforcement actions under this subdivision may be assessed based on the level and scope of the violations described in subdivisions 2 and 3 as follows and may be imposed immediately with no opportunity to correct the violation prior to imposition: (1) Level 1, no fines or enforcement; (2) Level 2, a fine of $500 per violation, in addition to any enforcement mechanism authorized in section 144G.20 for widespread violations; (3) Level 3, a fine of $3,000 per violation per incident, in addition to any enforcement mechanism authorized in section 144G.20; (4) Level 4, a fine of $5,000 per incident, in addition to any enforcement mechanism authorized in section 144G.20; and (5) for maltreatment violations for which the licensee was determined to be responsible for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000. A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury. (b) When a fine is assessed against a facility for substantiated maltreatment, the commissioner shall not also impose an immediate fine under this chapter for the same circumstance. Subd. 5. Immediate fine; payment. (a) For every Level 3 or Level 4 violation, the commissioner may issue an immediate fine. The licensee must still correct the violation in the time specified. The issuance of an immediate fine may occur in addition to any enforcement mechanism authorized under section 144G.20. The immediate fine may be appealed as allowed under this chapter. (b) The licensee must pay the fines assessed on or before the payment date specified. If the licensee fails to fully comply with the order, the commissioner may issue a second fine or suspend the license until the licensee complies by paying the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order. (c) A licensee shall promptly notify the commissioner in writing when a violation specified in the order is corrected. If upon reinspection the commissioner determines that a violation has not been corrected as indicated by the order, the commissioner may issue an additional fine. The commissioner shall notify the licensee by mail to the last known address in the licensing record that a second fine has been assessed. The licensee may appeal the second fine as provided under this subdivision. (d) A facility that has been assessed a fine under this section has a right to a reconsideration or hearing under this chapter and chapter 14.

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Subd. 6. Payment of fines required. When a fine has been assessed, the licensee may not avoid payment by closing, selling, or otherwise transferring the license to a third party. In such an event, the licensee shall be liable for payment of the fine. Subd. 7. Additional penalties. In addition to any fine imposed under this section, the commissioner may assess a penalty amount based on costs related to an investigation that results in a final order assessing a fine or other enforcement action authorized by this chapter. Subd. 8. Deposit of fines. Fines collected under this section shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner for special projects to improve home care in Minnesota as recommended by the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 36, the effective date. 144G.32 RECONSIDERATION OF CORRECTION ORDERS AND FINES. Subdivision 1. Reconsideration process required. The commissioner shall make available to assisted living facilities a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in section 144G.31, and any fine assessed. When a licensee requests reconsideration of a correction order, the correction order is not stayed while it is under reconsideration. The commissioner shall post information on its website that the licensee requested reconsideration of the correction order and that the review is pending. Subd. 2. Reconsideration process. An assisted living facility may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the facility. The written request for reconsideration must be received by the commissioner within 15 calendar days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in writing or reviewing the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a facility for a correction order reconsideration within 60 days of the date the facility requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the facility. Subd. 3. Findings. The findings of a correction order reconsideration process shall be one or more of the following: (1) supported in full: the correction order is supported in full, with no deletion of findings to the citation; (2) supported in substance: the correction order is supported, but one or more findings are deleted or modified without any change in the citation; (3) correction order cited an incorrect licensing requirement: the correction order is amended by changing the correction order to the appropriate statute or rule; (4) correction order was issued under an incorrect citation: the correction order is amended to be issued under the more appropriate correction order citation; (5) the correction order is rescinded;

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(6) fine is amended: it is determined that the fine assigned to the correction order was applied incorrectly; or (7) the level or scope of the citation is modified based on the reconsideration. Subd. 4. Updating the correction order website. If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website. Subd. 5. Exception; provisional licensees. This section does not apply to provisional licensees. History: 2019 c 60 art 1 s 37,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 37, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 37, the effective date. 144G.33 INNOVATION VARIANCE. Subdivision 1. Definition; granting variances. (a) For purposes of this section, "innovation variance" means a specified alternative to a requirement of this chapter. (b) An innovation variance may be granted to allow an assisted living facility to offer services of a type or in a manner that is innovative, will not impair the services provided, will not adversely affect the health, safety, or welfare of the residents, and is likely to improve the services provided. The innovative variance cannot change any of the resident's rights under the assisted living bill of rights. Subd. 2. Conditions. The commissioner may impose conditions on granting an innovation variance that the commissioner considers necessary. Subd. 3. Duration and renewal. The commissioner may limit the duration of any innovation variance and may renew a limited innovation variance. Subd. 4. Applications; innovation variance. An application for innovation variance from the requirements of this chapter may be made at any time, must be made in writing to the commissioner, and must specify the following: (1) the statute or rule from which the innovation variance is requested; (2) the time period for which the innovation variance is requested; (3) the specific alternative action that the licensee proposes; (4) the reasons for the request; and (5) justification that an innovation variance will not impair the services provided, will not adversely affect the health, safety, or welfare of residents, and is likely to improve the services provided. The commissioner may require additional information from the facility before acting on the request. Subd. 5. Grants and denials. The commissioner shall grant or deny each request for an innovation variance in writing within 45 days of receipt of a complete request. Notice of a denial shall contain the reasons for the denial. The terms of a requested innovation variance may be modified upon agreement between the commissioner and the facility. Subd. 6. Violation of innovation variances. A failure to comply with the terms of an innovation variance shall be deemed to be a violation of this chapter.

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Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or deny renewal of an innovation variance if: (1) it is determined that the innovation variance is adversely affecting the health, safety, or welfare of the residents; (2) the facility has failed to comply with the terms of the innovation variance; (3) the facility notifies the commissioner in writing that it wishes to relinquish the innovation variance and be subject to the statute previously varied; or (4) the revocation or denial is required by a change in law. History: 2019 c 60 art 1 s 39,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 39, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 39, the effective date. OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40 HOUSING AND SERVICES. Subdivision 1. Responsibility for housing and services. The facility is directly responsible to the resident for all housing and service-related matters provided, irrespective of a management contract. Housing and service-related matters include but are not limited to the handling of complaints, the provision of notices, and the initiation of any adverse action against the resident involving housing or services provided by the facility. Subd. 2. Uniform checklist disclosure of services. (a) All assisted living facilities must provide to prospective residents: (1) a disclosure of the categories of assisted living licenses available and the category of license held by the facility; (2) a written checklist listing all services permitted under the facility's license, identifying all services the facility offers to provide under the assisted living facility contract, and identifying all services allowed under the license that the facility does not provide; and (3) an oral explanation of the services offered under the contract. (b) The requirements of paragraph (a) must be completed prior to the execution of the assisted living contract. (c) The commissioner must, in consultation with all interested stakeholders, design the uniform checklist disclosure form for use as provided under paragraph (a). Subd. 3. Reservation of rights. Nothing in this chapter: (1) requires a resident to utilize any service provided by or through, or made available in, a facility; (2) prevents a facility from requiring, as a condition of the contract, that the resident pay for a package of services even if the resident does not choose to use all or some of the services in the package. For residents who are eligible for home and community-based waiver services under chapter 256S and section 256B.49, payment for services will follow the policies of those programs;

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(3) requires a facility to fundamentally alter the nature of the operations of the facility in order to accommodate a resident's request; or (4) affects the duty of a facility to grant a resident's request for reasonable accommodations. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 13,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 13, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 13, the effective date. 144G.401 PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS. For new assisted living facilities that did not operate as registered housing with services establishments prior to August 1, 2021, home and community-based services under section 256B.49 are not available when the new facility setting is adjoined to, or on the same property as, an institution as defined in Code of Federal Regulations, title 42, section 441.301(c). History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, subdivision 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.41 MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS. Subdivision 1. Minimum requirements. All assisted living facilities shall: (1) distribute to residents the assisted living bill of rights; (2) provide services in a manner that complies with the Nurse Practice Act in sections 148.171 to 148.285; (3) utilize a person-centered planning and service delivery process; (4) have and maintain a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by the Nurse Practice Act in sections 148.171 to 148.285; (5) provide a means for residents to request assistance for health and safety needs 24 hours per day, seven days per week; (6) allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract; (7) permit residents access to food at any time; (8) allow residents to choose the resident's visitors and times of visits; (9) allow the resident the right to choose a roommate if sharing a unit; (10) notify the resident of the resident's right to have and use a lockable door to the resident's unit. The licensee shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. An assisted living facility must not lock a resident in the resident's unit; (11) develop and implement a staffing plan for determining its staffing level that:

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(i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled needs of each resident as required by the residents' assessments and service plans on a 24-hour per day basis; and (iii) ensures that the facility can respond promptly and effectively to individual resident emergencies and to emergency, life safety, and disaster situations affecting staff or residents in the facility; (12) ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time; (iii) capable of communicating with residents; (iv) capable of providing or summoning the appropriate assistance; and (v) capable of following directions; and (13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The following apply: (A) menus must be prepared at least one week in advance, and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes; (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and (C) the facility cannot require a resident to include and pay for meals in their contract; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the resident, provide direct or reasonable assistance with arranging for transportation to medical and social services appointments, shopping, and other recreation, and provide the name of or other identifying information about the persons responsible for providing this assistance; (v) upon the request of the resident, provide reasonable assistance with accessing community resources and social services available in the community, and provide the name of or other identifying information about persons responsible for providing this assistance; (vi) provide culturally sensitive programs; and

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(vii) have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and that creates opportunities for active participation in the community at large. Subd. 2. Policies and procedures. Each assisted living facility must have policies and procedures in place to address the following and keep them current: (1) requirements in section 626.557, reporting of maltreatment of vulnerable adults; (2) conducting and handling background studies on employees; (3) orientation, training, and competency evaluations of staff, and a process for evaluating staff performance; (4) handling complaints regarding staff or services provided by staff; (5) conducting initial evaluations of residents' needs and the providers' ability to provide those services; (6) conducting initial and ongoing resident evaluations and assessments of resident needs, including assessments by a registered nurse or appropriate licensed health professional, and how changes in a resident's condition are identified, managed, and communicated to staff and other health care providers as appropriate; (7) orientation to and implementation of the assisted living bill of rights; (8) infection control practices; (9) reminders for medications, treatments, or exercises, if provided; (10) conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards; (11) ensuring that nurses and licensed health professionals have current and valid licenses to practice; (12) medication and treatment management; (13) delegation of tasks by registered nurses or licensed health professionals; (14) supervision of registered nurses and licensed health professionals; and (15) supervision of unlicensed personnel performing delegated tasks. Subd. 3. Infection control program. All assisted living facilities must establish and maintain an infection control program. Subd. 4. Clinical nurse supervision. All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. Subd. 5. Resident councils. The facility must provide a resident council with space and privacy for meetings, where doing so is reasonably achievable. Staff, visitors, and other guests may attend a resident council meeting only at the council's invitation. The facility must designate a staff person who is approved by the resident council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the resident council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the resident council, take reasonably achievable steps to make residents aware of upcoming meetings in a timely manner.

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Subd. 6. Family councils. The facility must provide a family council with space and privacy for meetings, where doing so is reasonably achievable. The facility must designate a staff person who is approved by the family council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the family council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the family council, take reasonably achievable steps to make residents and family members aware of upcoming meetings in a timely manner. Subd. 7. Resident grievances; reporting maltreatment. All facilities must post in a conspicuous place information about the facilities' grievance procedure, and the name, telephone number, and e-mail contact information for the individuals who are responsible for handling resident grievances. The notice must also have the contact information for the state and applicable regional Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, and must have information for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center. Subd. 8. Protecting resident rights. All facilities shall ensure that every resident has access to consumer advocacy or legal services by: (1) providing names and contact information, including telephone numbers and e-mail addresses of at least three organizations that provide advocacy or legal services to residents; (2) providing the name and contact information for the Minnesota Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, including both the state and regional contact information; (3) assisting residents in obtaining information on whether Medicare or medical assistance under chapter 256B will pay for services; (4) making reasonable accommodations for people who have communication disabilities and those who speak a language other than English; and (5) providing all information and notices in plain language and in terms the residents can understand. History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.42 BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed at the main entrance of each assisted living facility. The facility must provide a copy of the license to any person who requests it. Subd. 2. Quality management. The facility shall engage in quality management appropriate to the size of the facility and relevant to the type of services provided. "Quality management activity" means evaluating the quality of care by periodically reviewing resident services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to residents. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal.

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Subd. 3. Facility restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A facility or staff person may not: (1) accept a power-of-attorney from residents for any purpose, and may not accept appointments as guardians or conservators of residents; or (2) borrow a resident's funds or personal or real property, nor in any way convert a resident's property to the possession of the facility or staff person. (c) A facility may not serve as a resident's legal, designated, or other representative. (d) Nothing in this subdivision precludes a facility or staff person from accepting gifts of minimal value or precludes acceptance of donations or bequests made to a facility that are exempt from section 501(c)(3) of the Internal Revenue Code. Subd. 4. Handling residents' finances and property. (a) A facility may assist residents with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a resident's property. (b) Where funds are deposited with the facility by the resident, the licensee: (1) retains fiduciary and custodial responsibility for the funds; (2) is directly accountable to the resident for the funds; and (3) must maintain records of and provide a resident with receipts for all transactions and purchases made with the resident's funds. When receipts are not available, the transaction or purchase must be documented. (c) Subject to paragraph (d), if responsibilities for day-to-day management of the resident funds are delegated to the manager, the manager must: (1) provide the licensee with a monthly accounting of the resident funds; and (2) meet all legal requirements related to holding and accounting for resident funds. (d) The facility must ensure any party responsible for holding or managing residents' personal funds is bonded or obtains insurance in sufficient amounts to specifically cover losses of resident funds and provides proof of the bond or insurance. Subd. 5. Final accounting; return of money and property. Within 30 days of the effective date of a facility-initiated or resident-initiated termination of housing or services or the death of the resident, the facility must: (1) provide to the resident, resident's legal representative, and resident's designated representative a final statement of account; (2) provide any refunds due; (3) return any money, property, or valuables held in trust or custody by the facility; and (4) as required under section 504B.178, refund the resident's security deposit unless it is applied to the first month's charges.

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Subd. 6. Compliance with requirements for reporting maltreatment of vulnerable adults; abuse prevention plan. (a) The assisted living facility must comply with the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. The facility must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) The facility must develop and implement an individual abuse prevention plan for each vulnerable adult. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults; the person's risk of abusing other vulnerable adults; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. For purposes of the abuse prevention plan, abuse includes self-abuse. Subd. 7. Posting information for reporting suspected crime and maltreatment. The facility shall support protection and safety through access to the state's systems for reporting suspected criminal activity and suspected vulnerable adult maltreatment by: (1) posting the 911 emergency number in common areas and near telephones provided by the assisted living facility; (2) posting information and the reporting number for the Minnesota Adult Abuse Reporting Center to report suspected maltreatment of a vulnerable adult under section 626.557; and (3) providing reasonable accommodations with information and notices in plain language. Subd. 8. Employee records. (a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification if licensure, registration, or certification is required by this chapter or rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff persons providing supervision; (4) documentation of annual performance reviews that identify areas of improvement needed and training needs; (5) for individuals providing assisted living services, verification that required health screenings under subdivision 9 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. (b) Each employee record must be retained for at least three years after a paid employee, volunteer, or contractor ceases to be employed by, provide services at, or be under contract with the facility. If a facility ceases operation, employee records must be maintained for three years after facility operations cease. Subd. 9. Tuberculosis prevention and control. The facility must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report (MMWR). The program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors,

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students, and regularly scheduled volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines. Subd. 10. Disaster planning and emergency preparedness plan. (a) The facility must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) post an emergency disaster plan prominently; (3) provide building emergency exit diagrams to all residents; (4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing tenant residents. (b) The facility must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training annually available to all residents. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) The facility must meet any additional requirements adopted in rule. History: 2019 c 60 art 1 s 15,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 15, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 15, the effective date. 144G.43 RESIDENT RECORD REQUIREMENTS. Subdivision 1. Resident record. (a) Assisted living facilities must maintain records for each resident for whom it is providing services. Entries in the resident records must be current, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry. (b) Resident records, whether written or electronic, must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable relevant federal and state laws. The facility shall establish and implement written procedures to control use, storage, and security of resident records and establish criteria for release of resident information. (c) The facility may not disclose to any other person any personal, financial, or medical information about the resident, except: (1) as may be required by law; (2) to employees or contractors of the facility, another facility, other health care practitioner or provider, or inpatient facility needing information in order to provide services to the resident, but only the information that is necessary for the provision of services; (3) to persons authorized in writing by the resident, including third-party payers; and (4) to representatives of the commissioner authorized to survey or investigate facilities under this chapter or federal laws.

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Subd. 2. Access to records. The facility must ensure that the appropriate records are readily available to employees and contractors authorized to access the records. Resident records must be maintained in a manner that allows for timely access, printing, or transmission of the records. The records must be made readily available to the commissioner upon request. Subd. 3. Contents of resident record. Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, legal representatives, and designated representative; (3) names, addresses, and telephone numbers of the resident's health and medical service providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) the resident's advance directives, if any; (6) copies of any health care directives, guardianships, powers of attorney, or conservatorships; (7) the facility's current and previous assessments and service plans; (8) all records of communications pertinent to the resident's services; (9) documentation of significant changes in the resident's status and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (10) documentation of incidents involving the resident and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (11) documentation that services have been provided as identified in the service plan; (12) documentation that the resident has received and reviewed the assisted living bill of rights; (13) documentation of complaints received and any resolution; (14) a discharge summary, including service termination notice and related documentation, when applicable; and (15) other documentation required under this chapter and relevant to the resident's services or status. Subd. 4. Transfer of resident records. With the resident's knowledge and consent, if a resident is relocated to another facility or to a nursing home, or if care is transferred to another service provider, the facility must timely convey to the new facility, nursing home, or provider: (1) the resident's full name, date of birth, and insurance information; (2) the name, telephone number, and address of the resident's designated representatives and legal representatives, if any; (3) the resident's current documented diagnoses that are relevant to the services being provided; (4) the resident's known allergies that are relevant to the services being provided;

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(5) the name and telephone number of the resident's physician, if known, and the current physician orders that are relevant to the services being provided; (6) all medication administration records that are relevant to the services being provided; (7) the most recent resident assessment, if relevant to the services being provided; and (8) copies of health care directives, "do not resuscitate" orders, and any guardianship orders or powers of attorney. Subd. 5. Record retention. Following the resident's discharge or termination of services, an assisted living facility must retain a resident's record for at least five years or as otherwise required by state or federal regulations. Arrangements must be made for secure storage and retrieval of resident records if the facility ceases to operate. History: 2019 c 60 art 1 s 21,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 21, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 21, the effective date. 144G.45 MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS. Subdivision 1. Requirements. The following are required for all assisted living facilities: (1) public utilities must be available, and working or inspected and approved water and septic systems must be in place; (2) the location must be publicly accessible to fire department services and emergency medical services; (3) the location's topography must provide sufficient natural drainage and is not subject to flooding; (4) all-weather roads and walks must be provided within the lot lines to the primary entrance and the service entrance, including employees' and visitors' parking at the site; and (5) the location must include space for outdoor activities for residents. Subd. 2. Fire protection and physical environment. (a) Each assisted living facility must have a comprehensive fire protection system that includes: (1) protection throughout by an approved supervised automatic sprinkler system according to building code requirements established in Minnesota Rules, part 1305.0903, or smoke detectors in each occupied room installed and maintained in accordance with the National Fire Protection Association (NFPA) Standard 72; (2) portable fire extinguishers installed and tested in accordance with the NFPA Standard 10; and (3) the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment that is kept in a continuous state of good repair and operation with regard to the health, safety, comfort, and well-being of the residents in accordance with a maintenance and repair program. (b) Fire drills in assisted living facilities shall be conducted in accordance with the residential board and care requirements in the Life Safety Code, except that fire drills in secured dementia care units shall be conducted in accordance with section 144G.81, subdivision 2.

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(c) Existing construction or elements, including assisted living facilities that were registered as housing with services establishments under chapter 144D prior to August 1, 2021, shall be permitted to be continued in use provided such use does not constitute a distinct hazard to life. Any existing elements that an authority having jurisdiction deems a distinct hazard to life must be corrected. The facility must document in the facility's records any actions taken to comply with a correction order, and must submit to the commissioner for review and approval prior to correction. Subd. 3. Local laws apply. Assisted living facilities shall comply with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements. Subd. 4. Design requirements. (a) All assisted living facilities with six or more residents must meet the provisions relevant to assisted living facilities in the most current edition of the Facility Guidelines Institute "Guidelines for Design and Construction of Residential Health, Care and Support Facilities" and of adopted rules. This minimum design standard must be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. In addition to the guidelines, assisted living facilities shall provide the option of a bath in addition to a shower for all residents. (b) If the commissioner decides to update the edition of the guidelines specified in paragraph (a) for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new edition will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated edition. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 5. Assisted living facilities; Life Safety Code. (a) All assisted living facilities with six or more residents must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Residential Board and Care Occupancies chapter. The minimum design standard shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated Life Safety Code. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 6. New construction; plans. (a) For all new licensure and construction beginning on or after August 1, 2021, the following must be provided to the commissioner: (1) architectural and engineering plans and specifications for new construction must be prepared and signed by architects and engineers who are registered in Minnesota. Final working drawings and specifications for proposed construction must be submitted to the commissioner for review and approval; (2) final architectural plans and specifications must include elevations and sections through the building showing types of construction, and must indicate dimensions and assignments of rooms and areas, room

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finishes, door types and hardware, elevations and details of nurses' work areas, utility rooms, toilet and bathing areas, and large-scale layouts of dietary and laundry areas. Plans must show the location of fixed equipment and sections and details of elevators, chutes, and other conveying systems. Fire walls and smoke partitions must be indicated. The roof plan must show all mechanical installations. The site plan must indicate the proposed and existing buildings, topography, roadways, walks and utility service lines; and (3) final mechanical and electrical plans and specifications must address the complete layout and type of all installations, systems, and equipment to be provided. Heating plans must include heating elements, piping, thermostatic controls, pumps, tanks, heat exchangers, boilers, breeching, and accessories. Ventilation plans must include room air quantities, ducts, fire and smoke dampers, exhaust fans, humidifiers, and air handling units. Plumbing plans must include the fixtures and equipment fixture schedule; water supply and circulating piping, pumps, tanks, riser diagrams, and building drains; the size, location, and elevation of water and sewer services; and the building fire protection systems. Electrical plans must include fixtures and equipment, receptacles, switches, power outlets, circuits, power and light panels, transformers, and service feeders. Plans must show location of nurse call signals, cable lines, fire alarm stations, and fire detectors and emergency lighting. (b) Unless construction is begun within one year after approval of the final working drawing and specifications, the drawings must be resubmitted for review and approval. (c) The commissioner must be notified within 30 days before completion of construction so that the commissioner can make arrangements for a final inspection by the commissioner. (d) At least one set of complete life safety plans, including changes resulting from remodeling or alterations, must be kept on file in the facility. Subd. 7. Variance or waiver. (a) A facility may request that the commissioner grant a variance or waiver from the provisions of this section or section 144G.81, subdivision 5. A request for a waiver must be submitted to the commissioner in writing. Each request must contain: (1) the specific requirement for which the variance or waiver is requested; (2) the reasons for the request; (3) the alternative measures that will be taken if a variance or waiver is granted; (4) the length of time for which the variance or waiver is requested; and (5) other relevant information deemed necessary by the commissioner to properly evaluate the request for the waiver. (b) The decision to grant or deny a variance or waiver must be based on the commissioner's evaluation of the following criteria: (1) whether the waiver will adversely affect the health, treatment, comfort, safety, or well-being of a resident; (2) whether the alternative measures to be taken, if any, are equivalent to or superior to those permitted under section 144G.81, subdivision 5; and (3) whether compliance with the requirements would impose an undue burden on the facility.

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(c) The commissioner must notify the facility in writing of the decision. If a variance or waiver is granted, the notification must specify the period of time for which the variance or waiver is effective and the alternative measures or conditions, if any, to be met by the facility. (d) Alternative measures or conditions attached to a variance or waiver have the force and effect of this chapter and are subject to the issuance of correction orders and fines in accordance with sections 144G.30, subdivision 7, and 144G.31. The amount of fines for a violation of this subdivision is that specified for the specific requirement for which the variance or waiver was requested. (e) A request for renewal of a variance or waiver must be submitted in writing at least 45 days before its expiration date. Renewal requests must contain the information specified in paragraph (b). A variance or waiver must be renewed by the commissioner if the facility continues to satisfy the criteria in paragraph (a) and demonstrates compliance with the alternative measures or conditions imposed at the time the original variance or waiver was granted. (f) The commissioner must deny, revoke, or refuse to renew a variance or waiver if it is determined that the criteria in paragraph (a) are not met. The facility must be notified in writing of the reasons for the decision and informed of the right to appeal the decision. (g) A facility may contest the denial, revocation, or refusal to renew a variance or waiver by requesting a contested case hearing under chapter 14. The facility must submit, within 15 days of the receipt of the commissioner's decision, a written request for a hearing. The request for hearing must set forth in detail the reasons why the facility contends the decision of the commissioner should be reversed or modified. At the hearing, the facility has the burden of proving by a preponderance of the evidence that the facility satisfied the criteria specified in paragraph (b), except in a proceeding challenging the revocation of a variance or waiver. History: 2019 c 60 art 1 s 25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 25, the effective date. CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50 ASSISTED LIVING CONTRACT REQUIREMENTS. Subdivision 1. Contract required. (a) An assisted living facility may not offer or provide housing or assisted living services to a resident unless it has executed a written contract with the resident. (b) The contract must contain all the terms concerning the provision of: (1) housing; (2) assisted living services, whether provided directly by the facility or by management agreement or other agreement; and (3) the resident's service plan, if applicable. (c) A facility must: (1) offer to prospective residents and provide to the Office of Ombudsman for Long-Term Care a complete unsigned copy of its contract; and

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(2) give a complete copy of any signed contract and any addendums, and all supporting documents and attachments, to the resident promptly after a contract and any addendum has been signed. (d) A contract under this section is a consumer contract under sections 325G.29 to 325G.37. (e) Before or at the time of execution of the contract, the facility must offer the resident the opportunity to identify a designated representative according to subdivision 3. (f) The resident must agree in writing to any additions or amendments to the contract. Upon agreement between the resident and the facility, a new contract or an addendum to the existing contract must be executed and signed. Subd. 2. Contract information. (a) The contract must include in a conspicuous place and manner on the contract the legal name and the license number of the facility. (b) The contract must include the name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the facility and contracted service provider when applicable; (2) the licensee of the facility; (3) the managing agent of the facility, if applicable; and (4) the authorized agent for the facility. (c) The contract must include: (1) a disclosure of the category of assisted living facility license held by the facility and, if the facility is not an assisted living facility with dementia care, a disclosure that it does not hold an assisted living facility with dementia care license; (2) a description of all the terms and conditions of the contract, including a description of and any limitations to the housing or assisted living services to be provided for the contracted amount; (3) a delineation of the cost and nature of any other services to be provided for an additional fee; (4) a delineation and description of any additional fees the resident may be required to pay if the resident's condition changes during the term of the contract; (5) a delineation of the grounds under which the resident may be discharged, evicted, or transferred or have services terminated; (6) billing and payment procedures and requirements; and (7) disclosure of the facility's ability to provide specialized diets. (d) The contract must include a description of the facility's complaint resolution process available to residents, including the name and contact information of the person representing the facility who is designated to handle and resolve complaints. (e) The contract must include a clear and conspicuous notice of: (1) the right under section 144G.54 to appeal the termination of an assisted living contract;

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(2) the facility's policy regarding transfer of residents within the facility, under what circumstances a transfer may occur, and the circumstances under which resident consent is required for a transfer; (3) contact information for the Office of Ombudsman for Long-Term Care, the Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health Facility Complaints; (4) the resident's right to obtain services from an unaffiliated service provider; (5) a description of the facility's policies related to medical assistance waivers under chapter 256S and section 256B.49 and the housing support program under chapter 256I, including: (i) whether the facility is enrolled with the commissioner of human services to provide customized living services under medical assistance waivers; (ii) whether the facility has an agreement to provide housing support under section 256I.04, subdivision 2, paragraph (b); (iii) whether there is a limit on the number of people residing at the facility who can receive customized living services or participate in the housing support program at any point in time. If so, the limit must be provided; (iv) whether the facility requires a resident to pay privately for a period of time prior to accepting payment under medical assistance waivers or the housing support program, and if so, the length of time that private payment is required; (v) a statement that medical assistance waivers provide payment for services, but do not cover the cost of rent; (vi) a statement that residents may be eligible for assistance with rent through the housing support program; and (vii) a description of the rent requirements for people who are eligible for medical assistance waivers but who are not eligible for assistance through the housing support program; (6) the contact information to obtain long-term care consulting services under section 256B.0911; and (7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center. Subd. 3. Designation of representative. (a) Before or at the time of execution of an assisted living contract, an assisted living facility must offer the resident the opportunity to identify a designated representative in writing in the contract and must provide the following verbatim notice on a document separate from the contract: "RIGHT TO DESIGNATE A REPRESENTATIVE FOR CERTAIN PURPOSES. You have the right to name anyone as your "Designated Representative." A Designated Representative can assist you, receive certain information and notices about you, including some information related to your health care, and advocate on your behalf. A Designated Representative does not take the place of your guardian, conservator, power of attorney ("attorney-in-fact"), or health care power of attorney ("health care agent"), if applicable." (b) The contract must contain a page or space for the name and contact information of the designated representative and a box the resident must initial if the resident declines to name a designated representative.

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Notwithstanding subdivision 1, paragraph (f), the resident has the right at any time to add, remove, or change the name and contact information of the designated representative. Subd. 4. Filing. The contract and related documents must be maintained by the facility in files from the date of execution until five years after the contract is terminated or expires. The contracts and all associated documents must be available for on-site inspection by the commissioner at any time. The documents shall be available for viewing or copies shall be made available to the resident and the legal or designated representative at any time. Subd. 5. Waivers of liability prohibited. The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. The contract must not include any provision that the facility knows or should know to be deceptive, unlawful, or unenforceable under state or federal law, nor include any provision that requires or implies a lesser standard of care or responsibility than is required by law. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 26,47; 2020 c 83 art 1 s 36 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 26, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 26, the effective date. 144G.51 ARBITRATION. (a) An assisted living facility must clearly and conspicuously disclose, in writing in an assisted living contract, any arbitration provision in the contract that precludes, limits, or delays the ability of a resident from taking a civil action. (b) An arbitration requirement must not include a choice of law or choice of venue provision. Assisted living contracts must adhere to Minnesota law and any other applicable federal or local law. History: 2019 c 60 art 1 s 31,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 31, is effective August 1, 2021, for contracts entered into on or after that date. Laws 2019, chapter 60, article 1, section 31, the effective date. 144G.52 ASSISTED LIVING CONTRACT TERMINATIONS. Subdivision 1. Definition. For purposes of sections 144G.52 to 144G.55, "termination" means: (1) a facility-initiated termination of housing provided to the resident under the contract; or (2) a facility-initiated termination or nonrenewal of all assisted living services the resident receives from the facility under the contract. Subd. 2. Prerequisite to termination of a contract. (a) Before issuing a notice of termination of an assisted living contract, a facility must schedule and participate in a meeting with the resident and the resident's legal representative and designated representative. The purposes of the meeting are to: (1) explain in detail the reasons for the proposed termination; and (2) identify and offer reasonable accommodations or modifications, interventions, or alternatives to avoid the termination or enable the resident to remain in the facility, including but not limited to securing services from another provider of the resident's choosing that may allow the resident to avoid the termination.

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A facility is not required to offer accommodations, modifications, interventions, or alternatives that fundamentally alter the nature of the operation of the facility. (b) The meeting must be scheduled to take place at least seven days before a notice of termination is issued. The facility must make reasonable efforts to ensure that the resident, legal representative, and designated representative are able to attend the meeting. (c) The facility must notify the resident that the resident may invite family members, relevant health professionals, a representative of the Office of Ombudsman for Long-Term Care, or other persons of the resident's choosing to participate in the meeting. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must notify the resident's case manager of the meeting. (d) In the event of an emergency relocation under subdivision 9, where the facility intends to issue a notice of termination and an in-person meeting is impractical or impossible, the facility may attempt to schedule and participate in a meeting under this subdivision via telephone, video, or other means. Subd. 3. Termination for nonpayment. (a) A facility may initiate a termination of housing because of nonpayment of rent or a termination of services because of nonpayment for services. Upon issuance of a notice of termination for nonpayment, the facility must inform the resident that public benefits may be available and must provide contact information for the Senior LinkAge Line under section 256.975, subdivision 7. (b) An interruption to a resident's public benefits that lasts for no more than 60 days does not constitute nonpayment. Subd. 4. Termination for violation of the assisted living contract. A facility may initiate a termination of the assisted living contract if the resident violates a lawful provision of the contract and the resident does not cure the violation within a reasonable amount of time after the facility provides written notice of the ability to cure to the resident. Written notice of the ability to cure may be provided in person or by first class mail. A facility is not required to provide a resident with written notice of the ability to cure for a violation that threatens the health or safety of the resident or another individual in the facility, or for a violation that constitutes illegal conduct. Subd. 5. Expedited termination. (a) A facility may initiate an expedited termination of housing or services if: (1) the resident has engaged in conduct that substantially interferes with the rights, health, or safety of other residents; (2) the resident has engaged in conduct that substantially and intentionally interferes with the safety or physical health of facility staff; or (3) the resident has committed an act listed in section 504B.171 that substantially interferes with the rights, health, or safety of other residents. (b) A facility may initiate an expedited termination of services if: (1) the resident has engaged in conduct that substantially interferes with the resident's health or safety; (2) the resident's assessed needs exceed the scope of services agreed upon in the assisted living contract and are not included in the services the facility disclosed in the uniform checklist; or

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(3) extraordinary circumstances exist, causing the facility to be unable to provide the resident with the services disclosed in the uniform checklist that are necessary to meet the resident's needs. Subd. 6. Right to use provider of resident's choosing. A facility may not terminate the assisted living contract if the underlying reason for termination may be resolved by the resident obtaining services from another provider of the resident's choosing and the resident obtains those services. Subd. 7. Notice of contract termination required. (a) A facility terminating a contract must issue a written notice of termination according to this section. The facility must also send a copy of the termination notice to the Office of Ombudsman for Long-Term Care and, for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, to the resident's case manager, as soon as practicable after providing notice to the resident. A facility may terminate an assisted living contract only as permitted under subdivisions 3, 4, and 5. (b) A facility terminating a contract under subdivision 3 or 4 must provide a written termination notice at least 30 days before the effective date of the termination to the resident, legal representative, and designated representative. (c) A facility terminating a contract under subdivision 5 must provide a written termination notice at least 15 days before the effective date of the termination to the resident, legal representative, and designated representative. (d) If a resident moves out of a facility or cancels services received from the facility, nothing in this section prohibits a facility from enforcing against the resident any notice periods with which the resident must comply under the assisted living contract. Subd. 8. Content of notice of termination. The notice required under subdivision 7 must contain, at a minimum: (1) the effective date of the termination of the assisted living contract; (2) a detailed explanation of the basis for the termination, including the clinical or other supporting rationale; (3) a detailed explanation of the conditions under which a new or amended contract may be executed; (4) a statement that the resident has the right to appeal the termination by requesting a hearing, and information concerning the time frame within which the request must be submitted and the contact information for the agency to which the request must be submitted; (5) a statement that the facility must participate in a coordinated move to another provider or caregiver, as required under section 144G.55; (6) the name and contact information of the person employed by the facility with whom the resident may discuss the notice of termination; (7) information on how to contact the Office of Ombudsman for Long-Term Care to request an advocate to assist regarding the termination; (8) information on how to contact the Senior LinkAge Line under section 256.975, subdivision 7, and an explanation that the Senior LinkAge Line may provide information about other available housing or service options; and

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(9) if the termination is only for services, a statement that the resident may remain in the facility and may secure any necessary services from another provider of the resident's choosing. Subd. 9. Emergency relocation. (a) A facility may remove a resident from the facility in an emergency if necessary due to a resident's urgent medical needs or an imminent risk the resident poses to the health or safety of another facility resident or facility staff member. An emergency relocation is not a termination. (b) In the event of an emergency relocation, the facility must provide a written notice that contains, at a minimum: (1) the reason for the relocation; (2) the name and contact information for the location to which the resident has been relocated and any new service provider; (3) contact information for the Office of Ombudsman for Long-Term Care; (4) if known and applicable, the approximate date or range of dates within which the resident is expected to return to the facility, or a statement that a return date is not currently known; and (5) a statement that, if the facility refuses to provide housing or services after a relocation, the resident has the right to appeal under section 144G.54. The facility must provide contact information for the agency to which the resident may submit an appeal. (c) The notice required under paragraph (b) must be delivered as soon as practicable to: (1) the resident, legal representative, and designated representative; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the resident's case manager; and (3) the Office of Ombudsman for Long-Term Care if the resident has been relocated and has not returned to the facility within four days. (d) Following an emergency relocation, a facility's refusal to provide housing or services constitutes a termination and triggers the termination process in this section. Subd. 10. Right to return. If a resident is absent from a facility for any reason, including an emergency relocation, the facility shall not refuse to allow a resident to return if a termination of housing has not been effectuated. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 27,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 27, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 27, the effective date. 144G.53 NONRENEWAL OF HOUSING. (a) If a facility decides to not renew a resident's housing under a contract, the facility must either (1) provide the resident with 60 calendar days' notice of the nonrenewal and assistance with relocation planning, or (2) follow the termination procedure under section 144G.52. (b) The notice must include the reason for the nonrenewal and contact information of the Office of Ombudsman for Long-Term Care.

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(c) A facility must: (1) provide notice of the nonrenewal to the Office of Ombudsman for Long-Term Care; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, provide notice to the resident's case manager; (3) ensure a coordinated move to a safe location, as defined in section 144G.55, subdivision 2, that is appropriate for the resident; (4) ensure a coordinated move to an appropriate service provider identified by the facility, if services are still needed and desired by the resident; (5) consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals; and (6) prepare a written plan to prepare for the move. (d) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may instead choose to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the nonrenewal notice. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 28,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 28, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 28, the effective date. 144G.54 APPEALS OF CONTRACT TERMINATIONS. Subdivision 1. Right to appeal. Residents have the right to appeal the termination of an assisted living contract. Subd. 2. Permissible grounds to appeal termination. A resident may appeal a termination initiated under section 144G.52, subdivision 3, 4, or 5, on the ground that: (1) there is a factual dispute as to whether the facility had a permissible basis to initiate the termination; (2) the termination would result in great harm or the potential for great harm to the resident as determined by the totality of the circumstances, except in circumstances where there is a greater risk of harm to other residents or staff at the facility; (3) the resident has cured or demonstrated the ability to cure the reasons for the termination, or has identified a reasonable accommodation or modification, intervention, or alternative to the termination; or (4) the facility has terminated the contract in violation of state or federal law. Subd. 3. Appeals process. (a) The Office of Administrative Hearings must conduct an expedited hearing as soon as practicable under this section, but in no event later than 14 calendar days after the office receives the request, unless the parties agree otherwise or the chief administrative law judge deems the timing to be unreasonable, given the complexity of the issues presented.

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(b) The hearing must be held at the facility where the resident lives, unless holding the hearing at that location is impractical, the parties agree to hold the hearing at a different location, or the chief administrative law judge grants a party's request to appear at another location or by telephone or interactive video. (c) The hearing is not a formal contested case proceeding, except when determined necessary by the chief administrative law judge. (d) Parties may but are not required to be represented by counsel. The appearance of a party without counsel does not constitute the unauthorized practice of law. (e) The hearing shall be limited to the amount of time necessary for the participants to expeditiously present the facts about the proposed termination. The administrative law judge shall issue a recommendation to the commissioner as soon as practicable, but in no event later than ten business days after the hearing. Subd. 4. Burden of proof for appeals of termination. (a) The facility bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (4). (b) The resident bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (2) or (3). Subd. 5. Determination; content of order. (a) The resident's termination must be rescinded if the resident prevails in the appeal. (b) The order may contain any conditions that may be placed on the resident's continued residency or receipt of services, including but not limited to changes to the service plan or a required increase in services. Subd. 6. Service provision while appeal pending. A termination of housing or services shall not occur while an appeal is pending. If additional services are needed to meet the health or safety needs of the resident while an appeal is pending, the resident is responsible for contracting for those additional services from the facility or another provider and for ensuring the costs for those additional services are covered. Subd. 7. Application of chapter 504B to appeals of terminations. A resident may not bring an action under chapter 504B to challenge a termination that has occurred and been upheld under this section. History: 2019 c 60 art 1 s 29,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 29, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 29, the effective date. 144G.55 COORDINATED MOVES. Subdivision 1. Duties of facility. (a) If a facility terminates an assisted living contract, reduces services to the extent that a resident needs to move, or conducts a planned closure under section 144G.57, the facility: (1) must ensure, subject to paragraph (c), a coordinated move to a safe location that is appropriate for the resident and that is identified by the facility prior to any hearing under section 144G.54; (2) must ensure a coordinated move of the resident to an appropriate service provider identified by the facility prior to any hearing under section 144G.54, provided services are still needed and desired by the resident; and (3) must consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and

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section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals. (b) A facility may satisfy the requirements of paragraph (a), clauses (1) and (2), by moving the resident to a different location within the same facility, if appropriate for the resident. (c) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may choose instead to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the termination notice. (d) Sixty days before the facility plans to reduce or eliminate one or more services for a particular resident, the facility must provide written notice of the reduction that includes: (1) a detailed explanation of the reasons for the reduction and the date of the reduction; (2) the contact information for the Office of Ombudsman for Long-Term Care and the name and contact information of the person employed by the facility with whom the resident may discuss the reduction of services; (3) a statement that if the services being reduced are still needed by the resident, the resident may remain in the facility and seek services from another provider; and (4) a statement that if the reduction makes the resident need to move, the facility must participate in a coordinated move of the resident to another provider or caregiver, as required under this section. (e) In the event of an unanticipated reduction in services caused by extraordinary circumstances, the facility must provide the notice required under paragraph (d) as soon as possible. (f) If the facility, a resident, a legal representative, or a designated representative determines that a reduction in services will make a resident need to move to a new location, the facility must ensure a coordinated move in accordance with this section, and must provide notice to the Office of Ombudsman for Long-Term Care. (g) Nothing in this section affects a resident's right to remain in the facility and seek services from another provider. Subd. 2. Safe location. A safe location is not a private home where the occupant is unwilling or unable to care for the resident, a homeless shelter, a hotel, or a motel. A facility may not terminate a resident's housing or services if the resident will, as the result of the termination, become homeless, as that term is defined in section 116L.361, subdivision 5, or if an adequate and safe discharge location or adequate and needed service provider has not been identified. This subdivision does not preclude a resident from declining to move to the location the facility identifies. Subd. 3. Relocation plan required. The facility must prepare a relocation plan to prepare for the move to the new location or service provider. Subd. 4. License restrictions. Unless otherwise ordered by the commissioner, if a facility's license is restricted by the commissioner under section 144G.20 such that a resident must move or obtain a new service provider, the facility must comply with this section.

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Subd. 5. No waiver. The rights established under this section for the benefit of residents do not limit any other rights available under other law. No facility may request or require that any resident waive the resident's rights at any time for any reason, including as a condition of admission to the facility. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 30,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 30, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 30, the effective date. 144G.56 TRANSFER OF RESIDENTS WITHIN FACILITY. Subdivision 1. Definition. For the purposes of this section, "transfer" means a move of a resident within the facility to a different room or other private living unit. Subd. 2. Orderly transfer. A facility must provide for the safe, orderly, coordinated, and appropriate transfer of residents within the facility. Subd. 3. Notice required. (a) A facility must provide at least 30 calendar days' advance written notice to the resident and the resident's legal and designated representative of a facility-initiated transfer. The notice must include: (1) the effective date of the proposed transfer; (2) the proposed transfer location; (3) a statement that the resident may refuse the proposed transfer, and may discuss any consequences of a refusal with staff of the facility; (4) the name and contact information of a person employed by the facility with whom the resident may discuss the notice of transfer; and (5) contact information for the Office of Ombudsman for Long-Term Care. (b) Notwithstanding paragraph (a), a facility may conduct a facility-initiated transfer of a resident with less than 30 days' written notice if the transfer is necessary due to: (1) conditions that render the resident's room or private living unit uninhabitable; (2) the resident's urgent medical needs; or (3) a risk to the health or safety of another resident of the facility. Subd. 4. Consent required. The facility may not transfer a resident without first obtaining the resident's consent to the transfer unless: (1) there are conditions that render the resident's room or private living unit uninhabitable; or (2) there is a change in facility operations as described in subdivision 5. Subd. 5. Changes in facility operations. (a) In situations where there is a curtailment, reduction, or capital improvement within a facility necessitating transfers, the facility must: (1) minimize the number of transfers it initiates to complete the project or change in operations; (2) consider individual resident needs and preferences;

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(3) provide reasonable accommodations for individual resident requests regarding the transfers; and (4) in advance of any notice to any residents, legal representatives, or designated representatives, provide notice to the Office of Ombudsman for Long-Term Care and, when appropriate, the Office of Ombudsman for Mental Health and Developmental Disabilities of the curtailment, reduction, or capital improvement and the corresponding needed transfers. Subd. 6. Evaluation. If a resident consents to a transfer, reasonable modifications must be made to the new room or private living unit that are necessary to accommodate the resident's disabilities. The facility must evaluate the resident's individual needs before deciding whether the room or unit to which the resident will be moved is appropriate to the resident's psychological, cognitive, and health care needs, including the accessibility of the bathroom. Subd. 7. Disclosure. When entering into the assisted living contract, the facility must provide a conspicuous notice of the circumstance under which the facility may require a transfer, including any transfer that may be required if the resident will be receiving housing support under section 256I.06. History: 2019 c 60 art 1 s 14,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 14, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 14, the effective date. 144G.57 PLANNED CLOSURES. Subdivision 1. Closure plan required. In the event that an assisted living facility elects to voluntarily close the facility, the facility must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing by submitting a proposed closure plan. Subd. 2. Content of closure plan. The facility's proposed closure plan must include: (1) the procedures and actions the facility will implement to notify residents of the closure, including a copy of the written notice to be given to residents, designated representatives, legal representatives, and family and other resident contacts; (2) the procedures and actions the facility will implement to ensure all residents receive appropriate termination planning in accordance with section 144G.55, and final accountings and returns under section 144G.42, subdivision 5; (3) assessments of the needs and preferences of individual residents; and (4) procedures and actions the facility will implement to maintain compliance with this chapter until all residents have relocated. Subd. 3. Commissioner's approval required prior to implementation. (a) The plan shall be subject to the commissioner's approval and subdivision 6. The facility shall take no action to close the residence prior to the commissioner's approval of the plan. The commissioner shall approve or otherwise respond to the plan as soon as practicable. (b) The commissioner may require the facility to work with a transitional team comprised of department staff, staff of the Office of Ombudsman for Long-Term Care, and other professionals the commissioner deems necessary to assist in the proper relocation of residents.

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Subd. 4. Termination planning and final accounting requirements. Prior to termination, the facility must follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5, for residents. The facility must implement the plan approved by the commissioner and ensure that arrangements for relocation and continued care that meet each resident's social, emotional, and health needs are effectuated prior to closure. Subd. 5. Notice to residents. After the commissioner has approved the relocation plan and at least 60 calendar days before closing, except as provided under subdivision 6, the facility must notify residents, designated representatives, and legal representatives of the closure, the proposed date of closure, the contact information of the ombudsman for long-term care, and that the facility will follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must also provide this information to the resident's case manager. Subd. 6. Emergency closures. (a) In the event the facility must close because the commissioner deems the facility can no longer remain open, the facility must meet all requirements in subdivisions 1 to 5, except for any requirements the commissioner finds would endanger the health and safety of residents. In the event the commissioner determines a closure must occur with less than 60 calendar days' notice, the facility shall provide notice to residents as soon as practicable or as directed by the commissioner. (b) Upon request from the commissioner, the facility must provide the commissioner with any documentation related to the appropriateness of its relocation plan, or to any assertion that the facility lacks the funds to comply with subdivisions 1 to 5, or that remaining open would otherwise endanger the health and safety of residents pursuant to paragraph (a). Subd. 7. Other rights. Nothing in this section affects the rights and remedies available under chapter 504B. Subd. 8. Fine. The commissioner may impose a fine for failure to follow the requirements of this section. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 33,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 33, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 33, the effective date. STAFFING REQUIREMENTS 144G.60 STAFFING REQUIREMENTS. Subdivision 1. Background studies required. (a) Employees, contractors, and regularly scheduled volunteers of the facility are subject to the background study required by section 144.057 and may be disqualified under chapter 245C. Nothing in this subdivision shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) Data collected under this subdivision shall be classified as private data on individuals under section 13.02, subdivision 12. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits.

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Subd. 2. Qualifications, training, and competency. All staff persons providing assisted living services must be trained and competent in the provision of services consistent with current practice standards appropriate to the resident's needs, and promote and be trained to support the assisted living bill of rights. Subd. 3. Licensed health professionals and nurses. (a) Licensed health professionals and nurses providing services as employees of a licensed facility must possess a current Minnesota license or registration to practice. (b) Licensed health professionals and registered nurses must be competent in assessing resident needs, planning appropriate services to meet resident needs, implementing services, and supervising staff if assigned. (c) Nothing in this section limits or expands the rights of nurses or licensed health professionals to provide services within the scope of their licenses or registrations, as provided by law. Subd. 4. Unlicensed personnel. (a) Unlicensed personnel providing assisted living services must have: (1) successfully completed a training and competency evaluation appropriate to the services provided by the facility and the topics listed in section 144G.61, subdivision 2, paragraph (a); or (2) demonstrated competency by satisfactorily completing a written or oral test on the tasks the unlicensed personnel will perform and on the topics listed in section 144G.61, subdivision 2, paragraph (a); and successfully demonstrated competency on topics in section 144G.61, subdivision 2, paragraph (a), clauses (5), (7), and (8), by a practical skills test. Unlicensed personnel who only provide assisted living services listed in section 144G.08, subdivision 9, clauses (1) to (5), shall not perform delegated nursing or therapy tasks. (b) Unlicensed personnel performing delegated nursing tasks in an assisted living facility must: (1) have successfully completed training and demonstrated competency by successfully completing a written or oral test of the topics in section 144G.61, subdivision 2, paragraphs (a) and (b), and a practical skills test on tasks listed in section 144G.61, subdivision 2, paragraphs (a), clauses (5) and (7), and (b), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; (2) satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36; or (3) have, before April 19, 1993, completed a training course for nursing assistants that was approved by the commissioner. (c) Unlicensed personnel performing therapy or treatment tasks delegated or assigned by a licensed health professional must meet the requirements for delegated tasks in section 144G.62, subdivision 2, paragraph (a), and any other training or competency requirements within the licensed health professional's scope of practice relating to delegation or assignment of tasks to unlicensed personnel. Subd. 5. Temporary staff. When a facility contracts with a temporary staffing agency, those individuals must meet the same requirements required by this section for personnel employed by the facility and shall be treated as if they are staff of the facility. History: 2019 c 60 art 1 s 7,16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 7 and 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 7 and 16, the effective dates.

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144G.61 STAFF COMPETENCY EVALUATIONS. Subdivision 1. Instructor and competency evaluation requirements. Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be conducted by individuals with work experience and training in providing these services; and (2) training and competency evaluations of unlicensed personnel providing assisted living services must be conducted by a registered nurse, or another instructor may provide training in conjunction with the registered nurse. Subd. 2. Training and evaluation of unlicensed personnel. (a) Training and competency evaluations for all unlicensed personnel must include the following: (1) documentation requirements for all services provided; (2) reports of changes in the resident's condition to the supervisor designated by the facility; (3) basic infection control, including blood-borne pathogens; (4) maintenance of a clean and safe environment; (5) appropriate and safe techniques in personal hygiene and grooming, including: (i) hair care and bathing; (ii) care of teeth, gums, and oral prosthetic devices; (iii) care and use of hearing aids; and (iv) dressing and assisting with toileting; (6) training on the prevention of falls; (7) standby assistance techniques and how to perform them; (8) medication, exercise, and treatment reminders; (9) basic nutrition, meal preparation, food safety, and assistance with eating; (10) preparation of modified diets as ordered by a licensed health professional; (11) communication skills that include preserving the dignity of the resident and showing respect for the resident and the resident's preferences, cultural background, and family; (12) awareness of confidentiality and privacy; (13) understanding appropriate boundaries between staff and residents and the resident's family; (14) procedures to use in handling various emergency situations; and (15) awareness of commonly used health technology equipment and assistive devices. (b) In addition to paragraph (a), training and competency evaluation for unlicensed personnel providing assisted living services must include:

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(1) observing, reporting, and documenting resident status; (2) basic knowledge of body functioning and changes in body functioning, injuries, or other observed changes that must be reported to appropriate personnel; (3) reading and recording temperature, pulse, and respirations of the resident; (4) recognizing physical, emotional, cognitive, and developmental needs of the resident; (5) safe transfer techniques and ambulation; (6) range of motioning and positioning; and (7) administering medications or treatments as required. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.62 DELEGATION AND SUPERVISION. Subdivision 1. Availability of contact person to staff. (a) Assisted living facilities must have a registered nurse available for consultation by staff performing delegated nursing tasks and must have an appropriate licensed health professional available if performing other delegated services such as therapies. (b) The appropriate contact person must be readily available either in person, by telephone, or by other means to the staff at times when the staff is providing services. Subd. 2. Delegation of assisted living services. (a) A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act. The assisted living facility must establish and implement a system to communicate up-to-date information to the registered nurse or licensed health professional regarding the current available staff and their competency so the registered nurse or licensed health professional has sufficient information to determine the appropriateness of delegating tasks to meet individual resident needs and preferences. (b) When the registered nurse or licensed health professional delegates tasks to unlicensed personnel, that person must ensure that prior to the delegation the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each resident and is able to demonstrate the ability to competently follow the procedures and perform the tasks. If an unlicensed personnel has not regularly performed the delegated assisted living task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task to the registered nurse or appropriate licensed health professional. The registered nurse or licensed health professional must document instructions for the delegated tasks in the resident's record. Subd. 3. Supervision of staff. (a) Staff who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be supervised periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions to address issues relating to the staff's ability to provide the services. The supervision of the unlicensed personnel must be done by staff of the facility having the authority, skills, and ability to provide the supervision of unlicensed personnel and who can implement changes as needed, and train staff.

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(b) Supervision includes direct observation of unlicensed personnel while the unlicensed personnel are providing the services and may also include indirect methods of gaining input such as gathering feedback from the resident. Supervisory review of staff must be provided at a frequency based on the staff person's competency and performance. Subd. 4. Supervision of staff providing delegated nursing or therapy tasks. (a) Staff who perform delegated nursing or therapy tasks must be supervised by an appropriate licensed health professional or a registered nurse according to the assisted living facility's policy where the services are being provided to verify that the work is being performed competently and to identify problems and solutions related to the staff person's ability to perform the tasks. Supervision of staff performing medication or treatment administration shall be provided by a registered nurse or appropriate licensed health professional and must include observation of the staff administering the medication or treatment and the interaction with the resident. (b) The direct supervision of staff performing delegated tasks must be provided within 30 calendar days after the date on which the individual begins working for the facility and first performs the delegated tasks for residents and thereafter as needed based on performance. This requirement also applies to staff who have not performed delegated tasks for one year or longer. Subd. 5. Documentation. A facility must retain documentation of supervision activities in the personnel records. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.63 ORIENTATION AND ANNUAL TRAINING REQUIREMENTS. Subdivision 1. Orientation of staff and supervisors. All staff providing and supervising direct services must complete an orientation to assisted living facility licensing requirements and regulations before providing assisted living services to residents. The orientation may be incorporated into the training required under subdivision 5. The orientation need only be completed once for each staff person and is not transferable to another facility. Subd. 2. Content of required orientation. (a) The orientation must contain the following topics: (1) an overview of this chapter; (2) an introduction and review of the facility's policies and procedures related to the provision of assisted living services by the individual staff person; (3) handling of emergencies and use of emergency services; (4) compliance with and reporting of the maltreatment of vulnerable adults under section 626.557 to the Minnesota Adult Abuse Reporting Center (MAARC); (5) the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person;

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(7) handling of residents' complaints, reporting of complaints, and where to report complaints, including information on the Office of Health Facility Complaints; (8) consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county-managed care advocates, or other relevant advocacy services; and (9) a review of the types of assisted living services the employee will be providing and the facility's category of licensure. (b) In addition to the topics in paragraph (a), orientation may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and the challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 3. Orientation to resident. Staff providing assisted living services must be oriented specifically to each individual resident and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically. Subd. 4. Training required relating to dementia. All direct care staff and supervisors providing direct services must demonstrate an understanding of the training specified in section 144G.64. Subd. 5. Required annual training. (a) All staff that perform direct services must complete at least eight hours of annual training for each 12 months of employment. The training may be obtained from the facility or another source and must include topics relevant to the provision of assisted living services. The annual training must include: (1) training on reporting of maltreatment of vulnerable adults under section 626.557; (2) review of the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (3) review of infection control techniques used in the home and implementation of infection control standards including a review of hand washing techniques; the need for and use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable equipment; disinfecting environmental surfaces; and reporting communicable diseases; (4) effective approaches to use to problem solve when working with a resident's challenging behaviors, and how to communicate with residents who have dementia, Alzheimer's disease, or related disorders; (5) review of the facility's policies and procedures relating to the provision of assisted living services and how to implement those policies and procedures; and

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(6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person. (b) In addition to the topics in paragraph (a), annual training may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) the health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 6. Implementation. The assisted living facility must implement all orientation and training topics covered in this section. Subd. 7. Verification and documentation of orientation and training. The assisted living facility shall retain evidence in the employee record of each staff person having completed the orientation and training required by this section. History: 2019 c 60 art 1 s 22,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 22, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 22, the effective date. 144G.64 TRAINING IN DEMENTIA CARE REQUIRED. (a) All assisted living facilities must meet the following training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) for assisted living facilities with dementia care, direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 80 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with

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the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (4) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (5) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and other dementias; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; (4) communication skills; and (5) person-centered planning and service delivery. (c) The facility shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. History: 2019 c 60 art 1 s 23,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 23, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 23, the effective date. SERVICES 144G.70 SERVICES. Subdivision 1. Acceptance of residents. An assisted living facility may not accept a person as a resident unless the facility has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the assisted living contract. Subd. 2. Initial reviews, assessments, and monitoring. (a) Residents who are not receiving any services shall not be required to undergo an initial nursing assessment. (b) An assisted living facility shall conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a temporary service plan prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. If necessitated by either the geographic distance between the prospective resident and the facility, or urgent or unexpected circumstances, the assessment may be conducted using telecommunication methods based on practice standards that meet the resident's needs and reflect person-centered planning and care delivery. (c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. Ongoing resident reassessment and monitoring must be conducted as needed based

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on changes in the needs of the resident and cannot exceed 90 calendar days from the last date of the assessment. (d) For residents only receiving assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review of the resident's needs and preferences. The initial review must be completed within 30 calendar days of the start of services. Resident monitoring and review must be conducted as needed based on changes in the needs of the resident and cannot exceed 90 calendar days from the date of the last review. (e) A facility must inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. Subd. 3. Temporary service plan. When a facility initiates services and the individualized assessment required in subdivision 2 has not been completed, the facility must complete a temporary plan and agreement with the resident for services. A temporary service plan shall not be effective for more than 72 hours. Subd. 4. Service plan, implementation, and revisions to service plan. (a) No later than 14 calendar days after the date that services are first provided, an assisted living facility shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the facility and by the resident documenting agreement on the services to be provided. The service plan must be revised, if needed, based on resident reassessment under subdivision 2. The facility must provide information to the resident about changes to the facility's fee for services and how to contact the Office of Ombudsman for Long-Term Care. (c) The facility must implement and provide all services required by the current service plan. (d) The service plan and the revised service plan must be entered into the resident record, including notice of a change in a resident's fees when applicable. (e) Staff providing services must be informed of the current written service plan. (f) The service plan must include: (1) a description of the services to be provided, the fees for services, and the frequency of each service, according to the resident's current assessment and resident preferences; (2) the identification of staff or categories of staff who will provide the services; (3) the schedule and methods of monitoring assessments of the resident; (4) the schedule and methods of monitoring staff providing services; and (5) a contingency plan that includes: (i) the action to be taken if the scheduled service cannot be provided; (ii) information and a method to contact the facility;

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(iii) the names and contact information of persons the resident wishes to have notified in an emergency or if there is a significant adverse change in the resident's condition, including identification of and information as to who has authority to sign for the resident in an emergency; and (iv) the circumstances in which emergency medical services are not to be summoned consistent with chapters 145B and 145C, and declarations made by the resident under those chapters. Subd. 5. Referrals. If a facility reasonably believes that a resident is in need of another medical or health service, including a licensed health professional, or social service provider, the facility shall: (1) determine the resident's preferences with respect to obtaining the service; and (2) inform the resident of the resources available, if known, to assist the resident in obtaining services. Subd. 6. Medical cannabis. Assisted living facilities may exercise the authority and are subject to the protections in section 152.34. Subd. 7. Request for discontinuation of life-sustaining treatment. (a) If a resident, family member, or other caregiver of the resident requests that an employee or other agent of the facility discontinue a life-sustaining treatment, the employee or agent receiving the request: (1) shall take no action to discontinue the treatment; and (2) shall promptly inform the supervisor or other agent of the facility of the resident's request. (b) Upon being informed of a request for discontinuance of treatment, the facility shall promptly: (1) inform the resident that the request will be made known to the physician or advanced practice registered nurse who ordered the resident's treatment; (2) inform the physician or advanced practice registered nurse of the resident's request; and (3) work with the resident and the resident's physician or advanced practice registered nurse to comply with chapter 145C. (c) This section does not require the facility to discontinue treatment, except as may be required by law or court order. (d) This section does not diminish the rights of residents to control their treatments, refuse services, or terminate their relationships with the facility. (e) This section shall be construed in a manner consistent with chapter 145B or 145C, whichever applies, and declarations made by residents under those chapters. History: 2019 c 60 art 1 s 18,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 18, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 18, the effective date. 144G.71 MEDICATION MANAGEMENT. Subdivision 1. Medication management services. (a) This section applies only to assisted living facilities that provide medication management services.

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(b) An assisted living facility that provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines. (c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and resident and legal and designated representatives; disposing of unused medications; and educating residents and legal and designated representatives about medications. When controlled substances are being managed, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 23. Subd. 2. Provision of medication management services. (a) For each resident who requests medication management services, the facility shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the resident. The assessment must include an identification and review of all medications the resident is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. (b) The assessment must identify interventions needed in management of medications to prevent diversion of medication by the resident or others who may have access to the medications and provide instructions to the resident and legal or designated representatives on interventions to manage the resident's medications and prevent diversion of medications. For purposes of this section, "diversion of medication" means misuse, theft, or illegal or improper disposition of medications. Subd. 3. Individualized medication monitoring and reassessment. The assisted living facility must monitor and reassess the resident's medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually. Subd. 4. Resident refusal. The assisted living facility must document in the resident's record any refusal for an assessment for medication management by the resident. The facility must discuss with the resident the possible consequences of the resident's refusal and document the discussion in the resident's record. Subd. 5. Individualized medication management plan. (a) For each resident receiving medication management services, the assisted living facility must prepare and include in the service plan a written statement of the medication management services that will be provided to the resident. The facility must develop and maintain a current individualized medication management record for each resident based on the resident's assessment that must contain the following: (1) a statement describing the medication management services that will be provided; (2) a description of storage of medications based on the resident's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; (3) documentation of specific resident instructions relating to the administration of medications;

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(4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; (5) identification of medication management tasks that may be delegated to unlicensed personnel; (6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and (7) any resident-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions. (b) The medication management record must be current and updated when there are any changes. (c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Subd. 6. Administration of medication. Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse. Subd. 7. Delegation of medication administration. When administration of medications is delegated to unlicensed personnel, the assisted living facility must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's records; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 8. Documentation of administration of medications. Each medication administered by the assisted living facility staff must be documented in the resident's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the resident's needs when medication was not administered as prescribed and in compliance with the resident's medication management plan. Subd. 9. Documentation of medication setup. Documentation of dates of medication setup, name of medication, quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup. Subd. 10. Medication management for residents who will be away from home. (a) An assisted living facility that is providing medication management services to the resident must develop and implement policies and procedures for giving accurate and current medications to residents for planned or unplanned times away from home according to the resident's individualized medication management plan. The policies and procedures must state that: (1) for planned time away, the medications must be obtained from the pharmacy or set up by the licensed nurse according to appropriate state and federal laws and nursing standards of practice;

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(2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall provide medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days; (3) the resident must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; and (4) the medications must be placed in a medication container or containers appropriate to the provider's medication system and must be labeled with the resident's name and the dates and times that the medications are scheduled. (b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if: (1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to residents; and (2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the resident. The procedures must address: (i) the type of container or containers to be used for the medications appropriate to the provider's medication system; (ii) how the container or containers must be labeled; (iii) written information about the medications to be provided; (iv) how the unlicensed staff must document in the resident's record that medications have been provided, including documenting the date the medications were provided and who received the medications, the person who provided the medications to the resident, the number of medications that were provided to the resident, and other required information; (v) how the registered nurse shall be notified that medications have been provided and whether the registered nurse needs to be contacted before the medications are given to the resident or the designated representative; (vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and (vii) how the unlicensed personnel must document in the resident's record any unused medications that are returned to the facility, including the name of each medication and the doses of each returned medication. Subd. 11. Prescribed and nonprescribed medication. The assisted living facility must determine whether the facility shall require a prescription for all medications the provider manages. The facility must inform the resident whether the facility requires a prescription for all over-the-counter and dietary supplements before the facility agrees to manage those medications. Subd. 12. Medications; over-the-counter drugs; dietary supplements not prescribed. An assisted living facility providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The facility must verify that the medications are up to date and stored as appropriate.

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Subd. 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the assisted living facility is managing for the resident. Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152. Subd. 15. Verbal prescription orders. Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200. Subd. 16. Written or electronic prescription. When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the resident's record. Subd. 17. Records confidential. A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44. Subd. 18. Medications provided by resident or family members. When the assisted living facility is aware of any medications or dietary supplements that are being used by the resident and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the resident record. Subd. 19. Storage of medications. An assisted living facility must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access. Subd. 20. Prescription drugs. A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug. Subd. 21. Prohibitions. No prescription drug supply for one resident may be used or saved for use by anyone other than the resident. Subd. 22. Disposition of medications. (a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident's service plan ends or medication management services are no longer part of the service plan. Medications for a resident who is deceased or that have been discontinued or have expired may be provided for disposal. (b) The facility shall dispose of any medications remaining with the facility that are discontinued or expired or upon the termination of the service contract or the resident's death according to state and federal regulations for disposition of medications and controlled substances. (c) Upon disposition, the facility must document in the resident's record the disposition of the medication including the medication's name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition. Subd. 23. Loss or spillage. (a) Assisted living facilities providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation

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must be made in the resident's record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations. (b) The procedures must require that the facility providing medication management investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records. History: 2019 c 60 art 1 s 19,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 19, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 19, the effective date. 144G.72 TREATMENT AND THERAPY MANAGEMENT SERVICES. Subdivision 1. Treatment and therapy management services. This section applies only to assisted living facilities that provide treatment and therapy management services. Subd. 2. Policies and procedures. (a) An assisted living facility that provides treatment and therapy management services must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse or appropriate licensed health professional consistent with current practice standards and guidelines. (b) The written policies and procedures must address requesting and receiving orders or prescriptions for treatments or therapies, providing the treatment or therapy, documenting treatment or therapy activities, educating and communicating with residents about treatments or therapies they are receiving, monitoring and evaluating the treatment or therapy, and communicating with the prescriber. Subd. 3. Individualized treatment or therapy management plan. For each resident receiving management of ordered or prescribed treatments or therapy services, the assisted living facility must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the resident. The facility must also develop and maintain a current individualized treatment and therapy management record for each resident which must contain at least the following: (1) a statement of the type of services that will be provided; (2) documentation of specific resident instructions relating to the treatments or therapy administration; (3) identification of treatment or therapy tasks that will be delegated to unlicensed personnel; (4) procedures for notifying a registered nurse or appropriate licensed health professional when a problem arises with treatments or therapy services; and (5) any resident-specific requirements relating to documentation of treatment and therapy received, verification that all treatment and therapy was administered as prescribed, and monitoring of treatment or therapy to prevent possible complications or adverse reactions. The treatment or therapy management record must be current and updated when there are any changes. Subd. 4. Administration of treatments and therapy. Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health professional according to the appropriate practice standards for delegation or assignment. When administration

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of a treatment or therapy is delegated or assigned to unlicensed personnel, the facility must ensure that the registered nurse or authorized licensed health professional has: (1) instructed the unlicensed personnel in the proper methods with respect to each resident and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's record; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 5. Documentation of administration of treatments and therapies. Each treatment or therapy administered by an assisted living facility must be in the resident record. The documentation must include the signature and title of the person who administered the treatment or therapy and must include the date and time of administration. When treatment or therapies are not administered as ordered or prescribed, the provider must document the reason why it was not administered and any follow-up procedures that were provided to meet the resident's needs. Subd. 6. Treatment and therapy orders. There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. The order must contain the name of the resident, a description of the treatment or therapy to be provided, and the frequency, duration, and other information needed to administer the treatment or therapy. Treatment and therapy orders must be renewed at least every 12 months. Subd. 7. Right to outside service provider; other payors. Under section 144G.91, a resident is free to retain therapy and treatment services from an off-site service provider. Assisted living facilities must make every effort to assist residents in obtaining information regarding whether the Medicare program, the medical assistance program under chapter 256B, or another public program will pay for any or all of the services. History: 2019 c 60 art 1 s 20,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 20, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 20, the effective date. ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80 ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. Applicability. This section applies only to assisted living facilities with dementia care. Subd. 2. Demonstrated capacity. (a) An applicant for licensure as an assisted living facility with dementia care must have the ability to provide services in a manner that is consistent with the requirements in this section. The commissioner shall consider the following criteria, including, but not limited to: (1) the experience of the applicant in managing residents with dementia or previous long-term care experience; and (2) the compliance history of the applicant in the operation of any care facility licensed, certified, or registered under federal or state law.

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(b) If the applicant does not have experience in managing residents with dementia, the applicant must employ a consultant for at least the first six months of operation. The consultant must meet the requirements in paragraph (a), clause (1), and make recommendations on providing dementia care services consistent with the requirements of this chapter. The consultant must (1) have two years of work experience related to dementia, health care, gerontology, or a related field, and (2) have completed at least the minimum core training requirements in section 144G.64. The applicant must document an acceptable plan to address the consultant's identified concerns and must either implement the recommendations or document in the plan any consultant recommendations that the applicant chooses not to implement. The commissioner must review the applicant's plan upon request. (c) The commissioner shall conduct an on-site inspection prior to the issuance of an assisted living facility with dementia care license to ensure compliance with the physical environment requirements. (d) The label "Assisted Living Facility with Dementia Care" must be identified on the license. Subd. 3. Relinquishing license. (a) The licensee must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing at least 60 calendar days prior to the voluntary relinquishment of an assisted living facility with dementia care license. For voluntary relinquishment, the facility must at least: (1) give all residents and their designated and legal representatives 60 calendar days' notice. The notice must include at a minimum: (i) the proposed effective date of the relinquishment; (ii) changes in staffing; (iii) changes in services including the elimination or addition of services; (iv) staff training that shall occur when the relinquishment becomes effective; and (v) contact information for the Office of Ombudsman for Long-Term Care; (2) submit a transitional plan to the commissioner demonstrating how the current residents shall be evaluated and assessed to reside in other housing settings that are not an assisted living facility with dementia care, that are physically unsecured, or that would require move-out or transfer to other settings; (3) change service or care plans as appropriate to address any needs the residents may have with the transition; (4) notify the commissioner when the relinquishment process has been completed; and (5) revise advertising materials and disclosure information to remove any reference that the facility is an assisted living facility with dementia care. (b) Nothing in this section alters obligations under section 144G.57. History: 2019 c 60 art 1 s 47; art 2 s 1 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 1, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 1, the effective date.

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144G.81 ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS. Subdivision 1. Fire protection and physical environment. An assisted living facility with dementia care that has a secured dementia care unit must meet the requirements of section 144G.45 and the following additional requirements: (1) a hazard vulnerability assessment or safety risk must be performed on and around the property. The hazards indicated on the assessment must be assessed and mitigated to protect the residents from harm; and (2) the facility shall be protected throughout by an approved supervised automatic sprinkler system by August 1, 2029. Subd. 2. Fire drills. Fire drills in secured dementia care units in assisted living facilities with dementia care shall be conducted in accordance with the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. Subd. 3. Assisted living facilities with dementia care and secured dementia care unit; Life Safety Code. (a) All assisted living facilities with dementia care and a secured dementia care unit must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. The minimum design standards shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities with dementia care and a secured dementia care unit beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which these facilities must comply with the updated Life Safety Code. The date by which these facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 4. Awake staff requirement. An assisted living facility with dementia care providing services in a secured dementia care unit must have an awake person who is physically present in the secured dementia care unit 24 hours per day, seven days per week, who is responsible for responding to the requests of residents for assistance with health and safety needs, and who meets the requirements of section 144G.41, subdivision 1, clause (12). Subd. 5. Variance or waiver. A facility may request under section 144G.45, subdivision 7, that the commissioner grant a variance or waiver from the provisions of this section, except subdivision 4. History: 2019 c 60 art 1 s 11,25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 11 and 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 11 and 25, the effective dates. 144G.82 ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. The licensee of an assisted living facility with dementia care is responsible for the care and housing of the persons with dementia and the provision of person-centered care that promotes

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each resident's dignity, independence, and comfort. This includes the supervision, training, and overall conduct of the staff. Subd. 2. Additional requirements. (a) The licensee must follow the assisted living license requirements and the criteria in this section. (b) The assisted living director of an assisted living facility with dementia care must complete and document that at least ten hours of the required annual continuing educational requirements relate to the care of individuals with dementia. The training must include medical management of dementia, creating and maintaining supportive and therapeutic environments for residents with dementia, and transitioning and coordinating services for residents with dementia. Continuing education credits may include college courses, preceptor credits, self-directed activities, course instructor credits, corporate training, in-service training, professional association training, web-based training, correspondence courses, telecourses, seminars, and workshops. Subd. 3. Policies. (a) In addition to the policies and procedures required in the licensing of all facilities, the assisted living facility with dementia care licensee must develop and implement policies and procedures that address the: (1) philosophy of how services are provided based upon the assisted living facility licensee's values, mission, and promotion of person-centered care and how the philosophy shall be implemented; (2) evaluation of behavioral symptoms and design of supports for intervention plans, including nonpharmacological practices that are person-centered and evidence-informed; (3) wandering and egress prevention that provides detailed instructions to staff in the event a resident elopes; (4) medication management, including an assessment of residents for the use and effects of medications, including psychotropic medications; (5) staff training specific to dementia care; (6) description of life enrichment programs and how activities are implemented; (7) description of family support programs and efforts to keep the family engaged; (8) limiting the use of public address and intercom systems for emergencies and evacuation drills only; (9) transportation coordination and assistance to and from outside medical appointments; and (10) safekeeping of residents' possessions. (b) The policies and procedures must be provided to residents and the residents' legal and designated representatives at the time of move-in. History: 2019 c 60 art 1 s 47; art 2 s 2 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 2, the effective date.

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144G.83 ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. (a) An assisted living facility with dementia care must provide residents with dementia-trained staff who have been instructed in the person-centered care approach. All direct care staff assigned to care for residents with dementia must be specially trained to work with residents with Alzheimer's disease and other dementias. (b) Only staff trained as specified in subdivisions 2 and 3 shall be assigned to care for dementia residents. (c) Staffing levels must be sufficient to meet the scheduled and unscheduled needs of residents. Staffing levels during nighttime hours shall be based on the sleep patterns and needs of residents. (d) In an emergency situation when trained staff are not available to provide services, the facility may assign staff who have not completed the required training. The particular emergency situation must be documented and must address: (1) the nature of the emergency; (2) how long the emergency lasted; and (3) the names and positions of staff that provided coverage. Subd. 2. Staffing requirements. (a) The licensee must ensure that staff who provide support to residents with dementia can demonstrate a basic understanding and ability to apply dementia training to the residents' emotional and unique health care needs using person-centered planning delivery. Direct care dementia-trained staff and other staff must be trained on the topics identified during the expedited rulemaking process. These requirements are in addition to the licensing requirements for training. (b) Failure to comply with paragraph (a) or subdivision 1 shall result in a fine under section 144G.31. Subd. 3. Supervising staff training. Persons providing or overseeing staff training must have experience and knowledge in the care of individuals with dementia, including: (1) two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or another related field; and (2) completion of training equivalent to the requirements in this section and successfully passing a skills competency or knowledge test required by the commissioner. Subd. 4. Preservice and in-service training. Preservice and in-service training may include various methods of instruction, such as classroom style, web-based training, video, or one-to-one training. The licensee must have a method for determining and documenting each staff person's knowledge and understanding of the training provided. All training must be documented. History: 2019 c 60 art 1 s 47; art 2 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 3, the effective date. 144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA. (a) In addition to the minimum services required in section 144G.41, an assisted living facility with dementia care must also provide the following services:

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(1) assistance with activities of daily living that address the needs of each resident with dementia due to cognitive or physical limitations. These services must meet or be in addition to the requirements in the licensing rules for the facility. Services must be provided in a person-centered manner that promotes resident choice, dignity, and sustains the resident's abilities; (2) nonpharmacological practices that are person-centered and evidence-informed; (3) services to prepare and educate persons living with dementia and their legal and designated representatives about transitions in care and ensuring complete, timely communication between, across, and within settings; and (4) services that provide residents with choices for meaningful engagement with other facility residents and the broader community. (b) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (1) past and current interests; (2) current abilities and skills; (3) emotional and social needs and patterns; (4) physical abilities and limitations; (5) adaptations necessary for the resident to participate; and (6) identification of activities for behavioral interventions. (c) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident's activity preferences and needs. (d) A selection of daily structured and non-structured activities must be provided and included on the resident's activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (1) occupation or chore related tasks; (2) scheduled and planned events such as entertainment or outings; (3) spontaneous activities for enjoyment or those that may help defuse a behavior; (4) one-to-one activities that encourage positive relationships between residents and staff such as telling a life story, reminiscing, or playing music; (5) spiritual, creative, and intellectual activities; (6) sensory stimulation activities; (7) physical activities that enhance or maintain a resident's ability to ambulate or move; and (8) outdoor activities. (e) Behavioral symptoms that negatively impact the resident and others in the assisted living facility with dementia care must be evaluated and included on the service or care plan. The staff must initiate and coordinate outside consultation or acute care when indicated.

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(f) Support must be offered to family and other significant relationships on a regularly scheduled basis but not less than quarterly. (g) Access to secured outdoor space and walkways that allow residents to enter and return without staff assistance must be provided. History: 2019 c 60 art 1 s 47; art 2 s 4 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 4, the effective date. RESIDENT RIGHTS AND PROTECTIONS 144G.90 REQUIRED NOTICES. Subdivision 1. Assisted living bill of rights; notification to resident. (a) An assisted living facility must provide the resident a written notice of the rights under section 144G.91 before the initiation of services to that resident. The facility shall make all reasonable efforts to provide notice of the rights to the resident in a language the resident can understand. (b) In addition to the text of the assisted living bill of rights in section 144G.91, the notice shall also contain the following statement describing how to file a complaint or report suspected abuse: "If you want to report suspected abuse, neglect, or financial exploitation, you may contact the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about the facility or person providing your services, you may contact the Office of Health Facility Complaints, Minnesota Department of Health. You may also contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities." (c) The statement must include contact information for the Minnesota Adult Abuse Reporting Center and the telephone number, website address, e-mail address, mailing address, and street address of the Office of Health Facility Complaints at the Minnesota Department of Health, the Office of Ombudsman for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities. The statement must include the facility's name, address, e-mail, telephone number, and name or title of the person at the facility to whom problems or complaints may be directed. It must also include a statement that the facility will not retaliate because of a complaint. (d) A facility must obtain written acknowledgment from the resident of the resident's receipt of the assisted living bill of rights or shall document why an acknowledgment cannot be obtained. Acknowledgment of receipt shall be retained in the resident's record. Subd. 2. Notices in plain language; language accommodations. A facility must provide all notices in plain language that residents can understand and make reasonable accommodations for residents who have communication disabilities and those whose primary language is a language other than English. Subd. 3. Notice of dementia training. An assisted living facility with dementia care shall make available in written or electronic form, to residents and families or other persons who request it, a description of the training program and related training it provides, including the categories of employees trained, the frequency of training, and the basic topics covered. A hard copy of this notice must be provided upon request.

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Subd. 4. Notice of available assistance. A facility shall provide each resident with identifying and contact information about the persons who can assist with health care or supportive services being provided. A facility shall keep each resident informed of changes in the personnel referenced in this subdivision. Subd. 5. Notice to residents; change in ownership or management. (a) A facility must provide written notice to the resident, legal representative, or designated representative of a change of ownership within seven calendar days after the facility receives a new license. (b) A facility must provide prompt written notice to the resident, legal representative, or designated representative, of any change of legal name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the manager of the facility, if applicable; and (2) the authorized agent. History: 2019 c 60 art 1 s 17,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 17, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 17, the effective date. 144G.91 ASSISTED LIVING BILL OF RIGHTS. Subdivision 1. Applicability. This section applies to residents living in assisted living facilities. Subd. 2. Legislative intent. The rights established under this section for the benefit of residents do not limit any other rights available under law. No facility may request or require that any resident waive any of these rights at any time for any reason, including as a condition of admission to the facility. Subd. 3. Information about rights. Before receiving services, residents have the right to be informed by the facility of the rights granted under this section and the recourse residents have if rights are violated. The information must be in plain language and in terms residents can understand. The facility must make reasonable accommodations for residents who have communication disabilities and those who speak a language other than English. Subd. 4. Appropriate care and services. (a) Residents have the right to care and assisted living services that are appropriate based on the resident's needs and according to an up-to-date service plan subject to accepted health care standards. (b) Residents have the right to receive health care and other assisted living services with continuity from people who are properly trained and competent to perform their duties and in sufficient numbers to adequately provide the services agreed to in the assisted living contract and the service plan. Subd. 5. Refusal of care or services. Residents have the right to refuse care or assisted living services and to be informed by the facility of the medical, health-related, or psychological consequences of refusing care or services. Subd. 6. Participation in care and service planning. Residents have the right to actively participate in the planning, modification, and evaluation of their care and services. This right includes: (1) the opportunity to discuss care, services, treatment, and alternatives with the appropriate caregivers; (2) the right to include the resident's legal and designated representatives and persons of the resident's choosing; and

Official Publication of the State of Minnesota Revisor of Statutes

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MINNESOTA STATUTES 2020

(3) the right to be told in advance of, and take an active part in decisions regarding, any recommended changes in the service plan. Subd. 7. Courteous treatment. Residents have the right to be treated with courtesy and respect, and to have the resident's property treated with respect. Subd. 8. Freedom from maltreatment. Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act. Subd. 9. Right to come and go freely. Residents have the right to enter and leave the facility as they choose. This right may be restricted only as allowed by other law and consistent with a resident's service plan. Subd. 10. Individual autonomy. Residents have the right to individual autonomy, initiative, and independence in making life choices, including establishing a daily schedule and choosing with whom to interact. Subd. 11. Right to control resources. Residents have the right to control personal resources. Subd. 12. Visitors and social participation. (a) Residents have the right to meet with or receive visits at any time by the resident's family, guardian, conservator, health care agent, attorney, advocate, or religious or social work counselor, or any person of the resident's choosing. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. (b) Residents have the right to engage in community life and in activities of their choice. This includes the right to participate in commercial, religious, social, community, and political activities without interference and at their discretion if the activities do not infringe on the rights of other residents. Subd. 13. Personal and treatment privacy. (a) Residents have the right to consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Staff must respect the privacy of a resident's space by knocking on the door and seeking consent before entering, except in an emergency or where clearly inadvisable or unless otherwise documented in the resident's service plan. (b) Residents have the right to have and use a lockable door to the resident's unit. The facility shall provide locks on the resident's unit. Only a staff member with a specific need to enter the unit shall have keys. This right may be restricted in certain circumstances if necessary for a resident's health and safety and documented in the resident's service plan. (c) Residents have the right to respect and privacy regarding the resident's service plan. Case discussion, consultation, examination, and treatment are confidential and must be conducted discreetly. Privacy must be respected during toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. Subd. 14. Communication privacy. (a) Residents have the right to communicate privately with persons of their choice. (b) If an assisted living facility is sending or receiving mail on behalf of residents, the assisted living facility must do so without interference. (c) Residents must be provided access to a telephone to make and receive calls.

Official Publication of the State of Minnesota Revisor of Statutes

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Subd. 15. Confidentiality of records. (a) Residents have the right to have personal, financial, health, and medical information kept private, to approve or refuse release of information to any outside party, and to be advised of the assisted living facility's policies and procedures regarding disclosure of the information. Residents must be notified when personal records are requested by any outside party. (b) Residents have the right to access their own records. Subd. 16. Right to furnish and decorate. Residents have the right to furnish and decorate the resident's unit within the terms of the assisted living contract. Subd. 17. Right to choose roommate. Residents have the right to choose a roommate if sharing a unit. Subd. 18. Right to access food. Residents have the right to access food at any time. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. Subd. 19. Access to technology. Residents have the right to access Internet service at their expense. Subd. 20. Grievances and inquiries. Residents have the right to make and receive a timely response to a complaint or inquiry, without limitation. Residents have the right to know and every facility must provide the name and contact information of the person representing the facility who is designated to handle and resolve complaints and inquiries. Subd. 21. Access to counsel and advocacy services. Residents have the right to the immediate access by: (1) the resident's legal counsel; (2) any representative of the protection and advocacy system designated by the state under Code of Federal Regulations, title 45, section 1326.21; or (3) any representative of the Office of Ombudsman for Long-Term Care. Subd. 22. Information about charges. Before services are initiated, residents have the right to be notified: (1) of all charges for housing and assisted living services; (2) of any limits on housing and assisted living services available; (3) if known, whether and what amount of payment may be expected from health insurance, public programs, or other sources; and (4) what charges the resident may be responsible for paying. Subd. 23. Information about individuals providing services. Before receiving services identified in the service plan, residents have the right to be told the type and disciplines of staff who will be providing the services, the frequency of visits proposed to be furnished, and other choices that are available for addressing the resident's needs. Subd. 24. Information about other providers and services. Residents have the right to be informed by the assisted living facility, prior to executing an assisted living contract, that other public and private services may be available and that the resident has the right to purchase, contract for, or obtain services from a provider other than the assisted living facility.

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Subd. 25. Resident councils. Residents have the right to organize and participate in resident councils as described in section 144G.41, subdivision 5. Subd. 26. Family councils. Residents have the right to participate in family councils formed by families or residents as described in section 144G.41, subdivision 6. History: 2019 c 60 art 1 s 12,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 12, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 12, the effective date. 144G.911 RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS. The resident's rights in section 144G.91, subdivisions 12, 13, and 18, may be restricted for an individual resident only if determined necessary for health and safety reasons identified by the facility through an initial assessment or reassessment under section 144G.70, subdivision 2, and documented in the written service plan under section 144G.70, subdivision 4. Any restrictions of those rights for people served under chapter 256S and section 256B.49 must be documented by the case manager in the resident's coordinated service and support plan (CSSP), as defined in sections 256B.49, subdivision 15, and 256S.10. Nothing in this section affects other laws applicable to or prohibiting restrictions on the resident's rights in section 144G.91, subdivisions 12, 13, and 18. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.92 RETALIATION PROHIBITED. Subdivision 1. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person acting on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the director or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law; (6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or

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(9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 2. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; or (7) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices. Subd. 3. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken or threatened by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination. Subd. 4. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 2 within 30 days of an initial action described in subdivision 1, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. Subd. 5. Other laws. Nothing in this section affects the rights available to a resident under section 626.557. History: 2019 c 60 art 1 s 42,47

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MINNESOTA STATUTES 2020

NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 42, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 42, the effective date. 144G.93 CONSUMER ADVOCACY AND LEGAL SERVICES. Upon execution of an assisted living contract, every facility must provide the resident with the names and contact information, including telephone numbers and e-mail addresses, of: (1) nonprofit organizations that provide advocacy or legal services to residents including but not limited to the designated protection and advocacy organization in Minnesota that provides advice and representation to individuals with disabilities; and (2) the Office of Ombudsman for Long-Term Care, including both the state and regional contact information. History: 2019 c 60 art 1 s 43,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 43, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 43, the effective date. 144G.95 OFFICE OF OMBUDSMAN FOR LONG-TERM CARE. Subdivision 1. Immunity from liability. The Office of Ombudsman for Long-Term Care and representatives of the office are immune from liability for conduct described in section 256.9742, subdivision 2. Subd. 2. Data classification. All forms and notices received by the Office of Ombudsman for Long-Term Care under this chapter are classified under section 256.9744. History: 2019 c 60 art 1 s 32,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 32, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 32, the effective date. 144G.9999 RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE. Subdivision 1. Establishment. The commissioner shall establish a Resident Quality of Care and Outcomes Improvement Task Force to examine and make recommendations, on an ongoing basis, on how to apply proven safety and quality improvement practices and infrastructure to settings and providers that provide long-term services and supports. Subd. 2. Membership. The task force shall include representation from: (1) nonprofit Minnesota-based organizations dedicated to patient safety or innovation in health care safety and quality; (2) Department of Health staff with expertise in issues related to safety and adverse health events; (3) consumer organizations; (4) direct care providers or their representatives; (5) organizations representing long-term care providers and home care providers in Minnesota; (6) the ombudsman for long-term care or a designee;

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(7) national patient safety experts; and (8) other experts in the safety and quality improvement field. The task force shall have at least one public member who either is or has been a resident in an assisted living setting and one public member who has or had a family member living in an assisted living setting. The membership shall be voluntary except that public members may be reimbursed under section 15.059, subdivision 3. Subd. 3. Recommendations. The task force shall periodically provide recommendations to the commissioner and the legislature on changes needed to promote safety and quality improvement practices in long-term care settings and with long-term care providers. The task force shall meet no fewer than four times per year. The task force shall be established by July 1, 2020. History: 2019 c 60 art 1 s 40,47

Official Publication of the State of Minnesota Revisor of Statutes

Assisted Living Licensure in Minnesota: Frequently Asked Questions November 20, 2020

Background The 2019 Minnesota Legislature enacted a law creating new licensing requirements for assisted living in Minnesota. The new Assisted Living Licensure laws can be found here: 2020 Minnesota Statutes Chapter 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G). Assisted Living Licensure goes into effect Aug. 1, 2021 and applies to: ▪ Current and future facilities providing assisted living services and sleeping accommodations. ▪ Arranged home care providers in a housing with services (HWS) establishment. HWS designation will no longer be available as of Aug. 1, 2021. ▪ Providers of customized living services under the Elderly Waiver (EW), Brain Injury (BI), or Community Access for Disability Inclusion (CADI) waiver (exemptions are listed below). ▪ Organizations planning to provide assisted living services and/or customized living services in Minnesota (exemptions are listed below).

Frequently Asked Questions Basic Information and Instructions How do I know whether or not I need to apply for an Assisted Living License? If you intend to operate a facility that offers sleeping accommodations and assisted living services, either with or without dementia care, on or after Aug. 1, 2021, you must apply for an Assisted Living License. You will be prohibited from operating such a facility on or after Aug. 1, 2021, unless you have an Assisted Living License. Refer to “Background” section above. Certain housing settings are exempt from Assisted Living Facility Licensure, meaning an assisted living license is not required. Those settings are listed here: 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 10, paragraphs (1-10) (www.revisor.mn.gov/statutes/cite/144G.08). HWS establishments will sunset after Assisted Living Licensure is implemented on Aug. 1, 2021. After that date, the housing or services CANNOT be called “Assisted Living” unless the building is licensed as an assisted living facility under 2020 Minnesota Statutes 144G, sections 144G.08 through 144G.9999. Also note, providers of the Home and Community-Based Services (HCBS) waiver service of customized living services must have an assisted living license to continue delivering customized living services. This applies to the following waiver programs: 1

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Elderly Waiver (EW) Brain Injury (BI) Community Access for Disability Inclusion (CADI)

Finally, there are a limited number of customized living settings that are excluded from Assisted Living Licensure. These settings may continue to deliver customized living services, pending federal approval. The list of excluded settings include: ▪ Public Housing Buildings and Developments ▪ Section 202 (elderly) Multi-Family Buildings ▪ Section 811 (disability) Multi-Family Buildings These settings are excluded from Assisted Living Licensure: 2020 Minnesota Statutes 144G.08 Definitions: Subdivision 7, paragraphs (11-13) (www.revisor.mn.gov/statutes/cite/144G.08).

Will I still be able to use my Basic or Comprehensive Home Care License to provide other (non-customized living) services? Yes. Refer to: 2020 Minnesota Statutes 144A. Nursing Homes and Home Care (www.revisor.mn.gov/statutes/cite/144A), which will continue. If you plan to provide any services that fall under assisted living services found here: 2020 Minnesota Statutes 144G.08 Definitions: Subdivision 9 (www.revisor.mn.gov/statutes/cite/144G.08), you must have an Assisted Living License.

Will I be able to continue to renew my Basic or Comprehensive Home Care License? Yes

Where can I obtain an Assisted Living License application? Applications are not yet available. MDH plans to begin the application process on or around May 1, 2021. At that time, applications will be available on the MDH website.

As a HWS provider, what should I do if I have not been issued a 2020-2021 HWS certificate by the date that I need to apply for the new Assisted Living License? At this time, MDH has suspended HWS renewals due to the Covid-19 pandemic. Please check: MDH Housing with Services Establishments/Assisted Living Designation/Uniform Consurmer Information Guide (www.health.state.mn.us/facilities/regulation/hws/index.html ) for updates on the status of HWS renewal restart date. A HWS registration that expired on or after April 8, 2020, while in good standing, is considered in effect until the registrant has been notified otherwise by MDH.

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

What is the fee for an Assisted Living License? The fee structure for the new license will be: ▪ Assisted Living Facility License = $2,000 plus $75 per resident ▪ Assisted Living Facility with Dementia Care License = $3,000 plus $100 per resident

What is the deadline by which to apply for a HWS registration that is not subject to the new Assisted Living Licensure requirements? On Aug. 1, 2021, the HWS registration will no longer be in effect. At this time, MDH has suspended HWS renewals due to the Covid-19 pandemic. Please check: MDH Housing with Services Establishments/Assisted Living Designation/Uniform Consurmer Information Guide (www.health.state.mn.us/facilities/regulation/hws/index.html ) for updates on the status of HWS renewal restart date. If you wish to continue as an assisted living facility providing assisted living services on Aug. 1, 2021, you must apply for an Assisted Living License. An Assisted Living License must be obtained prior to providing assisted living services.

Currently, the Department of Human Services (DHS) Provider Eligibility and Compliance, enrolls customized living services providers under the EIN and information of the comprehensive license holder, rather than the HWS registrant. Should I be applying for an Assisted Living License with the information of the current comprehensive license holder, or the information of the current HWS registrant? You will use your HWS HFID information.

Do I need to develop policies and procedures for the Assisted Living Licensure? Yes, in order to obtain and retain an Assisted Living License, you must develop assisted living policies and plans as outlined by the statute.

What are the new requirements to customized living facilities? Providers of HCBS waiver service of customized living services must have an Assisted Living License to continue delivering customized living services. This applies to the following waiver programs: ▪ Elderly Waiver (EW) ▪ Brain Injury (BI) ▪ Community Access for Disability Inclusion (CADI) There are a limited number of customized living settings that are excluded from Assisted Living Licensure. These settings may continue to deliver customized living services, pending federal approval. The list of excluded settings include: 3

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Public Housing Buildings and Developments Section 202 (elderly) Multi-Family Buildings Section 811 (disability) Multi-Family Buildings

These settings are excluded from Assisted Living Licensure under: 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 7, paragraphs (11-13) (www.revisor.mn.gov/statutes/cite/144G.08).

What happens to my HWS business if I don’t have an Assisted Living License? You can no longer provide or advertise assisted living services without an Assisted Living License after Aug. 1, 2021. The facility will be subject to misdemeanor penalties for operating after license expiration.

Where do I find more information about resident notices of termination, moves, closure, and coordinated planning? MDH will provide ongoing updates to assist you through these events.

What will the new survey process look like? MDH is currently developing survey documents for survey licensure which will be shared upon completion.

When will the new survey process begin? Immediately upon the new Assisted Living Licensure becoming effective on Aug. 1, 2021.

What will enforcement look like? Are there new consequences (penalties/fines)? Enforcement: 2020 Minnesota Statutes 144G.20 Enforcement (www.revisor.mn.gov/statutes/cite/144G.20) Violations and Fines: 2020 Minnesota Statutes 144G.31 Violations and Fines (www.revisor.mn.gov/statutes/cite/144G.31)

What are residents’ rights and protections? Effective Aug. 1, 2021: 2020 Minnesota Statutes; Resident Rights and Protections (144G.90144G.9999) (www.revisor.mn.gov/statutes/cite/144G.31) and 2020 Minnesota Statutes 144G.07 Retaliation Prohibited (www.revisor.mn.gov/statutes/cite/144G.07) Effective through July 31, 2021: 2020 Minnesota Statutes 144A.44 Home Care Bill of Rights (www.revisor.mn.gov/statutes/cite/144A.44)

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

What questions should residents/caregivers ask providers/prospective providers? MDH will be developing a resource to assist residents and their loved ones to navigate the transition to Assisted Living Licensure.

Standards & Requirements Do I need to be licensed as an Assisted Living Facility if I have residents receiving customized living services and on a Medicaid waiver? Yes, if you are providing assisted living services to those residents and are not exempt under 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 7 (www.revisor.mn.gov/statutes/cite/144G.08). You will need an Assisted Living License if you plan to deliver these services to any new or existing residents on or after Aug. 1, 2021.

Do I need to be Medicaid certified to be licensed as an Assisted Living Facility? No. You are not required to be enrolled with DHS in order to be licensed as an assisted living facility. However, you are required to be enrolled with DHS, and be licensed as an assisted living provider through MDH, if you plan to deliver customized living services to people on HCBS waivers.

If I am already a licensed home care provider or a registered HWS facility, do I need to complete another background study? Potentially, yes. Any new individuals listed on the assisted living facility application, who have a direct ownership interest in the license or who are controlling individuals; including managerial officials, are subject to background study requirements. No individual may be involved in the management, operation, or control of an assisted living facility if the individual has been disqualified under 2020 Minnesota Statutes Chapter 245C. Human Services Background Studies (www.revisor.mn.gov/statutes/cite/245C). Current direct care staff who already have a completed background study do not need to repeat it.

What are the staffing requirements for the Assisted Living License? 2020 Minnesota Statutes 144G.60 Staffing Requirements (www.revisor.mn.gov/statutes/cite/144G.60).

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

Do I need to hire a Licensed Assisted Living Director? Yes. See 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 6 (www.revisor.mn.gov/statutes/cite/144G.08) and 2020 Minnesota Statutes 144A.20 Administrator Qualifications; Subdivision 4 (www.revisor.mn.gov/statutes/cite/144A.20).

Can the director and the clinical nurse supervisor be the same person? Yes, as long as the individual holds the proper licenses for each role.

What are the new training requirements for Assisted Living Staff? See: 2020 Minnesota Statutes 144G.63 Orientation and Annual Training Requirements (www.revisor.mn.gov/statutes/cite/144G.63) for assisted living and 2020 Minnesota Statutes 144G.64 Training in Dementia Care Required (www.revisor.mn.gov/statutes/cite/144G.64) for assisted living with dementia care.

What "experience" is required for an Assisted Living Dementia Care applicant (or consultant)? See: 2020 Minnesota Statutes 144G.80 Additional Licensing Requirements for Assisted Living Facilities with Dementia Care (www.revisor.mn.gov/statutes/cite/144G.80) and 2020 Minnesota Statutes 144G.83 Additional Training Requirements for Assisted Living Facilities with Dementia Care (www.revisor.mn.gov/statutes/cite/144G.83). MDH continues to develop more guidance around this topic.

If I have multiple buildings that house residents, how many licenses do I need? As of now, one license per physical address. Some exceptions exist for properties that consist of more than one building on a single property, or two or more buildings at different addresses which share a portion of a legal property boundary. See Proposed Rules 4659 Licensing in General: Assisted Living Facilities Proposed Rules (PDF) (www.health.state.mn.us/facilities/regulation/AssistedLiving/docs/proposedrules100820.pdf)

If I am converting to the new Assisted Living Licensure, what are the physical plant requirements? See: 2020 Minnesota Statutes 144G.45 Minimum Site, Physical Environment, and Fire Safety Requirements (www.revisor.mn.gov/statutes/cite/144G.45). MDH continues to develop more guidance around this topic.

What will the food code compliance expectations be? See: 2020 Minnesota Statutes 144G.41 Minimum Assisted Living Facility Requirements; Subdivision 1, Paragragh (13) (www.revisor.mn.gov/statutes/cite/144G.41) for food code requirements. 6

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

Can I accept Assisted Living residents before I get my new Assisted Living License? You may continue to provide services under 2020 Minnesota Statutes 144A. Nursing Homes and Home Care (www.revisor.mn.gov/statutes/cite/144A.20) until Aug. 1, 2021. You may not provide assisted living services under 2020 Minnesota Statutes 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G.41) until Aug. 1, 2021.

How can I ensure that our new construction/new building(s) are in compliance with new Assisted Living requirements? See: 2020 Minnesota Statutes 144G.45 Minimum Site, Physical Environment, and Fire Safety Requirements (www.revisor.mn.gov/statutes/cite/144G.45) for information on physical plant requirements.

Can I submit my construction plans for MDH to review prior to Aug. 1, 2021? No. At this time the new Assisted Living Licensure statues do not allow for plan review prior to Aug. 1, 2021. MDH is in further discussion surrounding this topic.

How will changes in ownership (CHOWs) be handled during this transition? CHOW sales must be finalized prior to Aug. 1, 2021. An Assisted Living License may not be transferred to another party. See: 2020 Minnesota Statutes 144G.19 Transfer of License Prohibited (www.revisor.mn.gov/statutes/cite/144G.19) for more information. Further guidance is currently being developed by MDH on this topic.

When will I get surveyed for the Assisted Living License? Per 2020 Minnesota Statutes 144G.16 Provisional License; Subdivision 2 Initial Survey (www.revisor.mn.gov/statutes/cite/144G.16), within 60 days of notice of having a resident receiving services and at a minimum of once every two years after Aug. 1, 2021.

What is the new licensing and renewal process? New applicants: 2020 Minnesota Statutes 144G.12 Applicaiton for Licensure (www.revisor.mn.gov/statutes/cite/144G.12). Renewals: 2020 Minnesota Statutes 144G.17 License Renewal (www.revisor.mn.gov/statutes/cite/144G.17).

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

Troubleshooting Issues How do I get a licensed director when BELTSS (Board of Executives for Long Term Services and Supports) isn’t licensing at this time? This situation is under discussion and more information will be forthcoming.

I submitted an application/registration, but I haven’t heard back from MDH? During COVID, under the Minnesota Governor’s Executive Order 20-32, MDH suspended license applications reviews. MDH will provide notification when the application/registration process is restarted.

How will I be allowed to promote my Assisted Living Facility? You must have an assisted living license to advertise as an assisted living provider. You must have an assisted living with dementia care license to advertise and provide specialized care for dementia related diagnoses.

I have already applied for a HWS registration, but MDH has not processed it yet. Can I be grandfathered in? During COVID, under the Minnesota Governor’s Executive Order 20-32, MDH suspended license and HWS registrations reviews. MDH will provide notification when the review process is restarted.

If I have not paid fines by my next renewal date, is outstanding debt a reason for revoking or not re-licensing? Yes, outstanding debts may be a reason for not renewing a license.

Next Steps We encourage you to read the new Assisted Living Licensure laws: 2020 Minnesota Statutes Chapter 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G). Please visit the Assisted Living Home Page on the MDH Website to review the Assisted Living Facilities Licensure proposed rules: Assisted Living Facilities Proposed Rules (PDF) (www.health.state.mn.us/facilities/regulation/AssistedLiving/docs/proposedrules100820.pdf) Before the end of 2020, a Notice of Hearing regarding the proposed rules will be posted. You will have at least 30 days to provide comments regarding these proposed rules prior to the Office of Administrative Hearing process. Questions about an existing HWS registration should be directed to the Health Regulation Division’s (HRD) HWS team: health.HWS@state.mn.us 8

ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS

Questions about an existing Home Care license should be directed to HRD’s Home Care and Assisted Living Program (HCALP) team: health.assistedLiving@state.mn.us

Additional Resources Additional sources of information regarding Assisted Living Licensure in Minnesota include: ▪ 2020 Minnesota Statutes 144G.02 Assisted Living; Subdivision 1. Protected title, restriction on use (www.revisor.mn.gov/statutes/cite/144G.02) ▪

Minnesota Department of Health Assisted Living Home Page (www.health.state.mn.us/assistedLiving)

▪

Assisted Living Licensure in Minnesota Fact Sheet (PDF) (www.health.state.mn.us/facilities/regulation/assistedLiving/docs/factsheet.pdf)

▪

Assisted Living Licensure in Minnesota Making the Transition (PDF) (www.health.state.mn.us/facilities/regulation/assistedLiving/docs/transitionfs.pdf)

Minnesota Department of Health Health Regulation Division PO Box 64900 St. Paul, MN 55164-0900 651-539-3049 or 844-926-1061 health.assistedliving@state.mn.us www.health.state.mn.us/assistedliving

11/23/2020 To obtain this information in a different format, call: 651-201-4101.

2021 Housing Managers' Education Series

QUALITY INITIATIVES IN SENIOR HOUSING March 4, 2021

Karen Ruda, Director of Customer Experience North Shore Healthcare

INTRODUCTIONS

Karen Ruda, Director of Customer Experience North Shore Healthcare

Karen Ruda started her career in long-term care as a nursing assistant. Over the course of 30+ years, she has enjoyed several other positions including therapeutic recreation director, post-acute director, nursing home administrator as well as consulting positions in therapeutic recreation, quality management and customer service. Karen has served as a Silver Award Quality examiner for AHCA for 7 years and is a certified professional in healthcare quality. Karen's current position is Director of Customer Experience for North Shore Healthcare and her primary role is reinforcing customer service standards that enhance the overall customer experience for all North Shore customers.

2021 Housing Managers' Education Series

Quality Initiatives In Senior Housing 2021 Housing Managers’ Education Series

Benefits of Quality Improvement

•The right care for the right client every time •Evidenced based • Meet regulations •Standards of practice •Turning what we know into everyday practice

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Icebreaker ‘Learning How to Think’ 5

Poll: Which figure is different from the others? A

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Objectives

Participant will: 1. Understand Minnesota Statutes for Home Care Quality Improvement (QI) requirements 2. Have knowledge of methods used to begin a QI Initiative/Project 3. Be able to describe one QI model 4. Have knowledge of various data sources for QI 5. Gain knowledge of various QI tools 6. Begin to develop personal action plan to implement QI

Handouts

• Power Point • Action Plan • Minnesota 2020 Statutes • CPM Quality Improvement • Data Sources • Quality Improvement Worksheet Samples • QAPI toolkit from Providigm

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Handout – Action Plan

Handout – CPM Quality Improvement

2021 Housing Managers' Education Series

Handout – Data Sources

Handout – QI Worksheet Sample

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Handout – PDSA Worksheet Sample

Handout – QAPI Toolkit

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Minnesota Statutes

• Subdivision 3. Quality Management. The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of survey, investigation or renewal.

Poll: What type of Quality Improvement Activities do you currently do? A. We have a committee that meets regularly to review our services. B. We have an informal process and need to make it more formal. C. We do it when we discover an error/mistake or when we are told to do it. D. None Your answer?

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• Start a folder/binder with Quality Improvement/Quality Management Activities

• Survey Ready Binder

What is Quality Improvement? • Systematic and continuous actions that lead to measurable improvement in health care services and the health status of your clients. • An ongoing effort to make performance better. • Using data to make improvements. • Systematic, formal approach to analyze current practice and efforts to improve performance. • The science of Improvement • It’s all about your clients • Doing the right thing well

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A commitment to you, your organization but more important‐to your residents

Quality Improvement vs. Quality Assurance

Quality Assurance

Quality Improvement

Program

Integrated into Work Processes

Focus on errors/mistakes

High risk/problem prone/high volume

Reactive, policing, punitive

Proactive, reduce risk

Committee Driven

Data Driven

Problem & People Focused.

Process / Systems Focus

No Historical Value or Customer Input

Team comprised of People that Work in the Process

Asks who?

Asks why?

2021 Housing Managers' Education Series

Quality Improvement • You could point the finger & decide who’s to blame or you could ask: “Why did this happen?”

Quality Improvement Hint: Systems thinking means no more blame game. • Find root cause + fix it + sustain it! = SUCCESS!

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History of Quality Improvement in U.S.

• Florence Nightingale • Quality Revolution in Japan post WWII W. Edwards Deming‐Guru of Industrial Quality Joseph Juran Walter Shewart model of improvement

1. Customer Focused

Foundation of of a Quality Culture Quality

2. All One Team

3. Scientific Approach

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Poll: If a culture of Quality includes customers, teamwork, using data or science; what would be a good way to find out what is important to your customers?

A. Satisfaction Surveys B. Resident / Consumer Council C. Complaints Received D. All the Above

Poll: If a culture of Quality includes customers, teamwork, using data or science; what would be a good way to find out what is important to your customers?

Correct Answer is A. Satisfaction Surveys B. Resident / Consumer Council C. Complaints Received D. All the Above

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Customer driven System optimization and alignment

Principles of Improvement

Continual improvement Continual learning Management through knowledge Collaboration and respect

What are your opportunities? A gap between what we know and what we practice…..

Gap Knowledge

Practice

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1. Customer Focused

Foundation of of a Quality Culture Quality

• Dedicated to customer value • Who are your customers? • What do they want?

• Teamwork • Cooperation • Everything we do a process

Foundation of of a Quality Culture Quality

2. All One Team 30

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Foundation of of a Quality Culture

• Using Data to Make Decisions

Quality

3. Scientific Approach

Poll: What data do you consider important to track for your community?

A. Clinical B. Client Experience C. Workforce D. Survey Outcomes E. Financial & Market

2021 Housing Managers' Education Series

Correct Answer is A.B.C.D.E.

Poll: What data do you consider important to track for your community?

A. Clinical B. Client Experience C. Workforce D. Survey Outcomes E. Financial & Market

Other Data you Measure? What is your important work?

SERVICES YOU DELIVER

CLIENT EXPERIENCE

WORKFORCE

LEADERSHIP/ GOVERNANCE

FINANCIAL & MARKET

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Data Source

Possible Data Sources Clinical Services Client Experience Workforce Leadership Governance Financial & Market

Minnesota DHS Minnesota Department of Health Care Providers of MN NCAL(National Center for Assisted Living) Long Term Care Trend Tracker National Investment Center Genworth Occupational Safety and Health Administration National Institute on Aging Institute of Healthcare Improvement CDC National Center for Health Statistics U.S. Bureau of Labor Statistics Agency for Healthcare Research and Quality CMS‐QAPI tools Stratis Health Customer Satisfaction Vendors State Surveys (DOH, Department of Social Services)

Look again at MN statutes Quality Management. The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients…..

2021 Housing Managers' Education Series

Questions?

2021 Housing Managers' Education Series

What areas need improvement?

What is your Data telling you?

• Dining services? • Food? • Environment? • Falls? • Workforce retention?

What is your Data Telling You?

Data that is important to your community. Is your performance getting better? Trending allows you to analyze your data over time. Getting better? • Trends =the rate of performance improvements or the sustainability of good performance (slope of the trend). • A minimum of 3 data points ascertains a trend.

2021 Housing Managers' Education Series

What is your Data Telling You?

Data that is important to your community. Are you results any good? • Refers to your community’s current level of performance. Need comparative data. • Comparisons‐your performance relative to competitors

2021 Housing Managers' Education Series

Poll: A proven method to prioritize what problems to work on first might be:

A. Conducting high risk, high volume, problem prone and high‐cost technique. B. Doing what the Health Department tells us to work on C. Focus on the problems that are costing us the most $. D. Doing what my gut tells me to work on.

Correct Answer: A

Poll: A proven method to prioritize what problems to work on first might be:

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Prioritize Problems 1. 2. 3. 4.

ID opportunities for improvement (OFI) Use a table Categorize ID processes into appropriate boxes as defined Problem in critical row is priority. High Volume

High Risk

Problem Prone

High Cost

Critical Extremely Important Very Important Important

Basic Steps to Improvement Step 1 Identify potential or actual quality issue(s).

Step 2 Determine the root cause, trends or patterns.

Step 3 Develop a corrective plan of action.

Step 4 Implement the corrective plan of action.

Step 5 Evaluate the outcomes of the corrective plan of action.

Step 6 Revise the corrective plan of action, if needed

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Basic Steps to Improvement 1. 2.

Find your focus/area to improve Organize your team to work on the improvement‐ people who know current process 3. Quantify the problem‐use your data 4. Identify the root cause of the problem • Why do you have the problem? 1. Education/training 2. System breakdown 3. Staff not following process 4. Equipment 5. Develop an action plan based on the root cause 6. Pilot on a small scale 7. Evaluate the effectiveness of the action plan 1. Revisit data 8. Make any changes to your action plan 9. Monitor effectiveness 10. Go back to root cause identification if problem not resolved.

Root Cause Analysis

Ever fix a problem only to find it happen again?

2021 Housing Managers' Education Series

Root Cause Analysis

If same problem occurs then you did not fix the ROOT CAUSE

If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions. ‐Albert Einstein

2021 Housing Managers' Education Series

Helps identify what, how and why something happened to prevent from recurrence.

Root Cause Analysis (RCA)

• What happened? • How did it happen? • Why did it happen?

RCA is key to developing effective actions. 51

Root Cause Analysis Major steps: • 1. Data Collection‐gather your data • a. Observation • b. Record review • c. Interview‐residents/family/staff • 2. Causal Factors‐flowchart/5 whys/data analysis • 3. Identify Root Cause • 4. Recommend Actions

2021 Housing Managers' Education Series

One sentence description of event or problem: Problem Statement Why? 

The 5 Whys

Why?  Why? 

• Simple problem‐solving technique to get to Root Cause quickly • Drill down by asking ‘why’ or ‘what caused the problem’

Why?  Why?  Root Cause(s):

1. 2. 3.

To validate root causes, ask the following: If you removed the root cause, would this event or problem have been prevented?

Scenario It was 5 p.m. I was frying chicken. My friend Jane stopped by on her way home from the doctor, and she was very upset. I invited her into the living room so we could talk. After about 10 minutes, the smoke detector near the kitchen came on. I ran into the kitchen and found a fire on the stove. I reached for the fire extinguisher and pulled the plug. Nothing happened. The fire extinguisher was not charged. In desperation, I threw water on the fire. The fire spread throughout the kitchen. I called the fire department, but the kitchen was destroyed. The fire department arrived in time to save the rest of the house.

2021 Housing Managers' Education Series

One sentence description of event or problem:

Kitchen destroyed by fire and damaged by smoke and water

Problem Statement

Kitchen is destroyed by fire and damage by smoke and water. Friend upset‐left chicken on Stove

Why? 

Fire Extinguisher did not work Why? 

Threw water on fire and fire spread Why?  Why?  Why?  Root Cause(s):

1. Mary leaves frying chicken unattended 2. Fire extinguisher does not operate when Mary tries to use it 3.. Mary throws water on fire To validate root causes, ask the following: If you removed the root cause, would this event or problem have been prevented?

Other tools to determine Root Cause Flowchart

2021 Housing Managers' Education Series

Other tools to determine Root Cause Fishbone

Medication Error Root Cause –Ask Why? The nurse made a medication error

WHY?

The wrong medication was in the drawer

WHY?

The pharmacy tech put it in the drawer

WHY?

The tech read it off the computer that way

WHY?

The nurse put it in the computer that way

WHY?

The nurse misread the doctor’s writing as the medication was only one letter different from the one the nurse thought was correct

WHY?

The nurse misread the doctor’s handwriting and entered The wrong medication on the order sheet

WHY?

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Commonly Used Models of Improvement 59

Basic Steps to Improvement Step 1 Identify potential or actual quality issue(s).

Step 2 Determine the root cause, trends or patterns.

Step 3 Develop a corrective plan of action.

Step 4 Implement the corrective plan of action.

Step 5 Evaluate the outcomes of the corrective plan of action.

Step 6 Revise the corrective plan of action, if needed

2021 Housing Managers' Education Series

Model for Improvement PDSA

Involve the right people on your PIP. Time specific Measurable Establish measures/data Select/Pilot proposed changes

Test your proposed changes PDSA Plan your change Do it Study results (data) Act on what is learned

Model for Improvement FADE

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Model for Improvement DMAIC Six Sigma

Remember the Basic Steps AND Keep It Simple

2021 Housing Managers' Education Series

Basic Steps to Improvement Step 1 Identify potential or actual quality issue(s).

Step 2 Determine the root cause, trends or patterns.

Step 3 Develop a corrective plan of action.

Step 4 Implement the corrective plan of action.

Step 5 Evaluate the outcomes of the corrective plan of action.

Step 6 Revise the corrective plan of action, if needed

Your Quality Improvement Model Figure out what ‘model’ you will use and become proficient at it. Train yourself and your staff. Practice it!

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Questions?

Let’s Practice!

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This Photo by Unknown Author is licensed under CC BY‐SA

Case Study #1 Client Satisfaction Surveys

Questions asked include: Resident/client satisfaction • How would you rate the food you receive? Response rate has been 75% but the rating for food received has been trending negatively the past 3 surveys. In addition to the formal surveys, you are receiving numerous complaints about the food including the dining room atmosphere and the food quality. What to do? 70

2021 Housing Managers' Education Series

Client Satisfaction Surveys Identify potential or actual quality issue(s). Food rating trending down; more food complaints: dining room & food quality Determine the root cause, trends or patterns Interview staff, residents, observe meals, gather past c/o and look for trends, Review menu, recipes, food prep, food vendor Develop a corrective plan of action. Implement food committee. Menus, recipes, meal of the month, dining room host, linens Implement the corrective plan of action.

Trial for one qtr.

Evaluate the outcomes of the corrective plan Do another survey specific to food/dining of action. Revise the corrective plan of action, if needed 71

Case Study #2 Falls at Sunnyside AL

2021 Housing Managers' Education Series

Sunnyside Assisted Living in St. Paul, MN has 50 clients and offers a wide variety of ala carte services. Various clinical results such as falls, pressure ulcers, weight loss and use of antipsychotics are tracked and reviewed daily, weekly and monthly. The IDT team has noticed an increase in the number of falls in the past 4 months. Falls are especially increased on the PM shift in resident apartments/rooms. The Quality Council has determined the need to start an improvement project. What to do?

Falls at Sunnyside ALF Identify potential or actual quality issue(s). Increase in falls; especially on PM shift in resident rooms/apartments. Determine the root cause, trends or patterns

Apartment safety audit. Toileting. Sundowners. Need for therapy. Activities. Interview Staff, residents, record review of fallers, falls scene investigation. Type of medications?

Develop a corrective plan of action.

PM Activities. Change staff breaks, room audits. Reduce use of psychotropic meds.

Implement the corrective plan of action.

Watch for falls trends

Evaluate the outcomes of the corrective plan # of falls of action. Revise the corrective plan of action, if needed

2021 Housing Managers' Education Series

Case Study #3

Warbler Landing Staffing This Photo by Unknown Author is licensed under CC BY‐ND

Warbler Landing is a housing community with 30 clients. Ideally, you would have 25 direct care employees. Even though you have hired 5 new staff members in the last months you continue to have staff quit at an alarming rate. Your turnover rate for 2020 is 75%. You conduct annual employee satisfaction surveys and the questions asked are: 1. 2. 3. 4.

Overall, how satisfied are you with your position at Warbler Landing? Do you feel employees are recognized as individuals? How motivated are you to see Warbler Landing succeed? Would you advise a friend to apply for at job at Warbler Landing?

When compared to annual surveys in 2018 and 2019, the 2020 annual employee satisfaction survey had negative trends in questions #2 and #4. You are in a staffing crisis and close to using agency staff. What can you do?

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Poll: At Warbler Landing, what is the most logical RCA for their staffing issue? A. Wages B. Employee dissatisfaction C. Generally, people just do not want to work D. Our housing community environment is outdated, and the breakroom is in the basement.

Answer: B Poll: At Warbler Landing, what is the most logical RCA for their staffing issue? A. Wages B. Employee dissatisfaction C. Generally, people just do not want to work D. Our housing community environment is outdated, and the breakroom is in the basement.

2021 Housing Managers' Education Series

Warbler Landing Staffing Identify potential or actual quality issue(s). Retention issues, Employee appreciation, Onboarding, hire right people. Direct care staff turnover rates at 75%. Determine the root cause, trends or patterns Onboarding issues, not appreciated, long term staff treating new staff poorly. Employees are dissatisfied. Develop a corrective plan of action. R & R Committee, exit interviews, staff mentor program. Staff recognition program. Implement the corrective plan of action. Evaluate the outcomes of the corrective plan Do a mini survey of new staff after 90 days. of action. Review turnover rates. Revise the corrective plan of action, if needed 79

Case Study #4 M & M Memory Care and Joe

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M & M Assisted Living has 25 clients who reside on a secured unit dedicated for memory care. The Executive Director and Clinical Director has noticed a huge increase in the number of resident‐to‐resident altercations after Joe was admitted. Joe has been at M & M just over 6 weeks. M & M has moved Joe to different rooms several times, but these incidents continue to occur with Joe’s roommates as well as during mealtimes. What is your plan? 81

M & M Memory Care and Joe Identify potential or actual quality issue(s). Joe’s meds, hx, too much stimulation, meal times, meal situation Determine the root cause, trends or patterns Joe has a history of being a loner and is overstimulated Develop a corrective plan of action.

Joe eats in a quiet setting and prefers to eat by himself.

Implement the corrective plan of action. Evaluate the outcomes of the corrective plan Reduced resident to resident altercations of action. Revise the corrective plan of action, if needed

2021 Housing Managers' Education Series

Everlasting Housing Services This Photo by Unknown Author is licensed under CC BY‐SA

Case Study #5 83

The corporate team has conducted a mock survey at Everlasting Housing Services and the team did not observe any activities occurring over the 3‐day mock survey. Most of the residents, when interviewed, reported they were bored. It was also noted that there were more ‘incidents’ such as residents quarreling, and residents falls during the pm shift. The activity director was also interviewed and stated many different types of activities have been scheduled with little or no participation. The activity director also stated that there are many individual activity supplies such as cards, games, reading materials and puzzles available to the residents. The activity director is part time and has no other staff in the department. After the mock survey, the ED provided the following action plan to corporate. 1. Hire a new activity director 2. ED will review the activity calendar prior to putting it in place. Is this adequate? What else shall be done?

2021 Housing Managers' Education Series

Everlasting Housing Services Identify potential or actual quality issue(s). Residents are bored and not interested in current activities Determine the root cause, trends or patterns Wrong kind of activities, wrong time of day, Resident interviews, activity interests/inventory Develop a corrective plan of action. Implement the corrective plan of action.

Design activity calendar based on resident’s interests Resident council, review attendance records, resident individual interviews

Evaluate the outcomes of the corrective plan of action. Revise the corrective plan of action, if needed 85

Case Study #6 “Mrs. P.”

This Photo by Unknown Author is licensed under CC BY‐SA‐NC

2021 Housing Managers' Education Series

Mrs. P has been at your ALF for 3 days and has slept only 3 hours per night. She is extremely restless and anxious and often cries out for her husband. She constantly wants to get up from her chair or bed. On the first night, the staff added a bed and chair alarm to Mrs. P so they could hear when she moves and prevent a fall. On night 3, Mrs. P was found on the floor by staff at 8 pm and apparently had fallen onto her buttocks; no injuries were found. Mrs. P was assisted to bed for the night. Later that same evening Mrs. P was found on the floor. Her undergarments were soiled, and she continued to cry out for her husband. She was assessed to have no injuries resulting from the fall. The nurse obtained an order for a sedative from the physician and Ativan 1.0 mg was given at 1 am. She was put back to bed and finally went to sleep for the night. What are your next steps? 87

Mrs. P Identify potential or actual quality issue(s). Falling, crying,, restless Determine the root cause, trends or patterns New surroundings, DX, Insomnia, Incontinent, Pain, Meds, falls hx, acute illness Develop a corrective plan of action.

Interview family, review hx, pain , toileting, why falling,

Implement the corrective plan of action.

Falls Scene Investigation‐therapy eval‐review meds‐sleep patterns

Evaluate the outcomes of the corrective plan of action. Revise the corrective plan of action, if needed

2021 Housing Managers' Education Series

The largest room in the Author world is the room for Unknown improvement.

Thoughts…

Fall seven times. Stand up eight.

Old Japanese Proverb

Perfection is not attainable, but if we Vince Lombardi chase perfection we can catch excellence. 89

Reminders • You are already identifying and fixing problems daily • Use Data that is important • Use Performance Improvement models/tools • Maintain Documentation (beginning to end) • Did you sustain the improvement • Teamwork • Share Results • Celebrate successes • It is a journey NOT a destination

2021 Housing Managers' Education Series

Keep Calm & Improve the Process 91

Questions?

Action Plan to Implement Quality Management

Action Plan to Implement Quality Management Housing Community: How? What are my actions?

Who? Assign Responsibility

When? Completion Dates

Measurables? How will you know?

Resources Needed? Completed What will you √ need?

Data Sources

Possible Data Sources Data Source Minnesota DHS Minnesota Department of Health Care Providers of MN NCAL(National Center for Assisted Living) Long Term Care Trend Tracker National Investment Center

Website https://www.mn.gov/dhs/ https://www.health.state.mn.us/ https://www.careproviders.org/ https://www.ahcancal.org/ncal/Pages/index.aspx https://ltctt.ahcancal.org/ https://www.nic.org/

Genworth Occupational Safety and Health Administration

https://www.genworth.com/

National Institute on Aging

https://www.nia.nih.gov/

Institute of Healthcare Improvement CDC National Center for Health Statistics

https://www.osha.gov/

http://www.ihi.org/ https://www.cdc.gov/

U.S. Bureau of Labor Statistics

https://www.bls.gov/

Agency for Healthcare Research and Quality

https://www.ahrq.gov/

CMS-QAPI tools

https://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/QAPI/qapitools.html

Stratis Health

http://www.stratishealth.org/index.html

Customer Satisfaction Vendors State Surveys (DOH, Department of Social Services)

Definitions for Quality Improvement

DEFINITIONS FOR QUALITY IMPROVEMENT Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. The Institute of Medicine's (IOM) which is a recognized leader and advisor on improving the Nation's health care, defines quality in health care as a direct correlation between the level of improved health services and the desired health outcomes of individuals and populations Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. There are numerous models used. Some commonly discussed include: • • • • •

FADE http://patientsafetyed.duhs.duke.edu/module_a/methods/methods.html PDSA http://patientsafetyed.duhs.duke.edu/module_a/methods/pdsa.html Six Sigma (DMAIC) http://patientsafetyed.duhs.duke.edu/module_a/methods/six_sigma.html CQI: Continuous Quality Improvement TQM: Total Quality Management

These models are all means to get at the same thing: Improvement. They are forms of ongoing effort to make performance better. • • •

In industry, quality efforts focus on topics like product failures or work-related injuries. In administration, one can think of increasing efficiency or reducing re-work. In medical practice, the focus is on reducing medical errors and needless morbidity and mortality.

Contrasting QI and QA Many people are familiar with the term Quality Assurance (QA), as it was a common term for many years. •

•

Quality Assurance – QA was reactive, retrospective, policing, and in many ways punitive. It often involved determining who was at fault after something went wrong. This term is older and not as likely to be used today. Quality Improvement – QI involves both prospective and retrospective reviews. It is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening. QI activities can be very helpful in improving how things work. Trying to find where the “defect” in the system is, and figuring out new ways to do things can be challenging and fun. It’s a great opportunity to “think outside the box.”

Care Providers of Minnesota_3/2016

MN Statutes

MINNESOTA STATUTES 2020

144A.479

144A.479 HOME CARE PROVIDER RESPONSIBILITIES; BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed in the home care provider's principal business office and copies must be displayed in any branch office. The home care provider must provide a copy of the license to any person who requests it. Subd. 2. Advertising. Home care providers shall not use false, fraudulent, or misleading advertising in the marketing of services. For purposes of this section, advertising includes any verbal, written, or electronic means of communicating to potential clients about the availability, nature, or terms of home care services. Subd. 3. Quality management. The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal. Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A home care provider or staff cannot accept powers-of-attorney from clients for any purpose, and may not accept appointments as guardians or conservators of clients. (c) A home care provider cannot serve as a client's representative. Subd. 5. Handling of client's finances and property. (a) A home care provider may assist clients with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a client's property. A home care provider must provide a client with receipts for all transactions and purchases paid with the client's funds. When receipts are not available, the transaction or purchase must be documented. A home care provider must maintain records of all such transactions. (b) A home care provider or staff may not borrow a client's funds or personal or real property, nor in any way convert a client's property to the home care provider's or staff's possession. (c) Nothing in this section precludes a home care provider or staff from accepting gifts of minimal value, or precludes the acceptance of donations or bequests made to a home care provider that are exempt from income tax under section 501(c) of the Internal Revenue Code of 1986. Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All home care providers must comply with requirements for the reporting of maltreatment of minors in chapter 260E and the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. Each home care provider must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) Each home care provider must develop and implement an individual abuse prevention plan for each vulnerable minor or adult for whom home care services are provided by a home care provider. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults or minors. For purposes of the abuse prevention plan, the term abuse includes self-abuse.

Official Publication of the State of Minnesota Revisor of Statutes

144A.479

MINNESOTA STATUTES 2020

Subd. 7. Employee records. The home care provider must maintain current records of each paid employee, regularly scheduled volunteers providing home care services, and of each individual contractor providing home care services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification, if licensure, registration, or certification is required by this statute or other rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff providing supervision; (4) documentation of annual performance reviews which identify areas of improvement needed and training needs; (5) for individuals providing home care services, verification that any health screenings required by infection control programs established under section 144A.4798 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. Each employee record must be retained for at least three years after a paid employee, home care volunteer, or contractor ceases to be employed by or under contract with the home care provider. If a home care provider ceases operation, employee records must be maintained for three years. Subd. 8. Labor market reporting. A home care provider shall comply with the labor market reporting requirements described in section 256B.4912, subdivision 1a. History: 2013 c 108 art 11 s 18; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 49,50; 1Sp2020 c 2 art 8 s 24

Official Publication of the State of Minnesota Revisor of Statutes

QAPI TOOLKIT

Sponsored by

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Employee Acknowledgement This QAPI Toolkit belongs to:

DATE:

PROVIDIGM QAPI TOOLKIT | 3

Quality Assurance and Performance Improvement (QAPI) is an effective way to improve the work and care practices of staff in nursing homes. QAPI should be a continuous process and a part of everyone’s daily work. QAPI principles, methods and tools are not new. QAPI principles were developed over the past few decades by Dr. W. Edwards Deming and Dr. Joseph Juran, among others. Successful QAPI requires leadership from senior management and clinicians, a supportive culture, and people trained in group processes and change management. All this needs to be aligned with the organization’s strategic objectives and with the quality management systems in place. Providigm developed this QAPI Toolkit to provide staff in long term care facilities a convenient and quick reference guide. Teaching staff how to do quality improvement is no easy task. For line staff, webinars and PowerPoint presentations are not the best teaching methods. When staff members participate in the QAPI Committee and/or are assigned to a Performance Improvement Project (PIP) team, they need to learn different skills for generating ideas, prioritizing problems, making decisions and working with data and numbers. The QAPI Toolkit provides “Just in Time” learning. The best way to use the QAPI Toolkit is to provide a copy to each team member of the QAPI Committee and to each team member of PIPs. Each team member is expected to bring the QAPI Toolkit to every meeting. The team members agree they will ‘learn’ at least one tool during each meeting. Whenever the team is stuck and wonders, “How do we do that? What do we do next?” they refer to the QAPI Toolkit and select any appropriate tool. Our aim at Providigm is to take the mystery out of QAPI and provide staff with an understandable and operational approach to quality assessment and quality improvement. We hope this QAPI Toolkit helps your quality journey run more smoothly. Regards,

Barbara Baylis RN, MSN Providigm Accreditation Program Director

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Author: Barbara Baylis, RN, MSN Member of CMS Technical Expert Panel (TEP) Quality Assurance and Performance Improvement (QAPI) Demonstration Project

About the author Barbara Baylis a registered nurse and is responsible for the oversight of Providigm’s International Quality Assurance and Performance Improvement (QAPI) Accreditation Program. Barbara also manages the granting of Providigm’s Embracing Quality Awards for top quality outcomes. Previously, Barbara served as Senior Vice President of Clinical Operations for Kindred Healthcare. Her prior executive experience includes Mariner Post-Acute Network as Vice President of Clinical Services, and Corporate Director of Nursing Services and Quality Programs of Living Centers of America. Barbara has a Bachelor’s Degree in Nursing from Molloy College in New York and a Master of Nursing Administration and Nursing Education from the University of Wyoming. Her areas of expertise include clinical practice, clinical and nursing administration policy and procedure, quality improvement and regulatory compliance. Barbara has served on various committees and subcommittees, and has presented at numerous workshops and conventions. As a member of the Centers for Medicare and Medicaid Services (CMS) Technical Expert Panel (TEP), she was part of the QAPI demonstration project. Barbara served as Chair of the AHCA Clinical Practice Committee and Co-Chair of the Nurse Executive Council. Barbara is a Master Examiner for American Health Care Association (ACHA) and has been a National Quality Award Examiner since 1996. She also serves on the AHCA Quality Award Program Board of Overseers, is a member of the Kentucky Center for Performance Excellence Operating Committee and a KYCPE award application examiner. In 2012 she was honored with the Mary K. Ousley Champion of Quality Award from the American Health Care Association. In addition to this QAPI Toolkit, she is co-author of Continuous Quality Improvement: Using the Regulatory Framework.

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QAPI is the merger of two complementary approaches to quality, Quality Assurance (QA) and Performance Improvement (PI). Both are data-driven, approaches to improving the quality of life, care and services in nursing homes, involving members at all levels of the organization.

• QA is a process of meeting quality standards and assuring that care reaches an acceptable level, hopefully beyond regulatory requirements. QA is a reactive, retrospective examination. • PI is a proactive and continuous study of processes to identify areas of opportunity and new approaches to fix underlying causes of persistent or systemic problems, for better health care delivery and resident quality of life. Source: CMS.gov

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Table of Contents QAPI Model for Improvement . . . . . . . . . . . . . . . . . . . 9 The Seven Steps of the QAPI Model . . . . . . . . . . . . . . 10 How to Use the PDSA Cycle . . . . . . . . . . . . . . . . . . . 11 Performance Improvement Process . . . . . . . . . . . . . . 12 Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Data Gathering Checklist Flow Charts Process Mapping Flow Chart and Process Mapping Symbols Root Cause Analysis Tools Fishbone Diagram Five Whys Tool Pareto Charts Trend or Run Charts Bar Charts Pie Charts Group Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Brainstorming Nominal Group Technique Multi-Voting Technique Structured Discussion Prioritization Techniques for Effective Meetings . . . . . . . . . . . . . . . . 40 Agenda Ground Rules Meeting Roles References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

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Quality is not an act, it is a habit. -Aristotle

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QAPI Model for Improvement First, you need to select a model for improvement. There are many models available. The Langley, Nolan & Nolan Model for Improvement is a simple yet powerful tool for accelerating positive change. It is the model we suggest and describe in this guide. This model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes. The Model for Improvement includes: AIM What are we trying to accomplish? MEASURE How will we know if a change is an improvement? CHANGE What changes can we make that will result in improvement? RAPID CYCLE IMPROVEMENT

AC T

PL Y UD

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The Seven Steps of the QAPI Model for Improvement 1. F orming the Team. Including the right people on a process

improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs.

2. S etting Aims. Improvement requires setting aims. The aim

should be time-specific and measurable; it should also define the specific population of residents or other system that will be affected.

3. Establishing Measures. Teams use quantitative

measures to determine if a specific change actually leads to an improvement.

4. S electing Changes. Ideas for change may come from the insights of those who work in the system, from change concepts, or other creative thinking techniques, or by borrowing them from the experience of others who have successfully improved.

5. T esting Changes. The Plan-Do-Study-Act (PDSA) cycle is

shorthand for testing a change in the real work setting by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method adapted for action oriented learning.

6. Implementing Changes. After testing a change on a small

scale, learning from each test, and refining the change through several PDSA cycles, the team may implement the change on a broader scale, for example, for an entire pilot population or unit.

7. Spreading Changes. After successful implementation of a

change, or a package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization.

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How to Use the PDSA Cycle Use ‘plan-do-study-act’ cycles to conduct small–scale tests of change Plan a change

• Identify an issue and define the problem • Collect baseline data for the identified process change

Do it in a small test

• Pilot process the change • Document procedures and observations • Collect the data produced by the change (on-going)

Study its effects

• Assess the collected data • Compare results and monitor trends • Fine tune changes

Act on what was learned

• Make permanent changes based on pilot by educating staff in organizational process change and new technology. • The PIP team uses and links small PDSA cycles for broader implementation.

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Quality Assurance Performance Improvement Process QAPI committee collects and evaluates data from a variety of sources, e.g., Quality Measures, Customer Satisfaction, Performance Improvement Tool, etc.

QAPI committee meets monthly to identify opportunities for improvement based on the evaluation of the data

Y UD ST

– Evaluate test results – Assess the collected data – Compare results and monitor trends – Fine tune changes

– Standardize & implement the improved process – Measure & analyze customer satisfaction based on feedback – Celebrate the quality story

QAPI Committee assigns a Performance Improvement Project (PIP) and a PIP Team to evaluate a process using a small-scale rapid cycle for improvement. PIP Team meets as often as necessary between monthly QAPI committee meetings

PIP Team reports findings to QAPI Committee

– ID product or service – ID customers, customer requirements – ID work process – ID improvement opportunities – Establish & verify cause & effect – Revise the work process

– Conduct a smallscale test(s) of the revised process – Document procedures and observations – Collect data produced by the change

1. QAPI Committee evaluates ongoing effectiveness of PIP Team 2. QAPI Committee sets timetable for follow-up of PIP, if necessary

QAPI Committee V. PIP Team QAPI Committee identifies opportunities for improvement. A PIP is formed to followup on the opportunity for improvement.

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Tools That Help You Understand Data And Analyze Your Process Tool Data Gathering Checklist

Flow Charting/Process Mapping

Root Cause Analysis – Fishbone/ Ishikawa/Cause & Effect Diagrams

5 Whys

Pareto Chart

Trend or Run Charts

Bar Chart

Pie chart

When to Use To collect data on your quality issue and identify the most important source of the problem To understand all the different steps that takes place in your process. A fundamental tool for any QAPI project To brainstorm about the main causes of a quality problem and the sub-cause leading to each main cause To drill down deeper to get to the root cause of a problem To see which causes or problems occur most frequently. To observe the Pareto Effect when 20% of the causes contribute to 80% of the overall problem To give a visual representation of data over a period of time To show comparisons among categories with a chart that uses either horizontal or vertical bars

To analyze polls, statistics, and managing money and data, pie charts are an easy way to visualize percentage breakdowns of a total

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Data Gathering Checklist A Data Gathering Checklist is a simple data collection tool that can help a PIP/QAPI team identify the most important cause of a quality problem. This tool is useful when the team has identified a number of causes or problems and wants to know which one is the most important. Procedure:

1. Generate a list of the most common defects or problems that contribute to your issue. A typical list comprises 6-10 defects or causes.

2. Create a checklist (see next page for example). 3. Decide how to collect the data, i.e. going forward or back in time, using chart audits or other documentation.

4. Pick a time frame for collecting data. Ideally, the time frame should be long enough to make at least 30 observations.

5. Identify who will collect the data. 6. Plot the data on a Pareto Chart.

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Data Gathering Checklist EXAMPLE Defects of interest: Why was bloodwork not completed?

DEFECT

TOTAL COUNTS

COUNTS

FREQUENCY (%)

Doctor forgot to order blood screen

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIII

Nurse forgot to process order

IIIIIIIIIIIIIIIIIIIIIIIIIII IIII

33%

Resident on leave

IIIIIIII

Lab forgot to take blood

III

Resident status changed

III

Ordered, but not done for other reasons

Resident tested but specimen spoiled and test not repeated

Resident refuses bloodwork

TOTAL

100%

48%

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Flowcharts A flowchart is a pictorial representation describing a process being studied. Flow charts give team members a common reference point when analyzing a work process and planning for process improvement. Procedure:

1. Decide on the process to flowchart. 2. Define the beginning and ending steps of the process. 3. Use ovals to indicate the beginning and ending boundaries of a process.

4. Write the beginning step in an oval. 5. Use rectangles to indicate each successive action step in the process.

6. When a step in the process requires decision, write a yes/no question in a diamond and develop paths for either answer.

7. Write the ending step in an oval.

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Flowcharts EXAMPLE Pressure Ulcer Identification

Initial Assessment

Education and Development of Treatment Plan

Nutritional Assessment and Support

Wound Care Management

Is the Ulcer Healing?

Reassessment of Treatment Plan and Evaluation Adherence

Ulcer Care: Managing Bacterial Colonization

Yes

Monitor

Return to the Beginning

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Process Mapping In a process map, each “lane” is labeled with a care team member or location that is critical for the process to succeed. Do not forget to include the resident. Each step of the process is placed in the appropriate lane according to who is handling the step. A process map allows the PIP team to see how many hand-offs occur during the process from start to finish. Unnecessary hand-offs signal inefficiencies and an increased opportunity for mistakes to occur. Procedure: Once you have completed the process map, ask the following questions:

1. Where are the bottlenecks? How can we address these? 2. Are there inconsistencies in how things are done? What can be standardized?

3. Can things be done in a different order? In parallel? By a

different person with better or the same quality, at a lower or the same cost?

4. Can steps be located closer together to reduce travel? 5. Does each step add value? If not, can it be eliminated?

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Process Mapping EXAMPLE

Doctor

Orders Medication

Prescribes New Order

Nurse

Process Order

Calls Doctor to Inform of Discrepancy

Pharmacist

The example below shows the process of a resident receiving a new medication. A minimum of three hand-offs of the medication order occur during the process; from the physician to the nurse, from the nurse to the pharmacist, then to the resident. If there is a question, then the hand-offs continue back through the nurse and physician.

Reviews and Questions Order

Necessary to Re-Order?

Yes

Calls Nurse to Inform of Discrepancy

Resident

Receives Medication

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Flow chart and process MAPPING SYMBOLS Process

Rectangle

Decision Point

Diamond

Start or Stop Point

Oval

Input or Output Data

Parallelogram

Documentation

Document

Delay

Bullet

Database

Cylinder

Unclear Step

Cloud

Connector

Circle

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Root Cause Analysis FISHBONE DIAGRAM Root Cause Analysis allows the PIP Team to get at the “root” of the problem by better understanding where and why the problem exists. Conducting a Root Cause Analysis guides the workgroup or Performance Improvement Committee to make decisions based on data rather than “hunches” and to seek lasting solutions rather than quick fixes. One Root Cause Analysis tool is the Fishbone Diagram, so named because of its resemblance to the skeleton of a fish. It is also known as the Cause and Effect Diagram. This tool is useful in assisting teams to focus on possible root causes of performance improvement issues. The five main causes generally used are:

1. Manpower/People 2. Environment 3. Material 4. Equipment 5. Methods/Processes

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Root Cause Analysis FISHBONE DIAGRAM Before creating the Fishbone Diagram, the desired outcome needs to be decided. Beginning with the desired outcome, work backward to identify the main factors that could affect that outcome and show them as the prominent branches or “bones” of the diagram’s structure. Once the team has established the desired outcome, the next step of the analysis is to consider all of the factors that support or impede the outcome. Begin the Root Cause Analysis with “brainstorming”. The workgroup talks about all of the factors of the problem. Identify where and why a system or process problem exists. Afterwards, the PIP team takes the information that they have discussed and begins to work on constructing a Fishbone Diagram. Based on the analysis process, the PIP team launches new interventions designed to address the problem. Procedure:

1. Identify the problem the group will work on. Write the problem in a box on the right side of a flip chart.

2. Draw the “fish” outline, a long horizontal line (backbone)

coming from the box and a series of diagonal lines (rib bones) coming off of the backbone.

3. Identify the main branches with the categories of causes. 4. Brainstorm for specific causes, which contribute to the main branches.

5. Clarify as needed. Develop the causes by asking “why” until a useful level of detail is reached.

6. Under each main branch list all of the relevant factors associated with the branch that will influence the desired outcome.

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Root Cause Analysis FISHBONE DIAGRAM EXAMPLE Manpower

Agency Staff

New Staff

Lack of Staff

Materials Lack of Meal Carts

Resident/ Patient Meals are Late or Cold

Orientation of Nutrition Services Staff

Broken Steam Table Element

Equipment Methods

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Root Cause Analysis: The Five Whys Another method of completing a root cause analysis is by making a table that asks a series of questions. The analysis repeatedly digs deeper by asking “Why?” then, when answered, “Why?” again, and so on until the cause of the issue is determined. Procedure:

1. W rite down the specific problem. Writing the issue helps you

formalize the problem and describe it completely. It also helps a team focus on the same problem.

2. A sk ‘Why’ the problem happens and write the answer down below the problem.

3. If the answer you just provided doesn’t identify the root cause of the problem that you wrote down in Step 1, ask ‘Why’ again and write that answer down.

4. L oop back to step 3 until the team is in agreement that the problem’s root cause is identified.

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Five Whys Tool Problem Statement (One sentence description of event)

Why?

Root Cause(s) 1. 2. 3. To evaluate Root Causes, ask the following: If you removed this Root Cause, would this event have been prevented?

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Pareto Charts The Pareto Chart is a tool that helps teams see which causes or problems occur most frequently. The chart plots out the activities or areas that contribute most to poor quality. The Pareto Chart is based on the theory that a small number of causes will have the largest contribution to poor quality. When a few activities contribute to most of the problem, it is called the Pareto Effect. A classic Pareto Effect is observed when 20% of the causes contribute to 80% of the overall problem. Procedure:

1. Place the data captured in the Check Sheet into a table, in

descending order. From this table, calculate the percentage frequency and the cumulative frequency.

2. Plot this information as a bar chart, where each vertical bar represents a different cause or problem and the left vertical axis represents the number of causes and problems.

3. Identify the bar where the cumulative frequency is high relative to the number of categories.

4. Look for a Pareto Effect, where the first few categories account for most of the problems.

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Pareto Chart EXAMPLE

Pareto Chart: Reasons Why Blood Work Was Not Completed 50 45 Frequency Count

40 35 30 25 20 15 10 5 0

Defect Type (Reason Blood Work Was Not Completed)

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Trend or Run Charts A trend chart gives visual representation of data over a period of time. It is also used to establish baseline performance, identify special cause variation and to compare members of a group with each other. Trend charts often include a line representing the average or mean of the data. Procedure:

1. Gather data in a chronological or sequential form.

Measurements must be taken over a period of time.

2. Divide the data into two sets of values, X and Y. The values for X represent the time intervals and the values for Y represent the measurements taken.

3. Plot the data for each time interval. 4. If an average or mean line is to be used, calculate and plot.

Average or means is equal to the sum of all data points divided by the number of data points - i.e., 2, 5, 4, and 9 equals 20. Twenty divided by four equals an average of five.

5. Connect the points for easier visualization.

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Trend or Run Charts EXAMPLE Average Length of Stay (days) per Month 60 50

Days

40 30

Made Change Here

20 10 0

Month

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Bar Chart Purpose: A bar graph is a chart that uses either horizontal or vertical bars to show comparisons among categories. One axis of the chart shows the specific categories being compared, and the other axis represents a discrete value. Some bar graphs present bars clustered in groups of more than one (grouped bar graphs), and others show the bars divided into subparts to show cumulate effect (stacked bar graphs). Procedure:

1. Determine the discrete range. Examine your data to find the

bar with the largest value. This will help you determine the range of the vertical axis and the size of each increment. Then label the vertical axis.

2. Determine the number of bars. Examine your data to find

how many bars your chart will contain. These may be single, grouped, or stacked bars. Use this number to draw and label the horizontal axis.

3. Determine the order of the bars. Bars may be arranged in

any order. (A bar chart arranged from highest to lowest incidence is called a Pareto Chart.) Normally, bars showing frequency will be arranged in chronological (time) sequence. Draw the bars.

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Bar Chart EXAMPLE

Percentage (Number of Errors Over Number of Total Meds Administrated)

Percentage of Medication Errors

5 4.5 4 3.5 3 2.5 2 1.5 1 .5 0

Defect Type (Reasons for medication error)

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Pie Chart Pie charts, a form of an area chart, are an easy way to visualize percentage breakdowns of a total. They’re useful for analyzing polls, statistics, and managing money and data. And they make an excellent visual display for explaining data to other people. Procedure:

1. Calculate Pie Chart Proportions. 2. Gather your numerical data and label information and write it down with one data point per line, in descending order.

3. Add the data all together, calculate the total. This number will be your denominator.

4. Calculate the percentage of the total for each data point by dividing each one by the denominator (total) calculated above.

5. Calculate the angle between the two sides of each pie slice. To

do this, multiply each percentage (still in decimal form) by 360 (the number of degrees in a circle).

6. Utilize the charting capabilities in Microsoft Office (Excel or Word). To complete manually, use a mathematical compass to draw a circle. To draw a pie chart accurately, you need to start with a perfect circle. This can be done using a compass (and a protractor to measure the angles). If you don’t have a compass, try tracing around a circle template, using something round such as a lid or a CD.

7. Draw the radius. Start in the exact center of the circle an draw a straight line to the outside of the circle.

8. Place your protractor on the circle. Position it on the circle so that the 90 degrees crosshair is situated directly above the center of the circle. The zero point should be vertically aligned along the vertical plot line.

9. Draw each section division. Draw the sections by marking the first division against the edge of the protractor at the correct angle, using the angle formulations you got in the earlier step. Each time you add a section, the radius changes to the line you just drew; rotate your protractor accordingly.

10. Color each segment. You can use color, patterns or just words,

depending on what meets your purpose best. Add the name of each section and the percent it represents in the chart.

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Pie Chart EXAMPLE Reasons for Indwelling Catheter Use

Mobility Impairment

Coma

Incontinence

Terminal Illness

Resident Request

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Group Techniques Technique

When to use

Brainstorming

To generate many ideas in a short amount of time. Ideas are suggested while criticism and evaluation is avoided

Nominal Group Techniques

To generate a list of options for a structured decision through the contributions of group members working individually

Multi-Voting

To select the most important of popular topics from a list with limited group discussion and difficulty

Structured Discussion

To gain group consensus on a list of ideas or topics

High Volume, High Risk, Problem Prone, High Cost

To prioritize issues so that those issues with the largest impact are addressed first and resources are utilized appropriately

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Brainstorming Brainstorming is a technique designed to generate many ideas in a short amount of time. Ideas are suggested while criticism and evaluation is avoided. Members should feel free to build on others’ ideas. Procedure:

1. Decide on a topic to be “brainstormed”. 2. Give the group a minute or two to quietly think about the issue and its causes.

3. Encourage group members to write down their ideas. 4. In order, have each member offer one idea about the situation being discussed.

5. Record each answer on a flip chart. 6. Continue until all ideas are recorded. 7. With the group’s agreement, similar ideas can be clarified or combined.

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Nominal Group Technique Nominal Group Technique is a structured decision-making technique designed to generate a list of options through the contributions of group members working individually. Procedure:

1. Clarify the nominal group objective. Write on a flip chart

and/or handout individual papers with the objective to each workgroup member.

2. Each member, individually, lists as many ideas as possible. 3. Call out one idea from each list in turn, around the group until everyone’s list is complete.

4. Record each idea on a flip chart. 5. Pass when all ideas on a list have been presented. 6. Clarify each idea and eliminate duplicates after all ideas have been listed.

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Multi-Voting Multi-voting is a group decision-making technique designed to select the most important or popular topics from a list with limited discussion and difficulty. Multi-voting often follows a brainstorming session in order to identify the few topics worthy of immediate attention. Procedure:

1. Generate a list of topics. 2. Agree on the criteria for selecting ideas. 3. Assign each idea on the list a letter of the alphabet. 4. Agree on the number of ideas (20 – 30%) for which all members will vote.

5. Each member votes individually, listing the letters of each selected idea.

6. After all members have completed their selections, tally the votes.

7. Let members vote by a show of hands as each topic number is called out.

8. Record and add the votes on a flip chart. 9. Decide which ideas will receive further consideration and attention.

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Structured Discussion Purpose: Structured discussion is a group decision-making technique designed to gain group consensus on a list of ideas or topics. Procedure:

1. Agree on the criteria for a decision. 2. Take turns discussing the issues taking all sides into consideration.

3. Ask questions for clarification. 4. S ummarize points of agreement after all members have had an opportunity to express their ideas.

5. Debate and discuss differences of opinions. 6. Search for alternatives that meet goals of all members. 7. D o a check periodically by asking each member to state his/her current point of view.

8. Continue above steps until a consensual decision is reached. Key Points:

1. C onsensus takes time. Meetings should be long enough to allow full discussion.

2. Additional meetings should be scheduled as needed to allow a decision to emerge.

3. If a discussion becomes too heated, agree to disagree for the time being.

4. Come back to the discussion at a future meeting after everyone has had time to think about the issue.

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How To Prioritize Issues High volume, high risk, problem prone, and high cost is a technique used to prioritize issues so that issues with the largest impact are addressed first and resources are appropriately utilized. Procedure:

1. Identify opportunities for improvement (OFI). 2. Make a table. OFI: Improve Patient Care Processes High Volume

High Risk

Problem Prone

High Cost

Critical Extremely Important Very Important Important

3. Categorize indentified processes into the appropriate areas as defined horizontally and vertically.

OFI: Improve Patient Care Processes High Volume

High Risk

Problem Prone

High Cost

Critical

Pressure ulcers

Extremely Important

Lost Laundry

IV Therapy

IV Therapy Lost Laundry

IV therapy Lost Laundry

Medication Pass

Meal Service

Falls

Very Important Important

4. B ased on the number of categories that the issue appears

under, determine the priority in which to address each issue. For example, critical issues are addressed first because the issue is in all four categories.

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Techniques for Effective Meetings Techniques

Purpose

Agenda

An agenda provides structure that guides the meeting. Use of agendas improves meeting efficiency and improves likelihood of achieving outcomes

Ground Rules

Ground rules are agreements about acceptable and unacceptable individual and group behaviors. The purpose of ground rules is to limit distraction and help keep members focused

Meeting Roles

Assigning meeting roles clarifies and assigns esponsibilities. Roles help hold members accountable and ensure meeting time is productive

Agenda An agenda provides structure that guides the meeting. Use of agendas improves meeting efficiency and increases the likelihood of achieving outcomes. Structure and Organization: Agendas should include:

• Purpose of the Meeting • Topics • Time Estimates for each Topic • Lead Person for each Topic

Guidelines for use: • The agenda should be developed prior to the meeting, if possible, and distributed to participants. • Review agenda with participants at the start of the meeting. • Discuss and make any necessary changes.

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Ground Rules Ground rules are agreements about acceptable and unacceptable individual and group behaviors. The purpose of ground rules is to limit distraction and help keep members focused. Ground rules should be established during the first few meetings and may be reviewed and revised as necessary. Examples:

• Start and end meetings on time • Minimize interruptions – turn off all cell phones and pagers • Listen constructively • Keep an open mind • Critique ideas, not people • Maintain communication courtesy • One person speaks at a time • Share responsibilities • Have fun • Celebrate success

Guidelines for use: • Establish during first few minutes • Review and revise as necessary

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Meeting Roles Assigning meeting roles clarifies and assigns responsibilities. Roles help hold members accountable and ensure meeting time is productive.

Chairperson

• Sets the date and time of meeting • Prepares the agenda • Ensures the meeting room is set up • Notifies committee members of scheduled time and meeting location • Notifies guests of scheduled time and meeting location • Prints and distributes the meeting minutes • Ensures data reports are available • Compiles a list of potential agenda topics and distributes to members • Looks for trends and prioritizes the information • Maintains meeting schedule • Schedules subsequent meetings in response to a significant finding

Facilitator

• Facilitates the meeting • Opens meeting • Announces agenda and time allotments for each topic • Announces meeting direction and goals • Maintains control of flow of meeting • Encourages team member participation • Ensures needed actions are assigned • Defines and delegates tasks • Knows when it is time to summarize information • Announces next meeting time and place • Closes meeting

42 | PROVIDIGM QAPI TOOLKIT

Meeting Roles CONTINUED Timekeeper • Keeps accurate track of time during meeting • Alerts when the time allotted for an agenda topic is almost up so the group can decide whether to keep discussing or move on • Assists the group to manage time effectively Recorder (Note taker) • Writes updates on the Meeting Minutes as directed by the team discussion and input • Condenses discussion points when possible • Verifies that ideas and information is written accurately • Summarizes discussions in complete sentences • Gets input from group on wording of needs, preference, problems, goals and interventions Member • Reviews data reports in their area of responsibility and notifies the meeting organizer of potential agenda topics • Arrives on time and is prepared • Remains attentive and focused throughout the meeting • Is prepared to share and participate in discussion • Contributes to development of action plans • Accurately completes assigned documentation • Proceeds to share/implement action plans

PROVIDIGM QAPI TOOLKIT | 43

Notes

References Brassard, M, Ritter, D, & Oddo, F (2010). The Memory Jogger II: A Pocket Guide of Tools for Continuous Improvement and Effective Planning. Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP, Moen, R. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009. Joiner, BL, Scholtes, PR, & Streibel, BJ (2003). The Team Handbook. Madison: Suttle-Straus, Inc. (2012). Quality Improvement Guide Long-Term Care. Ontario: Health Quality Ontario (HQO). The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart’s cycle to PDSA, replacing “Check” with “Study.” [See Deming WE. The New Economics for Industry, Government, and Education. Cambridge, MA: The MIT Press; 2000.]

Have questions about this toolkit or need more information? Contact Providigm at 877-221-0184

46 | PROVIDIGM QAPI TOOLKIT

PROVIDIGM QAPI TOOLKIT | 47

abaqis: For greater success in all 5 elements of QAPI

Design & Scope

Governance & Leadership

YES

Feedback, Data Systems & Monitoring

Performance Improvement Projects (PIPs)

Systematic Analysis & Systemic Action

Progressive care organizations are using the abaqis Quality Management System for QAPI compliance, survey readiness, enhancing the quality of care and as the foundation for a continuous quality improvement system in their facilities. Comprehensive yet easy-to-use, abaqis helps you comply with regulations, monitor readmissions, enhance resident satisfaction and effectively promote your quality initiatives. Developed by Providigm. Supported by Medline. Designed for you.

Medline Industries, Inc. One Medline Place Mundelein, IL 60060 ©2014 Medline Industries, Inc. All rights reserved. abaqis and Providigm are registered trademarks of Providigm, LLC. Medline is a registered trademark of Medline Industries, Inc. Disclaimer: Use of this tool is not mandated by CMS for regulatory compliance nor does its completion ensure regulatory compliance. Nursing homes are encouraged to adapt this tool to meet their needs. MKT1436920 / 5M / VP30

PDSA (Plan-Do-Study-Act) Worksheet Housing Center Name: Date: Identified area of improvement: PLAN We plan to: _____________________________________________________________________________________________ _____________________________________________________________________________________________ We hope this results in: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Steps to execute: 1. 2. 3. 4.

______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

DO We observed:

STUDY We learned the following. We met/did not meet our measurement goal.

ACT Based on our cycle of PDSA, we have concluded the following:

Disclaimer: This worksheet is a sample and Use of this tool does not ensure regulatory compliance.

Quality Improvement Worksheet Housing Community: ____________________________________________________________ Work Team Members: ______________________________________________________________________________ ______________________________________________________________________________ Date:_________________________________________________________________________ Step 1. Identify the Opportunity for Improvement/ Problem State the problem and describe in detail. Problem Statement: Why are you doing this project? What is the problem you are addressing? Who is affected? When is it a problem? Why does it matter? How does it affect the patient? Current situation is __________________, leading to _____________________ (undesirable event). Step 2. What is the root cause of the problem? Why do we have the problem/why is system not working? Conclude as to cause based on objective study and review-not assumption. What happened, why did it happen. What can be done to prevent it from happening again? Areas to consider: • • • • •

Manpower/People Environment Material Equipment Method/Process

Disclaimer: Worksheet tool is just an example taken from sources such as CMS and IHI. Use of this tool does not ensure regulatory compliance.

Root Cause Analysis: Problem Statement Why?



Why?



Why?



Why?



Why?



Root Cause(s):

One sentence description of problem/event:

1. 2. 3. 4.

To validate root causes, ask: If you removed the root cause, would this problem have been prevented?

Step 3. A. Establish your goal / aim. Be realistic, measurable and time specific. Think SMART (Specific, Measurable, Attainable, Realistic, Timely). B. Establish Measures (How will we know that the change made is an improvement? What data will we track? C. Change(s). What changes are we going to test?

(Continue with PDSA worksheet to test the change)

Disclaimer: Worksheet tool is just an example taken from sources such as CMS and IHI. Use of this tool does not ensure regulatory compliance.

Goal/Measures/Changes statement: To increase / decrease: __________________________________________ (process/outcome) from: ____________________________________________________ (baseline %, rate, #, etc.) to:_____________________________________________________ (goal/target %, rate, #, etc.) by: __________________________________________________ (date, 3-6-month timeframe) in: ________________________________________________________ (population impacted).

Additional Notes:________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Disclaimer: Worksheet tool is just an example taken from sources such as CMS and IHI. Use of this tool does not ensure regulatory compliance.

Plan, Do, Study, Act Worksheet Act: What changes are we going to make based on our findings?

Study: What were the results?

Plan: What exactly are we going to do?

Act

Plan

Study

Do: When and how did we do it?

Plan • What is the objective of the test? • What do you predict will happen and why? • What change will you make? • Who will it involve (e.g. one unit, one floor, one department)? • How long will the change take to implement? • What resources will they need? • What data need to be collected?

List your action steps along with person(s) responsible and time line

Do • Implement the change. Try out the test on a small scale. • Carry out the test. • Document problems and unexpected observations. • Begin analysis of the data.

Describe what actually happened when you ran the test

Disclaimer: Worksheet tool is just an example taken from sources such as CMS and IHI. Use of this tool does not ensure regulatory compliance.

Study Set aside time to analyze the data and study the results and determine if the change resulted in the expected outcome. • Complete the analysis of the data. • Compare the data to your predictions. • Summarize and reflect on what was learned. Look for: unintended consequences, surprises, successes, failures.

Describe the measured results and how they compared to the predictions.

Act If the results were not what you wanted you try something else Refine the change, based on what was learned from the test. • Adapt – modify the changes and repeat PDSA cycle • Adopt – consider expanding the changes in your organization to additional residents, staff, units • Abandon – change your approach and repeat PDSA cycle

Describe what modifications to the plan will be made for the next cycle from what you learned

Additional Notes:

Disclaimer: Worksheet tool is just an example taken from sources such as CMS and IHI. Use of this tool does not ensure regulatory compliance.

2021 Housing & Nurse Managers' Education Series

GROWING A HEALTHY RELATIONSHIP HOUSING MANAGERS & NURSE MANAGERS March 10, 2021

Amanda Johnson, RN, LNHA, CHC, Vice President of Clinical Operations, Chief Compliance Officer Tealwood Senior Living

Thank you to our sponsor

2021 Housing & Nurse Managers' Education Series

We’ve got you covered. Improve Resident Outcomes Create Workforce Efficiencies Further Your Financial Objectives

Over the past 20 years, Eldermark has become the leading electronic health record and operational technology solution for the senior care industry—and for good reason. We don’t offer piecemeal healthcare management solutions. Rather, we partner with senior living organizations to develop a comprehensive, mobile-friendly healthcare, communications, and business operations software platform that saves you time and money while raising the quality of care you provide. 100% user-ready for the 2021 MN Assisted Living Licensure requirements Eldermark Senior Housing Software 12400 Whitewater Drive Suite 2010 Minnetonka, MN 55343

Phone: 952-931-9660 repsales@eldermark.com

eldermark.com

GROWING A HEALTHY RELATIONSHIP - HOUSING MANAGERS & NURSE MANAGERS Care Providers of Minnesota 2021 Housing Managers/Nurse Managers Education Series

2021 Housing & Nurse Managers' Education Series

INTRODUCTIONS Amanda Johnson, RN, LNHA, CHC, Vice President of Clinical Operations, Chief Compliance Officer Tealwood Senior Living Ms. Johnson has worked in long term care since 1989. She holds a bachelor's degree in human services from the University of MN, Morris. She is a registered nurse and a licensed nursing home administrator. At Tealwood Senior Living her responsibilities include developing skilled nursing, housing and home care policy and procedures, health information technology, regulatory compliance, corporate compliance, collaborative performance improvement projects, multiple aspects of quality improvement, and overall company leadership. In addition to clinical oversight, Ms. Johnson also oversees operations for several properties within the Tealwood portfolio. She currently serves as Vice Chair of the Care Providers of MN Board of Directors, sits on the Long-Term Care Imperative Steering Committee, and was appointed to the MN state Board of Executives for Long Term Services and Supports (formally BENHA). Ms. Johnson has served on several committees with Care Providers of Minnesota and is a frequent speaker on regulatory, leadership, reimbursement and other industry related topics.

TODAY’S GOALS

UNDERSTAND THE RELATIONSHIP BETWEEN HOUSING MANAGEMENT AND NURSING MANAGEMENT

IDENTIFY THE KEY SYSTEMS OF ASSISTED LIVING

DISCUSS THE RISK AREAS OF EACH

2021 Housing & Nurse Managers' Education Series

MANAGER 101 A new manager spends a week at his new office with the manager he is replacing. On the last day the departing manager tells him, "I have left three numbered envelopes in the desk drawer. Open an envelope if you encounter a crisis you can't solve." Three months down the track there is a major drama, everything goes wrong - the usual stuff - and the manager feels very threatened by it all. He remembers the parting words of his predecessor and opens the first envelope. The message inside says "Blame your predecessor!" He does this and gets off the hook. About half a year later, the company is experiencing a dip in sales, combined with serious product problems. The manager quickly opens the second envelope. The message read, "Reorganize!" This he does, and the company quickly rebounds. Three months later, at his next crisis, he opens the third envelope. The message inside says "Prepare three envelopes".

POLL Do you have a good relationship with your housing or nurse manager? •Yes, I am housing manager •No, I am housing manager •Yes, I am nurse manager •No, I am nurse manager •Other, add to chat box

2021 Housing & Nurse Managers' Education Series

POLL Does your housing or nurse manager understand your role? •Yes, I am housing manager •No, I am housing manager •Yes, I am nurse manager •No, I am nurse manager •Other, add to chat box

HOW DO YOU DO BUSINESS?

2021 Housing & Nurse Managers' Education Series

WHO IS WATCHING HOW YOU OPERATE? • OLDER ADULT SERVICES

• TENANT LANDLORD LAWS

• MN BOARD OF NURSING

• HOUSING WITH SERVICES

• STANDARDS OF CARE

• FOOD AND LODGING

• EMPLOYMENT LAWS/STANDARDS • STATE AND FEDERAL REGULATIONS

• OSHA (MN LABOR AND INDUSTRY)

• CORPORATE POLICY AND PROCEDURES • FACILITY POLICY AND PROCEDURES • CUSTOMERS/CONSUMERS/ADVOCATES

WHO ELSE IS WATCHING...? EVERYONE!!!

2021 Housing & Nurse Managers' Education Series

Because you call yourself Assisted Living

WHY DO I NEED A NURSE?

• Must offer to provide or make available health related

services under any license

RN on-call, accessible to staff 24/7

MN 144G = WHY YOU NEED A NURSE

A system to check on each AL client at least daily A means for clients to request assistance with health/safety needs 24/7 Offer to have a nursing assessment and propose a service plan/agreement prior to the execution of a lease

2021 Housing & Nurse Managers' Education Series

DUTIES THAT ARE OFTEN SHARED • HR DIRECTOR • FAMILY COUNSELOR • STAFF COUNSELOR • MAINTENANCE • TEACHER • ADMINISTRATOR • ACCOUNTANT • NEGOTIATOR • WASTE MANAGERS

• NURSING DELEGATION IS NOT A SERVICE THAT CAN BE SHARED

COMMON THEMES AND TERMS • RENTAL AGREEMENT • SERVICE AGREEMENT • ASSESSMENTS • COACHING • TEACHING • DIRECTING • SUPERVISING

2021 Housing & Nurse Managers' Education Series

POLL Have you completed leasing/move in paperwork? •Yes, as housing manager •Yes, as nurse manager •Yes, as housing/nurse manager •Yes, as another staff •No

Pricing structures vary •

Rent/services

•

All inclusive rate- per month or per day

•

Ala carte

•

Tiers or levels

•

Base plus ala carte

•

EW clients – Customized Living Tool

2021 Housing & Nurse Managers' Education Series

NURSES DRIVE THE REVENUE

ASSESSMENT

SERVICES

REVENUE

CLINICAL PROCESS RN assessment/evaluation Service plan: description, delegation, cost Annual reviews Delegation of services Medication administration Supervisions Orientation and training On going assessments

2021 Housing & Nurse Managers' Education Series

LEASE

UPDATES

TENANT/ CLIENT= CUSTOMER

SERVICE AGREEMENT

EVALUATION

AN ACTIVE PROCESS 21

ASSISTED LIVING 101 HOUSING/TENANT

HOME CARE/CLIENT

SERVICES

Referral/Intake

Nursing/Admission Assessment

Care Plans-Assignment Sheets

Occupancy Agreement

Service Agreements/ Modifications

Re-Evaluation Plan

Eviction Notice

Supervisions

Discharge Plan Termination of Services

2021 Housing & Nurse Managers' Education Series

WHO TELLS NURSES WHAT TO DO? MN Board of Nursing State and Federal regulations Corporate/Facility policy and procedures Standards of care Home Care Directors Administrators Do you?????

Systems Manager- implement, train, delegate, synthesize Medications manager- not primarily setting up meds, utilizing others for MAR entry and or pharmacy communication Supervisor of personnel Relationship with Housing Director or Manager DELEGATION OF DUTIES

2021 Housing & Nurse Managers' Education Series

HR management Referrals Social Worker

AND DON’T FORGET…

Recreational Therapy Teacher Counselor Maintenance LOOK FAMILIAR?

WHAT DO THE NURSES DO?

Assessment: related to functional, physical, cognitive and supportive status of the resident

2021 Housing & Nurse Managers' Education Series

WHEN DO THEY COMPLETE THEM? • Prior to move-in • Upon admission to services • With significant changes in condition/service needs • Annually from admission date AND THINGS ARE HEATING UP

Care planning:

THEN WHAT DO THEY DO?

using information gathered during the assessment process, development of a care plan, communication of the care to the resident, family and staff & oversight of the care implementation by staff and recognition of deviation from the plan

2021 Housing & Nurse Managers' Education Series

Establish level of service/package needs

SERVICE PLANS = REVENUE

Need to be clear to consumer

Agency Policies and Procedures must be consistent

Not 24 hr. skilled nursing Adequate staff

Example: How is your staff directed to respond in case of a tenant/resident fall?

2021 Housing & Nurse Managers' Education Series

Medication management:

IS THAT ALL? testing of residents to determine ability for selfadministration of medication, oversight of medication storage and administration

POLL Have you completed home health aide/resident assistance training at your current community? •Yes •No •In the process

2021 Housing & Nurse Managers' Education Series

Basis for most services in home care/assisted living

Each nurse in responsible for their own license

RN DELEGATION

Non-licensed or certified personnel performing tasks

Nurse Practice Act and Standards of Practice

Training Competency Skills

Need clear and consistent documentation

NURSING DELEGATION

Return competency when appropriate Timely Reviewed with performance issues, annually Maintain records

2021 Housing & Nurse Managers' Education Series

Staff orientation

Supervisions

In-services

Infection control

ANYTHING ELSE?

Safety

Standards of practice

Know the Language

WHAT ELSE SHOULD I KNOW?

 Home Health Aide  Delegation  Supervision  Medication Reminders/Assistance/Administration  ADLs  Dressing, Grooming, Bathing  Toileting, Transfer assistance

2021 Housing & Nurse Managers' Education Series

Know How You are Getting Paid

SO WHAT SHOULD I KNOW?

 Private  LTC Insurance  EW  Customized Living Tool  GRH

Narcotics- storage, diversion prevention Service Plans/Agreements

HOT TOPICS

Reassessments Staff Training Medication Administration

2021 Housing & Nurse Managers' Education Series

DON’T GET CAUGHT BY SURPRISE Know Your Team-who is doing the hiring? Who works with you? Turnover? Know Your Customers-meet families, tenants, case managers etc. Know Your Systems- med administration, narcotics, falls, med errors, change in conditions, sit through training Know Your Strengths-licensed staff levels, direct care levels, memory care, extensive services, supervised living Know Your Weakness- untrained staff, meal service, staffing levels Know Your Risk Areas- medications administration, narcotic diversions, employee injury, needle sticks, hazardous waste

Includes training, monitoring, oversight of delegated administration Systems for security of all medications- especially controlled substances

MEDICATION MANAGEMENT

Communication with pharmacy, practitioners, families

= BIG DEAL

2021 Housing & Nurse Managers' Education Series

POLL Have you have passed medications in your current community? •Yes, as housing manager •Yes, as nurse manager •Yes, as housing/nurse manager •Yes, as another staff •No

Medication Management and Training Narcotic Management

“KEY OPERATIONAL SYSTEMS

Orientation Monitoring Status Incident Reporting and follow up Assessment/Re-Assessments Competencies

2021 Housing & Nurse Managers' Education Series

Consumers need to be clear on your services…so do you and your nurse.

WHAT DOES YOUR FACILITY OFFER?

Assisted Living is NOT required to provide 24-hour skilled care. You must have adequate staff to take care of your clients. Policies and Procedures must be consistent.

Entrance Criteria

KNOW YOUR REQUIREMENTS

Continued Stay Criteria

Alternative Placement Criteria

BE CONSISTENT!!!

2021 Housing & Nurse Managers' Education Series

SERVICE RECOVERY AND MITIGATION

Requires interdisciplinary solutions All hands-on deck approach to resolve Review for common themes, repeat issue ROOT CAUSE RED FLAGS: REPEAT ISSUES FREQUENT INCIDENTS COMMON COMPLAINTS

Know enough to be dangerous…

PROTECT YOURSELF AND YOUR CUSTOMERS

        

A Guide to the Survey Process A Guide to Home Care Vulnerable Adult Training Orientation Process Competencies Personnel Files Time Management Work Environment Customer Satisfaction

2021 Housing & Nurse Managers' Education Series

You need tenants to have clients Clients need services to stay Services generate revenue Revenue pays the bills Quality services generate customer satisfaction Customer satisfaction generates more tenants

Corporate Goals & Expectations Multi-facility Ownership Goals & Expectations Stand Alone Facility Goals & Expectations Tenant/Client Goals & Expectations Staff Goals & Expectations Personal Goals & Expectations 48

2021 Housing & Nurse Managers' Education Series

Communication

KEYS TO A SUCCESSFUL RELATIONSHIP

Trust Appreciation Knowledge Respect

QUESTIONS?

Amanda Johnson RN, LNHA Vice President of Clinical Operations Tealwood Senior Living 612-968-5530 amanda.johnson@twsl.com

…because the journey matters

2021 Housing & Nurse Managers' Education Series

LEGAL ISSUES FOR HOUSING & NURSE MANAGERS March 17, 2021

Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rob Rodè, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC

INTRODUCTIONS Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca K. Coffin is a partner with the law firm of Voigt, Rodè, Boxeth & Coffin, LLC practicing in health law, including accounts receivable, regulatory compliance, and HIPAA compliance. Ms. Coffin represents providers on nursing facility and home care licensing, including change of ownership and bed relocation transactions. Ms. Coffin also practices in employment law and advises clients on a variety of employment and labor issues. She currently represents a number of nursing facilities, home care agencies, and housing with services providers.

Rob Rodè, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Robert F. Rodè is a partner and practices in the areas of health law, civil litigation, employment law, administrative law, and construction law. Mr. Rodè has a special emphasis on long-term care providers, home health agencies, rehabilitative agencies, and housing with services providers. In practice, Mr. Rodè represents and advises clients on issues such as regulatory compliance; the long-term care survey and appeal process; behavior issues; resident discharge; contract negotiations and drafting; dispute resolution; housing; civil and administrative litigation; arbitration and mediation; employment; and accounts receivable.

2021 Housing & Nurse Managers' Education Series

LEGAL ISSUES FOR HOUSING & NURSE MANAGERS 2021 Care Providers of Minnesota Housing & Nurse Managers’ Education Series

Robert F. Rodè, Esq.

Rebecca K. Coffin, Esq.

rrode@vrb-law.com

rcoffin@vrb-law.com

Voigt, Rodè, Boxeth & Coffin, LLC 1000 University Ave W, Suite 250 St. Paul, MN 55101 651-209-6161

OBJECTIVES Learn applicable laws for HWS/AL and home care  Know federal and state Fair Housing laws and how they affect you  Understand consumer protection laws and how to avoid pitfalls  Consider when it is appropriate to terminate a lease  Understand POLST 

2021 Housing & Nurse Managers' Education Series

SUMMARY OF LAWS IMPACTING MN HWS/HOME CARE PROVIDERS Housing - Landlord • Landlord-Tenant law • Fair Housing Law – state and federal • Housing with Services law (through 7-31-21) • Assisted Living law (new 8-1-21) • Dementia disclosure and training laws • Consumer Protection laws

SUMMARY OF LAWS IMPACTING MN HWS/HOME CARE PROVIDERS (CONTINUED) Home care-related: • MN Home Care law • Nurse Practice Act • Assisted Living law (8-1-21) • Dementia training/disclosure laws • Consumer Protection laws • Elderly Waiver and other services 6

2021 Housing & Nurse Managers' Education Series

LANDLORD TENANT LAW Minnesota Chapter 504B  Applies to “independent” senior housing and housing with services  Defines when a lease is required  Mandatory lease provisions  Duties of landlord & tenant 

MINNESOTA STATUTES § 504B BRIEF OVERVIEW Written Lease  Deposits/Fee  Interest  Tenant’s Right to Privacy  Termination and Notice Provisions  Recovery of landlord’s attorney fees  Abandoned property  Eviction 

2021 Housing & Nurse Managers' Education Series

HOME CARE – APPLICABLE LAWS Nurse Practice Act – Minn. Stat. § 148.171 to 148.285  Home Care Law - Minn. Stat. Ch. 144A  Assisted Living law - Minn. Stat. Ch. 144G 

◦ AL rules are pending – in Administrative Law Judge’s hands 

Dementia training and disclosures

HOME CARE – APPLICABLE LAWS (CONTINUED) Consumer Protection laws (more on this later)  Elderly Waiver 

2021 Housing & Nurse Managers' Education Series

APPLICABLE NONDISCRIMINATION LAWS 

504 of the Rehabilitation Act



Fair Housing Amendments Act



Americans with Disabilities Act



Minnesota Human Rights Act



Local Ordinances

 

HUD Contract Requirements You may be able to “discriminate” against predatory offenders depending on facts

FAIR HOUSING BASICS WHAT IS IT? It offers protections for tenants when they are: • Renting • Buying • Securing financing for any housing

Applies to “dwellings,” including: • Senior apartments • Housing with Services • Memory Care • Assisted Living • Ownership town homes, condominiums, and cooperatives

2021 Housing & Nurse Managers' Education Series

FAIR HOUSING BASICS- TO WHOM DO THE LAWS APPLY?

Everyone involved with selling or renting real estate • More specifically, as applicable with HWS/AL: •

• Landlords • Property Managers • Owners

FAIR HOUSING Fair Housing applies to:  Housing with Services/Assisted Living  Senior Housing  Memory Care

2021 Housing & Nurse Managers' Education Series

PROTECTED CLASSES UNDER FAIR HOUSING LAWS • • • • • •

Race Family Status (having kids or being pregnant) Disability Sex (including sexual harassment) Public Assistance National Origin

•Color •Sexual Preference •Age (St. Paul) •Religion •Marital Status (being single or divorced) •Creed (beliefs)

FAIR HOUSING SENIOR HOUSING 

Housing for Seniors ◦ Must rent to families with children unless considered “housing for older persons”  80% of units must be occupied by at least one person 55 or older;  Units occupied solely by persons 62 and older; or  Housing provided under special federal and state funding programs

Advertising  Handicap discrimination 

2021 Housing & Nurse Managers' Education Series

WHO WILL ACCUSE THE PROVIDER OF DISCRIMINATION? Enforcement Mechanisms:  Family - Informal resolution with housing provider 

Public housing authority grievance procedure



Minnesota Housing Finance Agency



HUD



Local civil rights agencies/commissions

FAIR HOUSING ADVERTISING 

Advertising

◦ Not required to use the Fair Housing logos o Generally prohibited against making, printing or publishing, any notice, statement or advertisement that indicates any preference, discrimination or limitation because of race, color, national origin, religion, sex, familial status, or handicap



Fair Housing Poster:

◦ Must have a Fair Housing poster displayed prominently in the facility



Handicap discrimination

2021 Housing & Nurse Managers' Education Series

ADDITIONAL PROTECTION- DISABILITY/HANDICAP •

Individuals with: • A physical or mental impairment • • • • • • •

Hearing Mobility and visual impairments Chronic alcoholism Chronic mental illness AIDS AIDS related complex Mental Impairment

• A record of a disability • Regarded as having a disability

FAIR HOUSING HANDICAP DISCRIMINATION 

Cannot discriminate on basis of handicap ◦ Prospective tenants ◦ Current tenants ◦ Any person associated with tenant What is a “handicap”?

2021 Housing & Nurse Managers' Education Series

FAIR HOUSING ACT HANDICAP DEFINED Under the Act, “handicap” means:  with respect to a person, or mental impairment which substantially limits one or more major life activities  a record of such an impairment; or  being regarded as having such an impairment.

FAIR HOUSING HANDICAP DISCRIMINATION PROHIBITED Unlawful to discriminate against any person in the terms, conditions, or privileges of the rental of a dwelling, or in the provision of services or facilities in connection with such dwelling, because of handicap. NO INQUIRY RULE:  Unlawful to inquire to determine whether an applicant for a dwelling (or a person intending to reside in that dwelling after it is sold, rented, or made available or any person associated with that person) has a handicap.  Unlawful to inquire as to the nature or severity of a handicap of an applicant, potential tenant or associated person. 

2021 Housing & Nurse Managers' Education Series

FAIR HOUSING HANDICAP DISCRIMINATION: PERMITTED INQUIRIES 

Can make inquiries to determine if the applicant: • Can meet the requirements of tenancy – but those requirements must be non-discriminatory • Is a current illegal abuser or addict of a controlled substance • Has been convicted of the illegal manufacture or distribution of a controlled substance • Qualifies for a dwelling legally available only to persons with a disability or to persons with a particular type of disability • Qualifies for housing that is legally available on a priority basis to persons with disabilities or to persons with a particular disability

24 C.F.R. § 100.202

Don’t violate the No Inquiry Rule 23

FAIR HOUSING HANDICAP DISCRIMINATION EXCEPTION A Dwelling Need Not Be Made Available:  To an individual with a handicap who is a direct threat to the health or safety of other individuals; or  To an individual with a handicap whose tenancy would result in substantial physical damage to the property of others. Individual with a handicap listed in Fair Housing Act not “safe”? No exception. 24 C.F.R. 100.202(d)

2021 Housing & Nurse Managers' Education Series

FAIR HOUSING REASONABLE ACCOMMODATION •

Change, exception, or adjustment to a rule, policy, practice or service that may be necessary for a person with a disability to have an equal opportunity to use and enjoy a dwelling, including public and common use spaces.

•

Examples: • Service/companion animals in “no pet” building • Reserved parking space • Allow live-in aid

FAIR HOUSING REASONABLE MODIFICATION It is unlawful for any person to refuse to permit, at the expense of the handicapped person, reasonable modifications of existing premises occupied or intended to be occupied by such person if such modifications may be necessary to afford such person full enjoyment of the premises of a dwelling.  A “modification” means any change to the public or common use areas of a building or any change to a dwelling unit. 

2021 Housing & Nurse Managers' Education Series

LIMITS TO REASONABLE ACCOMMODATIONS AND MODIFICATIONS Can deny if the request was not made by or on behalf of a person with a disability; or • If there is no disability-related need for the accommodation •

•

Can be denied if providing the accommodation is not reasonable • It would impose an undue financial and administrative burden on the housing provider or alter the nature of the provider’s operation

FAIR HOUSING LAWS More issues  Examples 

2021 Housing & Nurse Managers' Education Series

WHAT ADVERTISING LAWS APPLY TO YOU?  Consumer  Breach

Protection Laws

of Contract

 Federal

and State Fair Housing Acts (Non-Discrimination Laws)

CONSUMER PROTECTION LAWS ◦ ◦ ◦ ◦

Deceptive Trade Practices Act State & Federal False Advertising Act Minnesota Consumer Fraud Act Deceptive Acts against a Senior Citizen or Disabled Person  $10,000 penalty if violate Consumer Protection Laws and actions are against a senior citizen or disabled person.

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DECEPTIVE TRADE PRACTICES ACT MINN. STAT. §§ 325D.43–325D.48

◦ A representation that goods or services have characteristics or benefits they do not have; ◦ Includes representing that goods and services are of a particular standard, quality or grade if they are of another 31

STATE AND FEDERAL FALSE ADVERTISING  Minn. Stat. §

325F.67

◦ Prohibits the use of untrue, deceptive or misleading statements in advertisements made available to the public with the intent to sell merchandise or services.  Federal: 15

U.S.C. §§ 41―58

◦ Misrepresent the nature, quality or characteristics of the goods or services 32

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FALSE ADVERTISING

MINNESOTA CONSUMER FRAUD ACT MINN. STAT. §§ 325F.68―325F.70

• Prohibits use of fraud or misrepresentation with the intent that others rely thereon in connection with the sale of merchandise. “Merchandise” includes services. • Frequently claim misrepresentation regarding the services provided (especially in IL v. AL realm), even when the person enters as an “independent resident.” o

Plaintiff not required to have actually been misled, deceived or damaged.

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EXAMPLES OF FALSE STATEMENTS ◦ Statements About Standard or Quality of Care:  Best care,” “highest quality,” “state of the art,” and “maximum degree of independence” may give rise to a breach of an express or implied warranty.  Words such as “quality,” “professional,” “superior” and “pre-eminent” are frequently cited in plaintiffs’ claims and litigation.

QUALITY OF CARE FALSE STATEMENTS  Statements

such as facility provides services “as required by law” or “quality standards above government regulations” led to Consumer Fraud, Deceptive Trade, and False Advertising Claims.

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EXAMPLES OF FALSE STATEMENTS 

Assisted Living v. Housing with Services: ◦ Be Careful! ◦ Plaintiffs’ attorneys frequently claim misrepresentation regarding the services provided (especially in HWS v. AL realm), even when the person enters the community as an “independent resident.” o Typical consumer does not understand that Assisted Living and HWS provide different services and are subject to separate regulations. ◦ New AL law (8-1-21) prohibits advertising as an AL if you are not one

DECEPTIVE ACTS AGAINST A SENIOR CITIZEN OR DISABLED PERSON MINN. STAT. §325F.71

◦ $10,000 additional penalty for violation of:  Minn. Stat. §§ 325D.43–.48 (Deceptive Trade Practices)  Minn. Stat. § 325F.67 (False Advertising)  Minn. Stat. §§ 325F.68–.70 (Consumer Fraud) 38

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MARKETING MATERIALS ARE ONGOING 

At move-in, “marketing” may end, but the risk of liability from marketing does not



The marketing may be misinterpreted by various audiences (e.g., family, ombudsman, MDH, AG) ◦ Just because you think your service scope is clear does not mean others do. ◦ All interested persons can bring an action. ◦ Other considerations: who’s got an axe to grind, is this an election year, disgruntled employees, etc.

SERVICES ADVERTISED 

Housing and home care providers must be upfront about services offered: • No false or misleading statements • Prospective tenant has right to know limits on services • New AL law requires list of services- be specific

“Home care providers shall not use false, fraudulent, or misleading advertising in the marketing of services. For purposes of this section, advertising includes any verbal, written, or electronic means of communicating to potential clients about the availability, nature, or terms of home care services.” Minn. Stat. § 144A.479(2) 40

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MARKETING MATERIALS ARE ONGOING Every contact by every staff person is “marketing” 



What is promised vs. what is delivered ◦ Do they match? ◦ Broadly define services in marketing. What you say may not be what the various audiences hear.

LEGAL ACTION BASED ON MARKETING IS POSSIBLE 

Real life example: Risk of marketing as “memory care” but unable to provide ongoing service. AG brings suit alleging these legal causes of action: ◦ Deceptive Trade Practices (MN Stat. §325D.44): Represents services of one kind when they are another ◦ False Advertising (MN Stat. §325F.67): Materials untrue, deceptive or misleading ◦ Consumer Fraud (MN Stat. §325F.69): False promise, misleading representation, whether or not the person was misled

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LEGAL ACTION BASED ON MARKETING IS POSSIBLE (CONTINUED) 

Real life example; AG brings suit alleging these legal causes of action: ◦ Deceptive Acts Perpetrated against Senior Citizens and Handicapped Persons (MS §325F.71): ◦ False advertising additional $10,000.00 fines if seniors or handicapped persons involved ◦ Medicaid Fraud (MS §256B.121): False representation and EW, then treble damages ◦ Patient Bill of Rights MS §144.651): Makes any interested person, including the AG able to bring an action



Best defense is a good offense – know what you are offering, deliver it and document it for proof.

CASE EXAMPLE OF CONSUMER FRAUD Alleged representations: Facility would: ◦ Accept husband if it believed it could provide appropriate services, ◦ Provide emergency assistance and ◦ Provide notice within 12 hours of potential emergencies  Claims: ◦ Negligence ◦ Violation of Minnesota Consumer Fraud Act ◦ Violation of Deceptive Acts Against Senior Citizens 

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MAARC REPORTING 

Under MN Vulnerable Adult Act, Minn. Stat. Sec. 626.557, report immediately, within 24 hours: ◦ Abuse ◦ Neglect ◦ Financial exploitation



Note nursing facilities must still report to OHFC (and abuse must be reported within 2 hours)

LEASE TERMINATION 

MN Landlord Tenant Laws ◦ MN Statutes 504B



Separate from home care agreement for home care services ◦ ONLY until 7-31-21

Also note current MN Executive Orders prohibiting evictions except for certain reasons due to COVID-19 46

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EVICTION ACTIONS - WHY EVICT? Non-payment  Violation of the terms of the Lease 

◦ More on this…

TERMINATE THE LEASE? 

Violation of the terms of the Lease



Examples:    

Illegal drugs Smoking in non-smoking community Destruction of Landlord’s Property Behavior issues…

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AL EVICTIONS UNDER NEW LAW One termination for assisted living contract (not separate home care and housing) 

Contract must include:

◦ “A delineation of the grounds under which the resident may be discharged, evicted, or transferred or have services terminated“

Minnesota Statutes § 144G.52, Subd. 2 ❖ Required

meeting with Resident BEFORE proceeding with terminating

❖Facility must meet with resident, resident’s legal representative and designated representative to: ❖ Explain the reasons for proposed termination; and ❖ Offer reasonable alternatives to avoid termination

❖ Must

be at least 7 days before Notice of Termination

AL EVICTIONS UNDER NEW LAW Expedited termination if: resident substantially interferes with rights health or safety of other residents, staff, or certain criminal actions  Expedited termination of services if conduct substantially interferes with resident’s safety or health; if needs exceed scope and services agreed upon  Appeal Process Different (ALJ hearing) 

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HE’S NOT SAFE…OR HE’S DANGEROUS     

Crisis management Eviction planning Other tenants/clients/staff at risk Too complex for home care services provided Uncooperative client/family

Toughest issue to convince family/client/tenant of their increased needs Set expectations early and remind family/client/tenant 51

BE PROACTIVE Have a flexible housing agreement -BROAD  Have a clear services agreement  Discuss the service level issues upfront  Set expectations early and remind often  Know about mandatory consultation law and how it impacts dementia clients – who can help them  Network with other service providers 

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MOTORIZED SCOOTERS

MOTORIZED SCOOTERS The NASCAR Granny  Audit rules related to use of motorized carts to determine possible discriminatory impact 

◦ Evaluate ability to reasonably accommodate ◦ Develop policies and procedures based on objective criteria ◦ Base any use restrictions on existence of direct threat to tenant safety

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MOTORIZED SCOOTERS 

When setting policy, residential communities may not deny use of motorized carts (scooters), but may create a policy for times and routes of use. As an example, in US v. Hillhaven Corporation the community had established policies prohibiting scooters in crowded lobby areas around mealtimes due to safety concerns. The facility went further to set routes to enter the dining room and required placement near exits. When some of the scooter owners challenged this rule, the court upheld that the reasoning was acceptable to protect overall resident safety and that the policy did not discourage residency for persons who needed a motorized cart.



Additionally, facilities should not include testing for scooter driving and use skills competency as a condition of tenancy. Though the ADA rule allows some of this type of testing, FHA does not. The Department of Housing and Urban Development, as well as the Department of Justice may consider testing prior to occupancy to be discriminatory.

ANIMALS

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OTHER CONSIDERATIONS 

Animals ◦ ◦ ◦ ◦

Pets Service Animals Companion Animals Comfort Animals What do you mean? The dog who has been scaring other residents and who bit a staff member yesterday now has a “certificate” and we will be discriminating if we force a goodbye?

PROVIDER’S ORDER FOR LIFE SUSTAINING TREATMENT (POLST) What is it?  How does it work?  Who signs it?  Is it the same as an advance directive? 

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LAST BUT NOT LEAST… NEW AND NEW(ISH) LEGISLATION Electronic Surveillance (1-1-20)  Assisted Living Law (8-1-21) 

◦ Licensed Assisted Living Directors

QUESTIONS?

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LEGAL ISSUES FOR HOUSING & NURSE MANAGERS 2021 Care Providers of Minnesota Housing & Nurse Managers’ Education Series

Robert F. Rodè, Esq.

Rebecca K. Coffin, Esq.

rrode@vrb-law.com

rcoffin@vrb-law.com

Voigt, Rodè, Boxeth & Coffin, LLC 1000 University Ave W, Suite 250 St. Paul, MN 55101 651-209-6161

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SENIOR HOUSING & EMERGENCY PLANNING March 18, 2021

Jill Schewe, Director of Assisted Living, Housing & Home Care Care Providers of Minnesota, Inc.

INTRODUCTIONS

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Empower Members to Performance Excellence

Senior Housing and Emergency Planning Jill Schewe Director of Assisted Living, Housing & Home Care

What Regulations Apply To Me?

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What Regulations Apply To Me? • You are responsible for compliance with any state licenses and/or codes: – – – –

Home care license (Comprehensive or Basic) Housing with Services (HWS) establishment registration Food license Minnesota State Fire Code

• You will always be responsible for compliance with any local licenses and/or codes: – Rental license, grilling guidelines, vending machine licenses, pet guidelines, etc. ©2021 Care Providers of Minnesota

How confident do you feel? POLL

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Emergency Planning Requirement • Both MDH and DHS have made significant comments regarding the lack of proper emergency planning, which has resulted in legislation: – Comprehensive Home Care regulations have requirements for training staff and having policies and a plan in place – HWS have requirements for having a plan and posting it (effective January 1, 2016)

Emergency Planning Requirement Home care providers need to have the following in place: • Must have a written plan of action to facilitate the management of the client's care and services in response to a natural disaster, such as flood and storms, or other emergencies that may disrupt the home care provider's ability to provide care or services. • The licensee must provide adequate orientation and training of staff on emergency preparedness. ©2021 Care Providers of Minnesota

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Emergency Planning Requirement What this means for Home Care providers:  The statute is vague, leaving you with lots of room for interpretation.  Something in place is better than nothing in place – because the statue is vague, surveyors have not ventured too far out of the lines when critiquing a plan.  Surveyors want to know your staff is being oriented and trained – what that actually looks like is up to you.  Providers have been tagged on not having a plan in place. ©2021 Care Providers of Minnesota

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 1. A written emergency plan that covers building evacuation procedures, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency.

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Emergency Planning Requirement Tips for #1:  Make sure the evacuation procedures cover all areas of the building (basement, garage, all floors, secure areas, etc. )  Sheltering in place means selecting a small, interior room, with no or few windows, and taking refuge there (a.k.a. staying put)  Temporary relocation sites could be a church, school, community center, grocery store, etc.  Staff assignments can be given by position type and not necessarily a person’s name ©2021 Care Providers of Minnesota

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 2. The emergency disaster plan must be posted prominently in the building and be available to emergency responders.

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Emergency Planning Requirement Tips for #2: Find a location that is accessible to everyone It shouldn’t be in a locked office or cupboard All staff should know where it’s located Emergency responders should know where to find it if needed  Make sure to check regularly that it’s still there and didn’t walk off    

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 3. Building evacuation diagrams must be provided to all tenants upon signing of a lease and evacuation diagrams shall be posted on each floor.

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Emergency Planning Requirement Tips for #3:  The evacuation diagram can be put in a new move-in packet, a handbook, an emergency preparedness packet, an addendum to a lease, etc.  Evacuation diagrams posted on each floor should be in a visible location where people will see it (i.e. next to an elevator, exit door, by mailboxes… ) – don’t forget the basement /garage area  If you’re a single floor may want 2+ postings  Regulation does not require you to post in each individual unit, but maybe not a bad idea ©2021 Care Providers of Minnesota

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 4. Each registered housing with services location must have a written policy and procedure regarding elopements or missing tenants.

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Emergency Planning Requirement Tips for #4:  This policy should include when to do a building search and a grounds search, when to notify authorities, and when to notify families  The policy should address residents both in a secure memory care area and those who are not  The policy should also include when to notify MAARC  All staff should be very aware of this policy

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 5. Provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter.

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Emergency Planning Requirement Tips for #5:  Remember: this orientation and training is a part of your HWS registration (not home care license)  ALL staff of the HWS should receive this training when hired and annually  Your communication to staff needs to be thorough when you’ve added elements to your plan or changed the plan  Make sure you document the training you’ve provided upon hire an annually (again, separate documentation than from your Home Care training)

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 6. Emergency and disaster training shall be made available annually to tenants.

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Emergency Planning Requirement Tips for #6:  Key words… made available – you can’t make your residents come and/or participate  Make sure you keep a file of documentation that you notified residents of the annual training  Documentation can include a dated activity calendar, a dated flyer, an outline of what the education was, etc.  This education does not need to be just about fires… it can be on anything related to emergency preparedness  This is a good opportunity to invite your local authorities in for a visit with your residents ©2021 Care Providers of Minnesota

Emergency Planning Requirement Registered HWS locations need to have the following seven elements in place: 7. Each registered housing with services location shall conduct and document a fire drill or other emergency drill at least every six months. Drills shall be coordinated with local fire departments or other community emergency resources.

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Emergency Planning Requirement Tips for #7:  Do one of these drills in conjunction with your annual resident training  Make sure you document when these drills were done  They do not HAVE to be just fire drills, the drills can be related to any other relevant emergency you may have (i.e. tornado, chemical spill, power outage, etc.)  You don’t have to do this alone – many local authorities will be more than happy to help you carry this out  Reach out to other providers who do it and share best practices ©2021 Care Providers of Minnesota

Emergency Planning Requirement POLL • Are you prepared as a Home Care provider? • Are you prepared as a HWS provider? • Are your first responders in your area prepared? • Are your residents prepared?

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Emergency Planning Requirement

Categories of Disasters/ Emergencies • Natural

– Floods, tornados, blizzards, wildfires, outbreaks …

• Unintentional

– Loss of utilities, fires from human-made actions, communication disruptions, structural collapses, explosions, accidents at large gatherings, elopements, transportation accidents …

• Intentional

– Arson, bombings, individual or terrorist attacks…

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Emergency Management Four phases of Preparedness

Phase 1 - Preparedness • Take steps to be able to take care of operations for at least 72 hours (minimum) • Develop your plan that:

Directs and coordinates emergencies, Focuses on preserving life, Responds appropriately to the incident, Helps preserve facility services, Aids in communication to the various stakeholders (families, city, state, etc.) – Helps maintain stabilization – – – – –

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Phase 1 - Preparedness • Planning is based on your community needs and the population you serve • First Responders need to understand your population and what their needs are for those with functional and cognitive needs, (i.e.: dependence in transfers, mobility, use of walkers, wheelchairs, cognitive impairment, mental illness, blindness, hard of hearing/deaf, etc.)

Phase 1 - Preparedness • Have a communication plan in place • Have available a “Chain of Command” staff list with phone & cell phone numbers • Keep an updated a list of all resident contact persons • Identify, in advance, where to seek shelter • Collect and assemble a disaster kit ©2021 Care Providers of Minnesota

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Disaster Kit • Water – one gallon of water per person, per day for at least three days (be sure and include staff)—Water used for drinking and sanitation • Food – three-day supply of non-perishable • Battery powered and a NOAA Weather Radio with tone alert and extra batteries • Flashlights and lots of batteries

Disaster Kit • First Aid Kit • Whistle to signal for help • Dust mask to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place • Moist towelettes, garbage bags, and plastic ties for personal sanitation

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Disaster Kit • Wrench or pliers to turn off utilities • Manual can opener for food • Local maps • Cell phone with chargers

Phase 2 - Response • Reach out to your local Emergency Management Agency (EMA) office • Know what resources you have and what you depend on others to provide • Plan well for any event (could be 15 minutes, 6 hours, overnight, or longer)

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Phase 3 - Recovery • Need short and a long-term plans • Periodic updates and review of plans, as they change • Coordinate with EMA and licensing agencies

Phase 4 - Mitigation • Mitigation is the effort to reduce loss of property and life by lessening the impact of disaster • Basically – you’re analyzing risk, reducing risk, and planning / insuring against risk • You act now – before the next disaster

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Good Planning • Good planning will: – Direct your managers and direct care staff on what to do – Instruct those external stakeholders outside your setting as to what to do and how to help

Planning Ahead • Disruption/Loss of Power Plan – Food/cooking – Lighting – Heating and Cooling – Medical Equipment use – Water for toilets and drinking – arrangements in place? – Multi-story buildings

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Planning Ahead • Evacuation Plan – Routes (internal) – Transportation (external) – Alternative Housing – Continuation of Services (medications, treatments, medical records, etc.) – Cell Phone for Communication – Satellite Phone – even better!

Planning Ahead • Plans should be prepared using internal and external stakeholders for development, ongoing review, and training • Internal stakeholders include:    

Residents Family members Direct caregivers Leadership and administrative employees

• External stakeholders include:    

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Fire Planning • Unlike Nursing Homes, HWS settings are not subject to federal fire safety standards • Also, regulations can be different around the state depending on who the delegated authority is and who oversees fire prevention in the area

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Fire/Smoke Protection Equipment – Kitchen • • • •

Stove/ oven/ gas controls Detectors Firefighting equipment Appropriate extinguishers

– Common Areas

• Detectors • Appropriate extinguishers • Extinguishers near smoking areas

– Sleeping Rooms, Units, Apartments, Guest Room • Detectors

– Sprinklers

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Fire/Smoke Protection Equipment – Documentation of operation: • Extinguishers – Check annually for charge and make sure they are tagged • Detectors – Check regularly for proper alarm (great way to get a “look-see” at your apartments) • Detectors – Change batteries annually and make sure to document!

Fire/Smoke Preparation • Evacuation Plan – do you have smoke compartments? • Drills – plan at different times of day • Have you trained on R.A.C.E

o Rescue - Rescue/Remove person(s) from the immediate fire scene o Alert - Alert Residents, Staff, and Call 911 o Confine - Confine fire and smoke by closing all doors in the area o Extinguish - Extinguish a small fire by using a portable fire

extinguisher. Evacuate the building immediately (unless you have smoke compartments; then evacuate the smoke compartment)

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Fire/Smoke Preparation • Practice with staff on how to use a fire extinguisher • The acronym P-A-S-S is used to describe the fourstep process in operating a fire extinguisher. o Pull: Pull the safety pin on the extinguisher. o Aim: Aim the hose of the extinguisher at the base of the fire. o Squeeze: Squeeze the handle to discharge the material. o Sweep: Sweep the hose across the base of the fire from side to side.

Fire/Smoke Preparation Training – Employees • At time of hire during orientation • Ongoing and annually

– Residents • 33% cannot hear alarms • 12% would ignore the alarms • 26% would call staff to see what’s going on

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Fire/Smoke Preparation Coordination & Communication – Does your fire department/first responder know what you do? – Are you coded as a high priority, needing additional staff? – Work with your fire department to develop your fire plans and drills

Fire Planning Laundry Dryers • Have a list of the locations of all dryers (in apartments or central locations?) • Lint Cleaning = Fire Safety • Do you have a system to check and maintain these?

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Fire Planning

Building Surveys… • You should be having an annual inspection by Local Fire Authorities for ongoing compliance with the MN State Fire Code – they may or may not be doing these inspections… • If you have a Food License, MDH (or delegated authority) should be coming at least annually for inspections

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Other considerations… • If your building is sprinkled, you must comply with NFPA 25, which is the Inspection, Testing, and Maintenance of Water-Based Sprinkler Systems. • If you have an alarm system, you must comply with NFPA 72, which is the Fire Alarm Code. • Make sure you have systems in place to meet annual testing requirements. ©2021 Care Providers of Minnesota

Fire and Evacuation Karlstad, MN October 12, 2012

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Karlstad Senior Living is located in a remote area of Northwestern MN  46 licensed skilled beds – fully occupied  24 Assisted Living apartments – fully occupied

Before the Fire September 29, 2012, staff were aware a fire was in the swamp behind them, still several miles out of town Winds were calm, fire under control at that time Numerous fire departments and DNR involved

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Notice to Evacuate Tuesday morning on October 2, 2012, winds started changing directions and picking up speed 1:05 PM the sheriff’s department ordered immediate evacuation and the National Guard was called in All residents and medication carts were at the First Lutheran Church 3 blocks away by 1:25 PM

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What The Staff Did Well  All residents were moved to safety very quickly  Staff knew and understood the fire plan—good drills and good leaders  Anticipated well before we knew there was danger  Staff stayed calm  Teamwork

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Opportunities for Improvement  Turn off air handling system sooner – decreased smoke entering the building  Had masks in facility, no one thought to grab or use them  Had not involved family members in full evacuation planning

Tornado Planning • Drills (practice) – Safe Locations – Sharp Objects – Closing Drapes • Tornado Watches and Warnings Procedures • NOAA Weather Alert Radio – SAME Technology limits false alarms

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Carbon Monoxide Detectors • Must have an approved and operational carbon monoxide alarm installed within ten feet of each room lawfully used for sleeping purposes • Owner must provide and install • Owner must replace if stolen, removed, or damaged prior to new occupancy • Occupant must keep and maintain the device in good repair

Carbon Monoxide Detectors There are two exceptions: 1) If the multifamily dwelling contains minimal or no sources of carbon monoxide, it may be exempted, provided that the owner certifies to the Commissioner of Public Safety that the dwelling poses no foreseeable carbon monoxide risk to the health and safety to the dwelling units

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Carbon Monoxide Detectors There are two exceptions: 2) Multifamily dwellings may have approved, and operational carbon monoxide alarms installed between 15 and 25 feet of carbon monoxide producing CENTRAL fixtures and equipment provided there is a CENTRALIZED alarm system or other mechanism for responsible persons to hear the alarm at all times.

Resident Belongings Do you have any restrictions regarding what a resident can or cannot have in their apartment/unit?

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Resident Belongings Have you thought about…  Flammable Liquids, explosives, space heaters, excessive combustibles, live wreaths/ Christmas trees, etc.  Any limits on how much oxygen a resident is allowed to store in an apartment?  Any storage method requirements (ventilated area)? ©2021 Care Providers of Minnesota

Resident Belongings Do you have a procedure to check the safety of residents’ belongings? – Frayed electrical wires, – Unsafe extension cords, – Ungrounded cords (old TV’s), – Overloaded circuits, – Oven storage, etc.

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Access to Apartments • If apartments have locks, do you have a copy of each key or a master? • Do you have a policy prohibiting the installation of additional locks that cannot be opened from the outside? • Who has keys? • What notification do you give before entering apartments? ©2021 Care Providers of Minnesota

Smoking • If you permit smoking in your units (by residents), know that they became a bit safer, in December of 2008. • Only “Fire-Safe” cigarettes are now legal to sell in Minnesota.

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Missing Resident Planning • Do you have a plan: – To contact and work with 911? – To search inside and outside building? – To enlist other/alternative assistance? • How do you know if someone is missing? • Areas of high risk… ponds, ledges, busy roads, trains, bridges, freezing weather, etc.

Missing Resident Planning Coordination & Communication – Does your police department, fire crew, and emergency responders know what you do and the type of people you serve? – Do they have you coded as a high priority, and potentially needing additional resources?

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Internal Safety Concerns • Maximum Water Temperature Checks – 105-115 degrees °F for safe comfort – Above 115 will scald

• Choking Plans – Heimlich maneuver training – CPR, AED’s…

Internal Safety Concerns • Shower/Tub grab bars – checked • Handrails • Nonslip tub/shower floors • GFI Outlets checked • CPR/DNR status as well as policies and procedures including AED’s • Unsafe Room Clutter (Hoarders) ©2021 Care Providers of Minnesota

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Internal Safety Concerns • Emergency Generators – Do you have one? (Not currently required in MN) • Sprinkler Systems – Required in some states – watch for changes in MN! • Carbon Monoxide Detectors – Do you need to have them?

Elevators • If you have them, they meet new code requirements in 2012 – See handout on the requirements • You should also know what your elevator does when there is an emergency (i.e. power outage, fire alarm, smoke, mechanical malfunction, etc.) ©2021 Care Providers of Minnesota

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Driving Safety • If residents have cars: – Do you have a policy to verify current drivers license? – Is there a procedure to enact if unsafe driving habits are noticed? • Scooters: (I’ll let the lawyers talk this one over) – Safety plan or negotiated risk agreement ©2021 Care Providers of Minnesota

Active Shooter / Attacker • This has happened in our settings • Think about incorporating an active shooter / attacker incident plan into your emergency plan • Train your staff!

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Emergency Planning Resources

Care Providers of Minnesota website: www.careproviders.org • Log in to the website • Follow this path: Regulatory  Emergency Preparedness Requirements

Emergency Planning Resources Care Providers of Minnesota website: www.careproviders.org • Login to the website • Follow this path: Regulatory  Emergency Preparedness Requirements  Housing with Services / Home Care

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Hazard Vulnerability Analysis (HVA) (not required now, but recommended)

• Examine the probability of each hazard • Examine the risk presented • Examine the preparedness of departmental and organizational response capability • Start planning based on likelihood and effect

Emergency Planning Resources AHCA/NCAL website: www.ahcancal.org • Log in to the website • Follow this path: from the menu select Survey, Regulatory & Legal Emergency Preparedness

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Emergency Planning Resources Federal Emergency Management Agency (FEMA): www.fema.gov

Communication  Plan for media  Decide on a spokesperson, in advance  Control the media, don’t let them control you  Use your Association, Care Providers of Minnesota, as a resource –  Call me or any of the association staff!

2021 Housing Managers' Education Series

In Summary… POLL

In Summary… • We want safe buildings • We want to minimize avoidable tragedies • We want to be prepared for things that are predictable, even when the risk is slight • We want to do the right thing!

2021 Housing Managers' Education Series

In Summary… • Make a plan • Educate staff and residents • Practice! • Not everything needs to be done at once – start at your areas of biggest risk and involve your residents!

Jill Schewe

Director of Assisted Living, Housing & Home Care Care Providers of Minnesota 952-851-2484 jschewe@careproviders.org

PERSONAL EMERGENCY EVACUATION PLANNING CHECKLIST Name:

Primary Location:

Building (home, office, etc.):

Primary Phone:

Address:

Cell Phone:

Floor:

E-mail:

Service Animal:

Yes

OCCUPANT NOTIFICATION Type of Emergency

Method or Device for Notification

Fire: Earthquake: Flood: Storm: Attack: Other (specify):

YES

N/A

Comments

Are there emergency notification devices (alarms, etc.) appropriate for this person? Does this person know the location of each emergency notification device/system and understand its meaning/function? Does this person know how to sound the alert for emergencies (manual pull box alarms, public address systems, radio, telephones)? If telephones are used to report emergencies, are emergency numbers posted near telephones, on employee notice boards, or in other conspicuous locations? Is there a way for a person with a hearing or speech impairment to report an emergency? If the communication system also serves as an alarm system, do all emergency messages have priority over all non-emergency messages? Is there a unique signal (sound, light, header) to indicate an emergency message?

Emergency Evacuation Planning Guide for People with Disabilities

WAY FINDING YES

N/A

Comments

Is there a usable way out? Where is it? (List all and indicate nearest.) Where is the established outside meeting place? Is the usable circulation path clearly marked to show the route to leave the building or to relocate to some other space within the building in an emergency? If a person exiting a doorway or turning a corner could inadvertently be directed into the path of a moving vehicle, is a safeguarding device with a warning sign in place? If the stairs in the circulation path lead anywhere but out of the building, are doors, partitions, or other effective means used to show the correct route out of the building? Do doors used to connect any room to a circulation path have proper maneuvering clearances? Can the doors be easily unlatched? Do exterior circulation paths (balcony, porch, gallery, roof) meet the preceding four requirements? Does the exterior circulation path have guardrails to protect open sides of walking surfaces? Is the exterior circulation path smooth, solid, and a substantially level travel surface? Does the exterior circulation path not branch off and head away from the public way? Is each exit marked with a clearly visible sign reading “EXIT” in all forms (visual, tactile, Braille)? Is every doorway or passage that might be mistaken for an exit marked “NOT AN EXIT” or with an indication of its actual use in all forms (visual, tactile, Braille)? Are signs posted and arranged along circulation paths to adequately show how to get to the nearest exit? Do the signs clearly indicate the direction of travel in all forms (visual, tactile, Braille)? Do brightly lit signs, displays, or objects in or near the line of vision not obstruct or distract attention from exit signs, particularly for people with low vision?

Emergency Evacuation Planning Guide for People with Disabilities

USE OF THE WAY YES

N/A

Comments

N/A

Comments

Are circulation paths always free of obstructions, including furniture and equipment, so everyone can safely exit the building during an emergency? Are people not required to travel through a room that can be locked, such as a restroom? Do all interior doors, other than fire doors, readily open from the inside without keys, tools, or special knowledge and require less than 5 pounds of force to unlatch and set the door in motion? Are exit signs not obstructed or concealed in any way, particularly for people with vision impairments who need to find and feel the sign? Are exit doors kept free of items that obscure the visibility of exit signs or that may hide visual, tactile, or Braille signage? Is the emergency escape path clear of obstacles caused by construction or repair ? Does the circulation path maintain a clear height of 6 feet 8 inches at all points? Do objects that stick out into the circulation path, such as ceiling fans and wall cabinets, not reduce the minimum height and width of the circulation path? Are usable circulation paths at least 32 inches wide for any segment less than 24 inches in length and 36 inches for all segments 24 inches or longer? Is each usable circulation path a permanent part of the facility? If the circulation path is not substantially level, are occupants provided with appropriate stairs or a ramp? Do building circulation paths lead to a public way, that is: Directly outside or to a street or walkway? To an area of refuge and from there to a public way? To an open space with access to the outside? To streets, walkways, or open spaces large enough to accommodate all building occupants likely to use the exit?

TYPE OF ASSISTANCE NEEDED YES Can the person evacuate himself or herself with a device or aid? What is the specific device or aid?

Emergency Evacuation Planning Guide for People with Disabilities

Where is the device or aid located? Does the person need assistance to evacuate? What does the assistant(s) need to do? Does the assistant(s) need any training? Has the training been completed? Where will the assistant(s) meet the person requiring assistance? When will the person requiring assistance contact the assistant(s)?

Number of Assistants Needed How many assistants are needed? How will the assistant(s) be contacted in an emergency? Name

Phone

Cell Phone

Assistant 1 Assistant 2 Assistant 3 Assistant 4 Assistant 5 Assistant 6

SERVICE ANIMAL YES

Comments

Has the person discussed with emergency management personnel his or her preferences with regard to evacuation and handling of the service animal? Has the person thought about under what circumstances a decision may have to be made about leaving the service animal behind? What is the best way to assist the service animal if it becomes hesitant or disoriented? Do first responders have a copy of the detailed information for the service animal? Where are extra food and supplies kept for the service animal?

Emergency Evacuation Planning Guide for People with Disabilities

E-mail

The U.S. Consumer Product Safety Commission estimates that 15,500 fires associated with clothes dryers occur annually. These fires account for an average of 10 deaths and 310 injuries and more than $84.4 million in property damage annually.

Overheated Clothes Dryers Can Cause Fires Fires can occur when lint builds up in the dryer or in the exhaust duct. Lint can block the flow of air, cause excessive heat build-up, and result in a fire in some dryers. To help prevent fires: 

Clean the lint screen/filter before or after drying each load of clothes. If clothing is still damp at the end of a typical drying cycle or drying requires longer times than normal, this may be a sign that the lint screen or the exhaust duct is blocked.



Clean the dryer vent and exhaust duct periodically. Check the outside dryer vent while the dryer is operating to make sure exhaust air is escaping. If it is not, the vent or the exhaust duct may be blocked. To remove a blockage in the exhaust path, it may be necessary to disconnect the exhaust duct from the dryer. Remember to reconnect the ducting to the dryer and outside vent before using the dryer again.



Clean behind the dryer, where lint can build up. Have a qualified service person clean the interior of the dryer chassis periodically to minimize the amount of lint accumulation. Keep the area around the dryer clean and free of clutter.



Replace plastic or foil, accordion-type ducting material with rigid or corrugated semi-rigid metal duct. Most manufacturers specify the use of a rigid or corrugated semi-rigid metal duct, which provides maximum airflow. The flexible plastic or foil type duct can more easily trap lint and is more susceptible to kinks or crushing, which can greatly reduce the airflow.



Take special care when drying clothes that have been soiled with volatile chemicals such as gasoline, cooking oils, cleaning agents, or finishing oils and stains. If possible, wash the clothing more than once to minimize the amount of volatile chemicals on the clothes and, preferably, hang the clothes to dry. If using a dryer, use the lowest heat setting and a drying cycle that has a cool-down period at the end of the cycle. To prevent clothes from igniting after drying, do not leave the dried clothes in the dryer or piled in a laundry basket.

Publication 5022 062003 022012 U.S. CONSUMER PRODUCT SAFETY COMMISSION • (800) 638-2772 • www.cpsc.gov • www.SaferProducts.gov

Housing with Services Resource Manual SECTION 2. General Policies

POLICY 2.10 Missing Tenant

EFFECTIVE/REVISED DATE: XX/XX/XXXX

POLICY: When tenants are missing staff will conduct a thorough search to locate the tenant.

PROCEDURE: In the event a tenant has disappeared the following will happen: 1. The person that first notices a tenant missing will alert co-workers that a tenant is missing. Include: name, apartment number, description, and where last seen. 2. Immediately search inside the building for the tenant. 3. Call family to ask them if they have forgotten to sign the tenant out. 4. If tenant is not found notify supervisor. 5. Supervisor will then assign employees to search outside the facility, covering all grounds in front of or behind building. 6. If tenant is still not found, notify 911. Have the following information available: • Name of tenant • Description of tenant including what the tenant was wearing • Time when tenant was last seen 7. Update family of steps taken to locate tenant. 8. When tenant is found make sure to complete an incident report including all information concerning disappearance. Including the following: • Time of first alert concerning tenant disappearance • Procedure taken, staff involved • Time of notification of 911 and family, if involved • Time when found

Responsible Staff All staff of [name of company]

Revision History DATE

DESCRIPTION

Page 1 of 1

BE PREPARED FOR AN

ACTIVE SHOOTER

Recent national tragedies remind us that the risk is real. Taking a few steps now can help you react quickly when every second counts.

FEMA V-1000/March 2018

An active shooter is an individual engaged in attempting to kill people in a confined space or populated area. Active shooters typically use firearms and have no pattern to their selection of victims.

24/7

Can happen anywhere

Can happen anytime

IF YOU ARE INVOLVED IN AN ACTIVE SHOOTER INCIDENT See something, say something.

Learn first aid skills so you can help others.

EXIT

Before you run, know the exits.

EXIT

Help law enforcement.

Find a place to hide.

Seek help to cope with trauma.

Run

Hide

Fight

HOW TO STAY SAFE

WHEN AN ACTIVE SHOOTER THREATENS Prepare NOW

If you see suspicious activity, let an authority know right away. Many places, such as houses of worship, workplaces, and schools, have plans in place to help you respond safely. Ask about these plans and get familiar with them. If you participate in an active shooter drill, talk with your family about what you learned and how to apply it to other locations. When you visit a building such as a shopping mall or healthcare facility, take time to identify two nearby exits. Get in the habit of doing this. Map out places to hide. In rooms without windows, behind solid doors with locks, under desks, or behind heavy furniture such as large filing cabinets can make good hiding places. Sign up for active shooter, first aid, and tourniquet training. Learn how to help others by taking FEMA’s You Are the Help Until Help Arrives course. Learn more at ready.gov/until-help-arrives.

Survive DURING

RUN. Getting away from the shooter or shooters is the top priority. Leave your things behind and run away. If safe to do so, warn others nearby. Call 911 when you are safe. Describe each shooter, their locations, and weapons. HIDE. If you cannot get away safely, find a place to hide. Get out of the shooter’s view and stay very quiet. Silence your electronic devices and make sure they won’t vibrate. Lock and block doors, close blinds, and turn off the lights. Do not hide in groups—spread out along walls or hide separately to make it more difficult for the shooter. Try to communicate with police silently— such as through text messages or by putting a sign in an exterior window. Stay in place until law enforcement gives you notice that all immediate danger is clear. FIGHT. Your last resort when you are in immediate danger is to defend yourself. Commit to your actions and act aggressively to stop the shooter. Ambushing the shooter together with makeshift weapons such as chairs, fire extinguishers, scissors, and books can distract and disarm the shooter.

FEMA V-1000 Catalog No. 17233-1

Be Safe AFTER

Keep hands visible and empty. Know that law enforcement’s first task is to end the incident. They may have to pass injured persons along the way. Follow law enforcement’s instructions and evacuate in the direction they tell you to. Consider seeking professional help for you and your family to cope with the long-term effects of trauma.

Take an Active Role in Your Safety Go to ready.gov and search for active shooter. Download the FEMA app to get more information about preparing for an active shooter. Find Emergency Safety Tips

HAZARD VULNERABILITY ANALYSIS Housing with Services

INSTRUCTIONS: Evaluate every potential event in each of the three categories of probability, risk, and preparedness. Add additional events as necessary. Issues to consider for probability include, but are not limited to: 1. Known risk 2. Historical data 3. Manufacturer/vendor statistics Issues to consider for risk include, but are not limited to: 1. Threat to life and/or health 2. Disruption of services 3. Damage/failure possibilities 4. Loss of community trust 5. Financial impact 6. Legal issues Issues to consider for preparedness include, but are not limited to: 1. Status of current plans 2. Training status 3. Insurance 4. Availability of back-up systems 5. Community resources Multiply the ratings for each event in the area of probability, risk and preparedness. The total values, in descending order, will represent the events most in need of organization focus and resources for emergency planning. Determine a value below which no action is necessary. Acceptance of risk is at the discretion of the organization.

Care Providers of Minnesota - HWS HVA 2011

EVENT

SCORE NATURAL EVENTS

PROBABILITY

RISK

PREPAREDNESS

HIGH

MED

LOW

NONE

LIFE THREAT

HEALTH/SAFETY

HIGH DISRUPTION

MODERATE DISRUPTION

LOW DISRUPTION

POOR

FAIR

GOOD

Hurricane Tornado Severe Rain Storm Snow fall Blizzard Ice Storm Earthquake Tidal Wave Temperature Extremes Drought Flood, External Wild Fire Landslide Volcano Epidemic

Care Providers of Minnesota - HWS HVA 2011

TOTAL

EVENT

SCORE

PROBABILITY

RISK

PREPAREDNESS

HIGH

MED

LOW

NONE

LIFE THREAT

HEALTH/SAFETY

HIGH DISRUPTION

MODERATE DISRUPTION

LOW DISRUPTION

POOR

FAIR

GOOD

TECH EVENTS Electrical Failure Generator Failure Transportation Failure Fuel Shortage Natural Gas Failure Water Failure Sewer Failure Steam Failure Fire Alarm Failure Communications Failure HVAC Failure Information Systems Failure Fire, Internal Flood, Internal Hazmat Exposure, Internal Unavailability of Supplies Structural Damage

Care Providers of Minnesota - HWS HVA 2011

TOTAL

EVENT

SCORE HUMAN EVENTS

PROBABILITY

RISK

PREPAREDNESS

HIGH

MED

LOW

NON E

LIFE THREAT

HEALTH/SAFETY

HIGH DISRUPTION

MODERATE DISRUPTION

LOW DISRUPTION

POOR

FAIR

GOOD

Mass Casualty Incident (trauma) Mass Casualty Incident (medical) Mass Casualty incident (hazmat) Hazmat Exposure, External Terrorism, Chemical Terrorism, Biological VIP Situation Hostage Situation Civil Disturbance Labor Action Bomb Threat

Care Providers of Minnesota - HWS HVA 2011

TOTAL

2021 Housing Managers' Education Series

SHOW ME THE MONEY—PAYMENT SOURCES March 23, 2021

Todd Bergstrom, Director of Research & Data Analysis Care Providers of Minnesota, Inc.

INTRODUCTIONS

Todd Bergstrom, Director of Research & Data Analysis Care Providers of Minnesota, Inc. As Care Providers of Minnesota's Director of Research and Data Analysis, Todd's duties fall into two general categories. First, he provides members with data, analysis, and other research items upon request. These requests may include Medicaid and Medicare rate analysis, demographic information, compensation data, survey development and analysis etc. Second, Todd supports the Association's legislative and administrative advocacy efforts through the research analysis of legislation and regulations that may impact the membership. He has a BA in History and Political Science from the University of Wisconsin, Madison and an MA from the Humphrey Institute of Public Affairs at the University of Minnesota, Twin Cities Campus.

2021 Housing Managers' Education Series

Show Me the Money—Payment Sources 2021 Housing Managers’ Education Series

TODD BERGSTROM DIRECTOR OF RESEARCH AND DATA ANALYSIS

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Agenda Medicare Medicaid Health Plans Billing, Level of Care, MnCHOICES, and Other Policies

3/23/2021

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2021 Housing Managers' Education Series

Medicare W W W. M E D I C A R E . G O V/ W W W. N G S M E D I C A R E . C O M

3/23/2021

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Medicare  65 and older or under 65 and disabled  Part A ◦ ◦ ◦ ◦

Inpatient care in hospitals Inpatient care in a skilled nursing facility (not custodial or long-term care) Hospice care services Home health care services

 Part B ◦ Medically-necessary services ◦ Preventive services

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Medicare  Part C ◦ ◦ ◦ ◦ ◦

Medicare Advantage Plan Covers Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. May offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). Premium to enrollee varies

 Part D ◦ Voluntary with monthly premium ◦ Medicare Prescription Drug Plans or Medicare Advantage Plans

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Medicare Part A - Detail  Hospital stays, which includes a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies.  Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. ◦ A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care. ◦ The coverage is limited to a maximum of 100 days in a benefit period. ◦ The first 20 days are paid in full, and the remaining 80 days will require a co-payment.

3/23/2021

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Medicare Part A - Detail  Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. ◦ Also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies.

 Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services.

3/23/2021

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Medicaid or Medical Assistance HTTP://MN.GOV/DHS/ HTTP://WWW.HEALTH.STATE.MN.US/INDEX.HTML

3/23/2021

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2021 Housing Managers' Education Series

Medicaid or Medical Assistance •

Medical Assistance (MA) is Minnesota’s Medicaid program. • • •

•

State and federal funds. Minnesota Department of Human Services The federal Centers for Medicare and Medicaid Services (CMS)

Health care programs (Medical Assistance, Minnesota-Care) •

1.2 Million people on average enrolled per month in 2017

•

Application at local county human service offices.

•

Most are enrolled in Health plans, and some to Fee for Service (FFS)

3/23/2021

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Personal Care / Home Care Nursing 6.4%

Physicians 1.4% All Other Expenditures 12.7%

Outpatient Hospital 0.8% Nursing Facilities 7.6%

MnCHOICES 1.3% Mental Health Services 1.3%

Brain Injury Waiver (BI) 0.7%

Community Access for Disability Inclusion Waiver (CADI) 8.9% Community Alternative Care Waiver (CAC) 0.4%

State and Federal Medicaid Expenditures by Category of Service for Minnesota (SFY 2020)

Day Training and Habilitation for ICF/DD Residents 0.1% Developmental Disabilities Waiver (DD) 11.5%

Elderly Waiver (EW) 3.5% Inpatient Hospital 2.7% Managed Care (HMO) 40.0% Intermediate Care Facilities for Persons with Developmental Disabilities 0.7% 12

2021 Housing Managers' Education Series

Nursing Facility Census in Minnesota 6.9 Million Fewer Paid Nursing Facility Days 12,000,000 10,023,405

10,000,000 8,000,000 6,000,000

4,852,359

4,684,476 4,000,000 2,069,858 2,000,000 760,164

976,178

905,067 187,414

0 Medicare

Other / Third Party 1991

Private Pay

Medicaid

2017

Source: 9-30-2017 DHS Annual Statistical and Cost Report of Nursing Facilities

3/23/2021

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69% of Seniors Meeting Medical Assistance Nursing Facility Level of Care Will Stay in Community, Assisted Living by 2023 50,000

Medicaid Monthly Average Recipients

45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Nursing Facility

Elderly Waiver

November 2020 DHS Medicaid Forecast 3/23/2021

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2021 Housing Managers' Education Series

Monthly Average Payments Source: DHS November 2020 Forecast

$9,000 $8,000 $7,000

$6,413

$6,000 $5,000 $4,000 $3,000 $2,000

$1,415

$1,000 $Nursing Facilities

Elderly Waiver

Intermediate Care Facilities for Persons with Developmental Disabilities

Day Training and Habilitation for ICF/DD Residents

2000

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Developmental Disabilities Waiver (DD)

Community Access for Disability Inclusion Waiver (CADI)

Community Alternative Care Waiver (CAC)

Brain Injury Waiver (BI)

2020 15

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Annual State Share Payments Source: DHS November 2020 Forecast

$800,000,000 $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $Nursing Facilities

Elderly Waiver

Intermediate Care Day Training and Facilities for Persons Habilitation for with Developmental ICF/DD Residents Disabilities

2000

3/23/2021

Developmental Community Access Disabilities Waiver for Disability (DD) Inclusion Waiver (CADI)

Community Alternative Care Waiver (CAC)

Brain Injury Waiver (BI)

2020

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Estimated Net Additional Nursing Facility Costs Without The Elderly Waiver Program $1,400,000,000

If all EW clients were served in nursing facilities state costs would be over $600 million higher annually

$1,200,000,000 $1,000,000,000 $800,000,000 $600,000,000 $400,000,000 $200,000,000 $0

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Net Additional Expenditures if Elderly Waiver Clients Resided in Nursing Facilities Elderly Waiver (Actual State Share Spending) Nursing Facility (Actual State Share Spending)

Source: February 2018 DHS Medicaid Forecast

3/23/2021

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Monthly Average Recipients Source: DHS November 2020 Forecast

100,000 90,000 80,000 Community Access for Disability Inclusion Waiver (CADI)

70,000 60,000

Developmental Disabilities Waiver (DD)

50,000 40,000 30,000

Elderly Waiver

20,000 Nursing Facilities

10,000 0

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Nursing Facilities

Elderly Waiver

Intermediate Care Facilities for Persons with Developmental Disabilities

Day Training and Habilitation for ICF/DD Residents

Developmental Disabilities Waiver (DD)

Community Access for Disability Inclusion Waiver (CADI)

Community Alternative Care Waiver (CAC)

Brain Injury Waiver (BI)

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State Share of Annual Medicaid Spending by Program Minnesota (DHS November 2020 Forecast $2,500,000,000

$2,000,000,000

Community Access for Disability Inclusion Waiver (CADI)

$1,500,000,000

$1,000,000,000 Developmental Disabilities Waiver (DD) $500,000,000

Elderly Waiver Nursing Facilities

$1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Nursing Facilities Intermediate Care Facilities for Persons with Developmental Disabilities Developmental Disabilities Waiver (DD) Community Alternative Care Waiver (CAC) 3/23/2021

Elderly Waiver Day Training and Habilitation for ICF/DD Residents Community Access for Disability Inclusion Waiver (CADI) Brain Injury Waiver (BI) 19

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Nursing Facility (NF) State/Federal funded program Must meet nursing facility level of care Minimum Data Set (MDS) used to determine 48 Medicaid and Private Pay Rates Payors include Medicaid, Private Pay, Medicare and Other/Third Party Rate Equalization New Medicaid Payment System on January 1, 2016 ◦ Value Based Reimbursement or VBR

New Medicare Payment System on October 1, 2019 ◦ Patient -Driven Payment Model (PDPM)

3/23/2021

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Nursing Facility (NF) Cont. Bed hold 30-Day enhanced rate for new admissions Surcharge Return to community PIPP QIIP Medicare Co-Insurance

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Elderly Waiver (EW) an alternative for a person age 65 years or older, who would otherwise require the level of care provided in a nursing facility.

Basic eligibility ◦ Age 65 years or older ◦ Chooses to receive community services instead of nursing facility services ◦ Eligible for Medical Assistance

Level of care determination Cost of care ◦ In aggregate, the average per person cost for persons in receipt of EW services cannot be greater than the average per person cost for persons in receipt of nursing facility services.

Source: Disability Services Program Manual (DSPM) 3/23/2021

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Elderly Waiver (EW) - Covered Services an alternative for a person age 65 years or older, who would otherwise require the level of care provided in a nursing facility. 24-hour customized living

Environmental accessibility adaptations

Adult day service bath

Extended home health aide

Adult day services, center-based and family-based

Extended personal care assistant

Adult foster care (family and corporate)

Extended private duty nursing (LPN and RN)

Caregiver assessment

Home-delivered meals

Caregiver training and education

Homemaker

Case management

Personal emergency response

Case management aide

Respite care (in home, out of home)

Chore service

Residential care services

Companion service

Specialized equipment and supplies

Consumer directed community supports

Transitional services

Customized living

Transportation

Source: Disability Services Program Manual (DSPM)

3/23/2021

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Elderly Waiver – Customized Living and 24-Hour Customized Living  Currently: For services provided in residential, Housing with Services Setting (HWS) and Comprehensive Home Care License  Until July 31, 2021

 August 1, 2021: Assisted Living License  Exceptions

 Client-based payment  Amount paid for a client's services is determined by EW Customized Living Workbook ◦ ◦ ◦ ◦ ◦

Minnesota Long-Term Care Consultation Services Assessment Services and Units of Services authorized EW Customized Living Rate Limits or Caps EW-CL or 24-Hour EW-CL CL Component Rates

Source: Minnesota Department of Human Services

3/23/2021

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Comprehensive Policy on Elderly Waiver (EW) Customized Living

www.dhs.state.mn.us/main/groups/publications /documents/pub/dhs-288337.pdf

3/23/2021

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2017 Legislative Amendments: Required Provider Communication for the Elderly Waiver and Alternative Care Programs https://mn.gov/dhs/generalpublic/publications-formsresources/bulletins/

The goal of the legislative changes is to promote better communication and coordination. The changes include: •

EW and AC Adult Day providers, in addition to EW customized living (CL) providers, must now be given the opportunity to provide recommendations related to the person’s needs prior to a lead agency assessment.

•

The EW Residential Services Tool (RS Tool) completed for an individual must now be sent to the provider.

3/23/2021

2021 Housing Managers' Education Series

Strategies Learn case mix system ◦ What do the case mix levels mean? ◦ How do the caps relate? ◦ Educate your staff

Understand your organization’s Elderly Waiver Client’s data ◦ This does require an upfront investment in time

Standardize and document each Elderly Waiver Client’s needs and care provided. Build around: ◦ Areas influencing case mix ◦ Services provided

3/23/2021

Be specific about the services you are providing Review the services you are providing for the client A.Talk to direct care staff B. Observe care and services C. Review nurse notes! D. What do your service agreements say? E.What do your ADL flow sheets/care plans say you are doing?

Include any care planning around behavior. Keep communication open between you and your staff

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Strategies Create collaborative relationship with assessors and case managers ◦ ◦ ◦ ◦

Meet with them Invite them to care conferences Inform them of hospitalizations, changes in needs and health, falls Notify changes in service, case mix?

Formalize processes for communication of client information to assessors and case managers

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Public Documents DHS Forms at: https://edocs.dhs.state.mn.us/

DHS-3428-ENG Minnesota Long-Term Care Consultation Services Assessment Form - English The 34-page document is found at: https://edocs.dhs.state.mn.us/lfserve r/Public/DHS-3428-ENG

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

AC, BI, CADI, EW Case Mix Classification Worksheet DHS-3428B-ENG

https://edocs.dhs.state.mn.us/lfserver/P ublic/DHS-3428B-ENG

3/23/2021

2021 Housing Managers' Education Series

AC, BI, CADI, EW Case Mix Classification Worksheet DHS-3428B-ENG https://edocs.dhs.state.mn.us/lfserv er/Public/DHS-3428B-ENG

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

AC, BI, CADI, EW Case Mix Classification Worksheet DHS-3428B-ENG https://edocs.dhs.state.mn.us/lfserver/Pu blic/DHS-3428B-ENG

3/23/2021

2021 Housing Managers' Education Series

AC, BI, CADI, EW Case Mix Classification Worksheet DHS-3428B-ENG https://edocs.dhs.state.mn.us/lfserver/Pu blic/DHS-3428B-ENG

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Elderly Waiver Residential Services https://mn.gov/dhs/partners-and-providers/policies-procedures/aging/elderly-waiver-residential-services/

The longstanding Excelbased workbook was retired. DHS will not publish new versions of the workbook. Starting September 1, 2020, The MN-IT system will reject Excel workbooks created on or after August 3, 2020. DHS will continue to provide technical support for existing Excel workbooks as needed.

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Residential Services Plan is Sent to Providers

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Residential Services Plan is Sent to Providers

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Residential Services Plan is Sent to Providers

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Residential Services Plan is Sent to Providers

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

EW-CL Workbook SCR Doc Input

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Services Authorized by EW-CL Workbook Homemaking ◦ Light housekeeping ◦ Heavy housekeeping ◦ Laundry - personal ◦ Laundry-linens ◦ Shopping Food Preparation - Individual Assistance w Meal Prep in Own Apartment Food Preparation and Service: Breakfast prep and serve, Lunch prep and serve, Supper prep and serve, Snack prep and serve Supportive Services: Making appts, Arrange Non-Medical Transportation, Money Mgt Socialization - Individual Non-Medical Transportation Mileage Personal Care ◦ Dressing ◦ Grooming ◦ Bathing ◦ Eating ◦ Continence Care ◦ Walking ◦ Assistance with Use of Wheelchair (Yes/No Dropdown) ◦ Transferring

3/23/2021

◦ Positioning Other Delegated Health Services ◦ Med Administration or assistance with self-administration ◦ Verbal or Visual Medication Reminders ◦ Insulin Injections ◦ Therapeutic Exercises (Yes/No Dropdown) ◦ Delegated clinical monitoring (Yes/No Dropdown) ◦ Delegated nursing tasks (Yes/No Dropdown) Medication Mgt by Licensed Nurse ◦ Med Set Ups and Monitoring ◦ Insulin Draws Active Cognitive or Behavioral Support ◦ Wandering ◦ Orientation issues ◦ Anxiety ◦ Verbal aggression ◦ Physical aggression ◦ Repetitive behavior ◦ Agitation ◦ Self-injurious behavior ◦ Property destruction Personal Security - Is the Mechanism included in the CL Rate?

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2021 Housing Managers' Education Series

EW-CL Workbook RS Rate Limits and Component Rates –Effective January 1, 2020 3/23/2021

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EW-CL Workbook Individual RS Plan In order to be eligible for the higher 24-hour CL rate limit, the participant must have the following needs: • Cognitive or behavioral intervention; or • Clinical monitoring with special treatment; or • Staff assistance in toileting, positioning, or transferring (single dependency); or • Medication management and at least 50 hours of service per month and a dependency in at least three of the following activities of daily living (ADL’s): bathing; dressing; grooming; walking; or eating (when eating is scored as 3 or greater) “Fifty hours of service” means 50 hours of direct component services per month approved to be part of the 24-hour Customized living plan as determined by the assessor, case manager, or care coordinator and the waiver participant.

3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook: Individual RS Plan – 24-hour CL LTC SD 46 Toileting How well can you manage using the toilet? Would you say that you: 00 • can use the toilet without help, including adjusting clothing? *01 • need some help to get to and on the toilet but don’t have “accidents”? *02 • have accidents sometimes, but not more than once a week? *03 • only have accidents at night? *04 • have accidents more than once a week? *05 • have bowel movements in your clothes more than once a week? *06 • wet your pants and have bowel movements in your clothes very often? LTC SD 43 Transferring How well can you get in and out of a bed or chair? Would you say that you: 00 • can get in and out of a bed or chair without help of any kind? 01 • need somebody to be there to guide you but you can move in and out of a bed or chair? *02 • need one other person to help you? *03 • need two other people or a mechanical aid to help you? *04 • never get out of a bed or chair? LTC SD 42 Bed Mobility (Positioning on DHS-3428C) How well can you manage sitting up or moving around in bed? Would you say that you: 00 • can move in bed without any help? 01 • need and get help sometimes to sit up? *02 • always need and get help to sit up? *03 • always need and get help to be turned or change positions? LTC SD 66 How about your ability to take your own medication? Would you say that you: 01 need no help or supervision 05 don’t take medications 06 need medication setup only 07 need verbal or visual reminders only 08 need medication setups and reminders 09 need medication setups and administration

3/23/2021

LTC SD 45 Behavior “Intervention” includes cues, redirection or behavior management/instruction. 00 • Behavior requires no intervention or no behaviors. 01 • Needs and receives occasional staff intervention in the form of cues because the person is anxious, irritable, lethargic or demanding. Person responds to cues. “Occasional” is defined as less than 4 times per week. *02 • Needs and receives regular staff intervention in the form of redirection because the person has episodes of disorientation, hallucinates, wanders, is withdrawn or exhibits similar behaviors. Person may be resistive, but responds to redirection. “Regular” is defined as 4 or more times per week. *03 • Needs and receives behavior management and staff intervention because person exhibits disruptive behavior such as verbally abusing others, wandering into private areas, removing or destroying property, or acting in a sexually aggressive manner. Person may be resistant to redirection. *04 • Needs and receives behavior management and staff intervention because person is physically abusive to self and others. Person may physically resist redirection. LTC SD 48 Clinical Monitoring: Clinical monitoring refers to a formal written plan that reflects the elements for clinical monitoring found in DHS 3428B – Case Mix Classification Worksheet. 00Less than once a day 01 1-2 shifts 02 All shifts PLUS Special Treatment (SD 47) LTC SD 51 Orientation Orientation is defined as the awareness of an individual to his/her present environment in relation to time, place and person. See H.7 and H.10 for memory/orientation information. 00 • Oriented. 01 • Minor forgetfulness. 02 • Partial or intermittent periods of disorientation. 03 • Totally disoriented; does not know time, place, identity. 04 • Comatose. 05 • Not determined.

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EW-CL Workbook: Individual RS Plan – Homemaking Light Housekeeping • Home Management/Homemaking and Support Services: $17.84 LTC SD 63 How well can you manage to do light housekeeping, like dusting or sweeping? Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Heavy Housekeeping • Home Management/Homemaking and Support Services: $17.84 LTC SD 64 How well can you do heavy housekeeping? Heavy housekeeping includes activities like yard work, or emptying the garbage, but not including laundry. Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Laundry – Personal / Linens • Home Management/Homemaking and Support Services: $17.84 LTC SD 65 What about your ability to do your own laundry, including putting clothes in the washer or dryer, starting and stopping the machine, and drying the clothes? Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Shopping • Home Management/Homemaking and Support Services: $17.84 LTC SD 61 Now I would like to know about how you manage shopping for food and other things you need. Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all 3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan – Food Preparation

Individual Assistance w Meal Prep in Own Apartment • Home Management/Homemaking and Support Services: $17.84 LTC SD 62 How well are you able to prepare meals for yourself? Meals may include sandwiches, cooked meals and TV dinners. Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Breakfast, Lunch, Supper, and Snack – Prep and Serve • Home Management/Homemaking and Support Services: $17.84 LTC SD 62 How well are you able to prepare meals for yourself? Meals may include sandwiches, cooked meals and TV dinners. Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all • • • •

Breakfast: $3.4597 Lunch: $4.3166 Supper: $4.3166 Snack: $0.4284

3/23/2021

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EW-CL Workbook Individual RS Plan – Supportive Services

Making Appts and Arrange Non-medical Transportation • Home Management/Homemaking and Support Services: $17.84 LTC SD 60 How well are you able to make a telephone call? Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Money Mgt. • Home Management/Homemaking and Support Services: $17.84 LTC SD 68 Now I want to know about your ability to handle your own money, like paying your bills, or balancing your checkbook. Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

Socialization with given Ratio of Staff/Resident / Hourly Rate • • • •

Socialization 1 Staff to 2-5 Residents: $5.10 Socialization 1 Staff to 6 - 12 Residents: $1.99 Socialization 1 Staff to 13 - 20 Residents: $1.09 Socialization 1 Staff to over 20 Residents: $0.59

3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan – Supportive Services

Non-medical Transportation and Mileage • Home Management/Homemaking and Support Services: $17.84 (Driver 1:1) • 1:1 Mileage: $0.5248 LTC SD 69 How well are you able to use public transportation or drive to places beyond walking distance? Would you say that you: 01 need no help or supervision 02 need some help or occasional supervision 03 need a lot of help or constant supervision 04 can’t do it at all

3/23/2021

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EW-CL Workbook Individual RS Plan – Personal Care Dressing • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 38 How well are you able to manage dressing? By dressing, we mean laying out the clothes and putting them on, including shoes, and fastening clothes. Would you say that you: 00 • can dress without help of any kind? 01 • need and get minimal supervision or reminding? *02 • need some help from another person to put your clothes on? *03 • cannot dress yourself and somebody dresses you? *04 • are never dressed?

Grooming • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 39 Now I have some questions about how you manage with grooming activities like combing your hair, putting on makeup, shaving, and brushing your teeth. Would you say that you: 00 • can comb your hair, wash your face, shave or brush your teeth without help of any kind? 01 • need and get supervision or reminding or grooming activities? *02 • needs and get daily help from another person? *03 • are completely groomed by somebody else?

Bathing • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 40 How well can you bathe or shower yourself? Bathing or showering by yourself means running the water, taking the bath or shower without any help, and washing all parts of the body, including your hair and face. Would you say that you: 00 • can bathe or shower without any help? 01 • need and get minimal supervision or reminding? 02 • need and get supervision only? 03 • need and get help getting in and out of the tub? *04 • need and get help washing and drying your body? *05 • cannot bathe or shower, need complete help?

3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan – Personal Care Eating • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 41 How well can you manage eating by yourself? Eating by yourself means drinking and eating without help from anybody else, but you can use special utensils and straws. It also means cutting most foods on your own. Would you say that you: 00 • can eat without help of any kind? 01 • need and get minimal reminding or supervision? *02 • need and get help in cutting food, buttering bread or arranging food? *03 • need and get some personal help with feeding or someone needs to be sure that you don’t choke? *04 • need to be fed completely or tube feeding or IV feeding?

Continence Care • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 46 How well can you manage using the toilet? (Using the toilet independently includes adjusting clothing, getting to and on the toilet, and cleaning one’s self. If reminders are needed to use the toilet this counts as some help. An individual who manages any type or level of incontinence independently is not considered dependent and MUST be scored using 00, independent in this activity.) Would you say that you: 00 • can use the toilet without help, including adjusting clothing? *01 • need some help to get to and on the toilet but don’t have “accidents”? *02 • have accidents sometimes, but not more than once a week? *03 • only have accidents at night? *04 • have accidents more than once a week? *05 • have bowel movements in your clothes more than once a week? *06 • wet your pants and have bowel movements in your clothes very often?

Walking • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 44 How well are you able to walk around, either without any help or with a cane or walker, but not including a wheelchair? Would you say that you: 00 • walk without help of any kind? 01 • can walk with help of a cane, walker, crutch or push wheelchair? *02 • need and get help from one person to help you walk? *03 • need and get help from two people to help you walk? *04 • cannot walk at all? 3/23/2021

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EW-CL Workbook Individual RS Plan – Personal Care Assistance with Use of Wheelchair - Wheeling • Home Care Aide Services including Active Behavioral Support: $23.72 Wheeling (not on LTC Assessment) 0 Does not use wheelchair, or receives no personal help wheeling. 1 Needs help negotiating doorways, elevators, ramps, locking or unlocking brakes. 2 Needs and receives total help with wheeling.

Transferring • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 43 How well can you get in and out of a bed or chair? Would you say that you: 00 • can get in and out of a bed or chair without help of any kind? 01 • need somebody to be there to guide you but you can move in and out of a bed or chair? *02 • need one other person to help you? *03 • need two other people or a mechanical aid to help you? *04 • never get out of a bed or chair?

Positioning • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 42 Bed Mobility (Positioning on DHS-3428C) How well can you manage sitting up or moving around in bed? Would you say that you: 00 • can move in bed without any help? 01 • need and get help sometimes to sit up? *02 • always need and get help to sit up? *03 • always need and get help to be turned or change positions?

3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan – Other Delegated Health Services Med Administration or assistance with self-administration • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 66 How about your ability to take your own medication? Would you say that you: 01 need no help or supervision 05 don’t take medications 06 need medication setup only 07 need verbal or visual reminders only 08 need medication setups and reminders 09 need medication setups and administration

Verbal or Visual Medication reminders • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 66 How about your ability to take your own medication? Would you say that you: 01 need no help or supervision 05 don’t take medications 06 need medication setup only 07 need verbal or visual reminders only 08 need medication setups and reminders 09 need medication setups and administration

Insulin Injections • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 67 Are you diabetic? If yes, how do you control your diabetes? 01 not diabetic 02 no insulin require; diet controlled only 03 oral medications 04 sliding scale insulin and oral medications 05 scheduled daily insulin 06 scheduled daily insulin plus daily sliding scale

3/23/2021

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EW-CL Workbook Individual RS Plan – Other Delegated Health Services Delegating clinical monitoring • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 48 Clinical monitoring refers to a formal written plan that reflects the elements for clinical monitoring found in DHS 3428B – Case Mix Classification Worksheet. 00 Less than once a day 01 1-2 shifts 02 All shifts

Delegated nursing tasks • Home Health Care Aide Services/Delegated Nursing Services: $27.04 LTC SD 48 Clinical monitoring refers to a formal written plan that reflects the elements for clinical monitoring found in DHS 3428B – Case Mix Classification Worksheet. 00 Less than once a day 01 1-2 shifts 02 All shifts

3/23/2021

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2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan – Medication Mgt by Licensed Nurse Med Administration or assistance with self-administration • Medication Setups by Licensed Nurse: $33.97 LTC SD 66 How about your ability to take your own medication? Would you say that you: 01 need no help or supervision 05 don’t take medications 06 need medication setup only 07 need verbal or visual reminders only 08 need medication setups and reminders 09 need medication setups and administration

3/23/2021

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EW-CL Workbook Individual RS Plan – Active Cognitive and Behavioral Support Wandering and Orientation Issues • Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 51 Orientation is defined as the awareness of an individual to his/her present environment in relation to time, place and person. See H.7 and H.10 for memory/orientation information. 00 • Oriented. 01 • Minor forgetfulness. 02 • Partial or intermittent periods of disorientation. 03 • Totally disoriented; does not know time, place, identity. 04 • Comatose. 05 • Not determined.

Anxiety, Verbal aggression, Physical aggression, Repetitive behavior, Agitation, Selfinjurious behavior, and Property destruction Home Care Aide Services including Active Behavioral Support: $23.72 LTC SD 45 Behavior - “Intervention” includes cues, redirection or behavior management/instruction. 00 • Behavior requires no intervention or no behaviors. 01 • Needs and receives occasional staff intervention in the form of cues because the person is anxious, irritable, lethargic or demanding. Person responds to cues. “Occasional” is defined as less than 4 times per week. *02 • Needs and receives regular staff intervention in the form of redirection because the person has episodes of disorientation, hallucinates, wanders, is withdrawn or exhibits similar behaviors. Person may be resistive, but responds to redirection. “Regular” is defined as 4 or more times per week. *03 • Needs and receives behavior management and staff intervention because person exhibits disruptive behavior such as verbally abusing others, wandering into private areas, removing or destroying property, or acting in a sexually aggressive manner. Person may be resistant to redirection. *04 • Needs and receives behavior management and staff intervention because person is physically abusive to self and others. Person may physically resist redirection. 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

EW-CL Workbook Individual RS Plan Rate Summary

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Resources

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Elderly Waiver 24-hour Customized Living Client Assessment Tracking (Excel)

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Elderly Waiver 24-hour Customized Living Client Assessment Tracking (Excel)

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Instructions Download and make sure to save the tool to your network. Since the tool uses Microsoft Excel, you will want to save a copy for each client you assess. To keep the workbook as simple as possible, it is designed only for 24-hour customized living clients. The tool has three worksheets: ◦ Step 1 – Assessment ◦ Step 2 – Case Mix ◦ Step 3 – Services

3/23/2021

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2021 Housing Managers' Education Series

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool MINNESOTA LONG-TERM CARE CONSULTATION SERVICES ASSESSMENT FORM – QUESTIONS USED Dressing

Telephone Calling

Grooming

Shopping

Bathing

Meal Preparation

Eating

Light Housekeeping

Bed Mobility

Heavy Housekeeping

Transferring

Laundry

Walking

Money Management

Toileting

Transportation

Special Treatments

Insulin Dependency

Clinical Monitoring

Neurological Diagnosis

Behavior

Vent Dependent

Orientation

Medication

Self-Preservation

3/23/2021

STEP 1 – ASSESSMENT

This worksheet contains the 28 questions from the Minnesota Long-Term Care Consultation Services Assessment Form that are used to either determine a client’s case mix classification or allow the case manager to authorize services. For the tool to work properly, you must answer each question on Step 1. A drop-down answer selection is used for each of the assessment questions.

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 1 – Assessment

3/23/2021

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2021 Housing Managers' Education Series

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 2 – Case Mix

3/23/2021

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Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 3 - Services This worksheet allows the user to determine the services that a client may need, the overall monthly payment for services, and whether a client is over their budget cap. The user enters the minutes per day and hours per month for each service. The worksheet uses the information entered in Step 1 to determine if the client qualifies for 24Hour CL as well as allow for services to be authorized (depending on the client’s assessment).

3/23/2021

Services Authorized Homemaking ◦ Light housekeeping ◦ Heavy housekeeping ◦ Laundry - personal ◦ Laundry-linens ◦ Shopping Food Preparation - Individual Assistance w Meal Prep in Own Apartment Food Preparation and Service: Breakfast prep and serve, Lunch prep and serve, Supper prep and serve, Snack prep and serve Supportive Services: Making appts, Arrange Non-Medical Transportation, Money Mgt Socialization - Individual Non-Medical Transportation Mileage Personal Care ◦ Dressing ◦ Grooming ◦ Bathing ◦ Eating ◦ Continence Care ◦ Walking ◦ Assistance with Use of Wheelchair (Yes/No Dropdown) ◦ Transferring ◦ Positioning

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Other Delegated Health Services ◦ Med Administration or assistance with self-administration ◦ Verbal or Visual Medication Reminders ◦ Insulin Injections ◦ Therapeutic Exercises (Yes/No Dropdown) ◦ Delegated clinical monitoring (Yes/No Dropdown) ◦ Delegated nursing tasks (Yes/No Dropdown) Medication Mgt by Licensed Nurse ◦ Med Set Ups and Monitoring ◦ Insulin Draws Active Cognitive or Behavioral Support ◦ Wandering ◦ Orientation issues ◦ Anxiety ◦ Verbal aggression ◦ Physical aggression ◦ Repetitive behavior ◦ Agitation ◦ Self-injurious behavior ◦ Property destruction Personal Security - Is the Mechanism included in the CL Rate?

2021 Housing Managers' Education Series

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 3 - Services Summary of Services 24-Hour EW-CL Over Limit!

Monthly Rates!

Scores used for service authorization

Enter Units of Service

3/23/2021

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Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 3 - Services

Under Limit!

Additional Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Elderly Waiver 24-Hour Customized Living Assessment and Payment Tool Step 3 - Services

Additional Services

3/23/2021

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Elderly Waiver Reform: Rate Methodology January 1, 2019 Rate Increase ◦ 10% of a new payment rate methodology for identified rates will be blended with 90% of the June 30, 2017 rates.

EW Caps/Limits Increases Moved to January 1 Programs included: ◦ Elderly Waiver (EW) and EW Customized Living (CL), EW Foster Care ◦ Community Access for Disability Inclusion (CADI) Customized Living (CL) ◦ Alternative Care (AC) ◦ Essential Community Supports (ECS)

3/23/2021

Establish base wages for each service rate using blended positions from the annual labor market information from the Minnesota Department of Employment and Economic Development (DEED). ◦ The Minneapolis-St. Paul-Bloomington, MN-WI MetroSA is the geographic area

Apply the following factors to the base wages determined for each service rate above: ◦ A payroll taxes and benefits factor ◦ A general and administrative factor ◦ A program plan support factor which is 12.8 percent ◦ A registered nurse management and supervision or social worker supervision factor equal to 15 percent

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2021 Housing Managers' Education Series

Elderly Waiver Reform: Assessments ELIGIBILITY AND ASSESSMENT TIMING EXTENDED FOR ELDERLY WAIVER CLIENTS

RE-ASSESSMENT REQUIREMENTS FOR ELDERLY WAIVER CLIENTS SPECIFIED

If an eligibility update is performed, the faceto-face assessment (Minnesota Long Term Care Consultation Services Assessment or reassessment), is good for 90-days, as opposed to 60, when determining program eligibility.

Lead agency shall conduct a change-in-condition reassessment where the client’s condition has changed due to:

Eligibility update performed over the phone.

◦ ◦ ◦ ◦

A major health event, An emerging need or risk, Worsening health condition, or Cases where the current services do not meet the client's needs.

A change-in-condition reassessment may be initiated by the lead agency, the client or by a party on behalf of the client, or the provider of services. The lead agency shall complete the change-incondition reassessment within 20 calendar days of the request.

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Elderly Waiver Reform: Information With the permission of the person being assessed or the person's designated or legal representative, to provide a copy of the provider's nursing assessment or written report outlining its recommendations regarding the client's care needs to the lead agency, in advance of the Minnesota Long Term Care Consultation Services Assessment or re-assessment. ◦ The lead agency conducting the assessment must notify the provider of the date by which this information is to be submitted.

EW-CL and adult day services providers that have provided a copy of the provider's nursing assessment or written report are to receive from the lead agency: ◦ The completed EW Workbook ◦ The final written Community Support Plan

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Essential Community Supports (ECS) The Essential Community Supports program may Services be available to you if you need services to live in the community and meet certain eligibility rules. Adult day service It is designed for people who do not need the level of care provided in a nursing home. You may qualify for up to $452 a month for services and supports. Required service coordination, limited to $600 annually (an additional $600 for service coordination to assist in transition planning is available one time).

Caregiver training and education Chore services Community living assistance Home-delivered meals Homemaker services Personal emergency response system Service coordination / case management

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

ECS Services and Eligibility Are age 65 or older

Are age 21 or older

Are not eligible for Medical Assistance

Can benefit from one or more of these services

Are not or no longer are eligible for nursing facility level of care Live in your own home or apartment Meet financial eligibility criteria for the Alternative Care program Need one or more of these services to live in the community.

3/23/2021

Live in your own home or apartment Lose your Medical Assistance eligibility at your 2015 annual assessment because of changes in the nursing facility level of care criteria Meet Alternative Care financial eligibility criteria No longer meet the nursing facility level of care criteria Previously received services in a nursing home or under the Alternative Care program or Brain Injury, Community Alternatives for Disabled Individuals or Elderly waiver programs. These programs are designed for people who need the level of care provided in a nursing home but choose to live at home

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

ECS Settings and Providers Requirements Settings

Providers Requirements

Are not available to individuals in congregate settings that may include foster care, board and lodge or noncertified boarding care.

Are the same as those in the EW waiver.

Are available to individuals in Housing with Services settings that are apartments.

Uses the state rates for these services.

◦ Providers previously enrolled to deliver one of these services were auto-enrolled to serve folks in ECS under major program UN-EC

An apartment is a self-contained unit that includes living, sleeping, cooking, dining areas and bathroom. 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Housing Supports Formerly known as Group Residential Housing (GRH) Housing Supports (formerly Group Residential Housing (GRH)) ◦ State funded program that pays for room and board costs for low income adults ◦ Housing Supports pays for those living in places like adult foster care, board and lodging establishments, supervised living facilities, and providers who are registered housing with services ◦ Housing Supports is administered through DHS and delegated back to a “Lead Agency” who is usually the county or tribe ◦ Contracts for Housing Supports are obtained through the county or Lead Agency

Housing Supports ◦ Effective July 1, 2020, this base rate is $934 per month ◦ To receive a Housing Supports payment, a person must meet certain eligibility requirements. These requirements include: ◦ ◦ ◦ ◦

being aged, blind, or over age 18 and disabled there are income and asset maximums

◦ The Housing Supports rate is a payment directly to the provider of housing on behalf of the eligible person.

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Housing Supports Formerly known as Group Residential Housing (GRH) Rate 1: This is the base rate. Rate 1 is a payment directly to the provider of housing on behalf of the eligible person. ◦ Many types of settings enter into a GRH contract with their county including Adult Foster Care (Family and Corporate), Board and Lodging establishments, Non-certified Boarding Care homes, and Registered Housing with Services establishments.

Rate 2: Rate 2 is known as the Service Rate and can only be paid in specific types of settings. ◦ These are Board and Lodge with Special Services, specific supervised living facilities licensed by the Department of Health’s Environmental Health Division, or Boarding Care Homes that are not certified for Medicaid. The Board and Lodge with Special Services settings are registered under Minnesota Statute 157.17. New Board and Lodge with Special Services Homes cannot be added to the system unless a facility closes and a replacement is developed with an equivalent number of beds. ◦ Counties negotiate Rate 2 with providers and cannot exceed the maximum unless the county agrees to pay the amount over the maximum with county funds, or the Legislature has specifically authorized a higher rate for a facility. Counties contracting with facilities receiving Rate 2 combine it with Rate 1 to provide the total GRH payment. These facilities typically serve mentally ill or chemically dependent clients who are not eligible for a Medical Assistance waiver.

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Alternative Care (AC) Program for age 65 years and older who are at risk of nursing home placement and are not yet financially eligible for Medical Assistance.

Eligibility  Age 65 or older

Covered Services

 Chooses to receive home and community-based services instead of nursing facility services  Has no other payer for needed community-based services  Has income and assets to sustain no more than 135 days of nursing facility services  Meets a nursing facility level of care

 The AC program covers the same services covered under the Elderly Waiver program with the exception of the services provided in out-of-home placements. In addition, the following services are covered under the Alternative Care Program: ◦ Case management conversion ◦ Discretionary services option ◦ Nutrition services

Source: Disability Services Program Manual (DSPM) 3/23/2021

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2021 Housing Managers' Education Series

Alternative Care (AC) For age 65 years and older who are at risk of nursing home placement and are not yet financially eligible for Medical Assistance.

Covered Services The AC program covers the same services covered under the Elderly Waiver program with the exception of the services provided in out-of-home placements. In addition, the following services are covered under the Alternative Care Program: ◦ Case management conversion ◦ Discretionary services option ◦ Nutrition services Source: Disability Services Program Manual (DSPM) 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Community Access for Disability Inclusion (CADI) Waiver an alternative for person who would otherwise require the level of care provided in a nursing facility.

Eligibility  A person must choose the CADI Waiver and meet all of the following criteria: ◦ ◦ ◦ ◦ ◦

Eligible for Medical Assistance (MA). Certified disabled by Social Security or the State Medical Review Team (SMRT) process. Under the age of 65 years at time of opening to the waiver. Determined by the case manager/service coordinator to need nursing facility level of care. Has an assessed need for supports and services over and above those available through the MA State plan.

 Meet the nursing facility level of care  Rate Setting in Customized Living

Source: Disability Services Program Manual (DSPM)

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Community Access for Disability Inclusion (CADI) Waiver an alternative for person who would otherwise require the level of care provided in a nursing facility.

Covered Services 24-Hour Emergency Assistance

Foster Care

Adult Companion Service

Home Delivered Meals

Adult Day Care/Adult Day Care Bath

Homemaker

Caregiver Living Expenses

Housing Access Coordination

Case Management

Independent Living Skills (ILS) Training

Case Management Aide

Prevocational Services

Chore Service Consumer Directed Community Supports (CDCS)

Residential Care Services

Customized Living

Respite

Customized Living 24 Hour

Specialized Supplies and Equipment

Environmental Accessibility Adaptations

Supported Employment Services

Extended Home Care Services

Transportation

Family Training and Counseling

Transitional Services

Source: Disability Services Program Manual (DSPM) 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Community Alternative Care (CAC) Waiver CAC Waiver services may be provided in ◦ ◦ ◦ ◦ ◦

a person’s own home in his/her biological or adoptive family’s home in a relative’s home (sibling, aunt, grandparent, etc.) in a family foster care home or corporate foster care home. If married, a person may receive CAC Waiver services while living at home with his or her spouse.

3/23/2021

Source: Minnesota Department of Human Services

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Community Alternative Care (CAC) Waiver alternative to institutionalization for those who would otherwise require the level of care provided in a hospital.

Covered Services

CAC Waiver services may be provided in

Case Management Case Management Aide Consumer Directed Community Supports (CDCS) Environmental Accessibility Adaptations Extended Home Care Services Family Training and Counseling Foster Care Home Delivered Meals Homemaker Respite Specialized Supplies and Equipment Transportation Transitional Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Developmental Disability (DD) Waiver an alternative for a person who would require the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities.

COVERED SERVICES 24-Hour Emergency Assistance Adult Day Care/Adult Day Care Bath Assistive Technology Caregiver Living Expenses Caregiver Training and Education Case Management Chore Service Consumer Directed Community Supports

(CDCS) Consumer Training and Education Crisis Respite Day Training and Habilitation Environmental Accessibility and Adaptations Extended Home Care Services Home Delivered Meals

Homemaker Housing Access Coordination Personal Support Prevocational Services Residential Habilitation (In-Home Family Support, Supported Living Services) Respite Specialist Services Supported Employment Services Transportation Transitional Services

Source: Disability Services Program Manual (DSPM)

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Brain Injury (BI) Waiver Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person and who would otherwise require the level of care provided in a specialized nursing facility or neurobehavioral hospital.

Eligibility A person must choose the BI Waiver and meet all of the following criteria: ◦ ◦ ◦ ◦ ◦ ◦

Eligible for Medical Assistance. Certified disabled by Social Security or the State Medical Review Team (SMRT). Under the age of 65 years at the time of opening to the waiver. Level of care criteria: Nursing Facility (BI-NF) or Neurobehavioral Hospital (BI-NB) Have a completed BI Waiver Assessment and Eligibility Determination (DHS-3471 PDF) Diagnosed with one of the following documented primary or secondary diagnoses of brain injury or related neurological condition that resulted in significant cognitive and behavioral impairment: ◦ Acquired or Traumatic brain injury that is not congenital ◦ Degenerative or genetic disease where cognitive impairment is present, becomes symptomatic on or after the person’s 18th birthday and is not congenital ◦ Able to function at a level that allows participation in rehabilitation. ◦ Has an assessed need for supports and services over and above those available through the MA State plan. ◦ In need of a service that is only available through the BI Waiver or requires a higher level of service than is available through other waivers due to cognitive and behavior impairments.

Source: Disability Services Program Manual (DSPM) 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Personal care assistance (reform continues) State/Federal Funded Program Personal care assistance services help a person with day-to-day activities in their home and community. PCAs help people with activities of daily living, health-related procedures and tasks, observation and redirection of behaviors and instrumental activities of daily living for adults. It is available to eligible people enrolled in a Minnesota Health Care Program. Under considerable policy review and restructuring

Source: Minnesota Department of Human Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Adult Foster Care * Foster care / supported living corporate will be renamed community residential services

A licensed, living arrangement that provides food, lodging, supervision, and household services. ◦ They may also provide personal care and medication assistance. ◦ Adult foster care providers may be licensed to serve up to four adults or five adults if all foster care residents are age 55 or older, have no serious or persistent mental illness nor any developmental disability.

There are two types of adult foster care: ◦ Family Adult Foster Care is an adult foster care home licensed by the Minnesota Department of Human Services. It is the home of the license holder and the license holder is the primary caregiver. ◦ Non-Family Adult Foster Care (Corporate Adult Foster Care) is an adult foster care home licensed by the Minnesota Department of Human Services that does not meet the definition of Family Adult Foster Care because the license holder does not live in the home and is not the primary caregiver. Instead, trained and hired staff generally provide services. Source: Minnesota Department of Human Services 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Adult Foster Care (Continued) * Foster care / supported living corporate will be renamed community residential services Payment ◦ Costs for room and board are met with client income such as Social Security Income, Supplemental Security Income, or other supplemental income support such as Housing Supports (GRH). ◦ GRH is available to help recipients pay for room and board costs when living in a licensed or registered setting.

◦ The cost of adult foster care services (provision of supervision, assistance with personal care and medication) may be met with client income such as Social Security Income, Supplemental Security Income, and through other state and federal programs. ◦ In order to be paid for services from a waiver, the provider must have a contract with a county agency and be enrolled as a health care provider with the Minnesota Department of Human Services. ◦ County human service agencies set the rates for services provided to individuals who need public funding to help pay for services. The amount of payment a provider receives to care for an individual varies based on the resident's service needs.

Source: Minnesota Department of Human Services 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Google Search: Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment

Provider Enrollment Minnesota Department of Human Services

https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVER SION&RevisionSelectionMethod=LatestReleased&dDocName=id_017530

Minnesota Provider Screening and Enrollment (MPSE) portal or Fill Out and Submit Forms Source: Minnesota Department of Human Services 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Managed Care and other issues 89

Minnesota Senior Health Options (MSHO) State/Federal funded program Voluntary Age 65 and Older Eligible for Medical Assistance Medicare Part A, B, and D Covers acute care, doctor visits, PCA, home health services, lab, dental, transportation, and: ◦ Elderly Waiver ◦ 180-day nursing facility liability

Source: Minnesota Department of Human Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Minnesota Senior Care (MSC) Plus State/Federal funded program Enrollment in MSC or MSC+ is mandatory. MSC is being phased out as the State moves to MSC+. MSC + is similar to MSHO, but does not include Medicare services and Part D Elderly Waiver 180-day nursing facility liability

Source: Minnesota Department of Human Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

MSHO (All 87 counties)

MSC + (All 87 Counties)

Medicare Part A & B

Medicare Special Needs Plan (SNP)

Fee for Service or other non-coordinated plan.

Medicare Part D Drugs

SNP

Separate Free standing Medicare PDP

Remaining Medicaid Drugs

SNP

Medicaid MCO

Medicaid Basic Care

SNP

Medicaid MCO

Medicaid NF

SNP (180 days for new community enrollees) remainder FFS

MCO (180 days for new community enrollees) remainder FFS

Medicaid Elderly Waiver (EW)

SNP

Medicaid MCO

MSHO and MSC+ 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

MSC+ Case Management and MSHO Care Coordination ◦ Some MCOs are contracting with counties ◦ Some with care systems and community organizations ◦ Some are health plan care coordinators ◦ Some have a mix of care coordination options ◦ Members will get letter with name of new care coordinator

Source: Minnesota Department of Human Services

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Providers Plans are responsible for providing provider training. Providers should carefully check MN-ITS (EVS) for eligibility and health plan coverage information. MSHO/MSC+ enrollment is noted on MN-ITS but other Medicare or Part D plan enrollment is not tracked by DHS. MSHO will provide primary coverage for Medicare SNF days. MSHO/MSC+ NF Liability will be 180 days for enrollees who enrolled when in the community. Nursing homes and EW providers need to be prepared to bill health plans for more services.

Source: Minnesota Department of Human Services 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Billing, Level of Care, MnCHOICES, and Other Policies 95

Billing!

Health Plans

• Fee for Service • • •

Screening Service Agreement MN-ITS

• mn-its.dhs.state.mn.us/

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Service Agreement  Document used to identify services, providers and payment information for a person receiving home care or waiver services.  Allows providers to bill for approved services and allows DHS to audit usage and payment data.  Long-term care and DD Waiver utilize the same Service Agreement DHS-3070 (PDF) to authorize services.  Service agreements are stored in MMIS.  Service agreements are waiver span and date sensitive.  Once a service agreement is entered into MMIS, MMIS generates notices to the case manager/service coordinator and to each provider listed on the service agreement.

3/23/2021

Source: Minnesota Department of Human Services CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE

| #CPMEDUCATES

MN-ITS and Help https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/contact-us/mhcp-help-desk.jsp

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

2021 Housing Managers' Education Series

Monthly to Daily Billing • •

Monthly and daily rate Effective July 1, 2016, Managed care organizations that don’t use MMIS will follow their own internal processes and procedures to ensure that service agreements are updated with the correct codes so that providers can bill accurately for their services.

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

MN E-Connect https://mneconnect.healthec.com/ProdMNeConnectAdmin/mnehome.aspx 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

100

2021 Housing Managers' Education Series

A single, comprehensive and integrated webbased assessment and support planning application for long-term services and supports in Minnesota.

MnCHOICES The new MnCHOICES assessment will replace current long-term care assessment processes and forms, including:

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

Developmental disability screening Long-term care consultation assessment Personal care assistance assessment Private duty nursing assessment, included in future enhancement

101

Background

Nursing Facility Level of Care (NF LOC)

Remember: To be on the EW, CADI, or AC waivers or in a nursing facility on Medicaid, a client must meet the standard for nursing facility level of care.

Put differently, one standard is used for all of these programs.

Implemented on January 1, 2015

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

102

2021 Housing Managers' Education Series

Nursing Facility Level of Care Criteria https://edocs.dhs.state.mn.us/lfserver/Public/DHS-7028-ENG

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

103

Nursing Facility Level of Care Criteria https://edocs.dhs.state.mn.us/lfserver/Public/DHS-7028-ENG

3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

104

2021 Housing Managers' Education Series

Resource

Link

DHS Manuals including Minnesota Health Care Programs Provider Manual

https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth od=LatestReleased&dDocName=Manuals

Billing for Elderly Waiver and Alternative Care (AC) Program

www.dhs.state.mn.us/main/id_056766

DHS Bulletins

https://mn.gov/dhs/general-public/publications-forms-resources/bulletins/

DHS eDocs and Forms

https://mn.gov/dhs/general-public/publications-forms-resources/edocs/

Community-Based Services Manual – Forms by Number

http://www.dhs.state.mn.us/main/id_018176

Medicare

https://www.medicare.gov/index.html

Resources 3/23/2021

CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES

105

2021 Housing & Nurse Managers' Education Series

ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? March 24, 2021

April J. Boxeth, JD, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC

INTRODUCTIONS April J. Boxeth, JD, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC April J. Boxeth is of counsel at Voigt, Rodè, Boxeth & Coffin, LLC. Ms. Boxeth practices in the areas of health law, assisted living, long term care, senior housing, home care, hospice and adult day. Ms. Boxeth advises clients in the areas of regulatory compliance, behavior issues, guardian/conservator issues, probate law, accounts receivable, and general corporate matters and is a frequent presenter on all of these topics. Ms. Boxeth has worked in health law for more than 25 years; she is a former adjunct professor of the Business Law Practicum at William Mitchell College of Law and currently serves as faculty at the University of MN in the HSM/Long Term Care Management and Law course.

Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca K. Coffin is a partner with the law firm of Voigt, Rodè, Boxeth & Coffin, LLC practicing in health law, including accounts receivable, regulatory compliance, and HIPAA compliance. Ms. Coffin represents providers on nursing facility and home care licensing, including change of ownership and bed relocation transactions. Ms. Coffin also practices in employment law and advises clients on a variety of employment and labor issues. She currently represents a number of nursing facilities, home care agencies, and housing with services providers.

2021 Housing & Nurse Managers' Education Series

ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? CARE PROVIDERS OF MINNESOTA 2021 HOUSING & NURSE MANAGERS’ EDUCATION SERIES

April J. Boxeth

aboxeth@vrb-law.com

Rebecca Coffin

rcoffin@vrb-law.com

Voigt, Rodè, Boxeth & Coffin, LLC 651-209-6161

Objectives today: 1. Review best practices for family involvement in care and services; 2. Learn proactive legal and ethical action to avoid lawsuits by families when a bad event occurs; and 3. Understand the importance of the role of family and consumer in providing excellent service and supporting your good reputation

2021 Housing & Nurse Managers' Education Series

Why address ? There are new challenges…  Laws and expectations for AL and Home Care Providers changing and growing…  State (and Federal) focus on abuse and neglect (DOJ); Increased IJs  active legislation this session: AL licensing, discharge, Staffing issues: supervision issues  Financial issues, ownership issues  EW reimbursement rates in AL/Home Care  Dementia care increasing – increases risks of allowing to age in place

Think about stepping into New Opportunities…  Abuse prevention is what you do – however, bad things happen  Protection and safety of residents are the most important part of your job – keeping seniors safe  Customer service is critical for PR and confidence in your services – YOU WANT TO HEAR families  You wish to promote good faith reporting to stop any ongoing maltreatment  You want to prohibit poor employees from working with you and your residents

2021 Housing & Nurse Managers' Education Series

RESIDENT/FAMILY/SERVICE PROVIDERS SAME GOALS:  It is the law and staff must be trained on VA – Family expectations and more vocal residents  Is it abuse or neglect? F689 Accidents and supervision are #1 cited for SNF – regulatory system response  Home care common deficiencies include contents of service plan  Is it a crime? 24 hour reporting for theft (no serious bodily injury) but 2 hour reporting to law enforcement if serious bodily injury  Are you a mandated reporter?  Is the individual a vulnerable adult? In AL?

RESIDENT/FAMILY/SERVICE PROVIDERS SAME GOALS:  Review the law and your VA policies EVERY TIME  Make your own conclusions: It WAS an accident  Document and retain if you decide NOT to report  Inform staff reporter whether you reported and if not, why not

2021 Housing & Nurse Managers' Education Series

SET NEW EXPECTATIONS OF STAFF  Name badges not enough – introduce over and over and over  Know the client/resident and personal interests of them and their family  Report: “Here is what I’ve done for you lately.”  Easier to pre-report than post-report  Listen after report

Complaints: Listen and Respond  Look at CMS All Cause Harm Prevention App A for ideas and use for training staff (document for surveyor review)  Policies and procedures – update when regs change  In-house strategy for handling complaints - written - from residents and clients - from family – The power of an apology – New CO LAW Colorado” (2019) - from staff – must investigate  Difference between a grievance and a VA issue  Staff hiring, retention program and education ongoing  Personal contact critical – supervision and audits

“Candor in

2021 Housing & Nurse Managers' Education Series

LISTENING TIPS  Active listening: completely focused, not thinking about your response. Let them VENT.  Reflective listening: restate back what the family told you. Clarify if necessary, what you heard. 1.

Be present, attentive and focused

Approach conversation as a collaborative experience

Refrain from trying to figure things out while family is speaking

Don’t take things personally

Let go of attachments, agendas or outcome

Investigation is KEY…So you know what to say to family:  Report to RN/Administrator/ED IMMEDIATELY  No choice – Investigate/Evaluate/CONCLUDE  Send employees home during investigation  Talk to all persons involved  Confidential and use two people  Document all – statements, and YOUR conclusions  Report back to staff and family (example: sex between residents)  Adhere to corporate compliance plan

2021 Housing & Nurse Managers' Education Series

VA Reporting – Does it Impact Me and should I tell the family?  No services? Just Housing? No impact. Policy?  Service Provider? Yes. License impacted? YOURS.

 With new AL License VA reporting required  Written request and conferences from licensing board  Separate responsibility (Mitigating factors) if employee is the perpetrator  Possible criminal charges and prosecution  Reputation of your facility  Let family know what is going on… before, during and after

Questions and Case Scenarios  Resident/Tenant refusing to eat or take medications  Family unresponsive and unaggressive physician  Dignity based upon resident’s complaints  Nephew stealing money from incapacitated resident  Hoarders  Cameras placed by families  Drug diversion – Bill of Rights citation – strict liability  QUESTIONS? YOUR CASE SCENARIO?

2021 Housing & Nurse Managers' Education Series

ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? CARE PROVIDERS OF MINNESOTA 2021 HOUSING & NURSE MANAGERS’ EDUCATION SERIES

April J. Boxeth

aboxeth@vrb-law.com

Rebecca Coffin

rcoffin@vrb-law.com

Voigt, Rodè, Boxeth & Coffin, LLC 651-209-6161

2021 Housing & Nurse Managers' Education Series

LEADERSHIP BEYOND COVID-19: IGNITE THE PASSION WITHIN March 31, 2021

Lisa Thomson, BA, LNHA, HSE, Chief Strategy and Marketing Officer Pathway Health

INTRODUCTIONS Lisa Thomson, BA, LNHA, HSE, Chief Strategy and Marketing Officer Pathway Health Lisa Thomson is the chief strategy and marketing officer at Pathway Health Services. She has over 30 years of experience in the post-acute and long-term care arena, as well as other healthcare settings. Lisa is a sought-after national thought leader in the healthcare arena. She presents to a wide variety of healthcare and other business provider types and is a known keynote and international speaker. She has written numerous articles and has been published in national communications across the healthcare provider continuum. She has been voted as a “Top Female Healthcare Executive” and serves as a mentor for healthcare leaders across the nation.

2021 Housing & Nurse Managers' Education Series

LEADERSHIP BEYOND COVID-19: IGNITE THE PASSION WITHIN Lisa Thomson Chief Strategy and Marketing Officer www.pathwayhealth.com

Objectives ◦ Describe three key concepts for leading in today’s health care world ◦ Learn a group activity that will foster creativity and collaboration in a regulated world ◦ Identify how to develop a team that values each others' strengths and to improve professional development

2021 Housing & Nurse Managers' Education Series

Rapid Pace

Landscape of Change COVID-19 Evolution

MN Assisted Living Regulations, Administrator/Director License and Education Requirements

New Regulations/Guidance, Clinical Priorities, Oversight and Enforcement

State of Emergency, Changing Guidance for AL and Housing New Health Care Platforms, Communication, and More

Re-Opening Visitation Resurgence

2021 Housing & Nurse Managers' Education Series

Recruiting

Customer Perception

Refereeing

Occupancy Survey Activity Reporting Outcomes

Staying Informed

Infection Control Priority

Training Budgeting

Modeling Coaching

Shut Down Admission or Move Ins

Monitoring Reporting Evaluating

New Licensure Requirements

Customer Expectations

PPE Shortages, Inventory

COVID - New Regulations and Guiidance

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Consulting | Talent | Training | Resources

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

Why healthcare? This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Consulting | Talent | Training | Resources

2021 Housing & Nurse Managers' Education Series

EMERGING TRENDS

Shift: Care Settings & Acuity

2021 Housing & Nurse Managers' Education Series

Clinical Priorities

Staff Education and Competency

New Expectations New Requirements ALDL

Care Coordination Partnerships

COVID Fatigue

Redesign

Workforce

Increased Acuity

Shortages

2021 Housing & Nurse Managers' Education Series

Consumerism

Technology

2021 Housing & Nurse Managers' Education Series

Health Care Preparedness

IGNITE Disrupting Status Quo

2021 Housing & Nurse Managers' Education Series

Crisis Leadership Model

https://www.ccl.org/wpcontent/uploads/2020/12/l eading-in-crisis-strategicpivot-center-for-creativeleadership.pdf

Pivot to Leap Ahead

https://www.ccl.org/wpcontent/uploads/2020/12/l eading-in-crisis-strategicpivot-center-for-creativeleadership.pdf

2021 Housing & Nurse Managers' Education Series

New Normal…

Core Leadership Skills Communicate vision and goals Listen Build Relationships Trust Include Others Be a leader – Not a boss

2021 Housing & Nurse Managers' Education Series

Myths of Leadership • Management Myth • Entrepreneur Myth • Knowledge Myth • Pioneer Myth • Position Myth Leadership 101 John Maxwell

Agile Break Out Savor Surprises Brain Power Mindset Change

Leadership Traits 26

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

“A leader isn’t good because they’re right; they’re good because they’re willing to learn and to trust. This isn’t easy stuff.” Stanley McChrystal - 4-star general This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

Drive Change and Innovation Ignite and Inspire

LEAPS -Soren Kaplan

2021 Housing & Nurse Managers' Education Series

Listen

Explore

2021 Housing & Nurse Managers' Education Series

Act

Persist

2021 Housing & Nurse Managers' Education Series

Seize

INNOVATION INSPIRATION A Leader’s Choice

2021 Housing & Nurse Managers' Education Series

Marble Jar Moment

Consulting | Talent | Training | Resources

Connect Involve Talk Listen Show Share This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only

2021 Housing & Nurse Managers' Education Series

Team Building

Simple Paper Fold 1 sheet of paper Eyes closed Follow instructions Open eyes Conclusion Open mind and creativity

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

Face Challenges Model-Set the Tone Positivity

Motivate

Emerging Leaders

Passion Inspire

3/30/2021

2021 Housing & Nurse Managers' Education Series

Consulting | Talent | Training | Resources

Passion

Obstacles to Opportunities

2021 Housing & Nurse Managers' Education Series

Ignite ◦ Engage your heart ◦ Reprogram your mind ◦ Take a break ◦ Remember the impact you make ◦ Learn

2021 Housing & Nurse Managers' Education Series

INSPIRE

2021 Housing & Nurse Managers' Education Series

Disclaimer ◦ “This presentation provided is copyrighted information of Pathway Health. Please note the presentation date on the title page in relation to the need to verify any new updates and resources that were listed in this presentation. This presentation is intended to be informational. The information does not constitute either legal or professional consultation. This presentation is not to be sold or reused without written authorization of Pathway Health.”

2021 Housing Managers' Education Series

THE ART & SCIENCE OF SELLING SENIOR HOUSING April 1, 2021

Peggy Scoggins, Owner Adept Selling

Thank you to our sponsor

2021 Housing Managers' Education Series

We’ve got you covered. Improve Resident Outcomes Create Workforce Efficiencies Further Your Financial Objectives

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C R M

We invite you to discover how Eldermark’s CRM will improve communication workflows and processes that enhance the productivity of your sales representatives. Seamlessly connected metrics and dashboard reports from marketing through sales and resident move-ins allow your team to continually improve workflows to drive occupancy results aligned with your goals. Eldermark Senior Housing Software 12400 Whitewater Drive Suite 2010 Minnetonka, MN 55343

Phone: 952-931-9660 repsales@eldermark.com

eldermark.com

INTRODUCTIONS

Peggy Scoggins, Owner Adept Selling Peggy Scoggins is the founder of Adept Selling, a sales coaching, training, and strategic planning company. Peggy has spent more than 26 years working with operations, sales, and marketing teams in senior housing to develop systems and skills necessary to meet organizational goals. Peggy holds a BS with honors in Business Management with a minor in Health Psychology from the University of Northwestern St. Paul. The word Adept means to be proficient or skilled; Peggy’s mission is to collaborate with senior housing providers to develop effective strategies that build adept teams.

2021 Housing Managers' Education Series

Poll: What percentage of your time is spent on sales & marketing activities?

None Less than 25% 25%-50% 51-75% More than 75%

2021 Housing Managers' Education Series

The Average Cost to Attract a Lead is $431

All Leads Are Not Created Equal

Enquire Solutions 2018-2019 Annual Report

2021 Housing Managers' Education Series

Phone Walk-In

•Who answers the call •Who is available

Electronic •How quick is response Lead Capture Plan 11

Call-ins and Walk-ins

Best Practices for Handling Inquiries Quickly

• Set a goal to connect voice-to-voice or face-to-face on the 1st attempt • Use a back-up team

Electronic Inquiries • Create a speed to lead process

Alternative options: call centers, live chats to website 12

2021 Housing Managers' Education Series

Differentiation Strategies

What is Differentiation?

2021 Housing Managers' Education Series

Communicating how your product/service is unique compared to competitive product/service.

Trout & Rivkin: Differentiate or Die

Top 10 Common Differentiators • Good customer service • Quality • Reputation • Good results • Our employees

• Knowledgeable • Consistent • Responsive/flexible • Innovative • Trust/Relationship

2021 Housing Managers' Education Series

Competition and Strategy

“Without competition, there would be no need

for strategy. Customers would buy whatever you make and pay whatever you want.” Michael Porter

8 Successful Differentiation Strategies

1. 2. 3. 4. 5. 6. 7. 8.

Be First Maintain Attribute Ownership Be a Leader Have a History Specialize in Your Market Be the Preferred Provider Make Your Products in a Special Way Be Hot

Differentiate or Die by: Jack Trout, Steve Rivkin

2021 Housing Managers' Education Series

Keys to developing a viable competitive advantage

Know Thyself

Know thy competitor

Know thy customer (think broadly here)

• See “know thyself”

• Why do they choose you • how can they become brand ambassadors

• Why do you do what you do • How do you do what you do • What do you do

Inquiry & Discovery Tour Planning

2021 Housing Managers' Education Series

1. Problem/Want Recognized 2. Information Search 3. Evaluate Options 4. Purchase Decision 5. Post Purchase Evaluation

Customer Journey

2021 Housing Managers' Education Series

Inquiry Parts

Inquiry calls those include the following components average 15 minutes • • • •

Opening (3% about 1 min) Discovery (75% about 10 min) Presenting (15% about 2.5 min) Closing: Agreed Upon Next Step (7% about 1.5 min)

Opening GOAL: Take control of the call and seek permission to ask questions 3-Step Opening • Reassure the caller that you will assist him/her • Ask permission to ask questions • Inform caller why you are asking questions Example: “It would be my pleasure to assist you, do you mind if I ask a few questions so that I can best meet your needs?” Mirroring: Brochure request: “I would be happy to send a brochure, do you mind if I ask a few questions, so I know what information to include in your packet?”

2021 Housing Managers' Education Series

Discovery • • • • • • • •

Reason for Inquiry Contact information Decision Makers Timeframe (perceived) How they heard about you Needs Wants Emotional Motivation

Offer

Presenting

Offer solutions to their Needs and Wants

Describe how they will feel and/or what

Describe they will achieve by accepting the solution

Present enough value to get them to the

Present next step

2021 Housing Managers' Education Series

Closing: 3-Part Assumptive Recap Part 1: Recap • Confirm understanding

Advise Part 2: Advise Next Step • Position yourself as the advisor, not the salesperson • Create a valueproposition (WIFM)

Options Part 3: Give Options • By providing choices, your prospect remains in control and you’re able to schedule AUNS

Tour Planning

Prepared

Personalized

Memorable

Tour Experience should answer these questions:

Will my Needs, Wants and Emotional Motivations be met?

Will I fit in?

2021 Housing Managers' Education Series

Tour Experience

1 Begin in a quiet, private place

2 Review understanding from initial discovery (walk-in complete discovery)

3 Describe what you have planned, seek agreement

4 Tour route personalized

5 Use lots of LOTS (Language of the Senses)

6 Return to quiet, private place to Close (recap, advise, options)

2021 Housing Managers' Education Series

Features, Advantages, Benefits

Feature

Advantage

Benefit

House Dog “Buddy”

As a therapy dog, Buddy brings smiles to the residents and provides them with a sense of responsibility when they care for him. Therapy dogs have been proven to offer a sense of calmness and reduces agitation for those with dementia.

I know your mom won’t be able to bring her dog with her when she moves. If she moves here, Buddy could be her “adopted” dog. He is always looking for someone to pet him and give him lots of attention. How do you think your mom would feel having Buddy around?

2021 Housing Managers' Education Series

Follow-Up

2021 Housing Managers' Education Series

Creative Follow-Up Ideas • Call to invite to an activity or education program of interest

• Set up a meet and greet with key staff (nursing, culinary, activities, maintenance, administrator)

• Do a home visit to learn more about them and their lifestyle

• Send articles of interest

• Offer a lifestyle experience stay (test drive or trial stay) • Send a Personal Touch gift • Offer to assist with laying out furniture for their new apartment (even if contemplating) • Meet to do a financial comparison

• Send testimonials (peer-to-peer is best practice) • Set up introductions to external resources (Realtor, mover, elder law attorney, financial advisor) • Delivery chicken noodle soup and tissue paper if they have a cold or not feeling well. (brand the food) • Create a future neighbor’s program for those on the wait list. Goal is to engage now!

• Schedule a retour with them and/or loved ones • Invite to have dinner with another resident

2021 Housing Managers' Education Series

Are They Ready To Buy MOVE?

GIGO

2021 Housing Managers' Education Series

Track interactions with customers

Customer Relations Management

• What Customers?

Data reports that are actionable • Consistency/reliable data • Trends • Deeper dives

Eldermark Market Minder Enquire Solutions

Poll: What CRM do you use?

PointClickCare CRM Salesforce Welcome Home Matrix Care Marketing Other None

2021 Housing Managers' Education Series

Personal Data

• Names, Addresses, phone #’s, email addresses, anniversary, birthday…

Demographic

• Age, income, occupation, education, religion…

Preferences

• Care level, unit style, activities, food…

What to Track

Marketing

• Lead source, status, campaigns…

Sales Activities

• Calls, tours, emails, home visits...

Transactions

• Wait list, deposits, move-ins, transfers, move-outs…

Leading Indicators: A Predictive Measurement PROSPECTS • Inquiries • Date of Inquiry • Method of Inquiry • Lead Source

Transactions • • • • • •

Sales Pipeline Wait List Deposits Cancelled Deposits Move-Ins Move-Outs

• Activities • 1st Tours Completed • Repeat Tours Completed • Call Outs (attempted and completed)

Referral Sources

• Conversions • Inquiry to Tour Ratio • Tour to Move-In Ratio

• Activities • Appointments Completed • Call Outs (attempted and completed) • Referrals Given

2021 Housing Managers' Education Series

Lagging Indicators: An Output Measurement

Occupancy Care Level • Units • People

Do it Daily

Set

Set time in your calendar

Best Practice Data Entry

Take

Take good notes

Pull

Pull your own reports

2021 Housing Managers' Education Series

Forecasting

peggy@adeptselling.com 651-560-6070 adeptselling.com

Thank You

Questions

Encounter Form- Initial Inquiry Opening: I am happy to assist you; do you mind if I ask a few questions, so I know how best to help you? Contact Name _________________________________ Phone Number __________________________ Prospect Name _________________________________ Relationship to Prospect __________________

Reason for Inquiry: What prompted you to call in today? Where do you/does your loved one currently live? _____________________________________________ Is he/she aware you are looking? YES / NO if YES, how does he/she feel about this? If NO, how do you think he/she would feel if they knew? Are you concerned about discussing this with him/her?

Emotional Motivator: What do you hope to achieve by making a move? How will this make you feel?

Needs & Wants: What is important to you regarding a senior living/assisted living/memory care community?

What type of support do you/does your loved one need now? What do you anticipate in the future?

How do you/does your loved one like to spend your/their day?

What are your/his/her hobbies or interest? www.adeptselling.com Updated May 2018

What type of activities do you/does your loved one like to do?

Tell me about your /your loved one’s background (occupation/volunteerism/military service)?

What do you/does your loved one like to do for fun?

What are all the options you’re considering?

What is your GREATEST concern right now?

Decision Makers: _____________________________________________________________________________ Time Frame (perceived): ______________________________________________________________________ How did you hear about us? ___________________________________________________________________ Address ________________________________ City _____________________ State ______ Zip ______________ Email __________________________________ Alt. Phone Humber _____________________________________

CLOSE: 3-Step Assumptive Recap: Based on what I’ve learned, it sounds like... (Present Solutions) Advise Next Step: Here is what I recommend that you do next... (Include Value Proposition) Option of 2: What works best for you ______________________ or _______________________ Agreed Upon Next Step (AUNS) ___________________________________________________ www.adeptselling.com Updated May 2018

2021 Housing Managers and Nurse Managers Virtual Education Series

SURVEY PREPARATION & SUCCESS/ELECTRONIC MONITORING April 6, 2021

Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.

INTRODUCTIONS Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc. Doug Beardsley has been involved in the field of long-term care since 1982, when he became a nursing home administrator. Mr. Beardsley has a Bachelor of Science degree in healthcare administration from the University of Wisconsin–Eau Claire. His experience includes 20 years as a nursing home administrator, three years as a long-term acute care hospital CEO, manager of an in-house LTC pharmacy, and other long-term care related activities. Mr. Beardsley has been the vice president of member services with Care Providers of Minnesota since 2005, where he is responsible for the regulatory activities pertaining to nursing facilities, home care, housing with services, assisted living, and hospice.

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

SURVEY PREPARATION & SUCCESS Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.

As you know, we are in the middle of a transition from: Registered Housing with Services + Arranged Comprehensive Home Care Provider = Assisted Living to Assisted Living License or Assisted Living with Dementia Care License 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

I will try to point out the differences that we are aware of, regarding the survey process in the current model as well as the model that will exist after 8-1-2021.

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

Current Red Roof Assisted Living

• An apartment—with all the landlord/tenant rights of any apartment • A registered housing with services establishment—registered with MDH’s Health Regulation Division (annual registration is required) • Has an arranged home care provider (internal or external) identified with MDH • May have elected with MDH to operate a special care unit or special program for Alzheimer’s or related disorders • May have elected with MDH to use the term “assisted living” • Has filed a Uniform Consumer Information Guide (UCIG) 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

Current Red Roof Assisted Living • Red Roof Assisted Living MUST identify an “arranged home care provider”. • The home care provider may or may not have common ownership with Red Roof.

04/06/2021

Care Provider

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

For the most part, it is the HOME CARE PROVIDER that is surveyed by MDH, not the HWS or AL. Care Provider

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

There are 4 types of home care in Minnesota: • Registered home management • Basic licensed home care • Comprehensive licensed home care • Comprehensive with Medicare certification

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

BASIC HOME CARE LICENSE Assistive tasks provided by licensed or unlicensed personnel that include: 1. Assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; 2. Providing standby assistance; 3. Providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the medication; 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

BASIC HOME CARE LICENSE Assistive tasks provided by licensed or unlicensed personnel that include: 4. Providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises; 5. Preparing modified diets ordered by a licensed health professional; and 6. Assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services if the provider is also providing at least one of the above services. 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

QUIZ Does a home care provider licensed as BASIC need a nurse on staff?

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

QUIZ

NO 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

COMPREHENSIVE HOME CARE LICENSE Can provide all of the BASIC license tasks, plus:

1. Services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

COMPREHENSIVE HOME CARE LICENSE Can provide any of the BASIC license tasks, plus:

2. Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; 3. Medication management services; 4. Hands-on assistance with transfers and mobility;

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

COMPREHENSIVE HOME CARE LICENSE Can provide any of the BASIC license tasks, plus:

5. Assisting clients with eating when the clients have complicating eating problems as identified in the client record or through an assessment, such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; or 6. Providing other complex or specialty healthcare services. 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

QUIZ Does a home care provider licensed as COMPREHENSIVE need a nurse on staff?

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

QUIZ

YES 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

“The RN must be available in-person or via phone, text, email, etc. whenever delegated nursing tasks are being performed.”

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

The 4th type of home care is a

MEDICARE-CERTIFIED HOME CARE AGENCY • In Minnesota, this must be a licensed COMPREHENSIVE home care provider with an additional Medicare certification • Must comply with both state and federal requirements • Able to bill Medicare for skilled services 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

By the numbers… • 1,287 HWS with AL designation • 814 HWS with AL designation and memory care • 1,274 comp. home care • 282 temp. comp. home care •

For comparison, there are 364 nursing facilities and 129 hospitals in MN

REVIEW

• Housing with services and AL • Scope of home care services • Types of home care in MN

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

SURVEYS - Current

• HWS requirements to be surveyed by MDH • Comprehensive home care provider requirements to be surveyed by MDH 23

MDH Surveys - Current • Within 12 months of issuing a new home care license (limited exception)—six months after a CHOW • At least every three years thereafter (statute—but not occurring) • Complaint investigations are an entirely different issue—conducted as-needed, based on triaged reports from the Minnesota Adult Abuse Reporting Center (MAARC) and investigated by the lead investigative agency (OHFC for HCALP) 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH Surveys - Current • 2016: 196 comprehensive HC providers surveyed • 2017: 191 comprehensive HC providers surveyed • 2018: 235 comprehensive HC providers surveyed • 2019: 103 comprehensive HC providers surveyed in first six months • Note—these are providers surveyed—not number of surveys conducted, which are over 600 per year (resurveys included) 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH Surveys - Current • MDH must survey approximately 125-150 initial licensed providers per year (new licensees with one-year deadline for survey) PLUS • CHOW surveys (approx. 50 per year?) six-month deadline for survey PLUS • MDH needs to survey approximately 440 comprehensive HC providers per year in order to achieve an every-three-year compliance cycle as mandated in statute 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

This number will jump to 600-700 per year in August 2021 for everyother-year surveys!

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH Surveys: Housing with Services Requirements - Current • • • • • •

Housing managers education (30 hours every two years) Required dementia training Emergency preparedness Use of the term assisted living (check your marketing materials and website) Uniform Consumer Information Guide (UCIG) 22 required elements in your HWS written contract

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH HWS Surveys: Housing Managers Education Current • • • • • •

30 hours every two years HWS manager is the person designated by the HWS owner Topics “relevant to the operations of the housing with services establishment and the needs of its tenants” Maintain records for three years No pre-approval or CEUs needed Other licensed CEUs may be applied

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH HWS Surveys: Required Dementia Training

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH HWS Surveys: Emergency Preparedness - Current Eight Required Elements

Each HWS must: 1. Have a written emergency disaster plan that contains: a) A plan for evacuation b) Addresses elements of sheltering in-place c) Identifies temporary relocation sites for tenants d) Details staff assignments in the event of a disaster or an emergency 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 2. Post an emergency disaster plan prominently 3. Provide building emergency exit diagrams to all tenants upon signing a lease 4. Post emergency exit diagrams on each floor 5. Have a written policy and procedure regarding missing tenants (elopements)

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 6. Provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter—staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on-site

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 7. Offer emergency and disaster training to all tenants annually 8. Conduct and document a fire drill or other emergency drill at least every six months—to the extent possible, drills must be coordinated with local fire departments or other community emergency resources

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH HWS Surveys: Other… • Use of the term “assisted living” (check your marketing materials) • Uniform Consumer Information Guide (UCIG) • 22 required elements in your HWS written contract 04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

MDH Comprehensive Home Care Surveys - Current Types of surveys: • • • •

Full survey Core survey Follow-up survey (re-survey) Complaint survey/investigation

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

MDH Comprehensive Home Care Surveys - Current • Full survey: HCALP, MDH Health Regulations Division • Core survey: HCALP, MDH Health Regulations Division • Follow-up survey: HCALP, MDH Health Regulation Division • Complaint Investigation: OHFC, MDH Health Regulation Division, or county adult protective services, or law enforcement, or a combo platter

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

Survey Basics - Current • Unannounced • Generally only one surveyor present, unless training is occurring • Typically takes 1–4 days ; 3 days average

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

Survey Basics - Current Length of survey depends, based on: • • • • •

Number of locations served by the licensee Number of home care clients Extent of issues discovered Complexity of care being provided Preparedness of the provider!

04/06/2021

CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

So What is Changing in August? One survey for the ALL – no separation from HWS and Comprehensive Home Care. Surveys every TWO years. Home Care elements remain the same, plus additional requirements. 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

So What is Changing in August? Building inspections (new!) Dementia Care Requirements (new!) Emergency Preparedness Requirements (new!) New Infection Control Section of Statue 04/06/2021

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So What is Changing in August? New disclosure forms New contract requirements New assessment elements New termination requirements 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

So What is Changing in August? Each site gets own independent survey – no more multiple sites under one home care licensed New AL Bill of Rights New Dementia Care Training 04/06/2021

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In theory… Everyone who converts to ALL or ALL with Dementia Care should experience a License Survey and a Building Survey by July 31st 2023.

04/06/2021

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Survey Basics

04/06/2021

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Survey Basics • The surveyor will ask for a series of documents upon entrance… this should not come as a surprise! • How will the information be gathered? • Who will gather it if the home care nurse manager is not in? • Consider creating a “survey binder” 04/06/2021

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MDH Guide to the Survey Process and Introduction

04/06/2021

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Entrance Conference Letter – Have Most Pre-Filled out! 04/06/2021

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Entrance

Interview Staff

Receive 2567

Building Tour

Interview Clients

Implement Changes

Client & Staff Observations

Document Review

Resurvey

Medication Observation

Exit Conference

Complete Survey Process

Conference

04/06/2021

(fines)

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04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

04/06/2021

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04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Client Observation and Record Review

04/06/2021

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SURVEY OUTCOMES • Averaging 12–13 correction orders per survey • We have seen deficiency-free surveys • We have seen surveys with 35+ correction orders • Multiple re-surveys are not uncommon • Stipulation orders with conditions

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Survey Outcomes • Correction orders: A correction order (also known as a licensing order) may be issued whenever the surveyor finds upon survey or during a complaint investigation that a home care provider, a managerial official, or an employee of the provider is not in compliance with sections of home care statutes • The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction 04/06/2021

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Survey Outcomes • Correction orders: The survey form indicating correction orders must be sent to the provider within 30 calendar days after the survey exit date

04/06/2021

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Survey Outcomes • Correction orders: The provider needs to implement a system improvement to correct each identified issue of noncompliance • The noncompliance must be completed within the time period identified on the survey document (for example: 21 days) • Surveyors will not tell you HOW to fix an issue, only what is not in compliance 04/06/2021

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Survey Outcomes • A plan of correction does not need to be submitted to MDH for review, acceptance, or approval • However, the home care provider must document any actions taken to comply with the correction order • Surveyors may request a copy of this documentation (and they will upon resurvey) 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Survey Outcomes • Don’t wait for a surveyor to ask for your documentation! • Have it ready, organized, and accurate— show your work! • How did you implement a quality improvement process? What have you changed since the survey to come into compliance? 04/06/2021

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Follow-Up Surveys (re-survey) For providers that have Level 3 or Level 4 violations, or any violations determined to be widespread, MDH shall conduct a follow-up survey within 90 calendar days of the survey Follow-up surveys should not be a surprise! You should be ready with system corrections made! 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Follow-Up Surveys (re-survey) • Follow-up surveys are intended to verify you have solved the identified correction order—both the individual finding and the system that failed to produce compliance • Once in your building, surveyors have the right to issue any new correction orders based on what they observe • Make it easy for them to get in-and-out of the followup survey! 04/06/2021

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04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Survey Exit Date Within 30 days MDH must send 2567 (correction orders)

Days indicated on 2567

Provider has XX days to correct identified correction orders Within 90 days MDH conducts follow-up survey for Level 3, Level 4, or widespread findings

Within 15 days Provider has opportunity to request any reconsiderations after receipt of 2567

Within Reconsideration must be 60 Determined days

04/06/2021

PASS or FAIL Start all over if FAIL

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Survey Findings Letter • • •

04/06/2021

Dates of survey Fines (if imposed) Explanation of the reconsideration process

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Survey Findings • • • • • • • 04/06/2021

Infamous 2567 form! NOT designed for home care Does NOT need to be signed Does not need to have plans of correction Does NOT need to be returned to MDH Half is left blank, doubling the size of the document Stupid form

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Survey Findings • Identifies: • • • •

04/06/2021

Statute reference Examples of deficient observed practice Scope and level for each correction order Compliance deadline for each correction order

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2021 Housing Managers and Nurse Managers Virtual Education Series

Levels and Scopes • Each correction order is assigned a Level and Scope •

Level 1 is a violation that has no potential to cause more than a minimal impact on the client and does not affect health or safety

•

Level 2 is a violation that did not harm a client's health or safety but had the potential to have harmed a client's health or safety, but was not likely to cause serious injury, impairment, or death

04/06/2021

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Levels and Scopes • Each correction order is assigned a Level and Scope •

Level 3 is a violation that harmed a client's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death

•

Level 4 is a violation that results in serious injury, impairment, or death

04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Levels and Scopes • Each correction order is assigned a Level and Scope •

•

Isolated, when one or a limited number of clients are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally Pattern, when more than a limited number of clients are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive Widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the clients

04/06/2021

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Levels and Scopes Level 4

Level 3

Level 2

Level 1

Isolated

Pattern

Widespread

04/06/2021

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SURVEY OUTCOMES Beginning July 1, 2019, all Level 3 ($1,000) and Level 4 ($5,000) findings will be issued a fine with no opportunity to correct prior to the fine; Level 2 ($500) findings may be fined without an opportunity to correct (widespread or impact?)

But there’s more! In addition to fines, MDH may also impose: • Immediate temporary suspension of a home care license • Immediate suspension of a home care license • Issue conditions on the license, such as: • Require consultation • Require supervision • Require training • Require reports to be submitted • Prohibit taking new clients for a period of time 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

REVIEW • • • • • • • • •

Housing with Services and AL Scope of home care services Types of home care in MN Types of surveys Select survey forms Survey timelines Survey process Survey communications Survey outcomes

So the question is…

04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

WHAT PROBLEMS ARE SURVEYORS CITING DURING SURVEYS?

04/06/2021

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Answer: A BUNCH OF STUFF

04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

My goal is to help you learn from the “mistakes” or ignorance of others. If other providers are having difficulty with a particular regulation or statute, there’s a good chance you may also be noncompliant in that area. 04/06/2021

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Correction Orders Issued in 35% or More of Surveys REGULATION

% of Surveys

Contents of Service Plan TB Prevention and Control Individualized Treatment/Therapy Mgt Plan Employee Records Individualized Medication Mgt Plan Provision of Medication Mgt Services Comprehensive Assessment and Monitoring Quality Management Individual Abuse Prevention Plan BOR - Accepted Standards Practice Contents of Client Record Documentation of Administration of Medication Policies and Procedures – Treatments and Therapy Content of Orientation 04/06/2021

50% + 50% + 50% + 50% + 40% - 50% 40% - 50% 40% - 50% 40% - 50% 30% + 30% + 30% + 30% + 30% + 30% +

Let’s deal with these “easy” ones first

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Let’s Address the “EASY” Ones First Employee Records 50 +% • Paper compliance and easy to audit! • Common issues • • • •

No job descriptions No annual performance review No background checks Incomplete required documentation

04/06/2021

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Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Kind of a stupid title • Really means a documented Performance Improvement Project or Quality Improvement Project

04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Let’s Address the “EASY” Ones First Quality Management 40% • The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal. 04/06/2021

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Let’s Address the “EASY” Ones First Root Cause Analysis

04/06/2021

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Let’s Address the “EASY” Ones First Quality Management 40 – 50% • Document the home care issue/problem/opportunity you are trying to improve • Gather data/baseline • Brainstorm potential system improvements • Implement/pilot and test the changes—measure • Make adjustments • Fully implement (and celebrate/praise) • Measure to determine if improvement held over time 04/06/2021

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Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Look at your complaint/concern log as a possible starting point—see if you can reduce the frequency of your #1 complaint! • Ask your staff what they think would improve client satisfaction or increase their ability to do the job better!

04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Under the “current” system, the quality management project needed to relate to “home care services.” • Under ALL, there is no such restriction.

04/06/2021

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Let’s Address the “EASY” Ones First Policies and Procedures—Treatments and Therapies 30% - 40% • Two required elements: 1.Must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures 2. Policies must address… 04/06/2021

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2021 Housing Managers and Nurse Managers Virtual Education Series

Let’s Address the “EASY” Ones First Policies and Procedures—Treatments and Therapies 30% – 40% 2. Policies must address… a) Requesting and receiving orders or prescriptions for treatments or therapies b) Providing the treatment or therapy c) Documenting of treatment or therapy activities d) Educating and communicating with clients about treatments or therapy they are receiving e) Monitoring and evaluating the treatment and therapy f) Communicating with the prescriber 04/06/2021

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Let’s Address the “EASY” Ones First • Policies and Procedures—Treatments and Therapies 30% - 40% • Common survey findings: • • • •

Employee B confirmed there were no treatment and therapy policies and procedures developed or implemented, to include the required content Verified the following treatment and therapy management policies had not been developed Employee A confirmed the treatment and therapy policies and procedures were not developed to include… The licensee's policies and procedures for treatment and therapy management lacked the following…

04/06/2021

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Let’s Address the “EASY” Ones First Content of Orientation 30% - 40% • Simply need to follow the statute • Specific list of required elements • Have a checklist of elements • Document

04/06/2021

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That leaves us with 10 more “complex” correction orders! % of Surveys Cited

REGULATION Contents of Service Plan

50% +

TB Prevention and Control

50% +

Individualized Treatment/Therapy Mgt Plan

50% +

Individualized Medication Mgt Plan

40% - 50%

Provision of Medication Mgt Services

40% - 50%

Comprehensive Assessment and Monitoring

40% - 50%

Individual Abuse Prevention Plan

30% +

BOR - Accepted Standards Practice

30% +

Contents of Client Record

30% +

Documentation of Administration of Medication

30% +

04/06/2021

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144A.4791 Subd. 9 (f) Contents of Service Plan

50% + of Surveys

• Service plans are completed no later than 14 days after initiation of home care services • The current signed service plans “match” the services you are providing to the client • Client needs change, and when the services you provide change to respond to these needs, so must the service plan be changed or be updated—in other words, the service plan is “accurate” • Service plans contain all the required “elements” 04/06/2021

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144A.4791 Subd. 9 (f) Contents of Service Plan

• • • • • • • •

Signed Info on ombudsman Info on rate change notice Description of services provided Fees for services provided Frequency of services provided ID of staff who will perform services Schedule of monitoring and reassessments (90 days and changes in condition) 04/06/2021

50% + of Surveys

• Frequency of staff supervision and who will supervise (30 days after hire and as necessary) • Contingency plan that includes: • Action if services not provided • Provider contact information • Client emergency names for emergencies and for signing • Circumstances when 911 will not be called and how you will respect any advance directives of the client CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates

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144A.4791 Subd. 9 (f) Contents of Service Plan

50% + of Surveys

• Tip: • Review the service plan when you conduct your every 90-day assessments—does it still match what you are doing? • Based on the assessment, are additional services recommended?

04/06/2021

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144A.4798 Subd. 1 Tuberculosis (TB) prevention and control

50% + of Surveys

Failure to have all the following elements documented: 1. Identify an individual or team responsible for TB infection control 2. Have a current written TB infection control plan 3. Document a current facility TB community risk assessment 4. Conduct initial and ongoing TB healthcare worker education 5. Conduct baseline screening of healthcare workers and regularly scheduled volunteers, including a screening of TB symptoms and testing using a properly administered and documented two-step TST or IGRA blood test 04/06/2021

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144A.4793 Subd. 3 Individualized treatment or therapy management plan 50% + of Surveys

Lacked at least one of the five required elements of a treatment and/or therapy plan: 1. A statement of the type of services to be provided 2. Documentation of specific client instructions 3. Identification of treatment or therapy task that will be delegated to unlicensed personnel 4. Procedures for contacting a RN or other health professional if problem arises 5. Any client-specific requirements related to documentation, verification treatment or therapy was completed as prescribed, and monitoring to prevent possible complications or adverse reactions 04/06/2021

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144A.4793 Subd. 3 Individualized treatment or therapy management plan 50% + of Surveys

Common treatments or therapies involved in this correction order… • TED socks/compression stockings • Daily exercises ordered • Daily ROM • Daily weights • Daily ambulation ordered • Leg elevation treatment • Braces & splints • Ace wraps • Blood glucose monitoring • INR management 04/06/2021

• • • • • • • • • •

Oximeters Catheter care Cough assist Trach care G-Tube CPAP/BiPAP Wound care Weekly vital signs Oxygen Blood pressure monitoring

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144A.4792 Subd. 5 Individualized medication management plan

40% - 50% of Surveys

The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following eight elements: 1. A statement describing the medication management services that will be provided; 2. A description of storage of medications based on the client's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; 3. Documentation of specific client instructions relating to the administration of medications; 4. Identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; 04/06/2021

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144A.4792 Subd. 5 Individualized medication management plan

40% - 50% of Surveys

The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following eight elements: 5. Identification of medication management tasks that may be delegated to unlicensed personnel; 6. Procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; 7. Any client-specific requirements relating to documenting medication administration; and 8. Verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions 04/06/2021

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144A.4792 Subd. 2 Provision of medication management services

40% - 50% of Surveys

• No medication management assessment documented • Medication management assessment was not done prior to managing medications • Lacked evidence the RN conducted the medication assessment face-to-face with the client • No documentation regarding the plan to prevent the diversion of medications (controlled substances)

04/06/2021

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144A.4792 Subd. 2 Provision of medication management services

40% - 50% of Surveys

• Medication management assessments lacked the following:

• Identification and review of all medications the client is known to be taking • Indications for medications • Side effects • Contraindications • Allergic or adverse reactions and actions to address these issues • Interventions needed to prevent diversion

04/06/2021

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100

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144A.4791 Subd. 8 Comprehensive Assessment and Monitoring

40% - 50% of Surveys

TWO reasons for this correction order—Reason 1: Timing: Failure to meet the timing requirements of assessments and monitoring: • • • •

Prior to medication management services Within 5 days Within 14 days Every 90 days thereafter

04/06/2021

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101

144A.4791 Subd. 8 Comprehensive Assessment and Monitoring

40% - 50% of Surveys

TWO reasons for this correction order—Reason 2: Updating & accuracy: Failure to reassess due to change in condition or as needed—common triggers include the following: • Falls • Injuries • Bruising • Skin Tears • Return from ER or hospitalization • Move to secured unit due to change in cognitive function • Note: relationship to incident reports and communication books 04/06/2021

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102

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2021 Housing Managers and Nurse Managers Virtual Education Series

144A.479 Subd. 6 (b) Individualized Abuse Prevention Plan

30% - 40% of Surveys

• Abuse prevention plans not done at all • Susceptibility of client does not match the plan (change in condition) • Incident reports indicate susceptibility that did not change provider’s plan/approach

04/06/2021

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103

144A.479 Subd. 6 (b) Individualized Abuse Prevention Plan

30% - 40% of Surveys

• Tip: Consider reviewing and updating when appropriate, the abuse prevention plan after each incident report and at each assessment/reassessment

04/06/2021

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104

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2021 Housing Managers and Nurse Managers Virtual Education Series

144A.479 Subd. 6 (b) Individualized Abuse Prevention

Blindness Cerebral palsy Dialysis Dementia, confusion, cognitive deficits • Traumatic brain injury • Parkinson’s • Socially inappropriate behaviors (sexual) • • • •

• Hallucinations, delirium • Elopements • Wandering into other tenants’ apartments • Aggressive behavior (verbal, physical, threatening, combative) • Inability to summon for assistance

04/06/2021

30% - 40% of Surveys

• Inability to follow directions • Inability to communicate needs • Behavior symptoms • Sensory limitations • Chronic pain • Suicidal threats • Frequent falls or bruising

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105

144A.44 Subd. 1(2) BOR—Acceptable Standards of Practice

30% - 40% of Surveys

The right to receive care and services according to a suitable and up-to-date plan, and subject to accepted healthcare, medical, or nursing standards, to take an active part in developing, modifying, and evaluating the plan and services. Actions in the following area were conducted outside of accepted standards of practice: • Infection control: Handwashing, glucometer cleaning, gloving, etc. • Side rails: Lack of assessment, documentation of education with client/family, compliance with FDA dimensional guidance, proper installation and maintenance • Alarms and restraints: Used inappropriately, no P/P, no assessments for use • Falls, bruises, and skin tears: Lack of evaluation, or reevaluation competed by a RN to assess for causative factor to determine individualized intervention to reduce future incidents (commonly documented in incident and communication books, but no followup done) • Oxygen: Who is responsible, proper storage, who refills and orders? 04/06/2021

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106

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2021 Housing Managers and Nurse Managers Virtual Education Series

144A.4794 Subd. 3 Contents of Client Record

30% - 40% of Surveys

The client record (chart or medical record) failed to include one or more of the 15 required elements. Example of missing information include: Description of pressure ulcers, including when discovered and action taken Documentation of wounds Target behaviors Incidents involving the client Significant changes in condition prior to hospitalization Significant changes in condition without hospitalization and actions taken in response • Discharge information, discharge summary, date of death

• • • • • •

04/06/2021

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107

144A.4794 Subd. 3 Contents of Client Record

30 – 40% of Surveys

The client record (chart or medical record) failed to include one or more of the 15 required elements. Example of missing information include: • Incidents, such as choking, elopement, and other situations of significance found in incident reports • Dressing, grooming, ambulation, toileting (per service plan) • Initiation of hospice services • Increased dementia or confusion • Client refusals of services

04/06/2021

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108

www.careproviders.org (952) 854-2844

2021 Housing Managers and Nurse Managers Virtual Education Series

144A.4792 Subd. 8 Documentation of Administration of Medications

30% - 40% of Surveys

• PRNs: • Given but not documented • Indications for use not documented • Effectiveness not documented • Medications given but not documented as given • Transcription errors • No reason documented for not giving med or follow-up to meet client needs • Oral and/or inhalant medications administered but not documented • Medications documented as given before they were administered • Documentation lacked required elements for medication documentation • Discrepancies between labels, MARs, and orders 04/06/2021

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109

Whew! 04/06/2021

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110

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What if I do not agree with my correction order? Request a reconsideration!

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Reconsiderations Your chance to “Get it Right!” • • • •

May challenge the correction order May challenge the level of the correction order May challenge the scope of the correction order May challenge the fine issued

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Reconsiderations • A written request for a reconsideration must be received by the commissioner (MDH) within 15 calendar days of the correction order receipt date • MDH shall respond in writing to the request from a home care provider for a correction order reconsideration within 60 days of the date the provider requests a reconsideration 04/06/2021

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Reconsiderations: MDH Options • Supported in full—no changes • Supported in substance, the correction order is supported, but one or more findings are deleted or modified without any change in the citation • Correction order is amended by changing the correction order to the appropriate statutory reference • Correction order is rescinded • Fine is amended • Level or scope of the citation is modified 04/06/2021

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Reconsideration Outcomes Outcomes from Reconsideration (FY2018)

Supported in full with no deletion of findings

40.5%

Supported in substance, correction order supported, one or more findings deleted or modified without any change in citation

38.1%

Order cited incorrect HC licensing requirement, order amended by changing to correct citation

2.4%

Fine is amended

1.2%

Correction order is rescinded

7.1%

Level or scope of citation is modified based on reconsideration

7.1%

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Almost 60% of the reconsiderations requested resulted in some change to the correction order. 7% resulted in the correction order being entirely deleted. 81 total correction orders were disputed.

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But Wait… There’s More! 04/06/2021

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Office of Health Facility Complaints 117

OHFC • OHFC does not conduct the initial or every-three-years surveys (or new two years) • Responds to complaints from clients, families, and the public. • Responds to self-reports of suspected neglect, abuse, or exploitation (theft) from providers (including home care) • Investigates both home care statutes and the Minnesota Vulnerable Adults Act (maltreatment—neglect, abuse, and exploitation) 04/06/2021

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OHFC • Unannounced investigations • Less communications due to the nature of the investigation • Will interview clients, family, and staff • VAA findings are unsubstantiated, inconclusive, or substantiated • May also include state correction orders 04/06/2021

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OHFC • Investigating violations of the MN Vulnerable Adults Act • Investigating state home care licensing violations • Investigating HWS requirements violations 04/06/2021

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OHFC • Violations of the MN Vulnerable Adults Act will be labeled as maltreatment and identified as neglect, abuse, or exploitation. • Findings of maltreatment can be substantiated against: • Individual(s) • Facility/provider • Both individual(s) and the facility/provider 04/06/2021

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OHFC: “Typical” Substantiated Findings in Assisted Living Neglect

• Failure to re-order medications • Failure to give medications as ordered • Elopements • Multiple falls, bruises, skin tears without intervention • Failure to address changes in condition • Failure to maintain oxygen services • Failure to provide care and services • Pressure ulcers • Failure to check on clients • Failure to supervise violent clients • Supervision of sexual activities

Abuse

• Staff that hit or slapped a home care client • Verbal abuse towards a home care client • Sexual abuse with a home care client

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Exploitation

• Theft of gift cards or credit cards • Theft of checks • Theft of cash • Theft of jewelry or other personal belongings • Theft of medications (usually controlled substances)

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OHFC and the Bill of Rights Issue • The Minnesota home care bill of rights provides the right for clients to be free from maltreatment, including neglect, abuse, or exploitation • This means that the home care provider will be cited for failing to ensure those rights when a “bad actor” engages in maltreatment of a home care client—even if the home care provider did nothing wrong (foreseeability) • One cannot use staff to be in regulatory compliance without having their negative actions also reflect on the home care provider

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MAARC • Mandated reporters under the MN Vulnerable Adults Act • Maltreatment: • Suspected neglect • Suspected abuse • Suspected exploitation/theft • Must report to MAARC within 24 hours— MARRC will generally forward to OHFC as the lead investigative agency 04/06/2021

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Random • CLIA

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Wrap Up • Survey process • Survey findings • Survey preparedness

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Survey Success

• • • • • • • • • • • • •

Know the statutes—knowledge is power First impressions, how would you respond? Train staff on what to say (and not say) during a survey Observations should not scare staff—practice! Audit, Audit, Audit Learn from the mistakes of others Be polite, surveyors are people too Ask clarifying questions—find the correct answers Provide additional information and guidance to surveyors Limit computer access to what is needed Have survey material ready—and have a backup person! Use the MDH forms when possible Use the reconsideration process 04/06/2021

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Use MDH Forms When Possible

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Look at Surveys

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Look at Surveys

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Questions? 04/06/2021

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Doug Beardsley Vice President of Member Services dbeardsley@careproviders.org 952-851-2489

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ELECTRONIC MONITORING Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.

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Electronic Monitoring: Handouts • • • • •

Electronic Monitoring 144.6502 (the law) Electronic Monitoring Sample Facility One-Pager Electronic Monitoring Sample Facility Policy Electronic Monitoring F&Qs Electronic Monitoring Consent Forms:

• • • •

Resident Resident’s Representative Roommate Roommate’s Representative

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Electronic Monitoring

• • • •

Background Timelines Requirements Q&As

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Electronic Monitoring: Background • 2016: Legislative mandated workgroup • •

Report required by January 15, 2017 Report gave numerous recommendations, but no proposed legislation

• 2018: Some individual legislation brought forward, nothing passed • 2018: Governor-appointed group brings forward expansive elderreform bill, including electronic monitoring •

Bill is vetoed along with most bills by the governor

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Electronic Monitoring: Background • 2018: New commissioner of health, Jan Malcolm, assembles workgroups regarding various elder protection issues, including electronic monitoring • An electronic monitoring workgroup is convened by the Minnesota Elder Justice Center • •

The workgroup develops consensus electronic monitoring language Previous workgroup recommendations, previous legislative language, and best practices from other state electronic monitoring laws were all evaluated

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Electronic Monitoring: Background • The consensus language was included in the 2019 Elder Care and Vulnerable Adult Protection Act • The bill passed in the 2019 legislative session • The bill was signed into law by the governor

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Electronic Monitoring: Timelines

• Effective January 1, 2020 • Does not wait for assisted living licensure

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Electronic Monitoring • What types of facilities does the law apply to? • Licensed nursing facilities • Licensed boarding care homes • Registered housing with services establishments that use the term “assisted living” (144G) or have disclosed a “special unit” on their registration • Effective August 1, 2021, all licensed assisted living facilities

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Electronic Monitoring • What is electronic monitoring?

• The placement and use of an electronic monitoring device by a resident (or resident representative) in the resident's room or private living unit in accordance with…the electronic monitoring law.

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Electronic Monitoring • What is an electronic monitoring device?

• “A camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident's room or private living unit and is used to monitor the resident or activities in the room or private living unit.”

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Electronic Monitoring • What is an electronic monitoring device? • Can be hidden or out in the open—the law makes no distinctions

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Electronic Monitoring • What is NOT considered an electronic monitoring device? • Facility-installed cameras in public areas of the building (lobby, entrances, corridors, dining rooms, etc.) or in areas intended for use only by staff (medication storage rooms) • Devices used to communicate with residents that are not intended to monitor the resident or activities in their room or private living unit (facetime, zoom, skype) 04/06/2021

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Electronic Monitoring

• What is and is not an electronic monitoring device is a moving target • New technologies will bring new questions • Intended use should remain consistent (“used to monitor”)

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Electronic Monitoring • Why would a resident or family member want to install an electronic monitoring device? • • • • •

Monitor resident activities, including falls or repositioning Peace of mind regarding care and services Document and verify care and services are being provided as promised Deter suspected or potential maltreatment Document situations of maltreatment (neglect, abuse, or thefts (exploitation))

• Most electronic monitoring devices have been installed when the family did not believe their concerns had been heard or adequately addressed by the facility’s administration 04/06/2021

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Electronic Monitoring • Resident protections • Facility cannot ban the use of electronic monitoring (check your policies) • Facility cannot refuse to admit or initiate the discharge of a resident regarding electronic monitoring • Facility cannot prevent installation or the use of electronic monitoring utilized consistent with the law • Facility cannot retaliate against a resident or family member for reasons surrounding electronic monitoring 04/06/2021

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Electronic Monitoring: The MN Law • Key elements: • Consent • Conditions on use of monitoring • Notification required •

• • • • •

Required Form

Notification options

Roommates/shared living space requirements Cost and installation Use of facility Wi-Fi Protections/use of recorded material Use in employee discipline

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Electronic Monitoring: Consent • Consent • Key to the law is the concept that a resident must consent to the use of electronic monitoring • If the resident is unable to provide consent due to cognitive issues, a substitute decision maker (resident representative) may be used…in this order: • • •

Court-appointed guardian Identified health care agent (145C.01 Subd.2) Other identified resident representative

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Electronic Monitoring: Consent • A resident representative is: • a person who is not an agent of a facility or of a home care provider; • designated in writing by the resident; and • whose name is maintained in the resident's records on file with the facility. 04/06/2021

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Electronic Monitoring: Consent •

Consent must be executed in writing

•

Consent must be provided on a designated form

•

MDH developed the forms, working with the Office of Ombudsman for Long Term Care (OOLTC). Many versions were reviewed

•

MDH published the forms on December 24, 2019 and revised them on 1/20/20. They are available via MDH Bulletin 19-06: https://www.health.state.mn.us/facilities/regulation/infobulletins/ib19_6.html.

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Electronic Monitoring: Consent

• MDH decided it was best to create FOUR versions of consent forms

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Electronic Monitoring: Consent The four options are: • Resident Consent Form: used when a resident is consenting for herself or himself • Resident Representative Consent Form: used when a resident has a representative complete the consent process according to statute • Roommate Consent Form: used when the resident shares a room or living unit with another person and the roommate is consenting for herself or himself • Roommate Representative Consent Form: used when the roommate has a representative complete the consent process according to statute

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Electronic Monitoring: Consent • If a resident representative is used for consent: • The resident must be offered the opportunity to affirmatively object to the electronic monitoring • The resident representative must explain a series of issues to the resident, including the type of electronic monitoring to be used, any conditions or limits the resident may desire, with whom the recordings may be shared, and the resident’s right to decline all recordings 04/06/2021

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Electronic Monitoring: Consent • The approved consent forms have many required elements: 1. Date 2. Who was present 3. Acknowledgement the resident did not affirmatively object 4. Source of resident representative’s authority 5. Roommate consent, if applicable 6. Type of electronic monitoring to be utilized

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Electronic Monitoring: Consent 7. A list of possible conditions or exceptions for consideration regarding the use of the electronic monitoring device: • • • •

Prohibited audio recording Prohibited video recording Prohibited broadcasting of audio or video When to turn off or block the recording device (e.g., exams, procedures, dressing, bathing, visits by clergy, ombudsman, attorney, intimate partner, financial planner, visitor, etc.)

8. Signature box 04/06/2021

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Electronic Monitoring: Consent • Consent may be withdrawn at any time • Withdrawal of consent must be documented in the original consent and notification form

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Electronic Monitoring: Notification • The signed consent, on the approved form, must be provided to the licensed facility prior to implementing electronic monitoring • However, there is an exception to the requirement to provide the notice to the licensed facility in advance of the electronic monitoring…

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Electronic Monitoring: Notification • Exception to notice to facility… • If the resident or resident representative: 1. reasonably fears retaliation against the resident, or 2. submits a written concern to the facility regarding a concern prompting desire for placement of electronic monitoring, and does not receive a timely response, or 3. has already submitted a MAARC report, OHFC complaint, or police report regarding the resident’s concern prompting desire for placement of electronic monitoring. 04/06/2021

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Electronic Monitoring: Notification • Then the resident or resident representative may, instead of providing the advance notice to the facility, provide the signed consent and notice form to the Office of Ombudsman for Long-Term Care (OOLTC). • This notice to the OOLTC is only valid for a period of 14 days • On the 15th day, the 14-day exception notice expires, and notification must be provided to the facility 04/06/2021

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Electronic Monitoring: Notification • Office of Ombudsman for Long-Term Care has hired one FTE to oversee this new responsibility.

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Electronic Monitoring: Notification • Exception to notice to facility… • During this 14-day period, the resident or resident representative has some additional responsibilities, such as timely contacting MAARC and law enforcement if the electronic device indicates evidence of suspected maltreatment • In other words, if they see suspected maltreatment, they must report it immediately

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Electronic Monitoring: Notification • Exception to notice to facility… • During this 14-day period, if a facility discovers an electronic monitoring device, and the facility has not been provided a signed consent and notice form, the facility should contact the OOLTC to confirm that the OOLTC was provided a signed consent and notice form

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Electronic Monitoring: Notification • Exception to notice to facility… • If neither the facility nor OOLTC have received a properly executed consent and notice form, the facility should contact the resident or resident’s representative to notify him/her that the electronic monitoring device is being used outside of the MN electronic monitoring law, and then request the resident or resident’s representative to disable or remove the device to protect the privacy rights of the resident until proper consent is received—Do not take the device away…it is not your property! 04/06/2021

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Electronic Monitoring: Roommates • All the same requirements apply to the roommate of a resident where electronic monitoring is intended to be implemented • If a roommate does not provide consent, then the electronic monitoring cannot proceed • If a roommate provides consent, and then later withdraws the consent, the electronic monitoring must cease. 04/06/2021

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Electronic Monitoring: Roommates • If a roommate does not consent, the facility must make reasonable attempts to accommodate the resident who desires electronic monitoring • Reasonable accommodations include, but are not limited to: • Offer to move to another room • Offer a private room (at resident’s expense) • Attempt to find alternative room every two weeks • Facility is not obligated to move roommate or provide free private room 04/06/2021

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Electronic Monitoring: Roommates • If a resident conducting authorized electronic monitoring gets a new roommate, the electronic monitoring must be removed by the resident or resident representative prior to the move-in of the roommate • Once the new roommate provides consent and notice, electronic monitoring may once again be placed in the room • If the new roommate does not provide consent and notice, the facility shall initiate reasonable accommodations for the resident 04/06/2021

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Electronic Monitoring: Devices • The cost of an electronic monitoring device is the responsibility of the resident or resident representative • The installation and maintenance is also at the expense of the resident or resident representative • Costs pertaining to the removal of the electronic monitoring devices is the responsibility of the resident or resident representative 04/06/2021

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Electronic Monitoring: Devices • If a facility provides free guest Wi-Fi, it must also make that Wi-Fi available for electronic monitoring. You cannot provide Wi-Fi for some resident purposes (e.g., streaming Netflix on an iPad), but deny access to it for electronic monitoring. Do not create roadblocks! • If a facility does not provide Wi-Fi to residents, the resident or resident representative will be responsible to contract and pay for such service (internet or Wi-Fi) for the electronic monitoring device (note: balance this decision with customer service and client/family expectations regarding services available) 04/06/2021

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Electronic Monitoring: Devices • Facilities should review their Wi-Fi policies • Best practice would be to have your secured business Wi-Fi separate from any guest Wi-Fi • What is the bandwidth capabilities of your guest Wi-Fi? • •

This may be limited in some areas of the state Cost of increasing bandwidth?

• Decide if guest Wi-Fi will be secured or not—if not secured, notify guest users of that fact 04/06/2021

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Electronic Monitoring: Devices • Electronic monitoring devices must be UL listed

• Extension cords and/or multi-tap surge suppressor strips must not be used in nursing facilities – per the NFPA Life Safety Code

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Electronic Monitoring: Signage • No signs are required outside or inside resident rooms where electronic monitoring is in use (this is a requirement in some states) • Signage requirement went into effect 1-1-20 • All facilities covered by this law (nursing facilities, boarding care homes, HWS/AL settings) must post signs at each facility entrance that is accessible to visitors that states: 04/06/2021

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Electronic Monitoring: Signage Electronic monitoring devices, including security cameras and audio devices, may be present to record persons and activities. 04/06/2021

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Electronic Monitoring: Signage • Type of sign, size of sign, font size, font type, font color, etc. are not delineated in the law • The facility is responsible for installing and maintaining the required signage • The signs give advance notice to staff and visitors that electronic monitoring may be present in the building

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Electronic Monitoring: Staff & Facility Responsibilities • If a resident or family member asks staff about electronic monitoring options or opportunities, who should staff refer them to within the facility? • If a consent form indicates any restrictions regarding when the electronic monitoring should be turned off or blocked, will you communicate those conditions to staff? Is the facility, or your staff, required to carry-out any identified conditions? Consider policy implications as well as customer service and person directed care implications. Untested waters! 04/06/2021

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Electronic Monitoring: Staff & Facility Responsibilities • Who, within the facility, should staff go to if they discover an electronic monitoring device has been installed in a resident’s living space? • Who in the facility will receive signed consent forms, and who will be responsible to contact the OOLTC to confirm a consent form was received by the OOTC when an electronic monitoring device is discovered when consent has not been provided to the facility?

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Electronic Monitoring: Staff & Facility Responsibilities • How will you make the authorized consent and notification forms available? The law requires you make them available. • How will you address or introduce electronic monitoring in your resident handbook or similar communications with residents and family members? The law requires facilities to inform residents of their option to conduct electronic monitoring. •

Assume residents and family member are unaware of the law

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Electronic Monitoring: Staff & Facility Responsibilities • Recommend staff training: • Always act in a manner where they assume they are being monitored by audio and video • • •

Verify staff understand they are prohibited from retaliating against a resident or others as a result of electronic monitoring having been initiated If staff will be accommodating restrictions, how will they know what restrictions are in place? Verify staff know that they are prohibited from tampering or destroying an electronic monitoring device

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Electronic Monitoring: Staff & Facility Responsibilities • Recommend staff training: • Verify staff know who at the facility they should contact regarding electronic monitoring questions • •

Verify staff know who at the facility they should refer a resident or family member to regarding electronic monitoring questions Review customer service expectations and your concern and grievance procedures with staff—remember that most electronic monitoring has occurred when family did not feel their concerns were listened to or adequately addressed

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Electronic Monitoring: Other • If a staff member is disciplined (or has proposed discipline) as a result of activity recorded via electronic monitoring: • the accused staff member must be given access to such evidence; • the accused staff member who obtains the recording or copy must not further disseminate it to any other person except as required by law; and • any copy of the recording must be returned to the facility or person who provided the copy when it is no longer needed for purposes of defending against a proposed disciplinary action. 04/06/2021

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Electronic Monitoring: Other • No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or the resident representative • Recordings may only be disseminated for the purposes of addressing health, safety, or welfare concerns of one or more residents

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Electronic Monitoring: Other • Admissibility of evidence: • Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring may be admitted into evidence in a civil, criminal, or administrative hearing

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Electronic Monitoring: Wrap-Up • • • • • • •

Understand the law Verify signage has been installed at public entrances Designate who at the facility will be responsible for this topic Train staff on the law, including responsibilities and expectations Enhance your customer service program Enhance your response and action to concerns and complaints Verify your policies and procedures: • •

Do not prohibit electronic monitoring Prohibit retaliation resulting from the use of electronic monitoring

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Electronic Monitoring: Wrap-Up • Determine what your action steps are when you receive a consent form: •

Has the resident or resident representative expressed concerns regarding staff or care? Have those concerns been addressed?

•

• • •

Many previous examples of electronic monitoring have occurred due to a consumer belief the facility had failed to address concerns

How will you verify the electronic monitoring device is UL-approved and installed in a safe manner? How can you assist with the process (not create roadblocks to the use of the electronic monitoring device)? Are their restrictions/conditions on when the electronic monitoring is not to be used—if so, what is your plan – to assist or not to assist?

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www.careproviders.org (952) 854-2844

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Electronic Monitoring: Wrap-Up • Develop a procedure outlining who will verify that proper consent has been received by the facility when an electronic monitoring device is discovered, and if no consent and notification has been received by the facility… • Determine who will contact the OOLTC to verify that the OOLTC has a consent and notification on file—the date of such notification to the OOLTC should be documented, with the expectation that a copy of the consent and notification will be received by the facility within 14 days after the consent and notification was provided to the OOLTC 04/06/2021

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Electronic Monitoring: Wrap-Up • Determine how you will communicate this option with residents/resident representatives: • Admission packet information? • Resident handbook? • Flyer or notice? • Resident or family council meetings? • Determine how you will make available the approved consent forms 04/06/2021

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Electronic Monitoring: Wrap-Up • Unknowns: • Facility Wi-Fi bandwidth • Clergy, attorney, ombudsman, surveyor recordings? • Changing technology—will the law be applicable? • Staff responsibilities regarding client/representative limits or conditions on what is to be recorded— resident representative reactions (appearance the facility is refusing to cooperate) and potential for errors made by staff (forgetting to turn on or off).

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Electronic Monitoring: Wrap-Up • Unknowns: • How often will the 14-day notice to the OOLTC will be used vs. direct notification to the facility? • Staff reaction to the use of electronic monitoring • Family disagreements regarding the use of electronic monitoring • Issues surrounding the residents’ ability to provide consent • Frequency of use—will the law increase or decrease use? • Consequences to consumers for not following the law?

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Electronic Monitoring: Wrap-Up Remember that this is a relatively new law in Minnesota. We have the ability to “fine-tune” the law in the future if there are unintended negative consequences or the law is unworkable.

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Questions?

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Client Observation and Record Review: Comprehensive TEMPORARY LICENSED AND LICENSED HOME CARE PROVIDERS

Purpose

Minnesota Department of Health (MDH) surveyors use this form to document evidence of: • • • • •

Observations of client care and services; Medication management services; Treatment and therapy services; Nursing assessments; and Client and/or family interviews

Providers may use this document to self-audit. Statute references (with links to the Revisor’s website) occur throughout (e.g., 144A.4792, Subd. 1). Click on the link and scroll to the noted subdivision for information about the specific requirement(s). If you are working from a printed document all links can be found at: Home Care Statutes (https://www.health.state.mn.us/facilities/regulation/homecare/laws/index.html)

Provider Information Provider name: _______________________________________________ HFID: __________________ Date/Time of survey: __________________________________________________________________

Client Information Name: ___________________________________________ Identifier: _________________________ Diagnoses: ___________________________________________________________________________ Start of care: _______________________ Current service plan date: ____________________________

Surveyor Surveyor name(s): ____________________________________________________________________

Discharged Client Record Review ☐ ☐

Discharge summary [144A. 4794, Subd. 3 (14)] Disposition of medications [144A. 4792, Subd. 22 (c)]

Client Daily Life Review Caregiver observed: __________________________________________________ (name and identifier) Position/title: ________________________________________________________________________

HCALP-F5022C 07/09/2019

CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE

Throughout the survey, surveyors observe staff as they provide services to clients. Surveyors interview staff and clients to evaluate and validate surveyor observations and findings. Areas reviewed include but are not limited to: ☐

☐

☐ ☐ ☐

☐ ☐

Staff knowledge and implementation of the client’s service plan. Client’s individualized vulnerable adult or minor abuse prevention plan. Client was free from physical and verbal abuse. Client care needs including but not limited to durable medical equipment, tube feedings, pressure ulcers, blood glucose checks, insulin, oxygen, dialysis, hospice care and falls. Care and services were provided in accordance with accepted medical and nursing standards. Current standards of practice for infection control were followed, including but not limited to appropriate hand hygiene, handling and transporting linen to prevent spread of infection and the use of protective gloves when appropriate. Client was treated with courtesy, respect, and client’s rights were not violated. Staff listened and were responsive to client requests. (Note staff interaction with both communicative and non-communicative clients.) Medication administration and/or assistance with self-administration of medications.

☐

Client’s bathing, dressing, grooming and toileting needs were met.

☐

Other observations/interviews as deemed necessary (e.g., behaviors, cognition, mobility, demeanor, environment, etc.).

☐

Client was free from physical and/or chemical restraints.

Client Record Review Surveyors review client records to determine if documentation standards were met related to evaluation and assessments and the services the client received. ☐

Individual abuse prevention plan (IAPP) was current and included: ☐ An individualized assessment of client’s susceptibility to abuse by other individuals; ☐ Assessment of the client’s risk of abusing other vulnerable adults or minors; and ☐ Statements of the specific measures to be taken to minimize the risk of abuse to the client and other vulnerable adults or minors and risk of self-abuse. Date of most current IAPP: _________________ [144A.479, Subd. 6 (b)]

☐

Client assessments by a registered nurse (RN) or other licensed health professional (LHP) were completed as required. [144A.4791, Subd. 8 (a)(b)(c)] ☐ Initial assessment within 5 days of starting services. Date: _________________ ☐ Reassessment within 14 days of starting services. Date: ___________________ ☐ Ongoing client monitoring at least every 90 days. Dates: __________ , _________ , ________ or with a change in client’s condition. Date(s): ____________ , _____________

☐

Service plan was completed within 14 days of start of services and revised as needed. Date(s): _______________, ______________ [144A.4791, Subd. 9 (a) (b) (c) (d) (e) (f)]

☐ ☐

Service plan had all required content [144A.4791, Subd. 9 (f)] All services were provided and documented (ADLs, IADLs, medications and treatments) as noted in the client’s service plan. [144A.4791, Subd. 9 (c) and 144A.4794, Subd. 3] HCALP-F5022C 07/09/2019

CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE

☐

Client-specific written instructions were present for delegated nursing procedures. [144A.4792, Subd. 7; and 144A.4793, Subd. 4] Date: _________________

☐

Documentation of client’s receipt (date and signature) and review of: ☐ Minnesota home care bill of rights ________________ [144A.4791, Subd. 1] ☐ Statement of home care services _________________ [144A.4791, Subd. 3]

☐

Written complaint notice ______________

[144A.4791, Subd. 11 (a) (b) (c)]

☐

Documentation of complaints received, if applicable, and resolution.

☐

Entries in the client’s record were current, authenticated and legible. [144A.4794 Subd. 1 (a)]

☐

Client records were kept confidential and secure. [144A.4794 Subd. 1 (b)] Significant changes or incident(s) and the actions taken in response were documented, (e.g. client falls, post-hospital, ER visits, any client deterioration) [144A.4791, Subd. 8 (c)]

Medication Management Services [144A.4792, Subd. 1-23] Surveyors review client’s record for compliance related to medication administration including all prescribed, non-prescribed, over-the-counter and dietary supplements taken by the client. ☐

RN developed and implemented an individual medication management plan prior to provision of services. [144A.4792, Subd. 2-7] Initial individual medication management plan date: _________________

☐

Individualized medication monitoring occurred when client had symptoms/issues related to medication.

☐

Reassessment occurred when the client presented with symptoms/issues that were medication related.

☐

Medication plan was current and the service plan was updated (if needed).

☐

☐ ☐ ☐

Annual reassessment occurred. Date: ________________ Individual medication management plan included descriptions of: ☐ Medication management services provided by nurse and unlicensed personnel (ULP) (included PRN). ☐ Type of medication storage system, based on client needs. ☐ Specific written instructions for client’s medication administration. ☐ Person responsible for monitoring medication supplies and refills. ☐ Medication management tasks that may be delegated to ULPs. ☐ Procedures for staff to notify an RN when problems arose. ☐ Any client-specific requirements (e.g., parameters: blood sugar, blood pressure, pulse, etc.) Medication administration records were complete; medications were administered as ordered and documented correctly, or if not administered reasons were documented. (Record includes reasons to use PRN medications and their effectiveness.) [144A.4792, Subd. 8] Medication set-up and administration were documented. [144A.4792, Subd. 9] Documentation of medication administration was completed for client who was away from home. [144A.4792, Subd. 10 (a) (b)] HCALP-F5022C 07/09/2019

CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE

☐

Prescriber’s orders were written and dated for medications administered and orders were complete. [144A.4792, Subd. 13]

☐

Medication orders were renewed at least every twelve months. [144A.4792, Subd. 14]

☐

Verbal orders were received only by a nurse or pharmacist, were entered into the client record and forwarded for signature by licensed prescriber. [144A.4792, Subd. 15]

☐

Electronically transmitted orders were recorded, communicated to the RN and placed in client record. [144A.4792, Subd. 16]

Treatment and Therapy Management Services [144A.4793, Subd. 1-6] Client’s record (including the service plan and treatment administration records) was reviewed for all prescribed treatments and therapies administered by the provider’s employee(s). Examples of treatments and therapies include but are not limited to using oxygen or a breathing apparatus or pulse oximetry, doing blood glucose checks or tube feedings, applying TED hose or splints, providing physical/occupational/speech-language therapy exercises, or wound care. Surveyors will also review maintenance procedures for equipment used in treatments and therapies.

Individual treatment and therapy management plan

☐ Service plan was current and updated with any changes. Date: _____________ [144A.4793, Subd. 3] ☐ RN or appropriate LHP developed a treatment and/or therapy plan (before services were provided). Date: __________________ [144A.4793, Subd. 3] Plan included the following items: ☐ ☐ ☐ ☐

Written statement of treatments and therapies to provide. [144A.4793, Subd. 3 (1)] Written instructions for each treatment or therapy. [144A.4793, Subd. 3 (2)] A list of the treatment or therapy tasks delegated to ULPs. [144A.4793, Subd. 3 (3)] Procedures to notify an RN or other LHP professional when problems arose with treatments or therapies. [144A.4793, Subd. 3 (4)] ☐ Client-specific instructions related to documentation of all treatments and/or therapies administered, or reason not administered, verified as administered and monitored to prevent complications or adverse reactions. [144A.4793, Subd. 3 (5)] ☐ Documentation of treatments and therapies was completed as required. [144A.4793, Subd. 5]

☐ Prescriber’s orders were written, complete and dated for treatments or therapies administered. [144A.4793, Subd. 6] Home Care and Assisted Living Program Health Regulation Division P.O. Box 3879 St. Paul, MN 55101-3879 Phone 651-201-5273 | Fax 651-215-9697 Home Care and Assisted Living (https://www.health.state.mn.us/facilities/regulation/homecare/index.html) To obtain this information in a different format, call 651-201-5273.

HCALP-F5022C 07/09/2019

Comprehensive Home Care Survey Self-Audit Tool

Topic: Employee Records Audited by:_____________________________ Date of Audit:___________________________ Task: Locate the following items: 1. Make five copies of this blank form 2. Retrieve five random employee records 3. Retrieve policies and procedures regarding employee records Review the items for compliance with the following requirements:

Requirement The home care provider maintains employee records and volunteer records. The employee record includes documentation of appropriate current professional licensure, registration, or certifications on file. The employee record includes documentation indicating: 1. Orientation (including all required topics) 2. Eight hours of annual training 3. Included in the eight hours of annual training is training in the areas of: a. Infection control b. Maltreatment of vulnerable adults c. Home care policies and procedures d. Home care bill of rights 4. Initial and annual dementia training (based upon position and duties)(may be included in the eight hours of annual training) 5. Competency evaluations are completed and signed by a RN (or therapist where appropriate) The employee record includes documentation of a current signed job description which includes: 1. Required qualifications 2. Job responsibilities 3. Identification of staff providing supervision The employee record includes documentation of annual performance reviews – including identification of areas where improvement or additional training is needed.

Met

Not N/A Met

The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Employee Records Audit Tool Page 1 of 2

Requirement

Met

The employee record includes documentation of TB screening and dates. of screening. The employee record includes documentation of completed DHS background study.

Not N/A Met

If any applicable requirements are identified as “Not Met”, correct the situation, audit other employee records, forms, policies and procedures, and other sources of information to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hints: • •

See other audit tool forms for additional resources This audit tool only covers and pertains to what is required by the Comprehensive Home Care regulation. This audit tool does not cover and include any other requirements regarding employment including applications, I9’s, W4’s, employee handbooks, other company employment policies, etc.

References: MN144A.479 Subd. 7, MN144A.4796 Subd. 3, MN144A.4796 Subd. 7

Comprehensive Home Care Survey Self-Audit Tool

Topic: Staff Orientation Audited by:_____________________________ Date of Audit:___________________________ Tasks: 1. Make five copies of this blank form 2. Retrieve five random employee personnel files 3. Locate a copy of the new employee orientation checklist Review the items for compliance with the following requirements:

Requirement Personnel files indicate that staff providing and supervising direct home care services successfully completed an orientation to comprehensive home care licensing requirements and regulations prior to providing home care services to clients. Such training is NOT transferable from another home care provider – it must be by your home care agency. The orientation documentation indicates that each of following topics was covered during orientation: An overview of Comprehensive Home Care Statutes (MN 144A.43 to 144A.4798). An introduction and review of all the provider's policies and procedures related to the provision of home care services. The handling of emergencies and use of emergency services. Training regarding the Minnesota Vulnerable Adults Act (reporting suspected maltreatment of vulnerable adults), including: 1. Status of home care staff as mandated reporters 2. Training regarding what constitutes suspected maltreatment, abuse, neglect, financial exploitation, unexplained physical injuries, accidents, and errors in the provision of therapeutic conduct. 3. Reporting internally 4. Immediate (not to exceed 24 hours) reporting to the Minnesota Adult Abuse Reporting Center (MAARC) A review of the Home Care Bill of Rights. Handling of clients' complaints, reporting of complaints, and where to report complaints including information on the Office of Health Facility Complaints and the Minnesota Adult Abuse Reporting Center (MAARC).

Met

Not N/A Met

The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2015 Care Providers of Minnesota Staff Orientation Audit Tool Page 1 of 2

Requirement

Met

Not N/A Met

Consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county managed care advocates, or other relevant advocacy services. A review of the types of home care services the employee will be providing and the provider's scope of licensure (hint – use the Home Care Disclosure Form used with clients – sample on MDH website). All direct care staff and supervisors working with those clients must receive training that includes a current explanation of Alzheimer's disease and related disorders, effective approaches to use to problem-solve when working with a client's challenging behaviors, and how to communicate with clients who have Alzheimer's or related disorders. If any applicable requirements are identified as “Not Met”, correct the situation, audit other personnel records to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hint: An orientation checklist that includes all the items noted above, in addition to any unique orientation topics you provide, signed and dated by the new employee and instructor(s) is one way to make sure all required topics are covered and documented. Reference: Comprehensive Home Care Statutes

Comprehensive Home Care Survey Self-Audit Tool

Topic: Service Plans Audited by:_____________________________ Date of Audit:___________________________ Task: 1. Make five blank copies of this form 2. Retrieve five random service plans from your current client caseload Audit for compliance in the following areas.

Requirement Service plans are finalized within 14 days after the initiation of client services. Service plans and any revisions are signed by both the home care provider and by the client or client's representative. The service plans include information about how to contact the Office of Ombudsman for Long-Term Care. The service plan includes a description of the home care services provided to the client. The service plan includes the fees for home care services provided to the client. The service plan includes the frequency of each home care service provided to the client. The service plan includes the identification of the type or categories of staff for each home care provided to the client. The service plan includes the schedule and methods of ongoing monitoring and reassessments. The service plan includes the frequency of supervision of staff and who will be supervising staff. The service plan includes a description of any medication management services (if any) that are being provided to the client. The service plan includes a description of any prescribed treatments or therapies (if any) that are being provided to the client. The service plan includes a contingency plan that identifies the actions to be taken by the home care provider if scheduled home care services cannot be provided.

Met

Not N/A Met

Requirement

Met

The service plan includes a contingency plan that identifies the actions to be taken by the client or client's representative if scheduled home care services cannot be provided. The service plan includes a contingency plan that includes information and methods for a home care client or client's representative to contact the home care provider. The service plan includes a contingency plan that includes names and contact information of persons the client wishes to have notified in an emergency or if there is a significant change in the client's condition. The service plan includes a contingency plan that includes identification and contact information of who has authority to sign for the client in an emergency. The service plan includes a contingency plan that includes identification of the circumstances in which emergency medical services are not to be summoned for the client, based on a client's completed advance directives, living will, and/or POLST forms. The service plan has been revised, based on client needs as identified in ongoing monitoring or reassessment visits. Services identified in the service plan are provided to the client as described in the service plan. No home care services are being provided to the client that are not listed on the current service plan. The service plan and the most recent revised service plan are included in the client record. Staff providing home care services to a client are informed of the current service plan for that client. Documentation indicates that the home care client was told in advance of any recommended changes by the provider to the service plan and the client was provided the opportunity to take an active part in any decisions about changes to the service plan.

Not N/A Met

If any applicable requirements are identified as “Not Met”, correct the situation, audit other service plans to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. References: 144A.44 Subd. 1 (04), 144A.4791 Subd. 9 (a)-(f), 144A.4792 Subd. 5 (a), 144A.4793 Subd. 3

Tuberculosis Prevention and Control: Surveyor Checklist TEMPORARY LICENSED AND LICENSED HOME CARE PROVIDERS

Provider and Survey Information Provider name: __________________________________ HFID: __________________________________ Date/Time of survey: ___________________________ Surveyor: __________________________________

Resource for all items on checklist “Regulations for Tuberculosis Control in Minnesota Health Care Settings: A Guide for Implementing Tuberculosis (TB) Infection Control Regulations in Your Facility” (Relevant pages are noted below.) Regulations for Tuberculosis Control in Minnesota Health Care Settings (https://www.health.state.mn.us/diseases/tb/rules/tbregsmanual.pdf)

Verify the following items ☐ Provider had designated and documented a qualified person or team with primary responsibility for the TB infection control program. (Page 5) ☐ Provider had a current written TB risk assessment, reviewed and updated periodically. (Pages 5-6) Date of most recent risk assessment ____________________ ☐ Provider had a written infection control plan that included: • •

Procedures for handling persons with active TB disease; and Documentation of initial and ongoing TB-related training and education for all health care workers. (Pages 6-7)

Date of most recent review of plan ___________________ ☐ Results of baseline TB screening of all paid and unpaid health care workers were documented. All reports or copies of tuberculin skin tests (two-step TSTs), IGRAs/TB blood tests for M. tuberculosis, medical evaluation (if appropriate), TB history and symptom screen, and chest radiograph results were maintained in the health care worker’s employee file. (Pages 10-14) ☐ Baseline screening included two-step skin testing (unless the TB blood test was used). (Pages 10-11) ☐ If the setting was classified as “medium risk” or higher, results of serial TB screening of all paid and unpaid health care workers were documented. All reports or copies of tuberculin skin tests (TSTs), IGRAs/TB blood tests for M. tuberculosis, medical evaluation, TB symptom screen, and chest radiograph results were maintained in the health care worker’s employee file. (Page 11) Home Care and Assisted Living Program Health Regulation Division P.O. Box 3879 St. Paul, MN 55101 Phone 651-201-5273 | Fax 651-215-9697

https://www.health.state.mn.us/facilities/regulation/homecare/index.html To obtain this information in a different format, call: 651-201-5273. HCALP-F5051 04/30/2019

Regulations for Tuberculosis Control in Minnesota Health Care Settings A guide for implementing tuberculosis (TB) infection control regulations in your facility

Tuberculosis Prevention and Control Program PO Box 64975 St. Paul, MN 55164-0975 Phone: 651-201-5414 or 1-877-676-5414 www.health.state.mn.us/tb

July 2013

Table of Contents Introduction ..................................................................................................................... 1 Chapter 1. Background .................................................................................................. 3 Determining which regulations to follow ..........................................................................................................3

Chapter 2. TB Infection Control Program ................................................................... 5 TB infection control team..................................................................................................................................5 Facility TB risk assessment ..............................................................................................................................5 Written TB infection control procedures ...........................................................................................................6 HCW education .................................................................................................................................................7

Chapter 3. Screening Health Care Workers (HCWs).................................................. 9 Definition of a HCW .........................................................................................................................................9 General principles............................................................................................................................................10 Baseline TB screening .....................................................................................................................................10 Serial TB screening .........................................................................................................................................11 Special situations HCW with signs or symptoms of active TB disease.................................................................................11 HCW with a newly-identified positive TST or IGRA...............................................................................12 HCW with written documentation of a previous positive TST or IGRA..................................................13 HCW with verbal (undocumented) history of a previous positive TST or IGRA ....................................13 Pregnant HCW ..........................................................................................................................................13 Conversions ..............................................................................................................................................13 HCW with TST results between 5 and 9 mm of induration......................................................................14 Students .....................................................................................................................................................14 Volunteers .................................................................................................................................................14 HCW with previous history of severe adverse reaction to TST ...............................................................14 HCW refusal .............................................................................................................................................14 HCW who travels outside of the United States ........................................................................................15 Baseline TB Screening Tool for HCWs ..........................................................................................................16 Serial TB Screening Tool for HCWs ...............................................................................................................18 Exemption Form for Tuberculin Skin Testing of a Pregnant HCW ................................................................20 Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm .........21

Chapter 4. Screening Residents ................................................................................... 23 General principles............................................................................................................................................23 Baseline TB screening of residents in boarding care homes and nursing homes............................................23 Baseline TB screening of residents in residential hospices .............................................................................24 Special situations Resident with newly identified positive TST or IGRA .............................................................................24 Resident with written documentation of previous positive TST or IGRA................................................24 Resident with verbal (undocumented) history of previous positive TST or IGRA .................................25 Residents with signs or symptoms of active TB disease ..........................................................................25 Residents with previous history of severe adverse reaction to TST .........................................................26 Resident refusal.........................................................................................................................................26 Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents ...................................27 Baseline TB Screening Tool for Residents in Residential Hospice.................................................................29

Glossary ......................................................................................................................... 31

Introduction The purpose of this manual is to assist health care facilities in Minnesota to understand what is needed to be in compliance with Minnesota laws revised in 2013 regarding TB prevention and control, and to provide tools for implementing legal regulations and best practices in their settings. Minnesota laws governing tuberculosis (TB) prevention and control regulations in health care settings (including TB screening of health care workers and residents) have historically consisted of a variety of separate rules written for specific settings at various times. Many of them were based on national recommendations published in the 1990s or earlier. In 2005, the U.S. Centers for Disease Control and Prevention (CDC) published revised guidelines* (www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm). Since that time, the Minnesota Department of Health (MDH) has recognized that legal regulations and best practices for TB infection control in Minnesota needed to be revised to meet these guidelines and to incorporate current knowledge and technology. The “TB waivers,” issued by MDH on March 9, 2009, were an interim step in this process to address the outdated TB laws for boarding care homes, home care providers, nursing homes, and supervised living facilities. The “TB waivers” stated that licensees were required to follow the 2005 CDC guidelines. As a final step, MDH proposed new legislation in 2013, which was adopted by the Minnesota Legislature and takes effect on August 1, 2013. These laws are based on the 2005 national guidelines and replace the 2009 “TB waivers.” They apply to settings licensed by MDH, including boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities. *Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 2005. From CDC, MMWR, December 30, 2005, 54(RR17);1-141.

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 1

Chapter 1 Background Determining which regulations to follow All state-licensed or federally-certified health care settings in Minnesota are required by law to follow certain measures to prevent and control TB in their facilities. In addition, facilities should follow the regulations of the Minnesota Occupational Safety and Health Administration (MN-OSHA). (see Resources) There are three categories of regulations related to TB: 1. TB infection control program 2. Process for screening health care workers (HCWs) 3. Process for screening residents This manual provides specific information about each type of regulation. To determine which of these regulations apply to your facility, see the table below. If you are unsure what type of license your facility has, you can look it up at www.health.state.mn.us/divs/fpc/directory/providerselect.cfm. TB infection control program (Chapter 2) Yes

Yes

Screening residents (Chapter 4) No

Boarding care home (MDH licensed) Home care provider (MDH licensed)

Yes

Hospice (MDH licensed)

Yes

Yes (residential hospice only)

Nursing home (MDH licensed)

Yes

Outpatient surgical center (MDH licensed)

Yes

Health care setting Assisted living facility

Screening HCWs (Chapter 3)

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Regulatory authority Minnesota Statutes, section 144A.4798, Subd. 11 Minnesota Statutes, section 144.56, Subd. 2c2 Minnesota Statutes, section 144A.4798, Subd. 11 Minnesota Statutes, section 144A.753, Subd.43 Minnesota Statutes, section 144A.04, Subd. 3b4 Minnesota Statutes, section 144.55, Subd. 3c5

July 2013 • Page 3

Background Health care setting Supervised living facility (MDH licensed) Supplemental nursing services agency (MDH licensed) All other settings

TB infection control program (Chapter 2) Yes

Chapter 1 Screening HCWs (Chapter 3) Yes

Screening residents (Chapter 4) No

Education program only

Yes

www.revisor.mn.gov/statutes/?id=144A.4798

www.revisor.mn.gov/statutes/?id=144.56

www.revisor.mn.gov/statutes/?id=144A.753

www.revisor.mn.gov/statutes/?id=144A.04

www.revisor.mn.gov/statutes/?id=144.55

www.revisor.mn.gov/statutes/?id=144.50

www.revisor.mn.gov/statutes/?id=144A.72

www.dli.mn.gov/OSHA/PDF/tuberculosis_cpl.pdf

Page 4 • July 2013

Regulatory authority Minnesota Statutes, section 144.50, Subd. 6a6 Minnesota Statutes, section 144A.72, Subd. 17 MN-OSHA8

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 2 TB Infection Control Program All health care settings in Minnesota should have an up-to-date TB infection control program that includes: • • • •

A team responsible for TB infection control A facility TB risk assessment Written TB infection control procedures Health care worker (HCW) education

TB infection control team Identify a qualified person or a team of persons in your facility and assign them primary responsibility and authority for TB infection control. This person or team will conduct your setting’s facility TB risk assessment; develop, implement, and enforce TB infection control policies (including HCW and resident TB screening); and ensure that HCWs receive adequate TB-related training and education.

Facility TB risk assessment The facility TB risk assessment is a structured evaluation of a health care facility or setting’s risk for transmission of M. tuberculosis. The infection control team determines the setting’s TB risk classification based on the results of the facility TB risk assessment. All health care settings in Minnesota should perform an initial facility TB risk assessment. Medium-risk settings should update their assessment yearly; low-risk settings should update theirs every other year. Keep your facility’s completed TB risk assessment worksheets on file for future reference. Your facility TB risk assessment should be conducted by your infection control team. In general, oneassessment encompasses an entire setting. However, in certain settings it may be appropriate to do separate assessments for specific areas within the setting. Information on the number of TB cases by county for the previous year are posted on MDH’s web site in May of each year. Risk assessments conducted early in the calendar year (before new data are posted) should use data from the previous year. Please do not contact MDH before May to obtain TB data for the previous year. Choose one of the following three methods to conduct your risk assessment(s): 1. Use the Facility TB Risk Assessment Worksheet for Health Care Settings Licensed by the Minnesota Department of Health (MDH). This worksheet was developed by MDH and can be used by boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities (see www.health.state.mn.us/divs/idepc/diseases/tb/rules/index. html#ch2). 2. Use the Appendix B: Tuberculosis (TB) risk assessment worksheet from the Centers for Disease Control and Prevention (CDC). (see www.health.state.mn.us/divs/idepc/diseases/tb/rules/index. html#ch2). 3. Create your own assessment tool using the criteria listed on pages 9-12 of CDC’s “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.” Regulations for Tuberculosis Control in Minnesota Health Care Settings

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TB Infection Control Program

Chapter 2

Use the results from your facility TB risk assessment to determine your TB risk classification. The three risk classifications are: • Low risk, in which persons with active TB disease are not expected to be encountered and exposure to TB is unlikely. • Medium risk, in which HCWs will or might be exposed to persons with active TB disease or clinical specimens that might contain M. tuberculosis. • Potential ongoing transmission, in which there is evidence of person-to-person transmission of M. tuberculosis. This is a temporary classification. If you determine that this classification applies to your setting, please consult with MDH’s TB Prevention and Control Program at 651-201-5414 for guidance. If the infection control team is unsure whether to classify your setting as low or medium risk, the medium risk classification should be used. When updating your facility TB risk assessment, you should confirm and document actions that were taken to address any problems identified during the previous risk assessment. In addition, you should conduct a problem evaluation to address any situations that may have occurred since your last risk assessment was done. Examples might include: • A person with suspected or confirmed active TB disease was not promptly recognized and appropriate airborne precautions were not initiated, • Certain administrative, environmental, or respiratory-protection controls failed, and • Infection control lapses were identified (for example, HCWs were not adequately screened for TB; baseline TB screening of residents [if applicable] was not consistently done and documented; there were delays in transferring of patients with symptoms of active TB disease; or TB-related education and training of HCWs was not done or needs to be updated).

Written TB infection control procedures Each facility should have written procedures to address TB infection control. Medium-risk settings should review their procedures annually and update, if necessary. Low-risk settings should review their procedures every other year and update, if necessary. Procedures should address: • Early recognition: All HCWs should know the signs and symptoms of TB and their role in their facility’s TB infection control program. • Isolation: Place a potentially infectious TB patient in an airborne infection isolation (AII) room if available; If not, place patient in separate room with door shut. • Referral: If your setting does not handle TB patients, transfer potentially infections TB patients to a setting that is equipped to evaluate and treat TB patients. The procedures should include information about working with the local or state public health department to conduct a TB contact investigation if health care-associated transmission of M. tuberculosis is suspected.

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TB Infection Control Program

Chapter 2

In addition, settings that expect to encounter (admit) patients with suspected or confirmed active TB disease are required to: • Implement and maintain environmental controls, including AII rooms, • Develop a respiratory protection program, and • Develop a plan for accepting patients with suspected or confirmed active TB disease.

HCW education TB training is required at time of hire for all HCWs. The content of the training should be appropriate to the job responsibilities and educational or professional background of the HCW. In medium-risk settings, TB training should be conducted annually. Low-risk settings should annually evaluate the need for TB training, and conduct training as needed. Content should focus on basic information about: • TB pathogenesis and transmission, • Signs and symptoms of active TB disease, and • Your health care setting’s infection control plan (i.e., how to implement your early recognition, isolation, and referral procedure), especially any sections that employees are responsible for implementing.

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Chapter 3 Screening Health Care Workers (HCWs) Definition of a HCW: For purposes of TB infection control procedures, the following staff should be considered HCWs and should be included in your TB screening program: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Administrators and managers Bronchoscopy Chaplains Clerical Computer programmers Construction Correctional officers Dental Dietician or dietary Educators Engineers Food service Health aides Health and safety Housekeeping or custodial Homeless shelter Infection control Janitorial, maintenance Laboratory Morgue Nurses Outreach Patient transport staff, including EMS Pharmacists Phlebotomists Physical and occupational therapists Physicians and other clinicians Public safety Radiology Respiratory therapists Social workers Students (e.g., medical, nursing, technicians, and allied health) Technicians (e.g., health, laboratory, radiology, and animal) Volunteers

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Screening Health Care Workers (HCWs)

Chapter 3

In addition, HCWs who perform any of the following activities should also be included in your TB screening program: • Entering patient rooms or treatment rooms whether or not a patient is present, • Participating in aerosol-generating or aerosol-producing procedures (e.g., bronchoscopy, sputum induction, and administration of aerosolized medications), • Participating in suspected or confirmed M. tuberculosis specimen processing, or • Installing, maintaining, or replacing environmental controls in areas in which persons with active TB disease are encountered.

General principles • There are two methods available to screen for TB infection: the tuberculin skin test (TST) and the Interferon Gamma Release Assay (IGRA). Information about these methods is available at www.health.state.mn.us/divs/idepc/diseases/tb/tst.html and www.health.state.mn.us/divs/idepc/ diseases/tb/bloodtests.html. • All reports or copies of TST or IGRA results and any related chest X-ray and medical evaluations should be maintained in the employee’s record. • TST documentation should include the date of the test (i.e., month, day, year), the number of millimeters of induration (if no induration, document “0” mm) and interpretation (i.e., positive or negative). • IGRA documentation should include the date of the test (i.e., month, day, year), the qualitative results (i.e., positive, negative, indeterminate or borderline) and the quantitative assay (i.e., Nil, TB and Mitogen concentrations or spot counts). Indeterminate or borderline results indicate an uncertain likelihood of M. tuberculosis infection and should be further evaluated by a physician. • HCWs should be encouraged to keep copies of the results of their TB screening for future use. • Disregard a HCW’s history of BCG vaccination when administering and interpreting a TST. • It is the responsibility of the infection control team to ensure that written procedures are in place and are followed by staff to ensure that employees are free of infectious TB disease before beginning employment. Questions regarding the significance of an individual’s medical test results (e.g., chest X-ray reports) should be referred to the appropriate medical or nursing staff in your facility.

Baseline TB screening Baseline TB screening is required for all HCWs (Table 3.1). Baseline TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST or single IGRA.

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Chapter 3

An employee may begin working with patients after a negative TB symptom screen (i.e., no symptoms of active TB disease) and a negative IGRA or TST (i.e., first step) dated within 90 days before hire. The second TST may be performed after the HCW starts working with patients. Available tool: Baseline TB Screening Tool for HCWs Template on pages 16-17.

Serial TB screening Serial TB screening refers to TB screening performed at regular intervals following baseline TB screening. The frequency of serial TB testing is based on your facility’s TB risk classification (Table 3.1). Serial TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a onestep TST or single IGRA. HCWs who have positive TSTs or IGRAs and who work in medium-risk settings do not need additional TSTs or IGRAs but should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time. Available tool: Serial TB Screening Tool for HCWs Template on pages 18-19.

Table 3.1: Baseline and serial TB screening regulations for HCWs Risk classification Low Medium Potential ongoing transmission (usually temporary)

Baseline screening Required Required Required

Serial screening Not required Annual May require testing on a quarterly or twice-yearly basis. Consult with the MDH TB Prevention and Control Program at 651-201-5414 regarding the frequency of testing under these circumstances.

Special Situations HCW with signs or symptoms of active TB disease A HCW with infectious TB disease poses a special risk in the workplace because of the potential to spread the infection to vulnerable patients. TB is not commonly found in Minnesota HCWs, but it does occur. In 2011-2012, a total of 12 HCWs in Minnesota were diagnosed with active TB disease. Do not wait for the results of a TST or IGRA before referring a person with TB symptoms for a medical evaluation. Approximately 25 percent of persons with active TB disease have a negative TST or IGRA because the body’s immune system is not strong enough to respond to the test.

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Screening Health Care Workers (HCWs)

Chapter 3

Persons with active TB disease may have one or more of the following symptoms: • • • • • • • • •

Prolonged cough (≥ three weeks ) Hemoptysis Weight loss Night sweats Fatigue Fever, chills Poor appetite Chest pain Other symptoms may be present, depending on the site of disease

Active TB disease most commonly affects the lungs (pulmonary). However, TB disease can occur in other parts of the body (most commonly, pleural or lymphatic). Any HCW with symptoms of active TB disease, regardless of the results of the TST or IGRA, should be promptly evaluated to exclude a diagnosis of active TB disease. This should include a medical evaluation, a chest X-ray, and collection of sputum specimens for mycobacterial smear and culture or additional testing if indicated. If active TB disease is confirmed or suspected, the diagnosing clinician should notify MDH at 651-201-5414 within one working day. HCWs with suspected or confirmed infectious TB disease or a draining TB skin lesion should be excluded from the workplace. They should be allowed to return to work only after a physicianknowledgeable and experienced in managing TB has determined that they are no longer infectious (this may be done in consultation with the health department). HCWs with extrapulmonary TB disease usually do not need to be excluded from the workplace as long as the respiratory tract is not involved and the HCW has been cleared for work by a physician.

HCW with a newly-identified positive TST or IGRA Before the HCW has direct patient contact, the following should be documented in their record: 1. Test result, 2. Assessment for current TB symptoms, 3. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the HCW has not been exposed to infectious TB disease since the chest X-ray was done, and 4. Medical evaluation to rule out a diagnosis of infectious TB disease. After the negative baseline chest X-ray is done and the results are documented, additional chest X-rays are not needed unless the HCW develops symptoms of active TB disease or a clinician recommends a repeat chest X-ray. HCWs who work in medium-risk settings should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time.

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Screening Health Care Workers (HCWs)

Chapter 3

HCW with written documentation of a previous positive TST or IGRA If the test is appropriately documented you do not need to repeat the test. Before the HCW has direct patient contact, the following should be documented in their record: 1. Test result, 2. Assessment for current TB symptoms, 3. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the HCW has not been exposed to infectious TB disease since the chest X-ray was done. If infectious TB disease is ruled out, additional chest X-rays are not needed unless the HCW develops symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 4. If the chest X-ray is done at the time of hire because documentation of a previous film was not available, a medical evaluation to rule out infectious TB disease should be done. No medical evaluation is required if HCW already has a chest X-ray dated after documented positive TST or IGRA. HCWs who work in medium-risk settings should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time.

HCW with a verbal (undocumented) history of a previous positive TST or IGRA These HCWs should undergo the same screening procedures as HCWs without previous positive results. Results of the screening should be documented in the HCW’s record. If the HCW has documentation of previous treatment for latent TB infection or active TB disease, that documentation may be substituted for documentation of previous positive TST or IGRA results.

Pregnant HCW Pregnancy is not a contraindication for TB testing. Pregnant women should be included in the same baseline and serial TB screening programs as other HCWs. If a pregnant HCW declines a TST, offer an IGRA if it is available. If an IGRA is not available, consider having the HCW and her personal health care provider complete the Exemption Form for Tuberculin Skin Testing of a Pregnant HCW (see page 20). A pregnant HCW with a newly identified positive TST or IGRA, or signs and symptoms of active TB disease, is at increased risk for active TB disease and should receive a chest X-ray, using an abdominal shield.

Conversions A conversion is when a person’s TST or IGRA result is initially negative but changes to positive at a later date. For surveillance purposes, an increase in induration of >10 mm is defined as a TST conversion. Follow instructions for a HCW with newly positive TST or IGRA. Additional information is available on pages 13 and 32-34 of “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.” Regulations for Tuberculosis Control in Minnesota Health Care Settings

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Screening Health Care Workers (HCWs)

Chapter 3

HCW with TST results between 5 and 9 mm of induration This result is considered negative for most HCWs but is positive for persons with certain risk factors, including: • • • •

HIV positive, Recent close contact with someone with infectious TB disease, Organ transplant recipient, Immunosuppressed due to taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for one month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn’s disease, or other autoimmune disorders, or • Have a current chest X-ray that shows “scarring” or “fibrosis” or “old, healed TB.” Because employers cannot legally collect information about these personal health TB risk factors, it is recommended, but not required, that these HCWs be given MDH’s Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm (see page 21) and encouraged to follow-up with their personal health care providers as necessary.

Students Students who will be performing health care-related activities should receive the same screening as paid HCWs. Health care facilities where students are placed should ensure that the students’ school has performed the required testing. Students who will be in the clinical setting for less than two weeks require only a one-step (not the two-step) TST.

Volunteers Volunteers who share airspace with patients for five to 10 hours or more per week should receive the same TB screening as paid HCWs.

HCW with previous history of severe adverse reaction to TST Severe adverse reactions (i.e., necrosis, blistering, anaphylactic shock or ulceration) to TSTs are rare events. A HCW who provides a convincing verbal report of a severe adverse reaction to a prior TST, even if the reaction is not documented, should NOT receive a TST. Substitute an IGRA for the TST if it is available. If an IGRA is not available, document the severe reaction, conduct the TB symptom screen and review TB risk factors.

HCW refusal HCWs who refuse a TST should be screened using an IGRA. HCWs who refuse an IGRA should be screened using a TST. HCWs who refuse both the TST and IGRA should receive a chest X-ray to rule out infectious TB disease.

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Screening Health Care Workers (HCWs)

Chapter 3

HCW who travels outside of the United States It is recommended, but not required, that HCWs who travel for more than four weeks to a country where TB is common and have close contact with residents of that country (e.g., visiting family, medical volunteer work) be tested with a single TST or IGRA eight to 10 weeks after returning to the United States. The CDC Health Information for International Travel (commonly called the Yellow Book) can provide more information. You can find it at: wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/tuberculosis.

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Chapter 3 Baseline TB Screening Tool for HCWs Template (page 1)

Baseline TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial

____/____/______ Date form completed

____/____/_____ Date of birth

(______)____________ Work phone number

Baseline TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.

Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)

Chest pain

Fatigue

Night sweats

Coughing up blood

Weight loss/poor appetite

Fever/chills

Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result.

HCW’s history (circle response) Have you ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Have you had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ Result ______________ Comments Have you ever had the BCG vaccine?

Yes

Have you ever been treated for latent TB infection?

Yes

Have you ever been treated for active TB disease?

Yes

Have you ever had an adverse reaction to a TB skin test?

Yes

Have you received a live-virus vaccine within the past 6 weeks?

Yes

Tool address: Page 16 • July 2013

www.health.state.mn.us/divs/idepc/diseases/tb/rules/basetbscrn.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 3 Baseline TB Screening Tool for HCWs Template (page 2) TB Blood Test Name of TB blood test (circle)

QuantiFERON TB-Gold

QuantiFERON-TB-Gold InTube

T-SPOT

Date of blood draw Results Interpretation of reading (circle)

Positive* Negative

Indeterminate

Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease

Tuberculin skin testing (TST) TST – First Step

TST – Second Step

Administration Name of person administering test Date and time administered Location (circle)

L forearm R forearm Other:________ L forearm R forearm Other:________

Tuberculin manufacturer Tuberculin expiration date and lot # Signature of person who administered test Results (read between 48-72 hours) Date and time read: Number of mm of induration: (across forearm)

____mm

Interpretation of reading* (circle)

Positive** Negative***

Positive** Negative

Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease *** If results are negative, perform the second step in one to three weeks

Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center

Tool address:

www.health.state.mn.us/divs/idepc/diseases/tb/rules/basetbscrn.doc

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Chapter 3 Serial TB Screening Tool for HCWs Template (page 1)

Serial TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial

____/____/______ Date form completed

____/____/_____ Date of birth

(______)____________ Work phone number

Serial TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a single TST.

Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)

Chest pain

Night sweats

Coughing up blood

Weight loss/poor appetite

Fever/chills

Fatigue

Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result.

Comments Have you ever had the BCG vaccine?

Yes

Have you ever been treated for latent TB infection?

Yes

Have you ever been treated for active TB disease?

Yes

Have you ever had an adverse reaction to a TB skin test?

Yes

Have you received a live-virus vaccine within the past 6 weeks?

Yes

Tool address: Page 18 • July 2013

www.health.state.mn.us/divs/idepc/diseases/tb/rules/sertbscrn.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 3 Serial TB Screening Tool for HCWs Template (page 2) TB Blood Test Name of TB blood test (circle)

QuantiFERON TB-Gold

QuantiFERON-TB-Gold InTube

T-SPOT

Date of blood draw Results Interpretation of reading (circle)

Positive*

Negative

Indeterminate

Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease

Tuberculin Skin Testing (TST) Administration Name of person administering test Date and time administered Location (circle)

L forearm R forearm Other:________

____mm

Interpretation of reading* (circle)

Positive** Negative

Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease

Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center

Tool address:

www.health.state.mn.us/divs/idepc/diseases/tb/rules/sertbscrn.doc

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Chapter 3 Exemption Form for Tuberculin Skin Testing of a Pregnant HCW Note: This is a suggested template developed by the Minnesota Department of Health (MDH) Tuberculosis Prevention and Control Program. It is designed to assist health care facilities who receive employee requests to be exempted from TB skin testing due to pregnancy. This is not an official MDH form. It may be adapted by individual health care facilities to create their own form. MDH does not recommend the practice of routinely exempting health care workers from TB skin testing due to pregnancy.

To remove “Sample” watermark: On the “Format” menu, click on “Background,” then click “Printed Watermark,” then click “No watermark.”

Exemption from Tuberculin Skin Testing for a Pregnant Health Care Worker I, _________ (physician’s name) recommend that my patient, ______, be exempted from tuberculin skin testing (TST) for the following reason: ______. I understand that the U.S. Centers for Disease Control and Prevention and the Minnesota Department of Health consider TST to be valid and safe during pregnancy and recommend that pregnant women with risk factors (e.g., health care workers) for exposure to tuberculosis (TB) should receive testing. Check one: ____I will arrange for my patient to receive a TB blood test (i.e., QuantiFERON, T-Spot) as a substitute for TST. ____I have been unable to locate a laboratory that will perform a TB blood test (i.e., QuantiFERON, T-Spot) for my patient. Signature: _________ (physician) Clinic name and phone number: _____________ I ___ (employee) have read the above information and understand that tuberculin skin testing is generally considered safe in pregnant women. Signature: _________ (employee) References: 1. American Thoracic Society, U.S. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent TB infection. MMWR 2000: 49(No. RR-6) 2. CDC fact sheet. Tuberculosis and Pregnancy (2008)

Tool address: Page 20 • July 2013

www.health.state.mn.us/divs/idepc/diseases/tb/rules/exmtpreghcw.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 3 Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm Note: This is a suggested template developed by the Minnesota Department of Health (MDH) Tuberculosis (TB) Prevention and Control Program. It is designed to assist health care facilities who have employees with tuberculin skin test (TST) results between 5 and 9 mm induration. TST results between 5 and 9 mm of induration are negative for most health care workers but are positive for those with certain risk factors. The purpose of this form is to educate health care workers who have TST results between 5 and 9 mm and may have these risk factors. Employers cannot and should not collect information about these personal health TB risk factors. Employers are not required to follow-up with employees who have TST results between 5 and 9 mm unless the employee also has signs or symptoms of active TB disease. This is not an official MDH form. It may be adapted by individual health care facilities to create their own form. To remove “Sample” watermark: On the “Format” menu, click on “Background,” then click “Printed Watermark,” then click “No Watermark.”

SAMPLE Dear employee: You recently participated in tuberculin skin testing (TST). This is a test for latent tuberculosis (TB) infection. Your TST result, administered on ___/___/______ and read on ___/___/_____ was _____ mm induration. This test result is considered “negative” (normal) for most health care workers, but is considered “positive” for people with the following risk factors: x Are HIV positive x Have had recent close contact with someone with active TB disease of the lungs x Have had an organ transplant x Are immunosuppressed due to taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for 1 month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn’s disease, or other autoimmune disorders x Have a current chest X-ray that shows “scarring” or “fibrosis” or “old, healed TB” If you have one or more of these risk factors, we strongly encourage you to set up an appointment with your personal health care provider to discuss your test results. We recommend that you bring this form with you to your medical appointment.

Additional information about TB testing and latent TB infection is available at www.health.state.mn.us/divs/idepc/diseases/tb/factsheets/tst.html.

Tool address:

www.health.state.mn.us/divs/idepc/diseases/tb/rules/hcwtstrslt.doc

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Chapter 4 Screening Residents Routine TB screening of residents (patients) is not required in Minnesota health care settings except for boarding care homes, nursing homes, and residential hospices. Residents in other facilities may be screened for TB at the discretion of their health care providers or the health care setting’s infection control team.

General principles • Screening should be initiated within 72 hours of admission or within 90 days prior to admission. • There are two methods available to screen for TB infection: the tuberculin skin test (TST) and the Interferon Gamma Release Assay (IGRA). Information about these methods is available at www.health.state.mn.us/divs/idepc/diseases/tb/tst.html and www.health.state.mn.us/divs/idepc/ diseases/tb/bloodtests.html. • It is the responsibility of the infection control team to ensure that written procedures are in place and are followed by staff to ensure that residents are free of infectious TB disease at time of admission. Questions regarding the significance of an individual’s medical test results (e.g., chest X-ray reports) should be referred to the appropriate medical or nursing staff in your facility. • All reports or copies of the TST or IGRA and any chest X-rays and medical evaluations conducted should be maintained in the resident’s medical record. • Residents who are temporarily transferred to other facilities (e.g., a hospital) do not need to be re-tested upon re-admission if that facility has a TB prevention and control program in place. • Disregard a resident’s history of BCG vaccination when administering and interpreting a TST. • TST documentation for residents should include the date (i.e., month, day, year), the number of millimeters of induration (if no induration, document “0” mm), and interpretation (i.e., positive or negative). If this information is not available, documentation of a history of infection with TB (e.g., a previous positive skin test or history of active TB disease) by a physician in the resident’s medical record is acceptable. • IGRA documentation should include the date of the test (i.e., month, day, year), the qualitative results (i.e., positive, negative, indeterminate, or borderline) and the quantitative assay (i.e., Nil, TB and Mitogen concentrations or spot counts). Indeterminate or borderline results indicate an uncertain likelihood of M. tuberculosis infection and should be further evaluated by a physician.

Baseline TB screening of residents in boarding care homes and nursing homes Baseline TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing for TB risk factors and TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST or single IGRA. Available tool: Baseline TB Screening Tool for Residents Template on pages 27-28.

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Screening Residents

Chapter 4

Baseline TB screening of residents in residential hospices Baseline TB screening consists of one component: 1. Assessing for current symptoms of active TB disease. Screening for the presence of infection with Mycobacterium tuberculosis using a TST or IGRA is not necessary. Available tool: Baseline TB Screening Tool for Residents in Residential Hospice Template on page 29.

Special Situations Resident with a newly identified positive TST or IGRA Documentation should include: 1. Test result, 2. Assessment for current TB symptoms, 3. Assessment of risk factors for progression to active TB disease, 4. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the resident has not been exposed to infectious TB disease since the chest X-ray was done. After a baseline chest X-ray is performed and infectious TB disease has been ruled out, the resident will not need additional chest X-rays unless they develop symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 5. Medical evaluation to rule out a diagnosis of infectious TB disease. Post the resident’s positive TST or IGRA status in a prominent place in their record to ensure that staff are aware of it in case the resident develops symptoms of active TB disease at a later date.

Resident with written documentation of a previous positive TST or IGRA If the result is appropriately documented, an additional TST or IGRA is not needed. Documentation should include: 1. Test result, 2. Assessment for current TB symptoms, 3. Assessment of risk factors for progression to active TB disease, 4. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the resident has not been exposed to infectious TB disease since the chest X-ray was done. After a baseline chest X-ray is performed and infectious TB disease has been ruled out, the resident will not need additional chest X-rays unless they develop symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 5. Medical evaluation to rule out a diagnosis of infectious TB disease if resident didn’t have an appropriately documented chest X-ray and needed to get one. No medical evaluation is required if resident already has a chest X-ray dated after the documented positive TST or IGRA.

Page 24 • July 2013

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Screening Residents

Chapter 4

Post the resident’s positive TST or IGRA status in a prominent place in their record to ensure that staff are aware of it in case the resident develops symptoms of active TB disease at a later date.

Resident with a verbal (undocumented) history of a previous positive TST or IGRA These residents should undergo the same screening process as residents without previous positive results. Results of the screening should be documented in the resident’s record. If the resident has documentation of previous treatment for latent TB infection or active TB disease, that documentation may be substituted for documentation of previous positive TST or IGRA results.

Resident with signs or symptoms of active TB disease Do not wait for the results of a TST or IGRA before referring a resident with TB symptoms for a medical evaluation. Approximately 25 percent of persons with active TB disease have a negative TST or IGRA because the body’s immune system is not strong enough to respond to the test. Residents with active TB disease may have one or more of the following: • • • • • • • • •

Prolonged cough (≥ three weeks ) Hemoptysis Weight loss Night sweats Fatigue Fever, chills Poor appetite Chest pain Other symptoms may be present, depending on the site of disease

Active TB disease most commonly affects the lungs (pulmonary), but approximately 40 percent of TB cases in Minnesota involve only an extrapulmonary site of disease (most commonly pleural or lymphatic). For infection control purposes, only pulmonary, pleural and laryngeal TB disease are considered potentially infectious; most extrapulmonary TB cannot be transmitted to others. Any resident with symptoms of infectious TB disease, regardless of the results of the TST or IGRA, should be transferred to a facility with respiratory isolation rooms and promptly evaluated to exclude a diagnosis of active TB disease. This should include a medical evaluation and symptom screen, a chest X-ray, and collection of sputum specimens or additional testing if indicated. If active TB disease is confirmed or suspected, the diagnosing clinician should notify MDH at 651-2015414 within one working day. The resident should remain in respiratory isolation until TB is diagnosed and effective treatment is initiated, or TB is ruled out. The resident’s physician and the public health department should be consulted for guidance regarding when a resident with infectious TB disease can be removed from isolation.

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 25

Screening Residents

Chapter 4

Resident with a previous history of severe adverse reaction to TST Severe adverse reactions (i.e., necrosis, blistering, anaphylactic shock or ulceration) to TSTs are rare events. Residents who provide a convincing verbal report of a severe adverse reaction to a prior TST, even if the reaction is not documented, should NOT receive a TST. Substitute an IGRA for the TST if it is available. If an IGRA is not available, document the severe reaction, conduct the TB symptom screen and review TB history and TB risk factors.

Resident refusal Residents who refuse a TST should be screened using an IGRA. Residents who refuse an IGRA should be screened using a TST. Residents who refuse both the TST and IGRA should receive a chest X-ray to rule out infectious TB disease.

Page 26 • July 2013

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 4 Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents (page 1)

Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents ______________________________________

_____/_____/______

____/____/_______

Last name, first name, middle initial

Date of birth

Date form completed

Baseline TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing the resident’s TB risk factors and TB history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.

Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)

Chest pain

Night sweats

Coughing up blood

Weight loss/poor appetite

Fever/chills

Fatigue

Note: If TB symptoms are present, promptly refer patient for a chest X-ray and medical evaluation. Do not wait for the TST or TB blood test result.

Resident’s history and risk factors (circle response) Ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ BCG vaccine?

Yes

Result_________________ Comments No Unknown

Treated for latent TB infection?

Yes

Unknown

Treated for active TB disease?

Yes

Unknown

Had a known exposure to TB < 2 years ago?

Yes

Unknown

Born outside of the U.S.?

Yes

Unknown

Traveled or lived outside of the U.S. in the past 2 years?

Yes

Unknown

HIV-infected?

Yes

Unknown

Immune suppressed*?

Yes

Unknown

History of substance abuse?

Yes

Unknown

End stage renal disease, diabetes, or silicosis?

Yes

Unknown

Scarring/fibrosis on chest X-ray?

Yes

Unknown

Undernourished or underweight (< 90% of ideal)

Yes

Unknown

Live-virus vaccine within the past 6 weeks?

Yes

Unknown

Severe adverse reaction to a TB skin test?

Yes

Unknown

*i.e., taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for 1 month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn's disease, or other autoimmune disorders

Tool address:

www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnbchnh.doc

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 27

Chapter 4 Baseline TB Screening Tool for Residents Template (page 2) TB Blood Test Name of TB blood test (circle)

QuantiFERON TB-Gold

QuantiFERON-TB-Gold InTube

T-SPOT

Date of blood draw Results Interpretation of reading (circle)

Positive* Negative

Indeterminate

Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease

Tuberculin skin testing (TST) TST – First Step

TST – Second Step

Administration Name of person administering test Date and time administered Location (circle)

L forearm R forearm Other:________ L forearm R forearm Other:________

____mm

Interpretation of reading* (circle)

Positive** Negative***

Positive** Negative

Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center

Tool address: Page 28 • July 2013

www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnbchnh.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings

Chapter 4 Baseline TB Screening Tool for Residents in Residential Hospice Template

Baseline TB Screening Tool for Residents in Residential Hospice ______________________________________

_____/_____/______

____/____/_______

Last name, first name, middle initial

Date of birth

Date form completed

Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)

Chest pain

Night sweats

Coughing up blood

Weight loss/poor appetite

Fever/chills

Fatigue

Note: If TB symptoms are present, promptly refer patient for a chest X-ray and full medical evaluation. Do not wait for the TST or IGRA result.

Tool address:

www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnrh.doc

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 29

Glossary Term

Defined as

active tuberculosis (TB) disease

Condition caused by Mycobacterium tuberculosis that has progressed to causing clinical or subclinical disease. TB disease usually affects the lungs, but it can also affect other parts of the body, such as the lymph nodes, bone, or brain. If TB is treated properly, most people can be cured. If TB is NOT treated properly, the disease can be fatal or develop into drug-resistant forms of TB. Compare to latent TB infection (LTBI). See also extrapulmonary TB and pulmanary TB.

airborne infection isolation (AII)

Isolation of patients infected with organisms that are spread via airborne droplet nuclei smaller than five microns in diameter (e.g., M. tuberculosis).

Bacille CalmetteGuérin (BCG) vaccine

A vaccine for TB used in many countries where active TB disease is endemic. It is not used in the United States. BCG vaccine helps prevent disseminated and meningeal TB disease in infants and young children, but offers much less protection for adults.

baseline TB screening

The initial screening for TB performed at the time that HCWs begin work or residents are admitted to a health care facility. Baseline screening identifies individuals with LTBI or active TB disease and is also used to compare with any future screening results. See also TB screening.

boosting

A phenomenon in which people who are skin tested many years after becoming infected with M. tuberculosis may have a negative reaction to an initial TST, followed by a positive reaction to a TST given up to a year later; this happens because the first TST boosts the immune response. Twostep testing is used in TB screening programs to tell the difference between boosted reactions and reactions caused by recent infection (see two-step TST). Boosting does not pertain to interferon gamma release assays (IGRAs).

conversion

A change in the result of a test for M. tuberculosis infection (TST or IGRA) which is interpreted as having progressed from uninfected to infected. An increase of ≥10 mm in induration during a maximum of two years is defined as a TST conversion for the purposes of employee surveillance programs. A conversion indicates that a new M. tuberculosis infection has likely occurred; this poses an increased risk for progression to active TB disease.

exposure

Being subjected to something (e.g., an infectious agent) that could have an adverse health effect. A person exposed to M. tuberculosis does not necessarily become infected. See also transmission.

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 31

Glossary Term

Defined as

extrapulmonary TB

Active TB disease in any part of the body other than the lungs (e.g., lymph nodes, bone). An individual can have both pulmonary and extrapulmonary TB disease at the same time. Extrapulmonary TB is typically not considered infectious.

facility

A physical building or set of buildings.

facility TB risk assessment

An initial and ongoing evaluation of the risk for transmission of M. tuberculosis in a particular health care setting. To perform a risk assessment, the following factors should be considered: the community rate of TB, number of TB patients encountered in the setting, and the speed at which patients with active TB disease are suspected, isolated, and evaluated. The TB risk assessment determines the types of administrative and environmental controls and respiratory protection needed for a setting.

health care setting

A place where health care is delivered.

health care workers (HCWs)

Paid or unpaid person working in a health care setting.

hemoptysis

Coughing up of blood or blood-tinged sputum; one of the possible symptoms of pulmonary TB disease. Hemoptysis can also be observed in other pulmonary conditions (e.g., lung cancer).

induration

A palpable, raised, hardened area that may develop in response to the injection of tuberculin antigen. Induration is measured in only one direction (across the forearm), and the result is recorded in millimeters. The measurement is compared with guidelines to determine whether the test result is classified as positive or negative.

infectious

The ability of an individual with active TB disease to transmit (spread) TB bacteria to other persons. Directly related to the number of TB bacteria that the individual expels into the air. Persons who expel many bacilli are more infectious than those who expel few or no bacilli.

interferon gamma release assay (IGRA)

A test that detects the presence of M. tuberculosis infection by measuring the immune response to the TB bacteria in the blood. There are two commercially available IGRAs: QuantiFERON-TB and T-Spot.

Page 32 • July 2013

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Glossary Term

Defined as

latent TB infection (LTBI)

Persons with latent TB infection have M. tuberculosis organisms in their bodies but do not have active TB disease, have no symptoms, and are noninfectious. Such persons usually have a positive reaction to a TST or IGRA.

Mantoux tuberculin skin test

see tuberculin skin test

medical evaluation

A process for diagnosing active TB disease or LTBI, selecting treatment, and assessing response to therapy. A medical evaluation can include medical history and TB symptom screen, clinical or physical examination, screening and diagnostic tests (e.g., TSTs, IGRAs, chest X-rays, bacteriologic examination, and HIV testing), counseling, and treatment referrals.

Mycobacterium tuberculosis (M. tuberculosis or M. tb)

A type of tuberculous mycobacteria; a gram-positive bacterium that causes tuberculosis. Sometimes called the tubercle bacillus.

potential ongoing transmission

A risk classification for TB screening, including testing for M. tuberculosis infection when evidence of ongoing transmission of M. tuberculosis is apparent in the setting. Testing might need to be performed every 8–10 weeks until lapses in infection controls have been corrected, and no further evidence of ongoing transmission is apparent. Use potential ongoing transmission as a temporary risk classification only. After corrective steps are taken and conversion rates stabilize, reclassify the setting as medium risk for a period of at least one year.

pulmonary TB

Active TB disease that occurs in the lung, usually producing a cough that lasts ≥ 3 weeks.

purified protein derivative (PPD) (tuberculin)

A material used in the tuberculin skin test for detecting infection with M. tuberculosis. In the United States, PPD solution is approved for administration as an intradermal injection (5 TU per 0.1 mL), a diagnostic aid for LTBI (see tuberculin skin test).

respiratory protection

The use of N-95 or other respirators to protect a HCW from inhaling droplet nuclei containing M. tuberculosis.

serial TB screening

TB screening performed at regular intervals following initial baseline TB screening.

Regulations for Tuberculosis Control in Minnesota Health Care Settings

July 2013 • Page 33

Glossary Term

Defined as

symptom screen

A procedure used during a clinical evaluation in which patients are asked if they have experienced any of the common symptoms of active TB disease (e.g., cough, weight loss, night sweats).

TB blood test

see IGRA

TB screening

Methods used to identify persons who have active TB disease or LTBI. May include one or more of the following: TST, IGRA, chest x-ray, symptom screening.

transmission

Transmission occurs when a person inhales droplet nuclei containing M. tuberculosis, and the droplet nuclei transverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs, resulting in infection.

tuberculin skin test (TST)

Skin test used to detect TB infection. Sometimes referred to as “PPD” or “Mantoux.”

two-step TST

Procedure used for the baseline skin testing of persons who will receive serial TSTs (e.g., HCWs and residents of long term care facilities) to reduce the likelihood of mistaking a boosted reaction for a new infection. If an initial TST result is classified as negative, a second step of a two-step TST should be administered 1–3 weeks after the first TST result was read. If the second TST result is positive, it probably represents a boosted reaction, indicating infection most likely occurred in the past and not recently. If the second TST result is also negative, the person is classified as not infected.

Page 34 • July 2013

Regulations for Tuberculosis Control in Minnesota Health Care Settings

Baseline TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial

____/____/______ Date form completed

____/____/_____ Date of birth

(______)____________ Work phone number

Baseline TB screening includes three components:

(1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.

Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)

Chest pain

Night sweats

Coughing up blood

Weight loss/poor appetite

Fever/chills

Fatigue

Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result. HCW’s history (circle response) Have you ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Have you had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ Result ______________ Comments Have you ever had the BCG vaccine?

Yes

Have you ever been treated for latent TB infection?

Yes

Have you ever been treated for active TB disease?

Yes

Have you ever had an adverse reaction to a TB skin test?

Yes

Have you received a live-virus vaccine within the past 6 weeks?

Yes

TB Blood Test Name of TB blood test (circle)

QuantiFERON TB-Gold

QuantiFERON-TB-Gold InTube

T-SPOT

Date of blood draw Results Interpretation of reading (circle)

Positive*

Negative

Indeterminate

Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease

Tuberculin skin testing (TST)

TST – First Step

TST – Second Step

Administration Name of person administering test Date and time administered Location (circle)

L forearm R forearm Other:________ L forearm R forearm Other:________

____mm

Interpretation of reading* (circle)

Positive** Negative***

Positive**

Negative

Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center

Comprehensive Home Care Resource Manual – 4.07 [Name of Company] SAMPLE TREATMENT/ THERAPY MANAGEMENT PLAN Client Name: ___________________________________________________ Services being provided/ delegated to Unlicensed Personnel (ULP) include: ☐ Bed Positioning Device ☐ Occupational Therapy ☐ BiPAP ☐ Ostomy ☐ Blood Glucose Monitoring ☐ Oxygen ☐ Brace Assistance ☐ Oxygen Saturation ☐ Physical Therapy ☐ Catheter Care ☐ Compression Garments ☐ Range of Motion (ROM) ☐ CPAP ☐ Skilled Nursing ☐ Specialty Diet: ___________ ☐ INR Monitoring __________________________ ☐ Lymphedema Wraps __________________________ ☐ Nebulizer

☐ Suction ☐ Tube Feeding ☐ Vital Signs (provider ordered) ☐ Weight monitoring (provider ordered) ☐ Wound Care ☐ Other: _________________ __________________________ __________________________

Documentation of specific client instructions relating to the administration of treatments/ therapy is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: _______________________________________ Staff will notify a licensed nurse or appropriate licensed health professional when a problem arises with treatment/ therapy management services, including refusals and potential treatment inaccuracies. Specific parameters regarding treatments are also located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________ Any client specific requirements relating to documenting treatments/ therapy services are located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________ Verification that all treatments/therapy services are administered/carried out as prescribed or ordered is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________

Page 1 of 2

Comprehensive Home Care Resource Manual – 4.07 Monitoring of treatment or therapy to prevent possible complications or adverse reactions is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Routine monitoring by nurse ☐ Other: ________________________________________ **This Medication/Treatment/Therapy Management Plan will be reviewed and updated as needed. Completed by: _____________________________________________Date:___________________ (Signature and Title)

Page 2 of 2

Comprehensive Home Care Survey Self-Audit Tool

Topic: Medication Management and Administration Audited by:_____________________________ Date of Audit:___________________________

Note: The following terms and definitions are used in the Comprehensive Home Care statutes: "Medication" means a prescription or over-the-counter drug and includes dietary supplements.

"Medication administration" means performing a set of tasks to ensure a client takes medications, and includes the following: • • • • •

Checking the client's medication record Preparing the medication as necessary Administering the medication to the client Documenting the administration or reason for not administering the medication Reporting to a nurse any concerns about the medication, the client, or the client's refusal to take the medication.

"Medication management" means the provision of any of the following medication-related services to a client: • • • • • • • • •

Performing medication setup Administering medication Storing and securing medications Documenting medication activities Verifying and monitoring effectiveness of systems to ensure safe handling and administration Coordinating refills Handling and implementing changes to prescriptions Communicating with the pharmacy about the client's medications Coordinating and communicating with the prescriber

"Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the client or by comprehensive home care staff.

The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Medication Management Audit Tool Page 1 of 4

Task: 1. 2. 3. 4.

Make five copies of this blank form Retrieve home care policies and procedures regarding medication management Retrieve five random client medication records Retrieve five employee records of random unlicensed staff that perform delegated medication management services

Review the items for compliance with the following requirements:

Requirement If you provide medication management services, your home care agency has developed, implemented, and maintained current written medication management policies and procedures. Documentation exists to indicate your medication management policies and procedures were developed under the supervision and direction of a RN, licensed health professional, or pharmacist, consistent with current medical practice standards and guidelines. The medication management policies and procedures address preparing and giving medications. The medication management policies and procedures address verifying that prescription medications are administered as prescribed. The medication management policies and procedures address documenting medication administration and related activities. The medication management policies and procedures address controlling and storing medications. The medication management policies and procedures address monitoring and evaluating medication use. The medication management policies and procedures address investigating and resolving medication errors. The medication management policies and procedures address communicating with the prescriber, pharmacist, and client/client's representative regarding medication issues. The medication management policies and procedures address educating clients and client’s representatives about medications. The medication management policies and procedures address how medication supplies are monitored, how refills are ordered in a timely manner, and how medication refills are received and put into use.

Met

Not N/A Met

Requirement The medication management policies and procedures identify: 1. How the home care provider will ensure the security of medications 2. How the home care provider will ensure accountability of medications 3. How the home care provider will provide overall management of medications 4. How the home care provider will control medications 5. How the home care provider will dispose of controlled substances. If the home care provider permits unlicensed staff to provide medication management for client's within unanticipated leaves (leave not to exceed 120 hours), the provider must have a policy and procedures outlining the following: 1. Permissible situations 2. Written instructions for clients 3. Availability and use of appropriate containers 4. Labeling instructions 5. Provider contact information 6. Advance training and competency testing by a RN 7. Any special requirements for controlled substances 8. Information to be documented in the record 9. A review by a RN after the fact. Home care providers providing medication management services must have policies and procedures in place regarding the loss or spillage of controlled substances. Home care providers providing medication management services must have policies and procedures in place to investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state and federal regulations, and document the investigation in required records. If the home care provider does not require a prescription for over-thecounter medications or dietary supplements, but does manage those items, verify that the home care provider retains the items in their original labeled containers with directions for use prior to setting up or later administration. If a home care provider becomes aware of any medications or dietary supplement used by a client that were not included in the assessment for medication management services, home care provider staff advised the RN and document it in the client record. Verify that documentation exists identifying staff persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis.

Met

Not N/A Met

Requirement Verify that prescription drugs for one client are not used or saved for use by anyone other than the client it was prescribed for. Verify that when client refuse to take medications as prescribed when medication management is being provided, the refusal is documented in the client record. Verify that medications are administered by a nurse, physician, or other licensed health care practitioner authorized to administer medications OR by unlicensed personnel who have been delegated medication administration tasks by a RN. Verify that documentation shows that unlicensed personnel delegated to administer medications have been instructed by a RN in the proper methods to administer medications. Verify that documentation shows that unlicensed personnel delegated to administer medications have demonstrated competency to a RN, the ability to competently follow the medication administration procedures. Verify that RNs provide instructions to unlicensed personnel providing delegated medication management services regarding the individual needs of each client.

Met

Not N/A Met

If any applicable requirements are identified as “Not Met”, correct the situation, audit other records, procedures, forms, software, and staff responsibilities to correct the problem going forward. References: 144A.4792 Subd. 1 (b), 144A.4792 Subd. 1 (c), 144A.4792 Subd. 10, 144A.4792 Subd. 12, 144A.4792 Subd. 18, 144A.4792 Subd. 21, 144A.4792 Subd. 23 (a), 144A.4792 Subd. 23 (b), 144A.4792 Subd. 4, 144A.4792 Subd. 6, 144A.4792 Subd. 7 (1), 144A.4792 Subd. 7 (3), 144A.43 Subd. 10-13

Comprehensive Home Care Survey Self-Audit Tool

Topic: Abuse Prevention Plans Audited by:_____________________________ Date of Audit:___________________________ Note: Individualized abuse prevention plans are required to be completed for all home care clients when they become a client. Many survey deficiencies are issued when the client’s vulnerability has changed, but the abuse prevention plan has not been updated to reflect the new vulnerability along with new approaches to protect the client. Task: 1. Make five copies of this blank form 2. Retrieve five client records, preferably of client’s whose conditions or behaviors have worsened recently Review the items for compliance with the following requirements:

Requirement Each client record contains a current individualized abuse prevention plan. The client vulnerabilities outlined in the abuse prevention plan match the current status of the client. Each abuse prevention plan contains: 1. The client’s susceptibility to abuse by other individuals (including other clients) 2. The client’s risk of abusing other vulnerable adults (including other clients) 3. Statements of the specific measures to be taken by the home care agency (or others) to minimize the risk of abuse to that client and other home care clients The specific measures outlined have proven to be effective in preventing abuse to the client or against other clients.

Met

Not N/A Met

If any applicable requirements are identified as “Not Met”, correct the situation, audit other records to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward.

The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Abuse Prevention Plans Audit Tool Page 1 of 2

Hint: Vulnerabilities commonly associated with survey deficiencies: o o o o o o o o o o o o o o o o o o o o

Dialysis Dementia, Confusion, Cognitive Deficits Traumatic Brain Injury Parkinson’s Socially inappropriate behaviors (sexual) Hallucinations, Delirium Elopements Wandering into other tenants apartments Aggressive behavior (verbal, physical, threatening, combative) Inability to summon for assistance Inability to follow directions Inability to communicate needs Behavior symptoms Sensory limitations Chronic Pain Suicidal threats Frequent falls Frequent bruising Lacking ability to adhere to safety precautions consistently Unsafe smoking

Reference: 626.557 Subd. 14

Before a side rail is utilized, a number of issues should be considered and addressed, such as: What is the intended and functional purpose of the side rail? • • • •

Side rails have proven to be ineffective at keeping adult bed occupants from rolling or falling out of bed. Side rails are never to be used as a form of restraint - if they prevent the bed occupant from independently exiting the bed...they are acting as a restraint. The potential for serious injury is more likely to be related to a fall from a bed with raised side rails when the patient attempts to climb over, around, between, or through the rails, than from a bed without side rails in use. Side rails can be an effective device to assist with repositioning while in the bed or as an aid to getting into or out of the bed.

Is the home care client a safe “match” for a side rail? • •

The population at risk for entrapment are clients who are frail or elderly or those who have conditions such as agitation, delirium, confusion, pain, uncontrolled body movement, hypoxia, fecal impaction, and acute urinary retention that cause them to move about the bed or try to exit from the bed. Initial and ongoing evaluation and monitoring of the client and side rail should occur.

Will the side rail be installed, utilized, and maintained in accordance to the manufacturer’s recommendations? • • •

Side rails must be designed to work with the bed “system”, including the siderail, bed frame, and mattress. Loose or “wobbly” side rails should not be used. Side rails designed for youth or children are not meant to be used with adults and should not be used.

Does the side rail being considered meet or exceed the FDA’s dimensional guidance to reduce entrapments? • • • •

The Minnesota Department of Health has determined that in order to meet accepted health, medical, and nursing standards of practice, side rails known to be used by a client of a licensed home care provider must meet the FDA’s dimensional guidance. To meet the FDA’s dimensional guidance, each designated space in zones 1-3 must not exceed 4 3/4 inches and zone 4 must not exceed 2 3/8 inches (see front for zone pictorial). Many (not all) rental beds are sent with side rails that do not meet the FDA’s dimensional guidance to reduce entrapment. When the design and use of a side rail is unsafe; strangulation, suffocation, bodily injury, or death can occur when clients or parts of their bodies are caught between side rails or between the side rails and mattresses. Refer to the drawings to the right.

Based on the responses to these issues, an evaluation should be conducted to assess the relative risk of using the side rail compared with not using it for each individual client. Clients and their family members should be educated about possible side rail danger to enable them to make an informed decision; including options for reducing the risks of side rail use. The client’s right to participate in care planning and make choices should be balanced with the home care provider’s and caregiver’s responsibility to provide care according to an individual assessment, professional standards of care, and any applicable state and federal laws and regulations.

Drawings of Siderail Entrapments

Between January 1, 1985 and January 1, 2013, the U.S. Food and Drug Administration (FDA) received 901 incidents of patients caught, trapped, entangled, or strangled in hospitaltype beds. The reports included 531 deaths, 151 nonfatal injuries, and 220 cases where staff needed to intervene to prevent injuries.

This brochure was developed by Care Providers of Minnesota, a trade association representing providers of home care and assisted living services.

Most patients were frail, elderly or confused. Not all clients are at risk for side rail entrapment, and not all side rails and bed systems pose a risk of entrapment. Side rails can prove very useful in certain limited situations. However, side rails can also function as a form of restraint, create a danger of the client falling to the floor from a greater height, create an entrapment danger, and even be a cause of death. In response to continued reports of patient entrapments and deaths, the FDA, in partnership with the U.S. Department of Veterans Affairs, Health Canada’s Medical Devices Bureau and representatives from national health care organizations and provider groups, patient advocacy groups, and medical bed and equipment manufacturers, formed a working group in 1999 known as the Hospital Bed Safety Workgroup (HBSW). Using retrospective studies of side rail related deaths, the HBSW identified 7 potential entrapment zones in hospital beds and published side rail design dimensional guidance for bed manufacturers to minimize entrapments. Unfortunately, many side rails in use around the world do not meet the recommended dimensional guidance, and entrapment injuries and deaths continue to occur.

Using Bed Side Rails in Home Care and Assisted Living Settings

The intended purpose of this brochure includes:

• Elimination of preventable entrapments and injuries caused by the unsafe use of side rails • Elimination of preventable deaths caused by the unsafe use of side rails • Elimination of side rails acting as restraints • Provide education to providers and consumers regarding side rail safety • Provide a tool for home care agencies to use in educating clients and client’s representatives about the risks and benefits of side rails • Decrease the frequency of side rail related home care survey deficiencies issued by the Minnesota Department of Health regarding side rail use This brochure was provided by:

For more information: http://www.fda.gov/medicaldevices/productsandmedicalprocedures/ generalhospitaldevicesandsupplies/hospitalbeds/default.htm The material in this pamphlet is for informational purposes only and not for the purpose of providing medical or legal advice. The information provided is not a substitute for medical or professional care, and you should not use the information in place of a call consultation or the advice of your physician or other healthcare provider. Care Providers of Minnesota is not liable or responsible for any advice, course of treatment, diagnosis or any other information, in this pamphlet.

2015 V1.4

Entrapment Zones

Each year many home health care professionals, home care clients, and family members of clients request that a side rail be attached to a client’s bed. The basis of the request is generally to prevent a fall from the bed, provide assistance with transferring in or out of the bed, or providing assistance with repositioning while in the bed. This brochure is designed to help home care providers and home care clients better understand the potential risks and benefits resulting from the use of side rails.

Comprehensive Home Care Survey Self-Audit Tool

Topic: Client Records Audited by:_____________________________ Date of Audit:___________________________ Task: Locate the following items: 1. 2. 3. 4.

Make five copies of this blank form Retrieve a sample of five random client files Retrieve two samples of discharged client files Retrieve all policies and procedures regarding client records

Review the items for compliance with the following requirements:

Requirement There is a client record for the client and the record is: 1. Current 2. Legible 3. Permanently recorded (no pencil) 4. Dated 5. Includes the name and title of each person making an entry The client record, whether written or electronic, is protected against loss, tampering, or unauthorized disclosure. There are written policies and procedures to control the use, storage and security of the client record. The client record is readily available to home care employees or contractors authorized to access the record. The client record is maintained in a manner that allows timely access, printing or transmission, as needed. The client record contains identifying information including the client’s: 1. Name 2. Date of birth 3. Address 4. Telephone number The client record contains the name, address, and telephone number of the client’s: 1. Identified emergency contact 2. Family members 3. Client’s representative (if any) 4. Others as identified by the client

Met

Not N/A Met

The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 1 of 4

Requirement The client record contains the name, address, and telephone number of the client’s identified health and medical service providers and other home care providers that are being used by the client (if known.) The client record contains health information, including: 1. Medical history 2. Allergies 3. Any other relevant health records When the home care provider is providing medication management services, treatments or therapy services, the client record contains relevant documentation. The client record contains any advance directives such as a living will, health care directive, POLST, etc. (if any). The client record contains the current and most recent previous assessments. The client record contains the current and most recent previous service plans. The client record contains all records of communication pertinent to the client’s home care services. The client record contains documentation of significant changes in the client’s status and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional. The client record contains, in writing by an RN, specific instructions for medication management delegated to unlicensed personnel. Each medication administered is documented in the client record. Each medication administered and documented in the client record includes: 1. The signature of the person who administered the medication 2. The title of the person who administered the medication 3. The name of the medication 4. The dose of the medication 5. The date the medication was administered 6. The time the medication was administered 7. The method and route of administration If a medication is not administered as prescribed, staff have documented the reason it was not administered as prescribed and any follow-up procedures that were provided to meet the client’s needs. If the client has refused to take medication as prescribed when medication management is being provided, education/discussion and possible consequences of the client refusal is documented in the client record. Documentation in the client’s record of treatment or therapy service administered includes: 1. The signature of the person who administered the service

Met

Not N/A Met

Requirement 2. The title of the person who administered the service 3. The date and time when the service was provided The client record contains documentation that services have been provided as identified in the service plan. The client record contains documentation that the client (or client’s representative) has received and reviewed the appropriate version of the home care bill of rights. The client record contains documentation that the client (or client’s representative) has received the home care statement of disclosure and limitations of services document. The client record contains documentation of complaints received and the resolution of complaints received. The client understands they have a right to access their own records and written information from those records. If medications have been disposed of by the home care provider, documentation in the client record includes: 1. Disposition of the medication 2. The medication’s name 3. The medication’s strength 4. The medication’s prescription number (if applicable) 5. Quantity of medication disposed 6. To whom (if anyone) the medications were given, 7. Date of disposition 8. Names of staff and other individuals involved in the disposition The client record contains a discharge summary, including service termination notice and related documentation. Copies of client records are kept by the home care provider for a period of five years following a client’s discharge or termination of services. The home care provider, upon request of the client or client’s representative, provides a copy or summary of the client’s record to another home care provider, other health care practitioner or provider, or inpatient facility to assist with a coordinated transfer, when applicable.

Met

Not N/A Met

If any applicable requirements are identified as “Not Met”, correct the situation, audit other client records, forms, policies and procedures, and other sources of information to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hint: If you thin out your client records in anyway, make sure that you and your staff remember that they are part of the entire client record and are available to surveyors if needed, including making sure there is access to them if they are located in a different area than the “active” client chart. The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 3 of 4

References: MN144A.44 Subd. 1, 144A.4792 Subd. 4, 144A.4792 Subd. 7, 144A.4792 Subd. 8, 144A.4792 Subd. 22, 144A.4793 Subd. 5, 144A.4794 Subd. 1, 144A.4794 Subd. 2, 144A.4794 Subd. 3, 144A.4794 Subd. 4, 144A.4794 Subd. 5

Additional Resources: Survey Preparation & Success/Electronic Monitoring Temporary Licensed Home Care Providers Survey Forms https://www.health.state.mn.us/facilities/regulation/homecare/survey/templicensed.html Licensed Home Care Provider Survey Forms https://www.health.state.mn.us/facilities/regulation/homecare/survey/licensed.html

2021 Housing Managers' Education Series

HUMAN RESOURCE MANAGEMENT April 8, 2021

Jennifer Edwards PHR, SHRM-CP, Senior Director of Human Resources The Waters Senior Living, LLC

Thank you to our sponsor

2021 Housing Managers' Education Series

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INTRODUCTIONS Jennifer Edwards PHR, SHRM-CP, Senior Director of Human Resources The Waters Senior Living, LLC

Jenny has been in the Human Resources industry for over 15 years, with the last 13 in Senior Living/Skilled Nursing. Jenny specializes in Employee and Labor Relations, Conflict Resolution and Performance Management with experience in multi-state labor laws and compliance.

2021 Housing Managers' Education Series

HUMAN RESOURCE MANAGEMENT H o u s i n g M a n a g e rs ’ Ed u cat i o n S e r i e s C a re Pro v i d e rs o f M i n n e s o ta

Jennifer Edwards PHR, SHRM‐CP, Senior Director of Human Resources

Agenda – Human Resource Management • • • •

Screening and Selection Practices Policy and Procedures Turnover and Retention Compliance and HR Audits

2021 Housing Managers' Education Series

Screening & Selection

Staffing & Selection Job Posting • New Position – job description, market analysis • Posting • Qualifications • Requirements vs. Preferred • Location – job boards, employment websites, local colleges, flyers in the community, print ads?? • Tracking Applications

2021 Housing Managers' Education Series

Recruiting Ideas

Market Adjustments If you determine that you are not receiving quality applicants, you will want to review how competitive you are in your market. Your “market” consists of other Skilled Nursing, Assisted Living, and Home Health Agencies where you may be losing applicants. Once determined that you are not competitive, the following process can be used: • Collect competitor wages • Review on‐line data such as Monster.com salary information, MN Department of Employment and Economic Development (DEED) • Determine costs (current staff and new hires) • Receive the appropriate approval

2021 Housing Managers' Education Series

Candidate Experience • Who will be involved in the hiring process? • Determine ahead of time what you are looking for in your ideal candidate. • Successful phone screening • Make sure that you understand the position • Plan the time accordingly • Be prepared – and on time • Traditional vs. Behavioral Based • Prepared questions – consistent questions • Tour

INTERVIEW EXERCISE Discriminatory Questions

2021 Housing Managers' Education Series

Selection Determine who the best candidate is based on the interview process. Conduct due‐diligence reference checks, attempt to obtain at least 2, document your attempts. • Previous employers • Personal references Make a job offer conditional on license verifications and background screening process.

Onboarding Orientation Schedule Mentor Program New Hire Checklist Personnel Files Think back to your first day of work. Was it a good or bad experience. What made it that way? If we set up our new hires for success right from day one, the odds of retaining them long‐term rises exponentially.

2021 Housing Managers' Education Series

Orientation Schedule & Details Determine who will participate in the orientation and how long will be given to each participant. How many days will be needed for orientation? Communicate the details for the orientation to your new hires prior to the date. Be prepared for the first day 15

Policy & Procedure

2021 Housing Managers' Education Series

Policy and Procedure Handbook Policies Conduct and Discipline Acknowledgement of Receipt Supervisor Manual Forms

Social Media National Labor Relations Act – Section VII – Provides your employees with the right to engage in concerted activities for the purpose of mutual aid or protection. They have the right to band together for their collective good. Section VIII – Prohibits employers from interfering or penalizing for their exercise of Section VII. 18

2021 Housing Managers' Education Series

Conduct & Discipline The failure to maintain a consistent strategy of managing performance and holding associate accountable results in turnover and staffing issues, as well as claims and charges against the organization for discrimination, wrongful termination, and others. Even while in the midst of a staffing “crisis”, you still need to maintain the same level of performance expectations in order to be seen as a credible leader in the facility. So when there is a performance problem identified, what should you do?

Methods of Corrective Action Investigative Suspension‐ Take as much time as needed Documented Education/Coaching Notice of Discipline – Verbal, Written, Final Written Termination

2021 Housing Managers' Education Series

Performance Evaluations There should be nothing on a performance evaluation that the employee doesn’t already know about. Performance management should be timely and specific. Evaluations should accurately reflect the employee’s overall job performance.

Documentation ‐ when should it happen        

Annual performance evaluations Commendations Changes in job status When any performance problem arises Correction plans/disciplinary actions Performance improvement plans Termination Employee voluntarily quits

2021 Housing Managers' Education Series

Why to Document  Better outcomes as a result of good documentation  Consistent practices and treatment of employees  Positive employee morale, job satisfaction, and job performance  Improved overall quality of care for residents

 Peace of mind ‐ knowing documentation is in order if needed

Corrective Action Do:  Use plain non‐technical language  Use verified facts  Explain actual or potential harm that resulted  State expectations for future  State consequences of further violations  Follow internal policies  Sign documents

Avoid:  Inconsistent Messages  Overuse of “insubordination”  Favoritism  Passing the buck  Using pretextual criticisms  Use of hyperbole or inflammatory language  References to protected class status

2021 Housing Managers' Education Series

2018 Housing Managers’ Education Series

Supervisory Files – Employee Relations Include: Notes or records relating to the following:  Informal or formal employee counseling sessions  Employee attendance reviews  Observations of employee work performance  Re‐education or re‐training received by the employee  Investigation notes and witness statements

Do Not Include: Because this file is not the employee's official personnel file, copies of the following shall not be kept in the supervisory file:  Letters/correspondence related to disciplinary matters  Notices of official disciplinary action  Notices of less than good service ratings  A notation in the file that such action did occur is permissible

Emails and Email Files Should contain:

Should not contain:

Professional exchanges

Gossip

Objective information

Rumor

Just the facts

Insensitivity to relationships Lack of candor Suggestions of not enforcing policies and procedures Personal observations or opinions

When in doubt – use the phone! 26

2021 Housing Managers' Education Series

Final Thoughts on Documentation  Assume whatever you write may be seen by a third party ◦ Be objective ◦ Be descriptive ◦ Avoid opinions ◦ Avoid judgments ◦ Be mindful of tone  Assume the third party is not familiar with long‐term care ◦ Provide appropriate descriptions and information  Identify the purpose of the document ◦ i.e., investigative note, witness statement, summary of complaint, and investigative findings

The Best Documentation Wins

2021 Housing Managers' Education Series

Turnover & Retention

WHAT IS THE COST OF TURNOVER???

2021 Housing Managers' Education Series

Turnover Management Employees rarely leave over wages. They leave because of their manager. Or a toxic work culture! Respect at Work ‐ #1 Job Satisfaction Factor in SHRM Study 2017 A majority of employees leave within the first year of employment‐ When are we losing them? 30/60/90‐365 turnover Where are we losing them? Department, Unit, Shift KNOW YOUR DATA

2021 Housing Managers' Education Series

Retention Tools Turnover Management‐Root Cause Analysis Exit Interviews Employee Satisfaction Surveys  Review Results  Develop Action Plans Complaint Resolution/Open Door Policy Performance Evaluations Leadership  Rounding – know your employees on ALL shifts  Communication – Performance Evaluations  Effective Meetings  Stay Interviews

2021 Housing Managers' Education Series

Stay Interview Questions Informal/Casual Conversation: • • • • • • • • • • • •

What do you look forward to when you come to work each day? What do you like most or least about working here? What keeps you working here? If you could change one thing about your job, what would that be? What would make your job more satisfying? How do you like to be recognized? What talents are not being used in your current role? What would you like to learn or develop here? What motivates you? Or what demotivates you? What can I do to support you? What can I do more (or less) of as your manager? What might tempt you to leave?

Summarize the conversation, develop a plan of action if necessary, share your appreciation with the employee.

New Hire Questions 30 Day Check‐In Done by hiring manager Is this the job what I told you it would be? What’s working well? Who has been very helpful ‐ whom should I thank for you? Watch for names never mentioned Can you tell me something from your last job that we could do to improve? 90 Day Check‐In : Same as 30 Days PLUS: Do you know someone we could call?

2021 Housing Managers' Education Series

“Probationary Period” What is the magic of 90 days? Performance expectations are the same on day 35, 57, 89 or 91. Good retention begins during the hiring process 37

Compliance & HR Audits

2021 Housing Managers' Education Series

Employment at Will Employee or Employer can end the employment relationship without reason and without notice

Employment at Will vs. Just Cause • Manage to your employee handbook and policies • Ensure there’s an acknowledgement of receipt • Confirm – did the employee understand the “rule”? • Did they know they could be disciplined? • Is there objective evidence? • Is the action reasonable – consistent and appropriate? 40

2021 Housing Managers' Education Series

Department of Labor ‐ Audits •Wage and Hour • Overtime • Time Management • Breaks • Bonus Structures • FLSA Classifications • Contractor Status •FMLA 41

Department of Labor Overtime:

• Must define the work week – 40 hours or 8/80 option for healthcare – 168 Hour period for Work Week (can vary by job classification) • Include in Calculation: worked hours, training, travel time, bonus programs • Not Included: PTO, On‐call

Timekeeping:

• Signed timecard edits • Break punches

2021 Housing Managers' Education Series

Department of Labor FLSA Exemption: A. Salary Basis:

◦ As of 1/1/2020 $684 per week – allowing certain bonuses and incentive payments to be included in that wage

B. Job Duties Tests: 1. Executive – Managing the enterprise or subdivision, directing work for 2 or more FTE’s, having the authority to hire/fire 2. Professional – Work required advanced knowledge, field of science or learning acquired by prolonged course instruction, and performs work requiring the consistent exercise of discretion and judgement. 3. Administrative – Managing general business operations, including exercise of discretion and independent judgment with respect to matters of significance 4. Computer – programmer, engineer, analyst with work including design, development, testing, etc. 5. Outside Sales – Making sales or obtaining orders or contracts for services and regularly engaged away from the employer’s place of business

Employee vs. Contractor EMPLOYEE

• Instructions on when, where, and how to complete the work • Training provided • Little or no personal investment in tools • Paid wages or commissions • No written contract • Covered by employer benefit plans

CONTRACTOR

• Worker decides when to work within deadlines • Little to no training • Provides own work tools and equipment • Typically flat fee for the job • Written contract with clear terms • Not included in benefit programs

2021 Housing Managers' Education Series

Bermuda Triangle of Employment Workers’ Compensation

Americans With Disabilities Act

Leaves of Absence

Family Medical Leave Act

FMLA Compliance Steps to full Compliance: 1. Post the revised FMLA Poster “Employee Rights and Responsibilities Under the Family and Medical Leave Act” – last revised April 2016 2. Within 5 business days after employee informs you of the need for leave, must complete and provide the employee with Notice of Eligibility and Rights & Responsibilities. 3. Attach with this notice the Appropriate Medical Certification Form. 4. Provide at least 15 Calendar days to return the certification form. 5. Within 5 business days of receiving the certification form, the employer must complete and provide the employee with designation notice. FMLA Guidance and Forms: http://www.dol.gov/whd/fmla/

2021 Housing Managers' Education Series

Americans with Disabilities Act (ADA.gov) Prohibits discrimination and guarantees that people with disabilities have the same opportunities as everyone else to participate in the mainstream of American life – to enjoy employment opportunities, to purchase goods and services, and to participate in State and local government programs and services. Covered Employers: 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year

Covered Employees (and Applicants!):

◦ Physical or mental impairment that substantially limits one or more major life activity; or, ◦ Has a record of such an impairment; or ◦ Is regarded as having such an impairment

Americans with Disabilities Act cont’d Qualified employee or applicant – with a disability who with or without a reasonable accommodation can perform the essential functions of the position that such individual holds or desires ****Job Descriptions**** Interactive Process – • Review and analyze essential job requirements • Determine from discussions with the individual and information provided by healthcare providers any specific job related limitations caused by the impairment • Determine specific reasonable accommodation(s) that would allow the individual to perform the essential function of the job • Document and retain all notes and written communications

2021 Housing Managers' Education Series

Workers’ Compensation Insurance to provide wage replacement and medical benefits to an employee injured in the course of employment in exchange of the employee’s relinquishment of their right to sue for negligence. Indemnity – works with FMLA, typically 2/3 of wages paid Return to Work – works with ADA if total disability is determined, then interactive process may be necessary Experience Modification Rate: ◦ 3 years look back ◦ 1. 0 = Average in Industry ◦ Manage claims frequency and severity

Compliance with Policies Equal Employment Opportunity Affirmative Action Whistleblower – Retaliation COBRA Jury Duty/Witness Leave Voting Access to Personnel Files Lactation Support Bone Marrow Donation and Organ Donor Leave Breaks

Parental/Adoption Leave School, Conferences, and Activities Leave FMLA – to include military leave Drug Testing Confidentiality – HIPAA Sexual Harassment Electronic Communications Code of Conduct, Ethics, and Corporate Compliance

2021 Housing Managers' Education Series

Human Resources Audit 1. Department of Labor 2. Employee Safety 3. Staffing and Selection 4. Employee Relations 5. Training

Resources FLSA Overtime Security Advisor: http://www.dol.gov/elaws/esa/flsa/overtime/menu.htm MN Department of Labor – Frequently Asked Questions: http://www.dli.mn.gov/LS/FaqWages.asp FMLA Guidance and Forms: http://www.dol.gov/whd/fmla/ National Right to Work http://www.nrtw.org/ Minnesota Department of Human Rights http://mn.gov/mdhr/employers/index.html

2021 Housing Managers' Education Series

Questions

www.careproviders.org (952) 854-2844

BEHAVIORAL BASED INTERVIEW QUESTIONS

•

Describe a situation in which you were able to use persuasion to successfully convince someone to see things your way.

•

Describe a time when you were faced with a stressful situation that demonstrated your coping skills.

•

Give me a specific example of a time when you used good judgment and logic in solving a problem.

•

Give me an example of a time when you set a goal and were able to meet or achieve it.

•

Tell me about a time when you had to use your presentation skills to influence someone's opinion.

•

Give me a specific example of a time when you had to conform to a policy with which you did not agree.

•

Please discuss an important written document you were required to complete.

•

Tell me about a time when you had to go above and beyond the call of duty in order to get a job done.

•

Tell me about a time when you had too many things to do and you were required to prioritize your tasks.

•

Give me an example of a time when you had to make a split second decision.

•

What is your typical way of dealing with conflict? Give me an example.

•

Tell me about a time you were able to successfully deal with another person even when that individual may not have personally liked you (or vice versa).

•

Tell me about a difficult decision you've made in the last year.

•

Give me an example of a time when something you tried to accomplish and failed.

•

Give me an example of when you showed initiative and took the lead.

•

Tell me about a recent situation in which you had to deal with a very upset customer or co-worker.

•

Give me an example of a time when you motivated others.

•

Tell me about a time when you delegated a project effectively.

•

Give me an example of a time when you used your fact-finding skills to solve a problem.

•

Tell me about a time when you missed an obvious solution to a problem.

•

Describe a time when you anticipated potential problems and developed preventive measures.

•

Tell me about a time when you were forced to make an unpopular decision.

•

Please tell me about a time you had to fire a friend.

•

Describe a time when you set your sights too high (or too low).

Additional Resources: Human Resource Management US Department of Labor & Industry, Wage and Hour Division Employer fact sheets, posters, resources https://www.dol.gov/agencies/whd Here is the minimum wage information for MN: https://www.dli.mn.gov/business/employment-practices/minimum-wage-minnesota Minneapolis minimum wage: http://minimumwage.minneapolismn.gov/ St. Paul minimum wage: https://www.stpaul.gov/departments/human-rights-equal-economic-opportunity/labor-standardsenforcement-and-education-0 FMLA eligibility/Covered Employers: https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/whdfs28.pdf

2021 HOUSING MANAGERS’ EDUCATION SERIES

APPENDIX

2021 HOUSING MANAGERS’ EDUCATION SERIES

APPENDIX OF OTHER RESOURCES A. 2019 Statutes  Basic Home Care  Comprehensive Home Care  Housing with Services  Assisted Living  Vulnerable Adults Act  Electronic Monitoring  Disclosure of Special Care Status B. Statement of Home Care Services C. MDH Website References for Housing with Services and Home Care D. Reporting—Minnesota Vulnerable Adults Act and MAARC E. Federal Fair Housing Act Guidance F. EW Residential Services (Customized Living) - Workbook – Released 2/11/2020.  Printout of select pages from workbook  Customized Living Component Service Definitions: A Reference Guide for Computing Time for Rate-Setting Tools Additional resources: https://mn.gov/dhs/partners-and-providers/policies-procedures/ aging/elderly-waiver-residential-services/ G. New Laws Affecting Assisted Living/Home Care  Changes to Licensed Comprehensive Home Care Regulations  Assisted Living Licensure  Retaliation Prohibited in a Registered Housing with Services Establishment  HWS-AL Sample Retaliation Policy  Do I need an AL License–Decision Tree  Routes to becoming an Assisted Living Director–Flow Chart  I’m OK Check–Decision Tree H. Electronic Monitoring  Electronic Monitoring FAQs

2021 HOUSING MANAGERS’ EDUCATION SERIES

2 0 1 9

STATUTES

BASI CHOMECARE COMPREHENSI V EHOMECARE HOUSI NGWI THSERV I CES ASSI STEDL I V I NG V UL NERABL EADUL T SACT EL ECTRONI CMONI TORI NG DI SCL OSUREOFSPECI ALCAREST A TUS

7851 Metro Parkway, Suite 200 Bloomington, MN 55425 952-854-2844 800-462-0024

2019 Statutes

Home Care (Basic & Comprehensive)—144A Housing with Services—144D Assisted Living—144G Vulnerable Adults Act Reporting—626.557 Electronic Monitoring—144.6502 Disclosure of Special Care Status—325F.72

BASIC HOME CARE COMPREHENSIVE HOME CARE HOUSING WITH SERVICES ASSISTED LIVING VULNERABLE ADULTS ACT ELECTRONIC MONITORING

2019 STATUTES HOME CARE STATUTES—144A

DISCLOSURE OF SPECIAL CARE STATUS

PAGE #

Acceptance of Clients

Advertising

Assessments—Client Review & Monitoring—Basic License

Assessments—Temporary Plan for Initiation of Services

Assessments & Monitoring—Comprehensive License

38, 41 & 42

Background Studies—New License Application Owners & Managers

Background Studies—Staﬀ, Contractors & Volunteers

Basic Home Care Description

Bill of Rights Bill of Rights—Assisted Living Addendum

5 7

Bill of Rights—Notiﬁcation to Clients

Client Records— Required

Client Records—Access to Records

Client Records—Record Retention

Client Records—Required Contents

Client Records—Transfer of Records to Other Provider

Complaints—Record Retention

Complaints—Policies, Investigation and Documentation

Comprehensive Home Care Description

Deﬁnitions Dementia & Alzheimer's Disease—Notice & Staﬀ Training Requirements

1 37 & 52

Direct Home Care Services Deﬁnition

Disaster & Emergency Preparedness Plan

Discontinuing Life-Sustaining Treatment

Handling of Client Finances

Hearings

Home Care & Assisted Living Advisory Council

Infection Prevention—Communicable Diseases

Infection Prevention—Infection Control Program

Infection Prevention—TB

Innovation Variance

License—Applications

License—Changes in Ownership (CHOWs)

License—Display of License

License—Exclusions from Home Care Licensure

HOME CARE STATUTES—144A

PAGE #

License—Exemptions from Home Care Licensure

License—Fees & Renewal Fees

License—Immediate Temporary Suspension

License—Renewal

License—Required

License—Suspension or Conditional Licenses

License—Temporary/Initial Licenses Maltreatment Compensation Fund

19 24 & 26

Maltreatment Reporting—Vulnerable Adults Act

Medicare Certiﬁed Providers—Coordination of Surveys

Medicare Certiﬁed Providers—Equivalencies

Medication Management—Administration of Medications

Medication Management—Assessment & Provision of Services

41 & 42

Medication Management—Client Refusal

Medication Management—Clients Who Will Be Away From Home

Medication Management—Delegation to Unlicensed Personnel

Medication Management—Documentation of Administration

Medication Management—Documentation of Medication Setup

Medication Management—General

Medication Management—Individualized Medication Management Plan

Medications—Disposal or Disposition

Medications—Loss or Spillage

Medications—OTC & Dietary Supplements Not Prescribed

Medications—Packaging & Original Containers

Medications—Prescribed & Nonprescribed

Medications—Prohibition of Sharing Medications

Medications—Provided by Client or Family Members

Medications—Storage

Prescriptions— Renewals

Prescriptions—Records Conﬁdential

Prescriptions—Required for Managed Medications

Prescriptions—Verbal Orders

Quality Management Requirement

Referrals to Other Providers of Services

Regularly Engaged Home Care Services—Deﬁnition

Service Plan—Required Elements, Implementation & Revisions

Service Plan—Termination of Service Plan

Staﬀ—Training & Competency Evaluations for Unlicensed Staﬀ

Staﬀ—Availability of Staﬀ for Consultation

Staﬀ—Delegation of Home Care Tasks

Staﬀ—Documentation of Required Annual Training

Staﬀ—Documentation of Required Orientation

Staﬀ—Documentation of Supervision of Staﬀ Performing Home Care Services

Staﬀ—Employee Records

Staﬀ—Individual Contractors

Staﬀ—Nurses & Other Licensed Health Professionals

Staﬀ—Qualiﬁcations, Training & Competency

HOME CARE STATUTES—144A

PAGE #

Staﬀ—Required Annual Training

Staﬀ—Required Orientation Topics

Staﬀ—Supervision of Staﬀ Performing Home Care Services

Staﬀ—Temporary Staﬀ

Staﬀ—Unlicensed Personnel Qualiﬁcations

Statement of Home Care Services

Surveys—Fines for Correction Orders

Surveys—Fines for Maltreatment

Surveys—Frequency

9 & 20 & 22

Surveys—Process

Surveys—Reconsiderations for Correction Orders

Surveys—Correction Orders

Surveys—Enforcement

Surveys—Follow-Up Surveys

Surveys—Level & Scope of Correction Orders

Surveys—Temporary/Initial License Survey

Surveys—Types of Surveys

Termination of Home Care Services (AL)

Treatments & Therapies—Administration

Treatments & Therapies—Documentation

Treatments & Therapies—Elements of an Individualized Plan

Treatments & Therapies—Orders or Prescriptions

Treatments & Therapies—Policies & Procedures

Treatments & Therapies—Provision of Services

HOUSING WITH SERVICES STATUTES—144D

PAGE #

Arranged Home Care Provider Disclosure

Contracts—Documentation and Storage

Contracts—Record Retention

Contracts—Required Elements for Housing with Services

Deﬁnitions—Housing with Services Establishments

Dementia Care Training Required

Dementia Care Training—Enforcement and Fines

Housing with Services—Emergency Planning and Preparedness

Housing with Services—Manager Requirements

Housing with Services—Optional Registration

Housing with Services—Registration Required

Lease—Terminations

Long-Term Care Insurance—Deﬁnition

Other Laws

Registration of Housing with Services

Restraints

ASSISTED LIVING STATUTES—144G

PAGE #

Assisted Living—Assistance with Arranged Home Care Providers

Assisted Living—Awake Staﬀ Exemption

ASSISTED LIVING STATUTES—144G

PAGE #

Assisted Living—Nursing Assessment

Assisted Living—Termination of Housing with Services Contract

Assisted Living Term—Annual Registration with HWS Registration

Assisted Living Term—Title Protection

Minimum Requirements for Assisted Living

Reimbursement Under Assisted Living Service Packages

Reservation of Rights

Retaliation—Determined by Commissioner of Health

Retaliation Prohibited

Retaliation Prohibited —Employee

Retaliation Prohibited —Resident

Uniform Consumer Information Guide

August 1, 2021, Assisted Living Licensure

VULNERABLE ADULT ACT REPORTING STATUTES—626.557

77-159

PAGE #

Abuse Prevention Plans

174

VAA—Deﬁnitions—Abuse

177

VAA—Deﬁnitions—Accident

178

VAA—Deﬁnitions—Facility

178

VAA—Deﬁnitions—Financial Exploitation

179

VAA—Deﬁnitions—Immediate

179

VAA—Deﬁnitions—Maltreatment

180

VAA—Deﬁnitions—Mandated Reporter

180

VAA—Deﬁnitions—Neglect

180

VAA—Deﬁnitions—Vulnerable Adult VAA—External Investigation Requirements VAA—Information Required in Report

182 265 - 174 164

VAA—Internal Reporting

162

VAA—Protections for Reporters

163

VAA—Report Not Required VAA—Retaliation Prohibited for Good Faith Reporting VAA—Timing of Required Reports

ELECTRONIC MONITORING STATUTES—144.6502

161 & 162 175 161 & 162

PAGE #

Consent Form—Required Elements

186

Consent Notiﬁcation—Exceptions—Notiﬁcation to OOLCT

185

Consent Notiﬁcation to Facilities

185

Consent to Electronic Monitoring

183

Electronic Monitoring—Deﬁnitions

183

Electronic Monitoring—Admissibility of Evidence

188

Electronic Monitoring—Dissemination of Recordings

188

Electronic Monitoring—Liability

188

Electronic Monitoring—OOLTC Immunity from Liability

188

Electronic Monitoring—Penalties

188

ELECTRONIC MONITORING STATUTES—144.6502

PAGE #

Electronic Monitoring—Required Signs at Public Entrances

187

Electronic Monitoring Authorized

183

Electronic Monitoring Device—Costs and Installation

187

Electronic Monitoring Device—Obstruction

187

Employee Discipline Related to Electronic Monitoring

188

Resident Protections Related to Electronic Monitoring

188

Roommate Refusal of Consent Related to Electronic Monitoring

184

DISCLOSURE OF SPECIAL CARE STATUS—325F.72

PAGE #

Disclosure of Special Care Status

191

Required Elements of Disclosure

191

MINNESOTA STATUTES 2019

144A.43

Minnesota's Comprehensive and Basic Licensed Home Care Regulations

HOME CARE PROGRAM 144A.43 DEFINITIONS. Subdivision 1. Applicability. The definitions in this section apply to sections 144.699, subdivision 2,and 144A.43 to 144A.482. Subd. 1a. Agent. "Agent" means the person upon whom all notices and orders shall be served and who is authorized to accept service of notices and orders on behalf of the home care provider. Subd. 1b. Applicant. "Applicant" means an individual, organization, association, corporation, unit of government, or other entity that applies for a temporary license, license, or renewal of the applicant's homecare provider license under section 144A.472. Subd. 1c. Client. "Client" means a person to whom home care services are provided. Subd. 1d. Client record. "Client record" means all records that document information about the homecare services provided to the client by the home care provider. Subd. 1e. Client representative. "Client representative" means a person who, because of the client'sneeds, makes decisions about the client's care on behalf of the client. A client representative may be aguardian, health care agent, family member, or other agent of the client. Nothing in this section expands ordiminishes the rights of persons to act on behalf of clients under other law. Subd. 2. Commissioner. "Commissioner" means the commissioner of health. Subd. 2a. Controlled substance. "Controlled substance" has the meaning given in section 152.01,subdivision 4. Subd. 2b. Department. "Department" means the Minnesota Department of Health.

144A.43

MINNESOTA STATUTES 2019

Subd. 2c. Dietary supplement. "Dietary supplement" means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars, or metabolites. Subd. 2d. Dietitian. "Dietitian" is a person licensed under sections 148.621 to 148.633. Subd. 2e. Dietetics or nutrition practice. "Dietetics or nutrition practice" is performed by a licensed dietitian or licensed nutritionist and includes the activities of assessment, setting priorities and objectives, providing nutrition counseling, developing and implementing nutrition care services, and evaluating and maintaining appropriate standards of quality of nutrition care under sections 148.621 to 148.633. Subd. 3. Home care service. "Home care service" means any of the following services delivered in the home of a person whose illness, disability, or physical condition creates a need for the service: (1) assistive tasks provided by unlicensed personnel; (2) services provided by a registered nurse or licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; (3) medication and treatment management services; or (4) the provision of durable medical equipment services when provided with any of the home care services listed in clauses (1) to (3). Subd. 3a. Hands-on assistance. "Hands-on assistance" means physical help by another person without which the client is not able to perform the activity. Subd. 3b. Home. "Home" means the client's temporary or permanent place of residence. Subd. 4. Home care provider. "Home care provider" means an individual, organization, association, corporation, unit of government, or other entity that is regularly engaged in the delivery of at least one home care service, directly in a client's home for a fee and who has a valid current temporary license or license issued under sections 144A.43 to 144A.482. Subd. 5. [Repealed by amendment, 2013 c 108 art 11 s 7] Subd. 6. License. "License" means a basic or comprehensive home care license issued by the commissioner to a home care provider. Subd. 7. Licensed health professional. "Licensed health professional" means a person, other than a registered nurse or licensed practical nurse, who provides home care services within the scope of practice of the person's health occupation license, registration, or certification as regulated and who is licensed by the appropriate Minnesota state board or agency. Subd. 8. Licensee. "Licensee" means a home care provider that is licensed under this chapter. Subd. 9. Managerial official. "Managerial official" means an administrator, director, officer, trustee, or employee of a home care provider, however designated, who has the authority to establish or control business policy. Subd. 10. Medication. "Medication" means a prescription or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements.

MINNESOTA STATUTES 2019

144A.43

Subd. 11. Medication administration. "Medication administration" means performing a set of tasks that include the following: (1) checking the client's medication record; (2) preparing the medication as necessary; (3) administering the medication to the client; (4) documenting the administration or reason for not administering the medication; and (5) reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the client, or the client's refusal to take the medication. Subd. 12. Medication management. "Medication management" means the provision of any of the following medication-related services to a client: (1) performing medication setup; (2) administering medication; (3) storing and securing medications; (4) documenting medication activities; (5) verifying and monitoring effectiveness of systems to ensure safe handling and administration; (6) coordinating refills; (7) handling and implementing changes to prescriptions; (8) communicating with the pharmacy about the client's medications; and (9) coordinating and communicating with the prescriber. Subd. 12a. Medication reconciliation. "Medication reconciliation" means the process of identifying the most accurate list of all medications the client is taking, including the name, dosage, frequency, and route by comparing the client record to an external list of medications obtained from the client, hospital, prescriber, or other provider. Subd. 13. Medication setup. "Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the client or by comprehensive home care staff. Subd. 14. Nurse. "Nurse" means a person who is licensed under sections 148.171 to 148.285. Subd. 15. Occupational therapist. "Occupational therapist" means a person who is licensed under sections 148.6401 to 148.6449. Subd. 16. Over-the-counter drug. "Over-the-counter drug" means a drug that is not required by federal law to bear the symbol "Rx only." Subd. 17. Owner. "Owner" means a proprietor, a general partner, a limited partner who has five percent or more equity interest in a limited partnership, a person who owns or controls voting stock in a corporation in an amount equal to or greater than five percent of the shares issued and outstanding, or a corporation that owns equity interest in a licensee or applicant for a license.

144A.43

MINNESOTA STATUTES 2019

Subd. 18. Pharmacist. "Pharmacist" has the meaning given in section 151.01, subdivision 3. Subd. 19. Physical therapist. "Physical therapist" means a person who is licensed under sections 148.65 to 148.78. Subd. 20. Physician. "Physician" means a person who is licensed under chapter 147. Subd. 21. Prescriber. "Prescriber" means a person who is authorized by sections 148.235; 151.01, subdivision 23; and 151.37 to prescribe prescription drugs. Subd. 22. Prescription. "Prescription" has the meaning given in section 151.01, subdivision 16a. Subd. 23. Regularly scheduled. "Regularly scheduled" means ordered or planned to be completed at predetermined times or according to a predetermined routine. Subd. 24. Reminder. "Reminder" means providing a verbal or visual reminder to a client. Subd. 25. Respiratory therapist. "Respiratory therapist" means a person who is licensed under chapter 147C. Subd. 26. Revenues. "Revenues" means all money received by a licensee derived from the provision of home care services, including fees for services and appropriations of public money for home care services. Subd. 27. Service plan. "Service plan" means the written plan between the client or client's representative and the temporary licensee or licensee about the services that will be provided to the client. Subd. 28. Social worker. "Social worker" means a person who is licensed under chapter 148D or 148E. Subd. 29. Speech-language pathologist. "Speech-language pathologist" has the meaning given in section 148.512. Subd. 30. Standby assistance. "Standby assistance" means the presence of another person to assist a client with an assistive task by providing cues, oversight, and minimal physical assistance. Subd. 31. Substantial compliance. "Substantial compliance" means complying with the requirements in this chapter sufficiently to prevent unacceptable health or safety risks to the home care client. Subd. 32. Survey. "Survey" means an inspection of a licensee or applicant for licensure for compliance with this chapter. Subd. 33. Surveyor. "Surveyor" means a staff person of the department authorized to conduct surveys of home care providers and applicants. Subd. 34. Temporary license. "Temporary license" means the initial basic or comprehensive home care license the department issues after approval of a complete written application and before the department completes the temporary license survey and determines that the temporary licensee is in substantial compliance. Subd. 35. Treatment or therapy. "Treatment" or "therapy" means the provision of care, other than medications, ordered or prescribed by a licensed health professional provided to a client to cure, rehabilitate, or ease symptoms. Subd. 36. Unit of government. "Unit of government" means every city, county, town, school district, other political subdivisions of the state, or agency of the state or federal government, which includes any instrumentality of a unit of government.

MINNESOTA STATUTES 2019

144A.44

Subd. 37. Unlicensed personnel. "Unlicensed personnel" are individuals not otherwise licensed or certified by a governmental health board or agency who provide home care services in the client's home. Subd. 38. Verbal. "Verbal" means oral and not in writing. History: 1987 c 378 s 3; 1989 c 194 s 1; 1989 c 304 s 137; 1992 c 513 art 6 s 5,6; 1995 c 207 art 9 s 20; 1997 c 22 art 2 s 2,8; 1997 c 113 s 1; 2002 c 252 s 2-4,24; 2009 c 174 art 2 s 4; 2013 c 108 art 11 s 7; 2014 c 275 art 1 s 135; 2016 c 158 art 1 s 59; 1Sp2017 c 6 art 11 s 54; 1Sp2019 c 9 art 11 s 38-40 144A.44 HOME CARE BILL OF RIGHTS. Subdivision 1. Statement of rights. (a) A client who receives home care services in the community or in an assisted living facility licensed under chapter 144G has these rights: (1) receive written information, in plain language, about rights before receiving services, including what to do if rights are violated; (2) receive care and services according to a suitable and up-to-date plan, and subject to accepted health care, medical or nursing standards and person-centered care, to take an active part in developing, modifying, and evaluating the plan and services; (3) be told before receiving services the type and disciplines of staff who will be providing the services, the frequency of visits proposed to be furnished, other choices that are available for addressing home care needs, and the potential consequences of refusing these services; (4) be told in advance of any recommended changes by the provider in the service plan and to take an active part in any decisions about changes to the service plan; (5) refuse services or treatment; (6) know, before receiving services or during the initial visit, any limits to the services available from a home care provider; (7) be told before services are initiated what the provider charges for the services; to what extent payment may be expected from health insurance, public programs, or other sources, if known; and what charges the client may be responsible for paying; (8) know that there may be other services available in the community, including other home care services and providers, and to know where to find information about these services; (9) choose freely among available providers and to change providers after services have begun, within the limits of health insurance, long-term care insurance, medical assistance, other health programs, or public programs; (10) have personal, financial, and medical information kept private, and to be advised of the provider's policies and procedures regarding disclosure of such information; (11) access the client's own records and written information from those records in accordance with sections 144.291 to 144.298; (12) be served by people who are properly trained and competent to perform their duties; (13) be treated with courtesy and respect, and to have the client's property treated with respect;

144A.44

MINNESOTA STATUTES 2019

(14) be free from physical and verbal abuse, neglect, financial exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment of Minors Act; (15) reasonable, advance notice of changes in services or charges; (16) know the provider's reason for termination of services; (17) at least ten calendar days' advance notice of the termination of a service by a home care provider, except at least 30 calendar days' advance notice of the service termination shall be given by a home care provider for services provided to a client residing in an assisted living facility as defined in section 144G.08, subdivision 7. This clause does not apply in cases where: (i) the client engages in conduct that significantly alters the terms of the service plan with the home care provider; (ii) the client, person who lives with the client, or others create an abusive or unsafe work environment for the person providing home care services; or (iii) an emergency or a significant change in the client's condition has resulted in service needs that exceed the current service plan and that cannot be safely met by the home care provider; (18) a coordinated transfer when there will be a change in the provider of services; (19) complain to staff and others of the client's choice about services that are provided, or fail to be provided, and the lack of courtesy or respect to the client or the client's property and the right to recommend changes in policies and services, free from retaliation including the threat of termination of services; (20) know how to contact an individual associated with the home care provider who is responsible for handling problems and to have the home care provider investigate and attempt to resolve the grievance or complaint; (21) know the name and address of the state or county agency to contact for additional information or assistance; (22) assert these rights personally, or have them asserted by the client's representative or by anyone on behalf of the client, without retaliation; and (23) place an electronic monitoring device in the client's or resident's space in compliance with state requirements. (b) When providers violate the rights in this section, they are subject to the fines and license actions in sections 144A.474, subdivision 11, and 144A.475. (c) Providers must do all of the following: (1) encourage and assist in the fullest possible exercise of these rights; (2) provide the names and telephone numbers of individuals and organizations that provide advocacy and legal services for clients and residents seeking to assert their rights; (3) make every effort to assist clients or residents in obtaining information regarding whether Medicare, medical assistance, other health programs, or public programs will pay for services; (4) make reasonable accommodations for people who have communication disabilities, or those who speak a language other than English; and

MINNESOTA STATUTES 2019

144A.442

(5) provide all information and notices in plain language and in terms the client or resident can understand. (d) No provider may require or request a client or resident to waive any of the rights listed in this section at any time or for any reasons, including as a condition of initiating services or entering into an assisted living contract. Subd. 2. Interpretation and enforcement of rights. These rights are established for the benefit of clients who receive home care services. All home care providers, including those exempted under section 144A.471, must comply with this section. The commissioner shall enforce this section and the home care bill of rights requirement against home care providers exempt from licensure in the same manner as for licensees. A home care provider may not request or require a client to surrender any of these rights as a condition of receiving services. This statement of rights does not replace or diminish other rights and liberties that may exist relative to clients receiving home care services, persons providing home care services, or providers licensed under sections 144A.43 to 144A.482. History: 1987 c 378 s 4; 1991 c 133 s 1; 1998 c 407 art 2 s 81; 1Sp2001 c 9 art 1 s 39; 2002 c 379 art 1 s 113; 2007 c 147 art 7 s 75; art 10 s 15; 2009 c 79 art 8 s 7; 2013 c 108 art 11 s 8; 2014 c 275 art 1 s 135; 2019 c 60 art 1 s 47; art 4 s 16 144A.441 ASSISTED LIVING BILL OF RIGHTS ADDENDUM. Assisted living clients, as defined in section 144G.01, subdivision 3, shall be provided with the home care bill of rights required by section 144A.44, except that the home care bill of rights provided to these clients must include the following provision in place of the provision in section 144A.44, subdivision 1, clause (17): "(17) the right to reasonable, advance notice of changes in services or charges, including at least 30 days' advance notice of the termination of a service by a provider, except in cases where: (i) the recipient of services engages in conduct that alters the conditions of employment as specified in the employment contract between the home care provider and the individual providing home care services, or creates an abusive or unsafe work environment for the individual providing home care services; (ii) an emergency for the informal caregiver or a significant change in the recipient's condition has resulted in service needs that exceed the current service provider agreement and that cannot be safely met by the home care provider; or (iii) the provider has not received payment for services, for which at least ten days' advance notice of the termination of a service shall be provided." History: 2006 c 282 art 19 s 1; 2014 c 275 art 1 s 24; 2019 c 60 art 4 s 35 NOTE: This section is repealed by Laws 2019, chapter 60, article 4, section 35, effective August 1, 2021. Laws 2019, chapter 60, article 4, section 35. 144A.442 ASSISTED LIVING CLIENTS; SERVICE TERMINATION. If an arranged home care provider, as defined in section 144D.01, subdivision 2a, who is not also Medicare certified terminates a service agreement or service plan with an assisted living client, as defined in section 144G.01, subdivision 3, the home care provider shall provide the assisted living client and the legal or designated representatives of the client, if any, with a written notice of termination which includes the following information:

144A.442

MINNESOTA STATUTES 2019

(1) the effective date of termination; (2) the reason for termination; (3) without extending the termination notice period, an affirmative offer to meet with the assisted living client or client representatives within no more than five business days of the date of the termination notice to discuss the termination; (4) contact information for a reasonable number of other home care providers in the geographic area of the assisted living client, as required by section 144A.4791, subdivision 10; (5) a statement that the provider will participate in a coordinated transfer of the care of the client to another provider or caregiver, as required by section 144A.44, subdivision 1, clause (18); (6) the name and contact information of a representative of the home care provider with whom the client may discuss the notice of termination; (7) a copy of the home care bill of rights; and (8) a statement that the notice of termination of home care services by the home care provider does not constitute notice of termination of the housing with services contract with a housing with services establishment. History: 2006 c 282 art 19 s 2; 2014 c 275 art 1 s 25; 2016 c 158 art 1 s 60; 2019 c 60 art 4 s 35 NOTE: This section is repealed by Laws 2019, chapter 60, article 4, section 35, effective August 1, 2021. Laws 2019, chapter 60, article 4, section 35. 144A.45 REGULATION OF HOME CARE SERVICES. Subdivision 1. Regulations. The commissioner shall regulate home care providers pursuant to sections 144A.43 to 144A.482. The regulations shall include the following: (1) provisions to assure, to the extent possible, the health, safety, well-being, and appropriate treatment of persons who receive home care services while respecting a client's autonomy and choice; (2) requirements that home care providers furnish the commissioner with specified information necessary to implement sections 144A.43 to 144A.482; (3) standards of training of home care provider personnel; (4) standards for provision of home care services; (5) standards for medication management; (6) standards for supervision of home care services; (7) standards for client evaluation or assessment; (8) requirements for the involvement of a client's health care provider, the documentation of health care providers' orders, if required, and the client's service plan; (9) the maintenance of accurate, current client records; (10) the establishment of basic and comprehensive levels of licenses based on services provided; and

MINNESOTA STATUTES 2019

144A.47

(11) provisions to enforce these regulations and the home care bill of rights. Subd. 1a. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 1b. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 2. Regulatory functions. The commissioner shall: (1) license, survey, and monitor without advance notice, home care providers in accordance with sections 144A.43 to 144A.482; (2) survey every temporary licensee within one year of the temporary license issuance date subject to the temporary licensee providing home care services to a client or clients; (3) survey all licensed home care providers on an interval that will promote the health and safety of clients; (4) with the consent of the client, visit the home where services are being provided; (5) issue correction orders and assess civil penalties in accordance with section 144.653, subdivisions 5 to 8, for violations of sections 144A.43 to 144A.482; (6) take action as authorized in section 144A.475; and (7) take other action reasonably required to accomplish the purposes of sections 144A.43 to 144A.482. Subd. 3. [Repealed, 1997 c 113 s 22] Subd. 4. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 5. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 6. MS 2018 [Repealed, 1Sp2019 c 9 art 11 s 112] History: 1987 c 378 s 5; 1989 c 282 art 2 s 25; 1991 c 286 s 8; 1997 c 113 s 2,3; 1998 c 254 art 1 s 30,31; 2002 c 252 s 5,6,24; 2003 c 37 s 2; 2008 c 326 art 1 s 2,3; 2009 c 174 art 2 s 5,6; 2010 c 246 s 1,2; 2013 c 43 s 16; 2013 c 108 art 11 s 9; 2014 c 275 art 1 s 135 144A.46 [Repealed, 2014 c 275 art 1 s 134] 144A.4605 [Repealed, 2014 c 275 art 1 s 134] 144A.461 [Repealed, 2014 c 275 art 1 s 134] 144A.465 [Repealed, 2014 c 275 art 1 s 134] 144A.47 INFORMATION AND REFERRAL SERVICES. The commissioner shall ensure that information and referral services relating to home care are available in all regions of the state. The commissioner shall collect and make available information about available home care services, sources of payment, providers, and the rights of consumers. The commissioner may require home care providers to provide information requested for the purposes of this section as a condition of registration or licensure. The commissioner may publish and make available: (1) general information describing home care services in the state;

144A.47

MINNESOTA STATUTES 2019

(2) limitations on hours, availability of services, and eligibility for third-party payments, applicable to individual providers; and (3) other information the commissioner determines to be appropriate. History: 1987 c 378 s 7; 1995 c 207 art 9 s 21 HOME CARE LICENSING 144A.471 HOME CARE PROVIDER AND HOME CARE SERVICES. Subdivision 1. License required. A home care provider may not open, operate, manage, conduct, maintain, or advertise itself as a home care provider or provide home care services in Minnesota without a temporary or current home care provider license issued by the commissioner of health. Subd. 2. Determination of direct home care service. (a) "Direct home care service" means a home care service provided to a client by the home care provider or its employees, and not by contract. Factors that must be considered in determining whether an individual or a business entity provides at least one home care service directly include, but are not limited to, whether the individual or business entity: (1) has the right to control, and does control, the types of services provided; (2) has the right to control, and does control, when and how the services are provided; (3) establishes the charges; (4) collects fees from the clients or receives payment from third-party payers on the clients' behalf; (5) pays individuals providing services compensation on an hourly, weekly, or similar basis; (6) treats the individuals providing services as employees for the purposes of payroll taxes and workers' compensation insurance; and (7) holds itself out as a provider of home care services or acts in a manner that leads clients or potential clients to believe that it is a home care provider providing home care services. (b) None of the factors listed in this subdivision is solely determinative. Subd. 3. Determination of regularly engaged. (a) "Regularly engaged" means providing, or offering to provide, home care services as a regular part of a business. The following factors must be considered by the commissioner in determining whether an individual or a business entity is regularly engaged in providing home care services: (1) whether the individual or business entity states or otherwise promotes that the individual or business entity provides home care services; (2) whether persons receiving home care services constitute a substantial part of the individual's or the business entity's clientele; and (3) whether the home care services provided are other than occasional or incidental to the provision of services other than home care services. (b) None of the factors listed in this subdivision is solely determinative.

MINNESOTA STATUTES 2019

144A.471

Subd. 4. Penalties for operating without license. A person involved in the management, operation, or control of a home care provider that operates without an appropriate license is guilty of a misdemeanor. This section does not apply to a person who has no legal authority to affect or change decisions related to the management, operation, or control of a home care provider. Subd. 5. Basic and comprehensive levels of licensure. An applicant seeking to become a home care provider must apply for either a basic or comprehensive home care license. Subd. 6. Basic home care license provider. Home care services that can be provided with a basic home care license are assistive tasks provided by licensed or unlicensed personnel that include: (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; (2) providing standby assistance; (3) providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the medication; (4) providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises; (5) preparing modified diets ordered by a licensed health professional; and (6) assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services if the provider is also providing at least one of the activities in clauses (1) to (5). Subd. 7. Comprehensive home care license provider. Home care services that may be provided with a comprehensive home care license include any of the basic home care services listed in subdivision 6, and one or more of the following: (1) services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; (2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; (3) medication management services; (4) hands-on assistance with transfers and mobility; (5) treatment and therapies; (6) assisting clients with eating when the clients have complicating eating problems as identified in the client record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; or (7) providing other complex or specialty health care services. Subd. 8. Exemptions from home care services licensure. (a) Except as otherwise provided in this chapter, home care services that are provided by the state, counties, or other units of government must be licensed under this chapter.

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MINNESOTA STATUTES 2019

(b) An exemption under this subdivision does not excuse the exempted individual or organization from complying with applicable provisions of the home care bill of rights in section 144A.44. The following individuals or organizations are exempt from the requirement to obtain a home care provider license: (1) an individual or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under sections 256B.0625, subdivision 19a, and 256B.0659; (2) a provider that is licensed by the commissioner of human services to provide semi-independent living services for persons with developmental disabilities under section 252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020; (3) a provider that is licensed by the commissioner of human services to provide home and community-based services for persons with developmental disabilities under section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930; (4) an individual or organization that provides only home management services, if the individual or organization is registered under section 144A.482; or (5) an individual who is licensed in this state as a nurse, dietitian, social worker, occupational therapist, physical therapist, or speech-language pathologist who provides health care services in the home independently and not through any contractual or employment relationship with a home care provider or other organization. Subd. 9. Exclusions from home care licensure. The following are excluded from home care licensure and are not required to provide the home care bill of rights: (1) an individual or business entity providing only coordination of home care that includes one or more of the following: (i) determination of whether a client needs home care services, or assisting a client in determining what services are needed; (ii) referral of clients to a home care provider; (iii) administration of payments for home care services; or (iv) administration of a health care home established under section 256B.0751; (2) an individual who is not an employee of a licensed home care provider if the individual: (i) only provides services as an independent contractor to one or more licensed home care providers; (ii) provides no services under direct agreements or contracts with clients; and (iii) is contractually bound to perform services in compliance with the contracting home care provider's policies and service plans; (3) a business that provides staff to home care providers, such as a temporary employment agency, if the business: (i) only provides staff under contract to licensed or exempt providers; (ii) provides no services under direct agreements with clients; and

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(iii) is contractually bound to perform services under the contracting home care provider's direction and supervision; (4) any home care services conducted by and for the adherents of any recognized church or religious denomination for its members through spiritual means, or by prayer for healing; (5) an individual who only provides home care services to a relative; (6) an individual not connected with a home care provider that provides assistance with basic home care needs if the assistance is provided primarily as a contribution and not as a business; (7) an individual not connected with a home care provider that shares housing with and provides primarily housekeeping or homemaking services to an elderly or disabled person in return for free or reduced-cost housing; (8) an individual or provider providing home-delivered meal services; (9) an individual providing senior companion services and other older American volunteer programs (OAVP) established under the Domestic Volunteer Service Act of 1973, United States Code, title 42, chapter 66; (10) an employee of a nursing home or home care provider licensed under this chapter or an employee of a boarding care home licensed under sections 144.50 to 144.56 when responding to occasional emergency calls from individuals residing in a residential setting that is attached to or located on property contiguous to the nursing home, boarding care home, or location where home care services are also provided; (11) an employee of a nursing home or home care provider licensed under this chapter or an employee of a boarding care home licensed under sections 144.50 to 144.56 when providing occasional minor services free of charge to individuals residing in a residential setting that is attached to or located on property contiguous to the nursing home, boarding care home, or location where home care services are also provided; (12) a member of a professional corporation organized under chapter 319B that does not regularly offer or provide home care services as defined in section 144A.43, subdivision 3; (13) the following organizations established to provide medical or surgical services that do not regularly offer or provide home care services as defined in section 144A.43, subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit corporation organized under chapter 317A, a partnership organized under chapter 323, or any other entity determined by the commissioner; (14) an individual or agency that provides medical supplies or durable medical equipment, except when the provision of supplies or equipment is accompanied by a home care service; (15) a physician licensed under chapter 147; (16) an individual who provides home care services to a person with a developmental disability who lives in a place of residence with a family, foster family, or primary caregiver; (17) a business that only provides services that are primarily instructional and not medical services or health-related support services; (18) an individual who performs basic home care services for no more than 14 hours each calendar week to no more than one client;

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(19) an individual or business licensed as hospice as defined in sections 144A.75 to 144A.755 who is not providing home care services independent of hospice service; (20) activities conducted by the commissioner of health or a community health board as defined in section 145A.02, subdivision 5, including communicable disease investigations or testing; or (21) administering or monitoring a prescribed therapy necessary to control or prevent a communicable disease, or the monitoring of an individual's compliance with a health directive as defined in section 144.4172, subdivision 6. [See Note.] History: 2013 c 108 art 11 s 10; 2014 c 262 art 5 s 6; 2014 c 275 art 1 s 135; 2014 c 291 art 7 s 28; 2016 c 179 s 6; 2019 c 60 art 4 s 17,18 NOTE: The amendment to subdivision 9 striking clauses (10) and (11) by Laws 2019, chapter 60, article 4, section 18, is effective July 1, 2021. Laws 2019, chapter 60, article 4, section 18, the effective date. 144A.472 HOME CARE PROVIDER LICENSE; APPLICATION AND RENEWAL. Subdivision 1. License applications. Each application for a home care provider license must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the applicant's name, e-mail address, physical address, and mailing address, including the name of the county in which the applicant resides and has a principal place of business; (2) the initial license fee in the amount specified in subdivision 7; (3) the e-mail address, physical address, mailing address, and telephone number of the principal administrative office; (4) the e-mail address, physical address, mailing address, and telephone number of each branch office, if any; (5) the names, e-mail and mailing addresses, and telephone numbers of all owners and managerial officials; (6) documentation of compliance with the background study requirements of section 144A.476 for all persons involved in the management, operation, or control of the home care provider; (7) documentation of a background study as required by section 144.057 for any individual seeking employment, paid or volunteer, with the home care provider; (8) evidence of workers' compensation coverage as required by sections 176.181 and 176.182; (9) documentation of liability coverage, if the provider has it; (10) identification of the license level the provider is seeking; (11) documentation that identifies the managerial official who is in charge of day-to-day operations and attestation that the person has reviewed and understands the home care provider regulations; (12) documentation that the applicant has designated one or more owners, managerial officials, or employees as an agent or agents, which shall not affect the legal responsibility of any other owner or managerial official under this chapter;

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(13) the signature of the officer or managing agent on behalf of an entity, corporation, association, or unit of government; (14) verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures and keep them current: (i) requirements in sections 626.556, reporting of maltreatment of minors, and 626.557, reporting of maltreatment of vulnerable adults; (ii) conducting and handling background studies on employees; (iii) orientation, training, and competency evaluations of home care staff, and a process for evaluating staff performance; (iv) handling complaints from clients, family members, or client representatives regarding staff or services provided by staff; (v) conducting initial evaluation of clients' needs and the providers' ability to provide those services; (vi) conducting initial and ongoing client evaluations and assessments and how changes in a client's condition are identified, managed, and communicated to staff and other health care providers as appropriate; (vii) orientation to and implementation of the home care client bill of rights; (viii) infection control practices; (ix) reminders for medications, treatments, or exercises, if provided; and (x) conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards; and (15) other information required by the department. Subd. 2. Comprehensive home care license applications. In addition to the information and fee required in subdivision 1, applicants applying for a comprehensive home care license must also provide verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures in this subdivision and keep them current: (1) conducting initial and ongoing assessments of the client's needs by a registered nurse or appropriate licensed health professional, including how changes in the client's conditions are identified, managed, and communicated to staff and other health care providers, as appropriate; (2) ensuring that nurses and licensed health professionals have current and valid licenses to practice; (3) medication and treatment management; (4) delegation of home care tasks by registered nurses or licensed health professionals; (5) supervision of registered nurses and licensed health professionals; and (6) supervision of unlicensed personnel performing delegated home care tasks. Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license may be renewed for a period of one year if the licensee satisfies the following:

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(1) submits an application for renewal in the format provided by the commissioner at least 30 days before expiration of the license; (2) submits the renewal fee in the amount specified in subdivision 7; (3) has provided home care services within the past 12 months; (4) complies with sections 144A.43 to 144A.4798; (5) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under subdivision 1; (6) provides verification that all policies under subdivision 1 are current; and (7) provides any other information deemed necessary by the commissioner. (b) A renewal applicant who holds a comprehensive home care license must also provide verification that policies listed under subdivision 2 are current. Subd. 4. MS 2018 [Repealed, 2019 c 60 art 4 s 35] Subd. 5. Changes in ownership. (a) A home care license issued by the commissioner may not be transferred to another party. Before acquiring ownership of or a controlling interest in a home care provider business, a prospective owner must apply for a new license. A change of ownership is a transfer of operational control of the home care provider business and includes: (1) transfer of the business to a different or new corporation; (2) in the case of a partnership, the dissolution or termination of the partnership under chapter 323A, with the business continuing by a successor partnership or other entity; (3) relinquishment of control of the provider to another party, including to a contract management firm that is not under the control of the owner of the business' assets; (4) transfer of the business by a sole proprietor to another party or entity; or (5) transfer of ownership or control of 50 percent or more of the controlling interest of a home care provider business not covered by clauses (1) to (4). (b) An employee who was employed by the previous owner of the home care provider business prior to the effective date of a change in ownership under paragraph (a), and who will be employed by the new owner in the same or a similar capacity, shall be treated as if no change in employer occurred, with respect to orientation, training, tuberculosis testing, background studies, and competency testing and training on the policies identified in subdivision 1, clause (14), and subdivision 2, if applicable. (c) Notwithstanding paragraph (b), a new owner of a home care provider business must ensure that employees of the provider receive and complete training and testing on any provisions of policies that differ from those of the previous owner within 90 days after the date of the change in ownership. Subd. 6. Notification of changes of information. The temporary licensee or licensee shall notify the commissioner in writing within ten working days after any change in the information required in subdivision 1, except the information required in subdivision 1, clause (5), is required at the time of license renewal.

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Subd. 7. Fees; application, change of ownership, renewal, and failure to notify. (a) An initial applicant seeking temporary home care licensure must submit the following application fee to the commissioner along with a completed application: (1) for a basic home care provider, $2,100; or (2) for a comprehensive home care provider, $4,200. (b) A home care provider who is filing a change of ownership as required under subdivision 5 must submit the following application fee to the commissioner, along with the documentation required for the change of ownership: (1) for a basic home care provider, $2,100; or (2) for a comprehensive home care provider, $4,200. (c) For the period ending June 30, 2018, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted, according to the following schedule: License Renewal Fee Provider Annual Revenue

Fee

greater than $1,500,000

$6,625

greater than $1,275,000 and no more than $1,500,000

$5,797

greater than $1,100,000 and no more than $1,275,000

$4,969

greater than $950,000 and no more than $1,100,000

$4,141

greater than $850,000 and no more than $950,000

$3,727

greater than $750,000 and no more than $850,000

$3,313

greater than $650,000 and no more than $750,000

$2,898

greater than $550,000 and no more than $650,000

$2,485

greater than $450,000 and no more than $550,000

$2,070

greater than $350,000 and no more than $450,000

$1,656

greater than $250,000 and no more than $350,000

$1,242

greater than $100,000 and no more than $250,000

$828

greater than $50,000 and no more than $100,000

$500

greater than $25,000 and no more than $50,000

$400

no more than $25,000

$200

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(d) For the period between July 1, 2018, and June 30, 2020, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner in an amount that is ten percent higher than the applicable fee in paragraph (c). A home care provider's fee shall be based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted. (e) Beginning July 1, 2020, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted, according to the following schedule: License Renewal Fee Provider Annual Revenue

Fee

greater than $1,500,000

$7,651

greater than $1,275,000 and no more than $1,500,000

$6,695

greater than $1,100,000 and no more than $1,275,000

$5,739

greater than $950,000 and no more than $1,100,000

$4,783

greater than $850,000 and no more than $950,000

$4,304

greater than $750,000 and no more than $850,000

$3,826

greater than $650,000 and no more than $750,000

$3,347

greater than $550,000 and no more than $650,000

$2,870

greater than $450,000 and no more than $550,000

$2,391

greater than $350,000 and no more than $450,000

$1,913

greater than $250,000 and no more than $350,000

$1,434

greater than $100,000 and no more than $250,000

$957

greater than $50,000 and no more than $100,000

$577

greater than $25,000 and no more than $50,000

$462

no more than $25,000

$231

(f) If requested, the home care provider shall provide the commissioner information to verify the provider's annual revenues or other information as needed, including copies of documents submitted to the Department of Revenue. (g) At each annual renewal, a home care provider may elect to pay the highest renewal fee for its license category, and not provide annual revenue information to the commissioner. (h) A temporary license or license applicant, or temporary licensee or licensee that knowingly provides the commissioner incorrect revenue amounts for the purpose of paying a lower license fee, shall be subject to a civil penalty in the amount of double the fee the provider should have paid.

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(i) The fine for failure to comply with the notification requirements in section 144A.473, subdivision 2, paragraph (c), is $1,000. (j) Fees collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. All fees are nonrefundable. Fees collected under paragraphs (c), (d), and (e) are nonrefundable even if received before July 1, 2017, for temporary licenses or licenses being issued effective July 1, 2017, or later. (k) Fines and civil penalties collected under this subdivision shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. History: 2013 c 108 art 11 s 11; 2014 c 275 art 1 s 135; 1Sp2017 c 6 art 10 s 68; 2019 c 60 art 4 s 19; 1Sp2019 c 9 art 11 s 41,42 144A.473 ISSUANCE OF TEMPORARY LICENSE AND LICENSE RENEWAL. Subdivision 1. Temporary license and renewal of license. (a) The department shall review each application to determine the applicant's knowledge of and compliance with Minnesota home care regulations. Before granting a temporary license or renewing a license, the commissioner may further evaluate the applicant or licensee by requesting additional information or documentation or by conducting an on-site survey of the applicant to determine compliance with sections 144A.43 to 144A.482. (b) Within 14 calendar days after receiving an application for a license, the commissioner shall acknowledge receipt of the application in writing. The acknowledgment must indicate whether the application appears to be complete or whether additional information is required before the application will be considered complete. (c) Within 90 days after receiving a complete application, the commissioner shall issue a temporary license, renew the license, or deny the license. (d) The commissioner shall issue a license that contains the home care provider's name, address, license level, expiration date of the license, and unique license number. All licenses, except for temporary licenses issued under subdivision 2, are valid for up to one year from the date of issuance. Subd. 2. Temporary license. (a) For new license applicants, the commissioner shall issue a temporary license for either the basic or comprehensive home care level. A temporary license is effective for up to one year from the date of issuance, except that a temporary license may be extended according to subdivision 3. Temporary licensees must comply with sections 144A.43 to 144A.482. (b) During the temporary license period, the commissioner shall survey the temporary licensee within 90 calendar days after the commissioner is notified or has evidence that the temporary licensee is providing home care services. (c) Within five days of beginning the provision of services, the temporary licensee must notify the commissioner that it is serving clients. The notification to the commissioner may be mailed or e-mailed to the commissioner at the address provided by the commissioner. If the temporary licensee does not provide home care services during the temporary license period, then the temporary license expires at the end of the period and the applicant must reapply for a temporary home care license. (d) A temporary licensee may request a change in the level of licensure prior to being surveyed and granted a license by notifying the commissioner in writing and providing additional documentation or

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materials required to update or complete the changed temporary license application. The applicant must pay the difference between the application fees when changing from the basic level to the comprehensive level of licensure. No refund will be made if the provider chooses to change the license application to the basic level. (e) If the temporary licensee notifies the commissioner that the licensee has clients within 45 days prior to the temporary license expiration, the commissioner may extend the temporary license for up to 60 days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits. Subd. 3. Temporary licensee survey. (a) If the temporary licensee is in substantial compliance with the survey, the commissioner shall issue either a basic or comprehensive home care license. If the temporary licensee is not in substantial compliance with the survey, the commissioner shall either: (1) not issue a license and terminate the temporary license; or (2) extend the temporary license for a period not to exceed 90 days and apply conditions, as permitted under section 144A.475, subdivision 2, to the extension of a temporary license. If the temporary licensee is not in substantial compliance with the survey within the time period of the extension, or if the temporary licensee does not satisfy the license conditions, the commissioner may deny the license. (b) If the temporary licensee whose basic or comprehensive license has been denied or extended with conditions disagrees with the conclusions of the commissioner, then the temporary licensee may request a reconsideration by the commissioner or commissioner's designee. The reconsideration request process must be conducted internally by the commissioner or commissioner's designee, and chapter 14 does not apply. (c) The temporary licensee requesting reconsideration must make the request in writing and must list and describe the reasons why the temporary licensee disagrees with the decision to deny the basic or comprehensive home care license or the decision to extend the temporary license with conditions. (d) The reconsideration request and supporting documentation must be received by the commissioner within 15 calendar days after the date the temporary licensee receives the correction order. (e) A temporary licensee whose license is denied is permitted to continue operating as a home care provider during the period of time when: (1) a reconsideration request is in process; (2) an extension of a temporary license is being negotiated; (3) the placement of conditions on a temporary license is being negotiated; or (4) a transfer of home care clients from the temporary licensee to a new home care provider is in process. (f) A temporary licensee whose license is denied must comply with the requirements for notification and transfer of clients in section 144A.475, subdivision 5. History: 2013 c 108 art 11 s 12; 2014 c 275 art 1 s 135; 2016 c 179 s 7; 1Sp2019 c 9 art 11 s 43 144A.474 SURVEYS AND INVESTIGATIONS. Subdivision 1. Surveys. The commissioner shall conduct surveys of each home care provider. By June 30, 2016, the commissioner shall conduct a survey of home care providers on a frequency of at least once every three years. Survey frequency may be based on the license level, the provider's compliance history,

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the number of clients served, or other factors as determined by the department deemed necessary to ensure the health, safety, and welfare of clients and compliance with the law. Subd. 2. Types of home care surveys. (a) "Initial full survey" means the survey of a new temporary licensee conducted after the department is notified or has evidence that the temporary licensee is providing home care services to determine if the provider is in compliance with home care requirements. Initial full surveys must be completed within 14 months after the department's issuance of a temporary basic or comprehensive license. (b) "Change in ownership survey" means a full survey of a new licensee due to a change in ownership. Change in ownership surveys must be completed within six months after the department's issuance of a new license due to a change in ownership. (c) "Core survey" means periodic inspection of home care providers to determine ongoing compliance with the home care requirements, focusing on the essential health and safety requirements. Core surveys are available to licensed home care providers who have been licensed for three years and surveyed at least once in the past three years with the latest survey having no widespread violations beyond Level 1 as provided in subdivision 11. Providers must also not have had any substantiated licensing complaints, substantiated complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors Act, or an enforcement action as authorized in section 144A.475 in the past three years. (1) The core survey for basic home care providers must review compliance in the following areas: (i) reporting of maltreatment; (ii) orientation to and implementation of the home care bill of rights; (iii) statement of home care services; (iv) initial evaluation of clients and initiation of services; (v) client review and monitoring; (vi) service plan implementation and changes to the service plan; (vii) client complaint and investigative process; (viii) competency of unlicensed personnel; and (ix) infection control. (2) For comprehensive home care providers, the core survey must include everything in the basic core survey plus these areas: (i) delegation to unlicensed personnel; (ii) assessment, monitoring, and reassessment of clients; and (iii) medication, treatment, and therapy management. (d) "Full survey" means the periodic inspection of home care providers to determine ongoing compliance with the home care requirements that cover the core survey areas and all the legal requirements for home care providers. A full survey is conducted for all temporary licensees, for licensees that receive licenses due to an approved change in ownership, for providers who do not meet the requirements needed for a core survey, and when a surveyor identifies unacceptable client health or safety risks during a core survey. A full

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survey must include all the tasks identified as part of the core survey and any additional review deemed necessary by the department, including additional observation, interviewing, or records review of additional clients and staff. (e) "Follow-up surveys" means surveys conducted to determine if a home care provider has corrected deficient issues and systems identified during a core survey, full survey, or complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be concluded with an exit conference and written information provided on the process for requesting a reconsideration of the survey results. (f) Upon receiving information alleging that a home care provider has violated or is currently violating a requirement of sections 144A.43 to 144A.482, the commissioner shall investigate the complaint according to sections 144A.51 to 144A.54. Subd. 3. Survey process. The survey process for core surveys shall include the following as applicable to the particular licensee and setting surveyed: (1) presurvey review of pertinent documents and notification to the ombudsman for long-term care; (2) an entrance conference with available staff; (3) communication with managerial officials or the registered nurse in charge, if available, and ongoing communication with key staff throughout the survey regarding information needed by the surveyor, clarifications regarding home care requirements, and applicable standards of practice; (4) presentation of written contact information to the provider about the survey staff conducting the survey, the supervisor, and the process for requesting a reconsideration of the survey results; (5) a brief tour of a sample of the housing with services establishments in which the provider is providing home care services; (6) a sample selection of home care clients; (7) information-gathering through client and staff observations, client and staff interviews, and reviews of records, policies, procedures, practices, and other agency information; (8) interviews of clients' family members, if available, with clients' consent when the client can legally give consent; (9) except for complaint surveys conducted by the Office of Health Facilities Complaints, an on-site exit conference, with preliminary findings shared and discussed with the provider, documentation that an exit conference occurred, and written information provided on the process for requesting a reconsideration of the survey results; and (10) postsurvey analysis of findings and formulation of survey results, including correction orders when applicable. Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted without advance notice to home care providers. Surveyors may contact the home care provider on the day of a survey to arrange for someone to be available at the survey site. The contact does not constitute advance notice. Subd. 5. Information provided by home care provider. The home care provider shall provide accurate and truthful information to the department during a survey, investigation, or other licensing activities.

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Subd. 6. Providing client records. Upon request of a surveyor, home care providers shall provide a list of current and past clients or client representatives that includes addresses and telephone numbers and any other information requested about the services to clients within a reasonable period of time. Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home care provider's clients to gather information without notice to the home care provider. Before visiting a client, a surveyor shall obtain the client's or client's representative's permission by telephone, by mail, or in person. Surveyors shall inform all clients or client's representatives of their right to decline permission for a visit. Subd. 8. Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a home care provider, a managerial official, or an employee of the provider is not in compliance with sections 144A.43 to 144A.482. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction. (b) The commissioner shall mail copies of any correction order to the last known address of the home care provider, or electronically scan the correction order and e-mail it to the last known home care provider e-mail address, within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the home care provider, and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the home care provider must document in the provider's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the home care provider's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed. Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations under subdivision 11, or any violations determined to be widespread, the department shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor will focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made. Subd. 10. Performance incentive. A licensee is eligible for a performance incentive if there are no violations identified in a core or full survey. The performance incentive is a ten percent discount on the licensee's next home care renewal license fee. Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be assessed based on the level and scope of the violations described in paragraph (b) and imposed immediately with no opportunity to correct the violation first as follows: (1) Level 1, no fines or enforcement; (2) Level 2, a fine of $500 per violation, in addition to any of the enforcement mechanisms authorized in section 144A.475 for widespread violations; (3) Level 3, a fine of $3,000 per incident, in addition to any of the enforcement mechanisms authorized in section 144A.475; (4) Level 4, a fine of $5,000 per incident, in addition to any of the enforcement mechanisms authorized in section 144A.475;

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(5) for maltreatment violations for which the licensee was determined to be responsible for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000. A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury; and (6) the fines in clauses (1) to (4) are increased and immediate fine imposition is authorized for both surveys and investigations conducted. When a fine is assessed against a facility for substantiated maltreatment, the commissioner shall not also impose an immediate fine under this chapter for the same circumstance. (b) Correction orders for violations are categorized by both level and scope and fines shall be assessed as follows: (1) level of violation: (i) Level 1 is a violation that has no potential to cause more than a minimal impact on the client and does not affect health or safety; (ii) Level 2 is a violation that did not harm a client's health or safety but had the potential to have harmed a client's health or safety, but was not likely to cause serious injury, impairment, or death; (iii) Level 3 is a violation that harmed a client's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death; and (iv) Level 4 is a violation that results in serious injury, impairment, or death; (2) scope of violation: (i) isolated, when one or a limited number of clients are affected or one or a limited number of staff are involved or the situation has occurred only occasionally; (ii) pattern, when more than a limited number of clients are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive; and (iii) widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the clients. (c) If the commissioner finds that the applicant or a home care provider has not corrected violations by the date specified in the correction order or conditional license resulting from a survey or complaint investigation, the commissioner shall provide a notice of noncompliance with a correction order by e-mail to the applicant's or provider's last known e-mail address. The noncompliance notice must list the violations not corrected. (d) For every violation identified by the commissioner, the commissioner shall issue an immediate fine pursuant to paragraph (a), clause (6). The license holder must still correct the violation in the time specified. The issuance of an immediate fine can occur in addition to any enforcement mechanism authorized under section 144A.475. The immediate fine may be appealed as allowed under this subdivision. (e) The license holder must pay the fines assessed on or before the payment date specified. If the license holder fails to fully comply with the order, the commissioner may issue a second fine or suspend the license until the license holder complies by paying the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order.

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(f) A license holder shall promptly notify the commissioner in writing when a violation specified in the order is corrected. If upon reinspection the commissioner determines that a violation has not been corrected as indicated by the order, the commissioner may issue a second fine. The commissioner shall notify the license holder by mail to the last known address in the licensing record that a second fine has been assessed. The license holder may appeal the second fine as provided under this subdivision. (g) A home care provider that has been assessed a fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. (h) When a fine has been assessed, the license holder may not avoid payment by closing, selling, or otherwise transferring the licensed program to a third party. In such an event, the license holder shall be liable for payment of the fine. (i) In addition to any fine imposed under this section, the commissioner may assess a penalty amount based on costs related to an investigation that results in a final order assessing a fine or other enforcement action authorized by this chapter. (j) Fines collected under paragraph (a), clauses (1) to (4), shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. (k) Fines collected under paragraph (a), clause (5), shall be deposited in a dedicated special revenue account and appropriated to the commissioner to provide compensation according to subdivision 14 to clients subject to maltreatment. A client may choose to receive compensation from this fund, not to exceed $5,000 for each substantiated finding of maltreatment, or take civil action. This paragraph expires July 31, 2021. Subd. 12. Reconsideration. (a) The commissioner shall make available to home care providers a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in subdivision 11, and any fine assessed. During the correction order reconsideration request, the issuance for the correction orders under reconsideration are not stayed, but the department shall post information on the website with the correction order that the licensee has requested a reconsideration and that the review is pending. (b) A licensed home care provider may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the provider. The written request for reconsideration must be received by the commissioner within 15 calendar days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in the writing or reviewing of the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a home care provider for a correction order reconsideration within 60 days of the date the provider requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the home care provider. (c) The findings of a correction order reconsideration process shall be one or more of the following: (1) supported in full, the correction order is supported in full, with no deletion of findings to the citation; (2) supported in substance, the correction order is supported, but one or more findings are deleted or modified without any change in the citation;

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(3) correction order cited an incorrect home care licensing requirement, the correction order is amended by changing the correction order to the appropriate statutory reference; (4) correction order was issued under an incorrect citation, the correction order is amended to be issued under the more appropriate correction order citation; (5) the correction order is rescinded; (6) fine is amended, it is determined that the fine assigned to the correction order was applied incorrectly; or (7) the level or scope of the citation is modified based on the reconsideration. (d) If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website. (e) This subdivision does not apply to temporary licensees. Subd. 13. Home care surveyor training. (a) Before conducting a home care survey, each home care surveyor must receive training on the following topics: (1) Minnesota home care licensure requirements; (2) Minnesota home care bill of rights; (3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors; (4) principles of documentation; (5) survey protocol and processes; (6) Offices of the Ombudsman roles; (7) Office of Health Facility Complaints; (8) Minnesota landlord-tenant and housing with services laws; (9) types of payors for home care services; and (10) Minnesota Nurse Practice Act for nurse surveyors. (b) Materials used for the training in paragraph (a) shall be posted on the department website. Requisite understanding of these topics will be reviewed as part of the quality improvement plan in section 144A.483. Subd. 14. Maltreatment compensation fund. (a) Once a finding of maltreatment for which the licensee is determined to be responsible is substantiated and any request for reconsideration, if applicable, is completed, the commissioner shall pay the fine assessed under subdivision 11, paragraph (a), clause (5), as compensation to the client who was subject to the maltreatment, if: (1) the client chooses to receive a compensation payment of either $1,000 or $5,000 as determined by the fine assessed under subdivision 11, paragraph (a), clause (5), depending on the level of maltreatment; and (2) the client accepts payment of compensation under this subdivision as payment in full and agrees to waive any civil claims, including claims under section 626.557, subdivision 20, arising from the specific maltreatment incident that resulted in the fine.

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(b) The commissioner shall notify the client that the client may reject a compensation payment under this subdivision and instead pursue any civil claims. (c) Except as provided in paragraph (a), nothing in this subdivision affects the rights available to clients under section 626.557 or prevents a client from filing a maltreatment report in the future. (d) This subdivision expires July 31, 2021. History: 2013 c 108 art 11 s 13; 2014 c 275 art 1 s 135; 2014 c 291 art 6 s 13,14; 1Sp2017 c 6 art 10 s 69; 2019 c 60 art 4 s 20-22; 1Sp2019 c 9 art 11 s 44 144A.475 ENFORCEMENT. Subdivision 1. Conditions. (a) The commissioner may refuse to grant a temporary license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the home care provider or owner or managerial official of the home care provider: (1) is in violation of, or during the term of the license has violated, any of the requirements in sections 144A.471 to 144A.482; (2) permits, aids, or abets the commission of any illegal act in the provision of home care; (3) performs any act detrimental to the health, safety, and welfare of a client; (4) obtains the license by fraud or misrepresentation; (5) knowingly made or makes a false statement of a material fact in the application for a license or in any other record or report required by this chapter; (6) denies representatives of the department access to any part of the home care provider's books, records, files, or employees; (7) interferes with or impedes a representative of the department in contacting the home care provider's clients; (8) interferes with or impedes a representative of the department in the enforcement of this chapter or has failed to fully cooperate with an inspection, survey, or investigation by the department; (9) destroys or makes unavailable any records or other evidence relating to the home care provider's compliance with this chapter; (10) refuses to initiate a background study under section 144.057 or 245A.04; (11) fails to timely pay any fines assessed by the department; (12) violates any local, city, or township ordinance relating to home care services; (13) has repeated incidents of personnel performing services beyond their competency level; or (14) has operated beyond the scope of the home care provider's license level. (b) A violation by a contractor providing the home care services of the home care provider is a violation by the home care provider.

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Subd. 2. Terms to suspension or conditional license. (a) A suspension or conditional license designation may include terms that must be completed or met before a suspension or conditional license designation is lifted. A conditional license designation may include restrictions or conditions that are imposed on the provider. Terms for a suspension or conditional license may include one or more of the following and the scope of each will be determined by the commissioner: (1) requiring a consultant to review, evaluate, and make recommended changes to the home care provider's practices and submit reports to the commissioner at the cost of the home care provider; (2) requiring supervision of the home care provider or staff practices at the cost of the home care provider by an unrelated person who has sufficient knowledge and qualifications to oversee the practices and who will submit reports to the commissioner; (3) requiring the home care provider or employees to obtain training at the cost of the home care provider; (4) requiring the home care provider to submit reports to the commissioner; (5) prohibiting the home care provider from taking any new clients for a period of time; or (6) any other action reasonably required to accomplish the purpose of this subdivision and section 144A.45, subdivision 2. (b) A home care provider subject to this subdivision may continue operating during the period of time home care clients are being transferred to other providers. Subd. 3. Notice. (a) Prior to any suspension, revocation, or refusal to renew a license, the home care provider shall be entitled to notice and a hearing as provided by sections 14.57 to 14.69. In addition to any other remedy provided by law, the commissioner may, without a prior contested case hearing, temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 days, or issue a conditional license if the commissioner determines that there are level 3 violations that do not pose an imminent risk of harm to the health or safety of persons in the provider's care, provided: (1) advance notice is given to the home care provider; (2) after notice, the home care provider fails to correct the problem; (3) the commissioner has reason to believe that other administrative remedies are not likely to be effective; and (4) there is an opportunity for a contested case hearing within the 30 days unless there is an extension granted by an administrative law judge pursuant to subdivision 3b. (b) If the commissioner determines there are: (1) level 4 violations; or (2) violations that pose an imminent risk of harm to the health or safety of persons in the provider's care, the commissioner may immediately temporarily suspend a license, prohibit delivery of services by a provider, or issue a conditional license without meeting the requirements of paragraph (a), clauses (1) to (4). For the purposes of this subdivision, "level 3" and "level 4" have the meanings given in section 144A.474, subdivision 11, paragraph (b).

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Subd. 3a. Hearing. Within 15 business days of receipt of the licensee's timely appeal of a sanction under this section, other than for a temporary suspension, the commissioner shall request assignment of an administrative law judge. The commissioner's request must include a proposed date, time, and place of hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 90 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause or for purposes of discussing settlement. In no case shall one or more extensions be granted for a total of more than 90 calendar days unless there is a criminal action pending against the licensee. If, while a licensee continues to operate pending an appeal of an order for revocation, suspension, or refusal to renew a license, the commissioner identifies one or more new violations of law that meet the requirements of level 3 or 4 violations as defined in section 144A.474, subdivision 11, paragraph (b), the commissioner shall act immediately to temporarily suspend the license under the provisions in subdivision 3. Subd. 3b. Expedited hearing. (a) Within five business days of receipt of the license holder's timely appeal of a temporary suspension or issuance of a conditional license, the commissioner shall request assignment of an administrative law judge. The request must include a proposed date, time, and place of a hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 30 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause. The commissioner shall issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. Certified mail to the last known address is sufficient. The scope of the hearing shall be limited solely to the issue of whether the temporary suspension or issuance of a conditional license should remain in effect and whether there is sufficient evidence to conclude that the licensee's actions or failure to comply with applicable laws are level 3 or 4 violations as defined in section 144A.474, subdivision 11, paragraph (b), or that there were violations that posed an imminent risk of harm to the health and safety of persons in the provider's care. (b) The administrative law judge shall issue findings of fact, conclusions, and a recommendation within ten business days from the date of hearing. The parties shall have ten calendar days to submit exceptions to the administrative law judge's report. The record shall close at the end of the ten-day period for submission of exceptions. The commissioner's final order shall be issued within ten business days from the close of the record. When an appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed, the commissioner shall issue a final order affirming the temporary immediate suspension or conditional license within ten calendar days of the commissioner's receipt of the withdrawal or dismissal. The license holder is prohibited from operation during the temporary suspension period. (c) When the final order under paragraph (b) affirms an immediate suspension, and a final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that sanction, the licensee is prohibited from operation pending a final commissioner's order after the contested case hearing conducted under chapter 14. (d) A licensee whose license is temporarily suspended must comply with the requirements for notification and transfer of clients in subdivision 5. These requirements remain if an appeal is requested. Subd. 3c. Immediate temporary suspension. (a) In addition to any other remedies provided by law, the commissioner may, without a prior contested case hearing, immediately temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 days, or issue a conditional license, if the commissioner determines that there are: (1) level 4 violations; or

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(2) violations that pose an imminent risk of harm to the health or safety of persons in the provider's care. (b) For purposes of this subdivision, "level 4" has the meaning given in section 144A.474, subdivision 11, paragraph (b). (c) A notice stating the reasons for the immediate temporary suspension or conditional license and informing the license holder of the right to an expedited hearing under subdivision 3b must be delivered by personal service to the address shown on the application or the last known address of the license holder. The license holder may appeal an order immediately temporarily suspending a license or issuing a conditional license. The appeal must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the commissioner within five calendar days after the license holder receives notice. If an appeal is made by personal service, it must be received by the commissioner within five calendar days after the license holder received the order. (d) A license holder whose license is immediately temporarily suspended must comply with the requirements for notification and transfer of clients in subdivision 5. These requirements remain if an appeal is requested. Subd. 4. Time limits for appeals. To appeal the assessment of civil penalties under section 144A.45, subdivision 2, clause (5), and an action against a license under this section, a provider must request a hearing no later than 15 days after the provider receives notice of the action. Subd. 5. Plan required. (a) The process of suspending, revoking, or refusing to renew a license must include a plan for transferring affected clients' care to other providers by the home care provider, which will be monitored by the commissioner. Within three calendar days of being notified of the revocation, refusal to renew, or suspension, the home care provider shall provide the commissioner, the lead agencies as defined in section 256B.0911, county adult protection and case managers, and the ombudsman for long-term care with the following information: (1) a list of all clients, including full names and all contact information on file; (2) a list of each client's representative or emergency contact person, including full names and all contact information on file; (3) the location or current residence of each client; (4) the payor sources for each client, including payor source identification numbers; and (5) for each client, a copy of the client's service plan, and a list of the types of services being provided. (b) The revocation, refusal to renew, or suspension notification requirement is satisfied by mailing the notice to the address in the license record. The home care provider shall cooperate with the commissioner and the lead agencies, county adult protection and case managers, and the ombudsman for long-term care during the process of transferring care of clients to qualified providers. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension action, the home care provider must notify and disclose to each of the home care provider's clients, or the client's representative or emergency contact persons, that the commissioner is taking action against the home care provider's license by providing a copy of the revocation, refusal to renew, or suspension notice issued by the commissioner. If the provider does not comply with the disclosure requirements in this section, the commissioner shall notify the clients, client representatives, or emergency contact persons about the action being taken. Lead agencies, county adult protection and case managers, and the Office of Ombudsman for Long-Term Care may also provide this

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information. The revocation, refusal to renew, or suspension notice is public data except for any private data contained therein. (c) A home care provider subject to this subdivision may continue operating during the period of time home care clients are being transferred to other providers. Subd. 6. Owners and managerial officials; refusal to grant license. (a) The owner and managerial officials of a home care provider whose Minnesota license has not been renewed or that has been revoked because of noncompliance with applicable laws or rules shall not be eligible to apply for nor will be granted a home care license, including other licenses under this chapter, or be given status as an enrolled personal care assistance provider agency or personal care assistant by the Department of Human Services under section 256B.0659 for five years following the effective date of the nonrenewal or revocation. If the owner and managerial officials already have enrollment status, their enrollment will be terminated by the Department of Human Services. (b) The commissioner shall not issue a license to a home care provider for five years following the effective date of license nonrenewal or revocation if the owner or managerial official, including any individual who was an owner or managerial official of another home care provider, had a Minnesota license that was not renewed or was revoked as described in paragraph (a). (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend or revoke, the license of any home care provider that includes any individual as an owner or managerial official who was an owner or managerial official of a home care provider whose Minnesota license was not renewed or was revoked as described in paragraph (a) for five years following the effective date of the nonrenewal or revocation. (d) The commissioner shall notify the home care provider 30 days in advance of the date of nonrenewal, suspension, or revocation of the license. Within ten days after the receipt of the notification, the home care provider may request, in writing, that the commissioner stay the nonrenewal, revocation, or suspension of the license. The home care provider shall specify the reasons for requesting the stay; the steps that will be taken to attain or maintain compliance with the licensure laws and regulations; any limits on the authority or responsibility of the owners or managerial officials whose actions resulted in the notice of nonrenewal, revocation, or suspension; and any other information to establish that the continuing affiliation with these individuals will not jeopardize client health, safety, or well-being. The commissioner shall determine whether the stay will be granted within 30 days of receiving the provider's request. The commissioner may propose additional restrictions or limitations on the provider's license and require that the granting of the stay be contingent upon compliance with those provisions. The commissioner shall take into consideration the following factors when determining whether the stay should be granted: (1) the threat that continued involvement of the owners and managerial officials with the home care provider poses to client health, safety, and well-being; (2) the compliance history of the home care provider; and (3) the appropriateness of any limits suggested by the home care provider. If the commissioner grants the stay, the order shall include any restrictions or limitation on the provider's license. The failure of the provider to comply with any restrictions or limitations shall result in the immediate removal of the stay and the commissioner shall take immediate action to suspend, revoke, or not renew the license. Subd. 7. Request for hearing. A request for a hearing must be in writing and must:

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(1) be mailed or delivered to the department or the commissioner's designee; (2) contain a brief and plain statement describing every matter or issue contested; and (3) contain a brief and plain statement of any new matter that the applicant or home care provider believes constitutes a defense or mitigating factor. Subd. 8. Informal conference. At any time, the applicant or home care provider and the commissioner may hold an informal conference to exchange information, clarify issues, or resolve issues. Subd. 9. Injunctive relief. In addition to any other remedy provided by law, the commissioner may bring an action in district court to enjoin a person who is involved in the management, operation, or control of a home care provider or an employee of the home care provider from illegally engaging in activities regulated by sections 144A.43 to 144A.482. The commissioner may bring an action under this subdivision in the district court in Ramsey County or in the district in which a home care provider is providing services. The court may grant a temporary restraining order in the proceeding if continued activity by the person who is involved in the management, operation, or control of a home care provider, or by an employee of the home care provider, would create an imminent risk of harm to a recipient of home care services. Subd. 10. Subpoena. In matters pending before the commissioner under sections 144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance of witnesses and the production of all necessary papers, books, records, documents, and other evidentiary material. If a person fails or refuses to comply with a subpoena or order of the commissioner to appear or testify regarding any matter about which the person may be lawfully questioned or to produce any papers, books, records, documents, or evidentiary materials in the matter to be heard, the commissioner may apply to the district court in any district, and the court shall order the person to comply with the commissioner's order or subpoena. The commissioner of health may administer oaths to witnesses or take their affirmation. Depositions may be taken in or outside the state in the manner provided by law for the taking of depositions in civil actions. A subpoena or other process or paper may be served on a named person anywhere in the state by an officer authorized to serve subpoenas in civil actions, with the same fees and mileage and in the same manner as prescribed by law for a process issued out of a district court. A person subpoenaed under this subdivision shall receive the same fees, mileage, and other costs that are paid in proceedings in district court. History: 2013 c 108 art 11 s 14; 2014 c 275 art 1 s 135; 2014 c 291 art 6 s 15-17; 2016 c 179 s 8-10; 2019 c 60 art 4 s 23,24; 1Sp2019 c 9 art 11 s 45-47 144A.476 BACKGROUND STUDIES. Subdivision 1. Prior criminal convictions; owner and managerial officials. (a) Before the commissioner issues a temporary license, issues a license as a result of an approved change in ownership, or renews a license, an owner or managerial official is required to complete a background study under section 144.057. No person may be involved in the management, operation, or control of a home care provider if the person has been disqualified under chapter 245C. If an individual is disqualified under section 144.057 or chapter 245C, the individual may request reconsideration of the disqualification. If the individual requests reconsideration and the commissioner sets aside or rescinds the disqualification, the individual is eligible to be involved in the management, operation, or control of the provider. If an individual has a disqualification under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's disqualification is barred from a set aside, and the individual must not be involved in the management, operation, or control of the provider.

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(b) For purposes of this section, owners of a home care provider subject to the background check requirement are those individuals whose ownership interest provides sufficient authority or control to affect or change decisions related to the operation of the home care provider. An owner includes a sole proprietor, a general partner, or any other individual whose individual ownership interest can affect the management and direction of the policies of the home care provider. (c) For the purposes of this section, managerial officials subject to the background check requirement are individuals who provide direct contact as defined in section 245C.02, subdivision 11, or individuals who have the responsibility for the ongoing management or direction of the policies, services, or employees of the home care provider. Data collected under this subdivision shall be classified as private data on individuals under section 13.02, subdivision 12. (d) The department shall not issue any license if the applicant or owner or managerial official has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C; if the owner or managerial official, as an owner or managerial official of another home care provider, was substantially responsible for the other home care provider's failure to substantially comply with sections 144A.43 to 144A.482; or if an owner that has ceased doing business, either individually or as an owner of a home care provider, was issued a correction order for failing to assist clients in violation of this chapter. Subd. 2. Employees, contractors, and volunteers. (a) Employees, contractors, and volunteers of a home care provider are subject to the background study required by section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall be construed to prohibit a home care provider from requiring self-disclosure of criminal conviction information. (b) Termination of an employee in good faith reliance on information or records obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not subject the home care provider to civil liability or liability for unemployment benefits. History: 2013 c 108 art 11 s 15; 2014 c 275 art 1 s 135; 2019 c 60 art 4 s 25; 1Sp2019 c 9 art 11 s 48 144A.477 COMPLIANCE. Subdivision 1. Medicare-certified providers; coordination of surveys. If feasible, the commissioner shall survey licensees to determine compliance with this chapter at the same time as surveys for certification for Medicare if Medicare certification is based on compliance with the federal conditions of participation and on survey and enforcement by the Department of Health as agent for the United States Department of Health and Human Services. Subd. 2. Medicare-certified providers; equivalent requirements. For home care providers licensed to provide comprehensive home care services that are also certified for participation in Medicare as a home health agency under Code of Federal Regulations, title 42, part 484, the following state licensure regulations are considered equivalent to the federal requirements: (1) quality management, section 144A.479, subdivision 3; (2) personnel records, section 144A.479, subdivision 7; (3) acceptance of clients, section 144A.4791, subdivision 4; (4) referrals, section 144A.4791, subdivision 5; (5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792, subdivisions 2 and 3;

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(6) individualized monitoring and reassessment, sections 144A.4791, subdivision 8, and 144A.4792, subdivisions 2 and 3; (7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792, subdivision 5, and 144A.4793, subdivision 3; (8) client complaint and investigation process, section 144A.4791, subdivision 11; (9) prescription orders, section 144A.4792, subdivisions 13 to 16; (10) client records, section 144A.4794, subdivisions 1 to 3; (11) qualifications for unlicensed personnel performing delegated tasks, section 144A.4795; (12) training and competency staff, section 144A.4795; (13) training and competency for unlicensed personnel, section 144A.4795, subdivision 7; (14) delegation of home care services, section 144A.4795, subdivision 4; (15) availability of contact person, section 144A.4797, subdivision 1; and (16) supervision of staff, section 144A.4797, subdivisions 2 and 3. Violations of requirements in clauses (1) to (16) may lead to enforcement actions under section 144A.474. History: 2013 c 108 art 11 s 16; 2014 c 275 art 1 s 135 144A.478 INNOVATION VARIANCE. Subdivision 1. Definition. For purposes of this section, "innovation variance" means a specified alternative to a requirement of this chapter. An innovation variance may be granted to allow a home care provider to offer home care services of a type or in a manner that is innovative, will not impair the services provided, will not adversely affect the health, safety, or welfare of the clients, and is likely to improve the services provided. The innovative variance cannot change any of the client's rights under section 144A.44, home care bill of rights. Subd. 2. Conditions. The commissioner may impose conditions on the granting of an innovation variance that the commissioner considers necessary. Subd. 3. Duration and renewal. The commissioner may limit the duration of any innovation variance and may renew a limited innovation variance. Subd. 4. Applications; innovation variance. An application for innovation variance from the requirements of this chapter may be made at any time, must be made in writing to the commissioner, and must specify the following: (1) the statute or law from which the innovation variance is requested; (2) the time period for which the innovation variance is requested; (3) the specific alternative action that the licensee proposes; (4) the reasons for the request; and

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(5) justification that an innovation variance will not impair the services provided, will not adversely affect the health, safety, or welfare of clients, and is likely to improve the services provided. The commissioner may require additional information from the home care provider before acting on the request. Subd. 5. Grants and denials. The commissioner shall grant or deny each request for an innovation variance in writing within 45 days of receipt of a complete request. Notice of a denial shall contain the reasons for the denial. The terms of a requested innovation variance may be modified upon agreement between the commissioner and the home care provider. Subd. 6. Violation of innovation variances. A failure to comply with the terms of an innovation variance shall be deemed to be a violation of this chapter. Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or deny renewal of an innovation variance if: (1) it is determined that the innovation variance is adversely affecting the health, safety, or welfare of the licensee's clients; (2) the home care provider has failed to comply with the terms of the innovation variance; (3) the home care provider notifies the commissioner in writing that it wishes to relinquish the innovation variance and be subject to the statute previously varied; or (4) the revocation or denial is required by a change in law. History: 2013 c 108 art 11 s 17; 2014 c 275 art 1 s 135 144A.479 HOME CARE PROVIDER RESPONSIBILITIES; BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed in the home care provider's principal business office and copies must be displayed in any branch office. The home care provider must provide a copy of the license to any person who requests it. Subd. 2. Advertising. Home care providers shall not use false, fraudulent, or misleading advertising in the marketing of services. For purposes of this section, advertising includes any verbal, written, or electronic means of communicating to potential clients about the availability, nature, or terms of home care services. Subd. 3. Quality management. The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal. Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A home care provider or staff cannot accept powers-of-attorney from clients for any purpose, and may not accept appointments as guardians or conservators of clients. (c) A home care provider cannot serve as a client's representative.

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Subd. 5. Handling of client's finances and property. (a) A home care provider may assist clients with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a client's property. A home care provider must provide a client with receipts for all transactions and purchases paid with the client's funds. When receipts are not available, the transaction or purchase must be documented. A home care provider must maintain records of all such transactions. (b) A home care provider or staff may not borrow a client's funds or personal or real property, nor in any way convert a client's property to the home care provider's or staff's possession. (c) Nothing in this section precludes a home care provider or staff from accepting gifts of minimal value, or precludes the acceptance of donations or bequests made to a home care provider that are exempt from income tax under section 501(c) of the Internal Revenue Code of 1986. Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All home care providers must comply with requirements for the reporting of maltreatment of minors in section 626.556 and the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. Each home care provider must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) Each home care provider must develop and implement an individual abuse prevention plan for each vulnerable minor or adult for whom home care services are provided by a home care provider. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults or minors. For purposes of the abuse prevention plan, the term abuse includes self-abuse. Subd. 7. Employee records. The home care provider must maintain current records of each paid employee, regularly scheduled volunteers providing home care services, and of each individual contractor providing home care services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification, if licensure, registration, or certification is required by this statute or other rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff providing supervision; (4) documentation of annual performance reviews which identify areas of improvement needed and training needs; (5) for individuals providing home care services, verification that any health screenings required by infection control programs established under section 144A.4798 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. Each employee record must be retained for at least three years after a paid employee, home care volunteer, or contractor ceases to be employed by or under contract with the home care provider. If a home care provider ceases operation, employee records must be maintained for three years.

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Subd. 8. Labor market reporting. A home care provider shall comply with the labor market reporting requirements described in section 256B.4912, subdivision 1a. History: 2013 c 108 art 11 s 18; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 49,50 144A.4791 HOME CARE PROVIDER RESPONSIBILITIES WITH RESPECT TO CLIENTS. Subdivision 1. Home care bill of rights; notification to client. (a) The home care provider shall provide the client or the client's representative a written notice of the rights under section 144A.44 before the date that services are first provided to that client. The provider shall make all reasonable efforts to provide notice of the rights to the client or the client's representative in a language the client or client's representative can understand. (b) In addition to the text of the home care bill of rights in section 144A.44, subdivision 1, the notice shall also contain the following statement describing how to file a complaint with these offices. "If you have a complaint about the provider or the person providing your home care services, you may call, write, or visit the Office of Health Facility Complaints, Minnesota Department of Health. You may also contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities." The statement should include the telephone number, website address, e-mail address, mailing address, and street address of the Office of Health Facility Complaints at the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care, and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The statement should also include the home care provider's name, address, e-mail, telephone number, and name or title of the person at the provider to whom problems or complaints may be directed. It must also include a statement that the home care provider will not retaliate because of a complaint. (c) The home care provider shall obtain written acknowledgment of the client's receipt of the home care bill of rights or shall document why an acknowledgment cannot be obtained. The acknowledgment may be obtained from the client or the client's representative. Acknowledgment of receipt shall be retained in the client's record. Subd. 2. Notice of services for dementia, Alzheimer's disease, or related disorders. The home care provider that provides services to clients with dementia shall provide in written or electronic form, to clients and families or other persons who request it, a description of the training program and related training it provides, including the categories of employees trained, the frequency of training, and the basic topics covered. This information satisfies the disclosure requirements in section 325F.72, subdivision 2, clause (4). Subd. 3. Statement of home care services. Prior to the date that services are first provided to the client, a home care provider must provide to the client or the client's representative a written statement which identifies if the provider has a basic or comprehensive home care license, the services the provider is authorized to provide, and which services the provider cannot provide under the scope of the provider's license. The home care provider shall obtain written acknowledgment from the clients that the provider has provided the statement or must document why the provider could not obtain the acknowledgment. Subd. 4. Acceptance of clients. No home care provider may accept a person as a client unless the home care provider has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the service plan and that are within the provider's scope of practice.

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Subd. 5. Referrals. If a home care provider reasonably believes that a client is in need of another medical or health service, including a licensed health professional, or social service provider, the home care provider shall: (1) determine the client's preferences with respect to obtaining the service; and (2) inform the client of resources available, if known, to assist the client in obtaining services. Subd. 6. Initiation of services. When a provider provides home care services to a client before the individualized review or assessment by a licensed health professional or registered nurse as required in subdivisions 7 and 8 is completed, the licensed health professional or registered nurse must complete a temporary plan with the client and orient staff assigned to deliver services as identified in the temporary plan. Subd. 7. Basic individualized client review and monitoring. (a) When services being provided are basic home care services, an individualized initial review of the client's needs and preferences must be conducted at the client's residence with the client or client's representative. This initial review must be completed within 30 days after the date that home care services are first provided. (b) Client monitoring and review must be conducted as needed based on changes in the needs of the client and cannot exceed 90 days from the date of the last review. The monitoring and review may be conducted at the client's residence or through the utilization of telecommunication methods based on practice standards that meet the individual client's needs. Subd. 8. Comprehensive assessment, monitoring, and reassessment. (a) When the services being provided are comprehensive home care services, an individualized initial assessment must be conducted in person by a registered nurse. When the services are provided by other licensed health professionals, the assessment must be conducted by the appropriate health professional. This initial assessment must be completed within five days after the date that home care services are first provided. (b) Client monitoring and reassessment must be conducted in the client's home no more than 14 days after the date that home care services are first provided. (c) Ongoing client monitoring and reassessment must be conducted as needed based on changes in the needs of the client and cannot exceed 90 days from the last date of the assessment. The monitoring and reassessment may be conducted at the client's residence or through the utilization of telecommunication methods based on practice standards that meet the individual client's needs. Subd. 9. Service plan, implementation, and revisions to service plan. (a) No later than 14 days after the date that home care services are first provided, a home care provider shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the home care provider and by the client or the client's representative documenting agreement on the services to be provided. The service plan must be revised, if needed, based on client review or reassessment under subdivisions 7 and 8. The provider must provide information to the client about changes to the provider's fee for services and how to contact the Office of the Ombudsman for Long-Term Care. (c) The home care provider must implement and provide all services required by the current service plan.

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(d) The service plan and revised service plan must be entered into the client's record, including notice of a change in a client's fees when applicable. (e) Staff providing home care services must be informed of the current written service plan. (f) The service plan must include: (1) a description of the home care services to be provided, the fees for services, and the frequency of each service, according to the client's current review or assessment and client preferences; (2) the identification of the staff or categories of staff who will provide the services; (3) the schedule and methods of monitoring reviews or assessments of the client; (4) the schedule and methods of monitoring staff providing home care services; and (5) a contingency plan that includes: (i) the action to be taken by the home care provider and by the client or client's representative if the scheduled service cannot be provided; (ii) information and a method for a client or client's representative to contact the home care provider; (iii) names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in the client's condition; and (iv) the circumstances in which emergency medical services are not to be summoned consistent with chapters 145B and 145C, and declarations made by the client under those chapters. Subd. 10. Termination of service plan. (a) If a home care provider terminates a service plan with a client, and the client continues to need home care services, the home care provider shall provide the client and the client's representative, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the reason for termination; (3) a list of known licensed home care providers in the client's immediate geographic area; (4) a statement that the home care provider will participate in a coordinated transfer of care of the client to another home care provider, health care provider, or caregiver, as required by the home care bill of rights, section 144A.44, subdivision 1, clause (17); (5) the name and contact information of a person employed by the home care provider with whom the client may discuss the notice of termination; and (6) if applicable, a statement that the notice of termination of home care services does not constitute notice of termination of the housing with services contract with a housing with services establishment. (b) When the home care provider voluntarily discontinues services to all clients, the home care provider must notify the commissioner, lead agencies, and ombudsman for long-term care about its clients and comply with the requirements in this subdivision.

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Subd. 11. Client complaint and investigative process. (a) The home care provider must have a written policy and system for receiving, investigating, reporting, and attempting to resolve complaints from its clients or clients' representatives. The policy should clearly identify the process by which clients may file a complaint or concern about home care services and an explicit statement that the home care provider will not discriminate or retaliate against a client for expressing concerns or complaints. A home care provider must have a process in place to conduct investigations of complaints made by the client or the client's representative about the services in the client's plan that are or are not being provided or other items covered in the client's home care bill of rights. This complaint system must provide reasonable accommodations for any special needs of the client or client's representative if requested. (b) The home care provider must document the complaint, name of the client, investigation, and resolution of each complaint filed. The home care provider must maintain a record of all activities regarding complaints received, including the date the complaint was received, and the home care provider's investigation and resolution of the complaint. This complaint record must be kept for each event for at least two years after the date of entry and must be available to the commissioner for review. (c) The required complaint system must provide for written notice to each client or client's representative that includes: (1) the client's right to complain to the home care provider about the services received; (2) the name or title of the person or persons with the home care provider to contact with complaints; (3) the method of submitting a complaint to the home care provider; and (4) a statement that the provider is prohibited against retaliation according to paragraph (d). (d) A home care provider must not take any action that negatively affects a client in retaliation for a complaint made or a concern expressed by the client or the client's representative. Subd. 12. Disaster planning and emergency preparedness plan. The home care provider must have a written plan of action to facilitate the management of the client's care and services in response to a natural disaster, such as flood and storms, or other emergencies that may disrupt the home care provider's ability to provide care or services. The licensee must provide adequate orientation and training of staff on emergency preparedness. Subd. 13. Request for discontinuation of life-sustaining treatment. (a) If a client, family member, or other caregiver of the client requests that an employee or other agent of the home care provider discontinue a life-sustaining treatment, the employee or agent receiving the request: (1) shall take no action to discontinue the treatment; and (2) shall promptly inform the supervisor or other agent of the home care provider of the client's request. (b) Upon being informed of a request for termination of treatment, the home care provider shall promptly: (1) inform the client that the request will be made known to the physician or advanced practice registered nurse who ordered the client's treatment; (2) inform the physician or advanced practice registered nurse of the client's request; and (3) work with the client and the client's physician or advanced practice registered nurse to comply with the provisions of the Health Care Directive Act in chapter 145C.

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(c) This section does not require the home care provider to discontinue treatment, except as may be required by law or court order. (d) This section does not diminish the rights of clients to control their treatments, refuse services, or terminate their relationships with the home care provider. (e) This section shall be construed in a manner consistent with chapter 145B or 145C, whichever applies, and declarations made by clients under those chapters. Subd. 14. Application of other law. Home care providers may exercise the authority and are subject to the protections in section 152.34. History: 2013 c 108 art 11 s 19; 2014 c 275 art 1 s 135; 2016 c 179 s 11; 2018 c 170 s 3; 1Sp2019 c 9 art 11 s 51-56 144A.4792 MEDICATION MANAGEMENT. Subdivision 1. Medication management services; comprehensive home care license. (a) This subdivision applies only to home care providers with a comprehensive home care license that provide medication management services to clients. Medication management services may not be provided by a home care provider who has a basic home care license. (b) A comprehensive home care provider who provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines. (c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and client and client representative, if any; disposing of unused medications; and educating clients and client representatives about medications. When controlled substances are being managed, stored, and secured by the comprehensive home care provider, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 22. Subd. 2. Provision of medication management services. (a) For each client who requests medication management services, the comprehensive home care provider shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the client. The assessment must include an identification and review of all medications the client is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. (b) The assessment must: (1) identify interventions needed in management of medications to prevent diversion of medication by the client or others who may have access to the medications; and

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(2) provide instructions to the client or client's representative on interventions to manage the client's medications and prevent diversion of medications. "Diversion of medications" means the misuse, theft, or illegal or improper disposition of medications. Subd. 3. Individualized medication monitoring and reassessment. The comprehensive home care provider must monitor and reassess the client's medication management services as needed under subdivision 2 when the client presents with symptoms or other issues that may be medication-related and, at a minimum, annually. Subd. 4. Client refusal. The home care provider must document in the client's record any refusal for an assessment for medication management by the client. The provider must discuss with the client the possible consequences of the client's refusal and document the discussion in the client's record. Subd. 5. Individualized medication management plan. (a) For each client receiving medication management services, the comprehensive home care provider must prepare and include in the service plan a written statement of the medication management services that will be provided to the client. The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following: (1) a statement describing the medication management services that will be provided; (2) a description of storage of medications based on the client's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; (3) documentation of specific client instructions relating to the administration of medications; (4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; (5) identification of medication management tasks that may be delegated to unlicensed personnel; (6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and (7) any client-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions. (b) The medication management record must be current and updated when there are any changes. (c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Subd. 6. Administration of medication. Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse. Subd. 7. Delegation of medication administration. When administration of medications is delegated to unlicensed personnel, the comprehensive home care provider must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures;

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(2) specified, in writing, specific instructions for each client and documented those instructions in the client's records; and (3) communicated with the unlicensed personnel about the individual needs of the client. Subd. 8. Documentation of administration of medications. Each medication administered by comprehensive home care provider staff must be documented in the client's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the client's needs when medication was not administered as prescribed and in compliance with the client's medication management plan. Subd. 9. Documentation of medication setup. Documentation of dates of medication setup, name of medication, quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup. Subd. 10. Medication management for clients who will be away from home. (a) A home care provider who is providing medication management services to the client and controls the client's access to the medications must develop and implement policies and procedures for giving accurate and current medications to clients for planned or unplanned times away from home according to the client's individualized medication management plan. The policy and procedures must state that: (1) for planned time away, the medications must be obtained from the pharmacy or set up by a licensed nurse according to appropriate state and federal laws and nursing standards of practice; (2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall give the client or client's representative medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days; (3) the client or client's representative must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; (4) the medications must be placed in a medication container or containers appropriate to the provider's medication system and must be labeled with the client's name and the dates and times that the medications are scheduled; and (5) the client or client's representative must be provided in writing the home care provider's name and information on how to contact the home care provider. (b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if: (1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to clients; and (2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the client. The procedures must address: (i) the type of container or containers to be used for the medications appropriate to the provider's medication system;

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(ii) how the container or containers must be labeled; (iii) the written information about the medications to be given to the client or client's representative; (iv) how the unlicensed staff must document in the client's record that medications have been given to the client or the client's representative, including documenting the date the medications were given to the client or the client's representative and who received the medications, the person who gave the medications to the client, the number of medications that were given to the client, and other required information; (v) how the registered nurse shall be notified that medications have been given to the client or client's representative and whether the registered nurse needs to be contacted before the medications are given to the client or the client's representative; (vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and (vii) how the unlicensed staff must document in the client's record any unused medications that are returned to the provider, including the name of each medication and the doses of each returned medication. Subd. 11. Prescribed and nonprescribed medication. The comprehensive home care provider must determine whether the comprehensive home care provider shall require a prescription for all medications the provider manages. The comprehensive home care provider must inform the client or the client's representative whether the comprehensive home care provider requires a prescription for all over-the-counter and dietary supplements before the comprehensive home care provider agrees to manage those medications. Subd. 12. Medications; over-the-counter; dietary supplements not prescribed. A comprehensive home care provider providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The provider must verify that the medications are up-to-date and stored as appropriate. Subd. 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the comprehensive home care provider is managing for the client. Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152. Subd. 15. Verbal prescription orders. Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200. Subd. 16. Written or electronic prescription. When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the client's record. Subd. 17. Records confidential. A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44. Subd. 18. Medications provided by client or family members. When the comprehensive home care provider is aware of any medications or dietary supplements that are being used by the client and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the client's record.

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Subd. 19. Storage of medications. A comprehensive home care provider providing storage of medications outside of the client's private living space must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access. Subd. 20. Prescription drugs. A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug. Subd. 21. Prohibitions. No prescription drug supply for one client may be used or saved for use by anyone other than the client. Subd. 22. Disposition of medications. (a) Any current medications being managed by the comprehensive home care provider must be given to the client or the client's representative when the client's service plan ends or medication management services are no longer part of the service plan. Medications that have been stored in the client's private living space for a client who is deceased or that have been discontinued or that have expired may be given to the client or the client's representative for disposal. (b) The comprehensive home care provider will dispose of any medications remaining with the comprehensive home care provider that are discontinued or expired or upon the termination of the service contract or the client's death according to state and federal regulations for disposition of medications and controlled substances. (c) Upon disposition, the comprehensive home care provider must document in the client's record the disposition of the medication including the medication's name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition. Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation must be made in the client's record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations. (b) The procedures must require the comprehensive home care provider of medication management to investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records. History: 2013 c 108 art 11 s 20; 2014 c 275 art 1 s 26,135; 2016 c 179 s 12; 1Sp2019 c 9 art 11 s 57-60 144A.4793 TREATMENT AND THERAPY MANAGEMENT SERVICES. Subdivision 1. Providers with a comprehensive home care license. This section applies only to home care providers with a comprehensive home care license that provide treatment or therapy management services to clients. Treatment or therapy management services cannot be provided by a home care provider that has a basic home care license. Subd. 2. Policies and procedures. (a) A comprehensive home care provider who provides treatment and therapy management services must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures. The policies and procedures must be developed under the

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supervision and direction of a registered nurse or appropriate licensed health professional consistent with current practice standards and guidelines. (b) The written policies and procedures must address requesting and receiving orders or prescriptions for treatments or therapies, providing the treatment or therapy, documenting of treatment or therapy activities, educating and communicating with clients about treatments or therapy they are receiving, monitoring and evaluating the treatment and therapy, and communicating with the prescriber. Subd. 3. Individualized treatment or therapy management plan. For each client receiving management of ordered or prescribed treatments or therapy services, the comprehensive home care provider must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the client. The provider must also develop and maintain a current individualized treatment and therapy management record for each client which must contain at least the following: (1) a statement of the type of services that will be provided; (2) documentation of specific client instructions relating to the treatments or therapy administration; (3) identification of treatment or therapy tasks that will be delegated to unlicensed personnel; (4) procedures for notifying a registered nurse or appropriate licensed health professional when a problem arises with treatments or therapy services; and (5) any client-specific requirements relating to documentation of treatment and therapy received, verification that all treatment and therapy was administered as prescribed, and monitoring of treatment or therapy to prevent possible complications or adverse reactions. The treatment or therapy management record must be current and updated when there are any changes. Subd. 4. Administration of treatments and therapy. Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health professional according to the appropriate practice standards for delegation or assignment. When administration of a treatment or therapy is delegated or assigned to unlicensed personnel, the home care provider must ensure that the registered nurse or authorized licensed health professional has: (1) instructed the unlicensed personnel in the proper methods with respect to each client and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each client and documented those instructions in the client's record; and (3) communicated with the unlicensed personnel about the individual needs of the client. Subd. 5. Documentation of administration of treatments and therapies. Each treatment or therapy administered by a comprehensive home care provider must be documented in the client's record. The documentation must include the signature and title of the person who administered the treatment or therapy and must include the date and time of administration. When treatment or therapies are not administered as ordered or prescribed, the provider must document the reason why it was not administered and any follow-up procedures that were provided to meet the client's needs. Subd. 6. Treatment and therapy orders. There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. The order must contain the name of the client, a description of the treatment or therapy to be provided, and the frequency, duration, and other

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information needed to administer the treatment or therapy. Treatment and therapy orders must be renewed at least every 12 months. History: 2013 c 108 art 11 s 21; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 61 144A.4794 CLIENT RECORD REQUIREMENTS. Subdivision 1. Client record. (a) The home care provider must maintain records for each client for whom it is providing services. Entries in the client records must be current, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry. (b) Client records, whether written or electronic, must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable relevant federal and state laws. The home care provider shall establish and implement written procedures to control use, storage, and security of client's records and establish criteria for release of client information. (c) The home care provider may not disclose to any other person any personal, financial, medical, or other information about the client, except: (1) as may be required by law; (2) to employees or contractors of the home care provider, another home care provider, other health care practitioner or provider, or inpatient facility needing information in order to provide services to the client, but only such information that is necessary for the provision of services; (3) to persons authorized in writing by the client or the client's representative to receive the information, including third-party payers; and (4) to representatives of the commissioner authorized to survey or investigate home care providers under this chapter or federal laws. Subd. 2. Access to records. The home care provider must ensure that the appropriate records are readily available to employees or contractors authorized to access the records. Client records must be maintained in a manner that allows for timely access, printing, or transmission of the records. Subd. 3. Contents of client record. Contents of a client record include the following for each client: (1) identifying information, including the client's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of an emergency contact, family members, client's representative, if any, or others as identified; (3) names, addresses, and telephone numbers of the client's health and medical service providers and other home care providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) client's advance directives, if any; (6) the home care provider's current and previous assessments and service plans; (7) all records of communications pertinent to the client's home care services;

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(8) documentation of significant changes in the client's status and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional; (9) documentation of incidents involving the client and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional; (10) documentation that services have been provided as identified in the service plan; (11) documentation that the client has received and reviewed the home care bill of rights; (12) documentation that the client has been provided the statement of disclosure on limitations of services under section 144A.4791, subdivision 3; (13) documentation of complaints received and resolution; (14) discharge summary, including service termination notice and related documentation, when applicable; and (15) other documentation required under this chapter and relevant to the client's services or status. Subd. 4. Transfer of client records. If a client transfers to another home care provider or other health care practitioner or provider, or is admitted to an inpatient facility, the home care provider, upon request of the client or the client's representative, shall take steps to ensure a coordinated transfer including sending a copy or summary of the client's record to the new home care provider, the facility, or the client, as appropriate. Subd. 5. Record retention. Following the client's discharge or termination of services, a home care provider must retain a client's record for at least five years, or as otherwise required by state or federal regulations. Arrangements must be made for secure storage and retrieval of client records if the home care provider ceases business. History: 2013 c 108 art 11 s 22; 2014 c 275 art 1 s 135 144A.4795 HOME CARE PROVIDER RESPONSIBILITIES; STAFF. Subdivision 1. Qualifications, training, and competency. All staff providing home care services must: (1) be trained and competent in the provision of home care services consistent with current practice standards appropriate to the client's needs; and (2) be informed of the home care bill of rights under section 144A.44. Subd. 2. Licensed health professionals and nurses. (a) Licensed health professionals and nurses providing home care services as an employee of a licensed home care provider must possess a current Minnesota license or registration to practice. (b) Licensed health professionals and registered nurses must be competent in assessing client needs, planning appropriate home care services to meet client needs, implementing services, and supervising staff if assigned. (c) Nothing in this section limits or expands the rights of nurses or licensed health professionals to provide services within the scope of their licenses or registrations, as provided by law. Subd. 3. Unlicensed personnel. (a) Unlicensed personnel providing basic home care services must have: (1) successfully completed a training and competency evaluation appropriate to the services provided by the home care provider and the topics listed in subdivision 7, paragraph (b); or

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(2) demonstrated competency by satisfactorily completing a written or oral test on the tasks the unlicensed personnel will perform and in the topics listed in subdivision 7, paragraph (b); and successfully demonstrated competency of topics in subdivision 7, paragraph (b), clauses (5), (7), and (8), by a practical skills test. Unlicensed personnel providing home care services for a basic home care provider may not perform delegated nursing or therapy tasks. (b) Unlicensed personnel performing delegated nursing tasks for a comprehensive home care provider must: (1) have successfully completed training and demonstrated competency by successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b) and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5) and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; (2) satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36; or (3) have, before April 19, 1993, completed a training course for nursing assistants that was approved by the commissioner. (c) Unlicensed personnel performing therapy or treatment tasks delegated or assigned by a licensed health professional must meet the requirements for delegated tasks in subdivision 4 and any other training or competency requirements within the licensed health professional scope of practice relating to delegation or assignment of tasks to unlicensed personnel. Subd. 4. Delegation of home care tasks. A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act. The comprehensive home care provider must establish and implement a system to communicate up-to-date information to the registered nurse or licensed health professional regarding the current available staff and their competency so the registered nurse or licensed health professional has sufficient information to determine the appropriateness of delegating tasks to meet individual client needs and preferences. Subd. 5. Individual contractors. When a home care provider contracts with an individual contractor excluded from licensure under section 144A.471 to provide home care services, the contractor must meet the same requirements required by this section for personnel employed by the home care provider. Subd. 6. Temporary staff. When a home care provider contracts with a temporary staffing agency excluded from licensure under section 144A.471, those individuals must meet the same requirements required by this section for personnel employed by the home care provider and shall be treated as if they are staff of the home care provider. Subd. 7. Requirements for instructors, training content, and competency evaluations for unlicensed personnel. (a) Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel providing basic home care services must be conducted by individuals with work experience and training in providing home care services listed in section 144A.471, subdivisions 6 and 7; and (2) training and competency evaluations of unlicensed personnel providing comprehensive home care services must be conducted by a registered nurse, or another instructor may provide training in conjunction

144A.4795

MINNESOTA STATUTES 2019

with the registered nurse. If the home care provider is providing services by licensed health professionals only, then that specific training and competency evaluation may be conducted by the licensed health professionals as appropriate. (b) Training and competency evaluations for all unlicensed personnel must include the following: (1) documentation requirements for all services provided; (2) reports of changes in the client's condition to the supervisor designated by the home care provider; (3) basic infection control, including blood-borne pathogens; (4) maintenance of a clean and safe environment; (5) appropriate and safe techniques in personal hygiene and grooming, including: (i) hair care and bathing; (ii) care of teeth, gums, and oral prosthetic devices; (iii) care and use of hearing aids; and (iv) dressing and assisting with toileting; (6) training on the prevention of falls for providers working with the elderly or individuals at risk of falls; (7) standby assistance techniques and how to perform them; (8) medication, exercise, and treatment reminders; (9) basic nutrition, meal preparation, food safety, and assistance with eating; (10) preparation of modified diets as ordered by a licensed health professional; (11) communication skills that include preserving the dignity of the client and showing respect for the client and the client's preferences, cultural background, and family; (12) awareness of confidentiality and privacy; (13) understanding appropriate boundaries between staff and clients and the client's family; (14) procedures to utilize in handling various emergency situations; and (15) awareness of commonly used health technology equipment and assistive devices. (c) In addition to paragraph (b), training and competency evaluation for unlicensed personnel providing comprehensive home care services must include: (1) observation, reporting, and documenting of client status; (2) basic knowledge of body functioning and changes in body functioning, injuries, or other observed changes that must be reported to appropriate personnel; (3) reading and recording temperature, pulse, and respirations of the client; (4) recognizing physical, emotional, cognitive, and developmental needs of the client;

MINNESOTA STATUTES 2019

144A.4796

(5) safe transfer techniques and ambulation; (6) range of motioning and positioning; and (7) administering medications or treatments as required. (d) When the registered nurse or licensed health professional delegates tasks, they must ensure that prior to the delegation the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each client and are able to demonstrate the ability to competently follow the procedures and perform the tasks. If an unlicensed personnel has not regularly performed the delegated home care task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task to the registered nurse or appropriate licensed health professional. The registered nurse or licensed health professional must document instructions for the delegated tasks in the client's record. History: 2013 c 108 art 11 s 23; 2014 c 275 art 1 s 135 144A.4796 ORIENTATION AND ANNUAL TRAINING REQUIREMENTS. Subdivision 1. Orientation of staff and supervisors to home care. All staff providing and supervising direct home care services must complete an orientation to home care licensing requirements and regulations before providing home care services to clients. The orientation may be incorporated into the training required under subdivision 6. The orientation need only be completed once for each staff person and is not transferable to another home care provider. Subd. 2. Content. (a) The orientation must contain the following topics: (1) an overview of sections 144A.43 to 144A.4798; (2) introduction and review of all the provider's policies and procedures related to the provision of home care services by the individual staff person; (3) handling of emergencies and use of emergency services; (4) compliance with and reporting of the maltreatment of minors or vulnerable adults under sections 626.556 and 626.557; (5) home care bill of rights under section 144A.44; (6) handling of clients' complaints, reporting of complaints, and where to report complaints including information on the Office of Health Facility Complaints and the Common Entry Point; (7) consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county managed care advocates, or other relevant advocacy services; and (8) review of the types of home care services the employee will be providing and the provider's scope of licensure. (b) In addition to the topics listed in paragraph (a), orientation may also contain training on providing services to clients with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research-based, may include online training, and must include training on one or more of the following topics:

144A.4796

MINNESOTA STATUTES 2019

(1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 3. Verification and documentation of orientation. Each home care provider shall retain evidence in the employee record of each staff person having completed the orientation required by this section. Subd. 4. Orientation to client. Staff providing home care services must be oriented specifically to each individual client and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically. Subd. 5. Training required relating to Alzheimer's disease and related disorders. For home care providers that provide services for persons with Alzheimer's or related disorders, all direct care staff and supervisors working with those clients must receive training that includes a current explanation of Alzheimer's disease and related disorders, effective approaches to use to problem-solve when working with a client's challenging behaviors, and how to communicate with clients who have Alzheimer's or related disorders. Subd. 6. Required annual training. (a) All staff that perform direct home care services must complete at least eight hours of annual training for each 12 months of employment. The training may be obtained from the home care provider or another source and must include topics relevant to the provision of home care services. The annual training must include: (1) training on reporting of maltreatment of minors under section 626.556 and maltreatment of vulnerable adults under section 626.557, whichever is applicable to the services provided; (2) review of the home care bill of rights in section 144A.44; (3) review of infection control techniques used in the home and implementation of infection control standards including a review of hand-washing techniques; the need for and use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of communicable diseases; and (4) review of the provider's policies and procedures relating to the provision of home care services and how to implement those policies and procedures. (b) In addition to the topics listed in paragraph (a), annual training may also contain training on providing services to clients with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research-based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or

MINNESOTA STATUTES 2019

144A.4797

(3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 7. Documentation. A home care provider must retain documentation in the employee records of the staff who have satisfied the orientation and training requirements of this section. History: 2013 c 108 art 11 s 24; 2014 c 275 art 1 s 135; 2017 c 51 s 1,2; 1Sp2019 c 9 art 11 s 62 144A.4797 PROVISION OF SERVICES. Subdivision 1. Availability of contact person to staff. (a) A home care provider with a basic home care license must have a person available to staff for consultation on items relating to the provision of services or about the client. (b) A home care provider with a comprehensive home care license must have a registered nurse available for consultation to staff performing delegated nursing tasks and must have an appropriate licensed health professional available if performing other delegated services such as therapies. (c) The appropriate contact person must be readily available either in person, by telephone, or by other means to the staff at times when the staff is providing services. Subd. 2. Supervision of staff; basic home care services. (a) Staff who perform basic home care services must be supervised periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions to address issues relating to the staff's ability to provide the services. The supervision of the unlicensed personnel must be done by staff of the home care provider having the authority, skills, and ability to provide the supervision of unlicensed personnel and who can implement changes as needed, and train staff. (b) Supervision includes direct observation of unlicensed personnel while the unlicensed personnel are providing the services and may also include indirect methods of gaining input such as gathering feedback from the client. Supervisory review of staff must be provided at a frequency based on the staff person's competency and performance. (c) For an individual who is licensed as a home care provider, this section does not apply. Subd. 3. Supervision of staff providing delegated nursing or therapy home care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be supervised by an appropriate licensed health professional or a registered nurse periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions related to the staff person's ability to perform the tasks. Supervision of staff performing medication or treatment administration shall be provided by a registered nurse or appropriate licensed health professional and must include observation of the staff administering the medication or treatment and the interaction with the client. (b) The direct supervision of staff performing delegated tasks must be provided within 30 days after the date on which the individual begins working for the home care provider and first performs delegated tasks for clients and thereafter as needed based on performance. This requirement also applies to staff who have not performed delegated tasks for one year or longer. Subd. 4. Documentation. A home care provider must retain documentation of supervision activities in the personnel records.

144A.4797

MINNESOTA STATUTES 2019

Subd. 5. Exemption. This section does not apply to an individual licensed under sections 144A.43 to 144A.4798. History: 2013 c 108 art 11 s 25; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 63 144A.4798 DISEASE PREVENTION AND INFECTION CONTROL. Subdivision 1. Tuberculosis (TB) infection control. (a) A home care provider must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report. This program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines. (b) The home care provider must maintain written evidence of compliance with this subdivision. Subd. 2. Communicable diseases. A home care provider must follow current state requirements for prevention, control, and reporting of communicable diseases as defined in Minnesota Rules, parts 4605.7040, 4605.7044, 4605.7050, 4605.7075, 4605.7080, and 4605.7090. Subd. 3. Infection control program. A home care provider must establish and maintain an effective infection control program that complies with accepted health care, medical, and nursing standards for infection control. History: 2013 c 108 art 11 s 26; 1Sp2019 c 9 art 11 s 64 144A.4799 DEPARTMENT OF HEALTH LICENSED HOME CARE PROVIDER ADVISORY COUNCIL. Subdivision 1. Membership. The commissioner of health shall appoint eight persons to a home care and assisted living program advisory council consisting of the following: (1) three public members as defined in section 214.02 who shall be persons who are currently receiving home care services, persons who have received home care services within five years of the application date, persons who have family members receiving home care services, or persons who have family members who have received home care services within five years of the application date; (2) three Minnesota home care licensees representing basic and comprehensive levels of licensure who may be a managerial official, an administrator, a supervising registered nurse, or an unlicensed personnel performing home care tasks; (3) one member representing the Minnesota Board of Nursing; (4) one member representing the Office of Ombudsman for Long-Term Care; and (5) beginning July 1, 2021, one member of a county health and human services or county adult protection office. Subd. 2. Organizations and meetings. The advisory council shall be organized and administered under section 15.059 with per diems and costs paid within the limits of available appropriations. Meetings will be held quarterly and hosted by the department. Subcommittees may be developed as necessary by the commissioner. Advisory council meetings are subject to the Open Meeting Law under chapter 13D.

MINNESOTA STATUTES 2019

144A.482

Subd. 3. Duties. (a) At the commissioner's request, the advisory council shall provide advice regarding regulations of Department of Health licensed home care providers in this chapter, including advice on the following: (1) community standards for home care practices; (2) enforcement of licensing standards and whether certain disciplinary actions are appropriate; (3) ways of distributing information to licensees and consumers of home care and assisted living; (4) training standards; (5) identifying emerging issues and opportunities in home care and assisted living; (6) identifying the use of technology in home and telehealth capabilities; (7) allowable home care licensing modifications and exemptions, including a method for an integrated license with an existing license for rural licensed nursing homes to provide limited home care services in an adjacent independent living apartment building owned by the licensed nursing home; and (8) recommendations for studies using the data in section 62U.04, subdivision 4, including but not limited to studies concerning costs related to dementia and chronic disease among an elderly population over 60 and additional long-term care costs, as described in section 62U.10, subdivision 6. (b) The advisory council shall perform other duties as directed by the commissioner. (c) The advisory council shall annually make recommendations to the commissioner for the purposes in section 144A.474, subdivision 11, paragraph (i). The recommendations shall address ways the commissioner may improve protection of the public under existing statutes and laws and include but are not limited to projects that create and administer training of licensees and their employees to improve residents' lives, supporting ways that licensees can improve and enhance quality care and ways to provide technical assistance to licensees to improve compliance; information technology and data projects that analyze and communicate information about trends of violations or lead to ways of improving client care; communications strategies to licensees and the public; and other projects or pilots that benefit clients, families, and the public. History: 2013 c 108 art 11 s 27; 2014 c 291 art 6 s 18; 2016 c 179 s 13,14; 1Sp2017 c 6 art 10 s 70; 2019 c 60 art 4 s 26; 1Sp2019 c 9 art 11 s 65,66 144A.48 MS 2002 [Repealed, 2002 c 252 s 25] 144A.481 MS 2018 [Repealed, 1Sp2019 c 9 art 11 s 112]

MINNESOTA STATUTES 2019

144D.01

CHAPTER 144D HOUSING WITH SERVICES ESTABLISHMENT 144D.01

DEFINITIONS.

144D.06

OTHER LAWS.

144D.015

DEFINITION FOR PURPOSES OF LONG-TERM CARE INSURANCE.

144D.065

TRAINING IN DEMENTIA CARE REQUIRED.

144D.02

REGISTRATION REQUIRED.

144D.066

ENFORCEMENT OF DEMENTIA CARE TRAINING REQUIREMENTS.

144D.025

OPTIONAL REGISTRATION.

144D.07

RESTRAINTS.

144D.03

REGISTRATION.

144D.08

UNIFORM CONSUMER INFORMATION GUIDE.

144D.04

HOUSING WITH SERVICES CONTRACTS.

144D.045

INFORMATION CONCERNING ARRANGED HOME CARE PROVIDERS.

144D.09

TERMINATION OF LEASE.

144D.10

MANAGER REQUIREMENTS.

144D.05

AUTHORITY OF COMMISSIONER.

144D.11

EMERGENCY PLANNING.

144D.001 MS 2006 [Renumbered 15.001] 144D.01 DEFINITIONS. Subdivision 1. Scope. As used in sections 144D.01 to 144D.06, the following terms have the meanings given them. Subd. 2. Adult. "Adult" means a natural person who has attained the age of 18 years. Subd. 2a. Arranged home care provider. "Arranged home care provider" means a home care provider licensed under chapter 144A that provides services to some or all of the residents of a housing with services establishment and that is either the establishment itself or another entity with which the establishment has an arrangement. Subd. 3. Commissioner. "Commissioner" means the commissioner of health or the commissioner's designee. Subd. 3a. Direct-care staff. "Direct-care staff" means staff and employees who provide home care services listed in section 144A.471, subdivisions 6 and 7. Subd. 4. Housing with services establishment or establishment. (a) "Housing with services establishment" or "establishment" means: (1) an establishment providing sleeping accommodations to one or more adult residents, at least 80 percent of which are 55 years of age or older, and offering or providing, for a fee, one or more regularly scheduled health-related services or two or more regularly scheduled supportive services, whether offered or provided directly by the establishment or by another entity arranged for by the establishment; or (2) an establishment that registers under section 144D.025. (b) Housing with services establishment does not include: (1) a nursing home licensed under chapter 144A; (2) a hospital, certified boarding care home, or supervised living facility licensed under sections 144.50 to 144.56; (3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, or under chapter 245D or 245G;

144D.01

MINNESOTA STATUTES 2019

(4) a board and lodging establishment which serves as a shelter for battered women or other similar purpose; (5) a family adult foster care home licensed by the Department of Human Services; (6) private homes in which the residents are related by kinship, law, or affinity with the providers of services; (7) residential settings for persons with developmental disabilities in which the services are licensed under chapter 245D; (8) a home-sharing arrangement such as when an elderly or disabled person or single-parent family makes lodging in a private residence available to another person in exchange for services or rent, or both; (9) a duly organized condominium, cooperative, common interest community, or owners' association of the foregoing where at least 80 percent of the units that comprise the condominium, cooperative, or common interest community are occupied by individuals who are the owners, members, or shareholders of the units; (10) services for persons with developmental disabilities that are provided under a license under chapter 245D; or (11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593. Subd. 5. Supportive services. "Supportive services" means help with personal laundry, handling or assisting with personal funds of residents, or arranging for medical services, health-related services, social services, or transportation to medical or social services appointments. Arranging for services does not include making referrals, assisting a resident in contacting a service provider of the resident's choice, or contacting a service provider in an emergency. Subd. 6. Health-related services. "Health-related services" include professional nursing services, home health aide tasks, or the central storage of medication for residents. Subd. 7. Family adult foster care home. "Family adult foster care home" means an adult foster care home that is licensed by the Department of Human Services, that is the primary residence of the license holder, and in which the license holder is the primary caregiver. History: 1995 c 207 art 9 s 29; 1997 c 107 s 1; 1997 c 113 s 7-10; 3Sp1997 c 3 s 6; 1999 c 245 art 3 s 8; 2002 c 375 art 2 s 3; 2005 c 56 s 1; 2006 c 282 art 19 s 4; 2013 c 108 art 9 s 3; 2015 c 71 art 8 s 41; 2016 c 111 s 1; 2016 c 158 art 1 s 62; 2016 c 179 s 16; 2017 c 40 art 1 s 33; 2018 c 182 art 2 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.015 DEFINITION FOR PURPOSES OF LONG-TERM CARE INSURANCE. For purposes of consistency with terminology commonly used in long-term care insurance policies and notwithstanding chapter 144G, a housing with services establishment that is registered under section 144D.03 and that holds, or makes arrangements with an individual or entity that holds any type of home care license and all other licenses, permits, registrations, or other governmental approvals legally required for delivery

MINNESOTA STATUTES 2019

144D.03

of the services the establishment offers or provides to its residents, constitutes an "assisted living facility" or "assisted living residence." History: 2004 c 185 s 1; 2006 c 282 art 19 s 5; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.02 REGISTRATION REQUIRED. No entity may establish, operate, conduct, or maintain a housing with services establishment in this state without registering and operating as required in sections 144D.01 to 144D.06. History: 1995 c 207 art 9 s 30; 2006 c 282 art 19 s 6; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.025 OPTIONAL REGISTRATION. An establishment that meets all the requirements of this chapter except that fewer than 80 percent of the adult residents are age 55 or older, or a supportive housing establishment developed and funded in whole or in part with funds provided specifically as part of the plan to end long-term homelessness required under Laws 2003, chapter 128, article 15, section 9, may, at its option, register as a housing with services establishment. History: 2002 c 375 art 2 s 4; 2005 c 159 art 5 s 2; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.03 REGISTRATION. Subdivision 1. Registration procedures. The commissioner shall establish forms and procedures for annual registration of housing with services establishments. The commissioner shall charge an annual registration fee of $155. No fee shall be refunded. A registered establishment shall notify the commissioner within 30 days of the date it is no longer required to be registered under this chapter or of any change in the business name or address of the establishment, the name or mailing address of the owner or owners, or the name or mailing address of the managing agent. There shall be no fee for submission of the notice. Subd. 1a. Surcharge for injunctive relief actions. The commissioner shall assess each housing with services establishment that offers or provides assisted living under chapter 144G a surcharge on the annual registration fee paid under subdivision 1, to pay for the commissioner's costs related to bringing actions for injunctive relief under section 144G.02, subdivision 2, paragraph (b), on or after July 1, 2007. The commissioner shall assess surcharges using a sliding scale under which the surcharge amount increases with the client capacity of an establishment. The commissioner shall adjust the surcharge as necessary to recover the projected costs of bringing actions for injunctive relief. The commissioner shall adjust the surcharge in accordance with section 16A.1285. Subd. 2. Registration information. The establishment shall provide the following information to the commissioner in order to be registered: (1) the business name, street address, and mailing address of the establishment;

144D.03

MINNESOTA STATUTES 2019

(2) the name and mailing address of the owner or owners of the establishment and, if the owner or owners are not natural persons, identification of the type of business entity of the owner or owners, and the names and addresses of the officers and members of the governing body, or comparable persons for partnerships, limited liability corporations, or other types of business organizations of the owner or owners; (3) the name and mailing address of the managing agent, whether through management agreement or lease agreement, of the establishment, if different from the owner or owners, and the name of the on-site manager, if any; (4) verification that the establishment has entered into a housing with services contract, as required in section 144D.04, with each resident or resident's representative; (5) verification that the establishment is complying with the requirements of section 325F.72, if applicable; (6) the name and address of at least one natural person who shall be responsible for dealing with the commissioner on all matters provided for in sections 144D.01 to 144D.06, and on whom personal service of all notices and orders shall be made, and who shall be authorized to accept service on behalf of the owner or owners and the managing agent, if any; (7) the signature of the authorized representative of the owner or owners or, if the owner or owners are not natural persons, signatures of at least two authorized representatives of each owner, one of which shall be an officer of the owner; and (8) whether services are included in the base rate to be paid by the resident. Personal service on the person identified under clause (6) by the owner or owners in the registration shall be considered service on the owner or owners, and it shall not be a defense to any action that personal service was not made on each individual or entity. The designation of one or more individuals under this subdivision shall not affect the legal responsibility of the owner or owners under sections 144D.01 to 144D.06. History: 1995 c 207 art 9 s 31; 1997 c 113 s 11; 1Sp2001 c 9 art 1 s 41; 2002 c 379 art 1 s 113; 2006 c 282 art 19 s 7,8; 2007 c 147 art 10 s 11; 1Sp2010 c 1 art 17 s 1; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.04 HOUSING WITH SERVICES CONTRACTS. Subdivision 1. Contract required. No housing with services establishment may operate in this state unless a written housing with services contract, as defined in subdivision 2, is executed between the establishment and each resident or resident's representative and unless the establishment operates in accordance with the terms of the contract. The resident or the resident's representative shall be given a complete copy of the contract and all supporting documents and attachments and any changes whenever changes are made. Subd. 2. Contents of contract. A housing with services contract, which need not be entitled as such to comply with this section, shall include at least the following elements in itself or through supporting documents or attachments: (1) the name, street address, and mailing address of the establishment; (2) the name and mailing address of the owner or owners of the establishment and, if the owner or owners is not a natural person, identification of the type of business entity of the owner or owners;

MINNESOTA STATUTES 2019

144D.04

(3) the name and mailing address of the managing agent, through management agreement or lease agreement, of the establishment, if different from the owner or owners; (4) the name and address of at least one natural person who is authorized to accept service of process on behalf of the owner or owners and managing agent; (5) a statement describing the registration and licensure status of the establishment and any provider providing health-related or supportive services under an arrangement with the establishment; (6) the term of the contract; (7) a description of the services to be provided to the resident in the base rate to be paid by the resident, including a delineation of the portion of the base rate that constitutes rent and a delineation of charges for each service included in the base rate; (8) a description of any additional services, including home care services, available for an additional fee from the establishment directly or through arrangements with the establishment, and a schedule of fees charged for these services; (9) a conspicuous notice informing the tenant of the policy concerning the conditions under which and the process through which the contract may be modified, amended, or terminated, including whether a move to a different room or sharing a room would be required in the event that the tenant can no longer pay the current rent; (10) a description of the establishment's complaint resolution process available to residents including the toll-free complaint line for the Office of Ombudsman for Long-Term Care; (11) the resident's designated representative, if any; (12) the establishment's referral procedures if the contract is terminated; (13) requirements of residency used by the establishment to determine who may reside or continue to reside in the housing with services establishment; (14) billing and payment procedures and requirements; (15) a statement regarding the ability of a resident to receive services from service providers with whom the establishment does not have an arrangement; (16) a statement regarding the availability of public funds for payment for residence or services in the establishment; and (17) a statement regarding the availability of and contact information for long-term care consultation services under section 256B.0911 in the county in which the establishment is located. Subd. 2a. Additional contract requirements. (a) For a resident receiving one or more health-related services from the establishment's arranged home care provider, as defined in section 144D.01, subdivision 6, the contract must include the requirements in paragraph (b). A restriction of a resident's rights under this subdivision is allowed only if determined necessary for health and safety reasons identified by the home care provider's registered nurse in an initial assessment or reassessment, as defined under section 144A.4791, subdivision 8, and documented in the written service plan under section 144A.4791, subdivision 9. Any restrictions of those rights for people served under chapter 256S and section 256B.49 must be documented

144D.04

MINNESOTA STATUTES 2019

in the resident's coordinated service and support plan (CSSP), as defined under sections 256B.49, subdivision 15, and 256S.10. (b) The contract must include a statement: (1) regarding the ability of a resident to furnish and decorate the resident's unit within the terms of the lease; (2) regarding the resident's right to access food at any time; (3) regarding a resident's right to choose the resident's visitors and times of visits; (4) regarding the resident's right to choose a roommate if sharing a unit; and (5) notifying the resident of the resident's right to have and use a lockable door to the resident's unit. The landlord shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. Subd. 3. Contracts in permanent files. Housing with services contracts and related documents executed by each resident or resident's representative shall be maintained by the establishment in files from the date of execution until three years after the contract is terminated. The contracts and the written disclosures required under section 325F.72, if applicable, shall be made available for on-site inspection by the commissioner upon request at any time. History: 1995 c 207 art 9 s 32; 1Sp2001 c 9 art 1 s 42,43; 2002 c 379 art 1 s 113; 2006 c 282 art 19 s 9; 2007 c 147 art 7 s 75; 1Sp2010 c 1 art 17 s 2; 2012 c 247 art 4 s 4; 1Sp2017 c 6 art 2 s 1,2; art 10 s 73; 2019 c 54 art 2 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.045 INFORMATION CONCERNING ARRANGED HOME CARE PROVIDERS. If a housing with services establishment has one or more arranged home care providers, the establishment shall arrange to have that arranged home care provider deliver the following information in writing to a prospective resident, prior to the date on which the prospective resident executes a contract with the establishment or the prospective resident's move-in date, whichever is earlier: (1) the name, mailing address, and telephone number of the arranged home care provider; (2) the name and mailing address of at least one natural person who is authorized to accept service of process on behalf of the entity described in clause (1); (3) a description of the process through which a home care service agreement or service plan between a resident and the arranged home care provider, if any, may be modified, amended, or terminated; (4) the arranged home care provider's billing and payment procedures and requirements; and (5) any limits to the services available from the arranged provider. History: 2006 c 282 art 19 s 10; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.

MINNESOTA STATUTES 2019

144D.065

144D.05 AUTHORITY OF COMMISSIONER. The commissioner shall, upon receipt of information which may indicate the failure of the housing with services establishment, a resident, a resident's representative, or a service provider to comply with a legal requirement to which one or more of them may be subject, make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved. The commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which an establishment is located to compel the housing with services establishment to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions. History: 1995 c 207 art 9 s 33; 2006 c 282 art 19 s 11; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.06 OTHER LAWS. In addition to registration under this chapter, a housing with services establishment must comply with chapter 504B and the provisions of section 325F.72, and shall obtain and maintain all other licenses, permits, registrations, or other governmental approvals required of it. A housing with services establishment is not required to obtain a lodging license under chapter 157 and related rules. History: 1995 c 207 art 9 s 34; 1996 c 305 art 1 s 36; 1997 c 113 s 13; 1999 c 199 art 2 s 5; 1Sp2001 c 9 art 1 s 44; 2002 c 379 art 1 s 113; 1Sp2017 c 6 art 10 s 74; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.065 TRAINING IN DEMENTIA CARE REQUIRED. (a) If a housing with services establishment registered under this chapter has a special program or special care unit for residents with Alzheimer's disease or other dementias or advertises, markets, or otherwise promotes the establishment as providing services for persons with Alzheimer's disease or other dementias, whether in a segregated or general unit, employees of the establishment and of the establishment's arranged home care provider must meet the following training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b), or a supervisor meeting the requirements in clause (1), must be available for consultation with the new employee until the training

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requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (4) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and related disorders; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; and (4) communication skills. (c) The establishment shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. This information satisfies the disclosure requirements of section 325F.72, subdivision 2, clause (4). (d) Housing with services establishments not included in paragraph (a) that provide assisted living services under chapter 144G must meet the following training requirements: (1) supervisors of direct-care staff must have at least four hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial four hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or supervisor meeting the requirements under paragraph (a), clause (1), must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (4) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. History: 2003 c 37 s 3; 2006 c 282 art 19 s 12; 2014 c 291 art 6 s 19; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.

MINNESOTA STATUTES 2019

144D.066

144D.066 ENFORCEMENT OF DEMENTIA CARE TRAINING REQUIREMENTS. Subdivision 1. Enforcement. (a) The commissioner shall enforce the dementia care training standards for staff working in housing with services settings and for housing managers according to clauses (1) to (3): (1) for dementia care training requirements in section 144D.065, the commissioner shall review training records as part of the home care provider survey process for direct care staff and supervisors of direct care staff, in accordance with section 144A.474. The commissioner may also request and review training records at any time during the year; (2) for dementia care training standards in section 144D.065, the commissioner shall review training records for maintenance, housekeeping, and food service staff and other staff not providing direct care working in housing with services settings as part of the housing with services registration application and renewal application process in accordance with section 144D.03. The commissioner may also request and review training records at any time during the year; and (3) for housing managers, the commissioner shall review the statement verifying compliance with the required training described in section 144D.10, paragraph (d), through the housing with services registration application and renewal application process in accordance with section 144D.03. The commissioner may also request and review training records at any time during the year. (b) The commissioner shall specify the required forms and what constitutes sufficient training records for the items listed in paragraph (a), clauses (1) to (3). Subd. 2. Fines for noncompliance. (a) Beginning January 1, 2017, the commissioner may impose a $200 fine for every staff person required to obtain dementia care training who does not have training records to show compliance. For violations of subdivision 1, paragraph (a), clause (1), the fine will be imposed upon the home care provider, and may be appealed under the contested case procedure in section 144A.475, subdivisions 3a, 4, and 7. For violations of subdivision 1, paragraph (a), clauses (2) and (3), the fine will be imposed on the housing with services registrant and may be appealed under the contested case procedure in section 144A.475, subdivisions 3a, 4, and 7. Prior to imposing the fine, the commissioner must allow two weeks for staff to complete the required training. Fines collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. (b) The housing with services registrant and home care provider must allow for the required training as part of employee and staff duties. Imposition of a fine by the commissioner does not negate the need for the required training. Continued noncompliance with the requirements of sections 144D.065 and 144D.10 may result in revocation or nonrenewal of the housing with services registration or home care license. The commissioner shall make public the list of all housing with services establishments that have complied with the training requirements. Subd. 3. Technical assistance. From January 1, 2016, to December 31, 2016, the commissioner shall provide technical assistance instead of imposing fines for noncompliance with the training requirements. During the year of technical assistance, the commissioner shall review the training records to determine if the records meet the requirements and inform the home care provider. The commissioner shall also provide information about available training resources. History: 2015 c 71 art 8 s 42; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.

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144D.07 RESTRAINTS. Residents must be free from any physical or chemical restraints imposed for purposes of discipline or convenience. History: 1997 c 113 s 12; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.08 UNIFORM CONSUMER INFORMATION GUIDE. All housing with services establishments shall make available to all prospective and current residents information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This section does not apply to an establishment registered under section 144D.025 serving the homeless. History: 1Sp2010 c 1 art 17 s 3; 2013 c 43 s 19; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.09 TERMINATION OF LEASE. The housing with services establishment shall include with notice of termination of lease information about how to contact the ombudsman for long-term care, including the address and telephone number along with a statement of how to request problem-solving assistance. History: 1Sp2010 c 1 art 17 s 4; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.10 MANAGER REQUIREMENTS. (a) The person primarily responsible for oversight and management of a housing with services establishment, as designated by the owner of the housing with services establishment, must obtain at least 30 hours of continuing education every two years of employment as the manager in topics relevant to the operations of the housing with services establishment and the needs of its tenants. Continuing education earned to maintain a professional license, such as nursing home administrator license, nursing license, social worker license, and real estate license, can be used to complete this requirement. (b) For managers of establishments identified in section 325F.72, this continuing education must include at least eight hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter. (c) For managers of establishments not covered by section 325F.72, but who provide assisted living services under chapter 144G, this continuing education must include at least four hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter. (d) A statement verifying compliance with the continuing education requirement must be included in the housing with services establishment's annual registration to the commissioner of health. The establishment

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must maintain records for at least three years demonstrating that the person primarily responsible for oversight and management of the establishment has attended educational programs as required by this section. (e) New managers may satisfy the initial dementia training requirements by producing written proof of previously completed required training within the past 18 months. (f) This section does not apply to an establishment registered under section 144D.025 serving the homeless. History: 2014 c 291 art 6 s 20; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.11 EMERGENCY PLANNING. (a) Each registered housing with services establishment must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in-place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) post an emergency disaster plan prominently; (3) provide building emergency exit diagrams to all tenants upon signing a lease; (4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing tenants. (b) Each registered housing with services establishment must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training available to all tenants annually. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) Each registered housing with services location must conduct and document a fire drill or other emergency drill at least every six months. To the extent possible, drills must be coordinated with local fire departments or other community emergency resources. History: 2014 c 291 art 6 s 21; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.

MINNESOTA STATUTES 2019

CHAPTER 144G ASSISTED LIVING NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021. 144G.01

DEFINITIONS.

144G.51

ARBITRATION.

144G.02

ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION.

144G.52

ASSISTED LIVING CONTRACT TERMINATIONS.

144G.53

NONRENEWAL OF HOUSING.

144G.03

ASSISTED LIVING REQUIREMENTS.

144G.54

APPEALS OF CONTRACT TERMINATIONS.

144G.04

RESERVATION OF RIGHTS.

144G.55

COORDINATED MOVES.

144G.05

REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES.

144G.56

TRANSFER OF RESIDENTS WITHIN FACILITY.

144G.06

UNIFORM CONSUMER INFORMATION GUIDE.

144G.57

PLANNED CLOSURES.

144G.07

RETALIATION PROHIBITED. 144G.60

STAFFING REQUIREMENTS.

STAFFING REQUIREMENTS

ASSISTED LIVING LICENSURE 144G.08

DEFINITIONS.

144G.61

STAFF COMPETENCY EVALUATIONS.

144G.09

COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES.

144G.62

DELEGATION AND SUPERVISION.

144G.63

ORIENTATION AND ANNUAL TRAINING REQUIREMENTS.

144G.64

TRAINING IN DEMENTIA CARE REQUIRED.

144G.70

SERVICES.

144G.71

MEDICATION MANAGEMENT.

144G.72

TREATMENT AND THERAPY MANAGEMENT SERVICES.

144G.10

ASSISTED LIVING FACILITY LICENSE.

144G.11

APPLICABILITY OF OTHER LAWS.

144G.12

APPLICATION FOR LICENSURE.

144G.13

BACKGROUND STUDIES OF LICENSE APPLICANTS.

144G.15

CONSIDERATION OF APPLICATIONS.

144G.16

PROVISIONAL LICENSE.

144G.17

LICENSE RENEWAL.

144G.18

NOTIFICATION OF CHANGES IN INFORMATION.

144G.19

TRANSFER OF LICENSE PROHIBITED.

SERVICES

ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80

ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.81

ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS.

144G.82

ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.83

ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.

144G.84

SERVICES FOR RESIDENTS WITH DEMENTIA.

ENFORCEMENT 144G.20

ENFORCEMENT.

SURVEYS, CORRECTION ORDERS, AND FINES 144G.30

SURVEYS AND INVESTIGATIONS.

144G.31

VIOLATIONS AND FINES.

144G.32

RECONSIDERATION OF CORRECTION ORDERS AND FINES.

144G.33

INNOVATION VARIANCE.

OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40

HOUSING AND SERVICES.

144G.401

PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS.

RESIDENT RIGHTS AND PROTECTIONS 144G.90

REQUIRED NOTICES.

144G.91

ASSISTED LIVING BILL OF RIGHTS.

144G.911

RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS.

144G.41

MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS.

144G.42

BUSINESS OPERATION.

144G.43

RESIDENT RECORD REQUIREMENTS.

144G.92

RETALIATION PROHIBITED.

MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS.

144G.93

CONSUMER ADVOCACY AND LEGAL SERVICES.

144G.95

OFFICE OF OMBUDSMAN FOR LONG-TERM CARE.

144G.9999

RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE.

144G.45

CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50

ASSISTED LIVING CONTRACT REQUIREMENTS.

144G.01

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144G.03

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144G.03

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144G.07

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144G.08

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144G.08

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144G.08

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144G.08

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144G.09

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144G.12

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144G.16

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(2) the facility's policy regarding transfer of residents within the facility, under what circumstances a transfer may occur, and the circumstances under which resident consent is required for a transfer; (3) contact information for the Office of Ombudsman for Long-Term Care, the Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health Facility Complaints; (4) the resident's right to obtain services from an unaffiliated service provider; (5) a description of the facility's policies related to medical assistance waivers under chapter 256S and section 256B.49 and the housing support program under chapter 256I, including: (i) whether the facility is enrolled with the commissioner of human services to provide customized living services under medical assistance waivers; (ii) whether the facility has an agreement to provide housing support under section 256I.04, subdivision 2, paragraph (b); (iii) whether there is a limit on the number of people residing at the facility who can receive customized living services or participate in the housing support program at any point in time. If so, the limit must be provided; (iv) whether the facility requires a resident to pay privately for a period of time prior to accepting payment under medical assistance waivers or the housing support program, and if so, the length of time that private payment is required; (v) a statement that medical assistance waivers provide payment for services, but do not cover the cost of rent; (vi) a statement that residents may be eligible for assistance with rent through the housing support program; and (vii) a description of the rent requirements for people who are eligible for medical assistance waivers but who are not eligible for assistance through the housing support program; (6) the contact information to obtain long-term care consulting services under section 256B.0911; and (7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center. (f) The contract must include a description of the facility's complaint resolution process available to residents, including the name and contact information of the person representing the facility who is designated to handle and resolve complaints. Subd. 3. Designation of representative. (a) Before or at the time of execution of an assisted living contract, an assisted living facility must offer the resident the opportunity to identify a designated representative in writing in the contract and must provide the following verbatim notice on a document separate from the contract: "RIGHT TO DESIGNATE A REPRESENTATIVE FOR CERTAIN PURPOSES. You have the right to name anyone as your "Designated Representative." A Designated Representative can assist you, receive certain information and notices about you, including some information related to your health care, and advocate on your behalf. A Designated Representative does not take the place of your guardian, conservator, power of attorney ("attorney-in-fact"), or health care power of attorney ("health care agent"), if applicable."

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(b) The contract must contain a page or space for the name and contact information of the designated representative and a box the resident must initial if the resident declines to name a designated representative. Notwithstanding subdivision 1, paragraph (f), the resident has the right at any time to add, remove, or change the name and contact information of the designated representative. Subd. 4. Filing. The contract and related documents must be maintained by the facility in files from the date of execution until five years after the contract is terminated or expires. The contracts and all associated documents must be available for on-site inspection by the commissioner at any time. The documents shall be available for viewing or copies shall be made available to the resident and the legal or designated representative at any time. Subd. 5. Waivers of liability prohibited. The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. The contract must not include any provision that the facility knows or should know to be deceptive, unlawful, or unenforceable under state or federal law, nor include any provision that requires or implies a lesser standard of care or responsibility than is required by law. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 26,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 26, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 26, the effective date. 144G.51 ARBITRATION. (a) An assisted living facility must clearly and conspicuously disclose, in writing in an assisted living contract, any arbitration provision in the contract that precludes, limits, or delays the ability of a resident from taking a civil action. (b) An arbitration requirement must not include a choice of law or choice of venue provision. Assisted living contracts must adhere to Minnesota law and any other applicable federal or local law. History: 2019 c 60 art 1 s 31,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 31, is effective August 1, 2021, for contracts entered into on or after that date. Laws 2019, chapter 60, article 1, section 31, the effective date. 144G.52 ASSISTED LIVING CONTRACT TERMINATIONS. Subdivision 1. Definition. For purposes of sections 144G.52 to 144G.55, "termination" means: (1) a facility-initiated termination of housing provided to the resident under the contract; or (2) a facility-initiated termination or nonrenewal of all assisted living services the resident receives from the facility under the contract. Subd. 2. Prerequisite to termination of a contract. (a) Before issuing a notice of termination of an assisted living contract, a facility must schedule and participate in a meeting with the resident and the resident's legal representative and designated representative. The purposes of the meeting are to: (1) explain in detail the reasons for the proposed termination; and (2) identify and offer reasonable accommodations or modifications, interventions, or alternatives to avoid the termination or enable the resident to remain in the facility, including but not limited to securing

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services from another provider of the resident's choosing that may allow the resident to avoid the termination. A facility is not required to offer accommodations, modifications, interventions, or alternatives that fundamentally alter the nature of the operation of the facility. (b) The meeting must be scheduled to take place at least seven days before a notice of termination is issued. The facility must make reasonable efforts to ensure that the resident, legal representative, and designated representative are able to attend the meeting. (c) The facility must notify the resident that the resident may invite family members, relevant health professionals, a representative of the Office of Ombudsman for Long-Term Care, or other persons of the resident's choosing to participate in the meeting. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must notify the resident's case manager of the meeting. (d) In the event of an emergency relocation under subdivision 9, where the facility intends to issue a notice of termination and an in-person meeting is impractical or impossible, the facility may attempt to schedule and participate in a meeting under this subdivision via telephone, video, or other means. Subd. 3. Termination for nonpayment. (a) A facility may initiate a termination of housing because of nonpayment of rent or a termination of services because of nonpayment for services. Upon issuance of a notice of termination for nonpayment, the facility must inform the resident that public benefits may be available and must provide contact information for the Senior LinkAge Line under section 256.975, subdivision 7. (b) An interruption to a resident's public benefits that lasts for no more than 60 days does not constitute nonpayment. Subd. 4. Termination for violation of the assisted living contract. A facility may initiate a termination of the assisted living contract if the resident violates a lawful provision of the contract and the resident does not cure the violation within a reasonable amount of time after the facility provides written notice of the ability to cure to the resident. Written notice of the ability to cure may be provided in person or by first class mail. A facility is not required to provide a resident with written notice of the ability to cure for a violation that threatens the health or safety of the resident or another individual in the facility, or for a violation that constitutes illegal conduct. Subd. 5. Expedited termination. (a) A facility may initiate an expedited termination of housing or services if: (1) the resident has engaged in conduct that substantially interferes with the rights, health, or safety of other residents; (2) the resident has engaged in conduct that substantially and intentionally interferes with the safety or physical health of facility staff; or (3) the resident has committed an act listed in section 504B.171 that substantially interferes with the rights, health, or safety of other residents. (b) A facility may initiate an expedited termination of services if: (1) the resident has engaged in conduct that substantially interferes with the resident's health or safety; (2) the resident's assessed needs exceed the scope of services agreed upon in the assisted living contract and are not included in the services the facility disclosed in the uniform checklist; or

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144G.55

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144G.56

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144G.60

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144G.61

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144G.63

135

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136

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144G.64

137

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144G.70

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626.557 REPORTING OF MALTREATMENT OF VULNERABLE ADULTS. Subdivision 1. Public policy. The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment; to assist in providing safe environments for vulnerable adults; and to provide safe institutional or residential services, community-based services, or living environments for vulnerable adults who have been maltreated. In addition, it is the policy of this state to require the reporting of suspected maltreatment of vulnerable adults, to provide for the voluntary reporting of maltreatment of vulnerable adults, to require the investigation of the reports, and to provide protective and counseling services in appropriate cases. Subd. 2. [Repealed, 1995 c 229 art 1 s 24] Subd. 3. Timing of report. (a) A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained shall immediately report the information to the common entry point. If an individual is a vulnerable adult solely because the individual is admitted to a facility, a mandated reporter is not required to report suspected maltreatment of the individual that occurred prior to admission, unless: (1) the individual was admitted to the facility from another facility and the reporter has reason to believe the vulnerable adult was maltreated in the previous facility; or (2) the reporter knows or has reason to believe that the individual is a vulnerable adult as defined in section 626.5572, subdivision 21, paragraph (a), clause (4). (b) A person not required to report under the provisions of this section may voluntarily report as described above. (c) Nothing in this section requires a report of known or suspected maltreatment, if the reporter knows or has reason to know that a report has been made to the common entry point. (d) Nothing in this section shall preclude a reporter from also reporting to a law enforcement agency. (e) A mandated reporter who knows or has reason to believe that an error under section 626.5572, subdivision 17, paragraph (c), clause (5), occurred must make a report under this subdivision. If the reporter or a facility, at any time believes that an investigation by a lead investigative agency will determine or should determine that the reported error was not neglect according to the criteria under section 626.5572, subdivision 17, paragraph (c), clause (5), the reporter or facility may provide to the common entry point or directly to the lead investigative agency information explaining how the event meets the criteria under section 626.5572, subdivision 17, paragraph (c), clause (5). The lead investigative agency shall consider this information when making an initial disposition of the report under subdivision 9c. Subd. 3a. Report not required. The following events are not required to be reported under this section: (1) A circumstance where federal law specifically prohibits a person from disclosing patient identifying information in connection with a report of suspected maltreatment, unless the vulnerable adult, or the vulnerable adult's guardian, conservator, or legal representative, has consented to disclosure in a manner which conforms to federal requirements. Facilities whose patients or residents are covered by such a federal law shall seek consent to the disclosure of suspected maltreatment from each patient or resident, or a guardian, conservator, or legal representative, upon the patient's or resident's admission to the facility. Persons who

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are prohibited by federal law from reporting an incident of suspected maltreatment shall immediately seek consent to make a report. (2) Verbal or physical aggression occurring between patients, residents, or clients of a facility, or self-abusive behavior by these persons does not constitute abuse unless the behavior causes serious harm. The operator of the facility or a designee shall record incidents of aggression and self-abusive behavior to facilitate review by licensing agencies and county and local welfare agencies. (3) Accidents as defined in section 626.5572, subdivision 3. (4) Events occurring in a facility that result from an individual's error in the provision of therapeutic conduct to a vulnerable adult, as provided in section 626.5572, subdivision 17, paragraph (c), clause (4). (5) Nothing in this section shall be construed to require a report of financial exploitation, as defined in section 626.5572, subdivision 9, solely on the basis of the transfer of money or property by gift or as compensation for services rendered. Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter shall immediately make an oral report to the common entry point. The common entry point may accept electronic reports submitted through a web-based reporting system established by the commissioner. Use of a telecommunications device for the deaf or other similar device shall be considered an oral report. The common entry point may not require written reports. To the extent possible, the report must be of sufficient content to identify the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, any evidence of previous maltreatment, the name and address of the reporter, the time, date, and location of the incident, and any other information that the reporter believes might be helpful in investigating the suspected maltreatment. A mandated reporter may disclose not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, to the extent necessary to comply with this subdivision. (b) A boarding care home that is licensed under sections 144.50 to 144.58 and certified under Title 19 of the Social Security Act, a nursing home that is licensed under section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under Code of Federal Regulations, title 42, section 482.66, may submit a report electronically to the common entry point instead of submitting an oral report. The report may be a duplicate of the initial report the facility submits electronically to the commissioner of health to comply with the reporting requirements under Code of Federal Regulations, title 42, section 483.12. The commissioner of health may modify these reporting requirements to include items required under paragraph (a) that are not currently included in the electronic reporting form. Subd. 4a. Internal reporting of maltreatment. (a) Each facility shall establish and enforce an ongoing written procedure in compliance with applicable licensing rules to ensure that all cases of suspected maltreatment are reported. If a facility has an internal reporting procedure, a mandated reporter may meet the reporting requirements of this section by reporting internally. However, the facility remains responsible for complying with the immediate reporting requirements of this section. (b) A facility with an internal reporting procedure that receives an internal report by a mandated reporter shall give the mandated reporter a written notice stating whether the facility has reported the incident to the common entry point. The written notice must be provided within two working days and in a manner that protects the confidentiality of the reporter.

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(c) The written response to the mandated reporter shall note that if the mandated reporter is not satisfied with the action taken by the facility on whether to report the incident to the common entry point, then the mandated reporter may report externally. (d) A facility may not prohibit a mandated reporter from reporting externally, and a facility is prohibited from retaliating against a mandated reporter who reports an incident to the common entry point in good faith. The written notice by the facility must inform the mandated reporter of this protection from retaliatory measures by the facility against the mandated reporter for reporting externally. Subd. 5. Immunity; protection for reporters. (a) A person who makes a good faith report is immune from any civil or criminal liability that might otherwise result from making the report, or from participating in the investigation, or for failure to comply fully with the reporting obligation under section 609.234 or 626.557, subdivision 7. (b) A person employed by a lead investigative agency or a state licensing agency who is conducting or supervising an investigation or enforcing the law in compliance with this section or any related rule or provision of law is immune from any civil or criminal liability that might otherwise result from the person's actions, if the person is acting in good faith and exercising due care. (c) A person who knows or has reason to know a report has been made to a common entry point and who in good faith participates in an investigation of alleged maltreatment is immune from civil or criminal liability that otherwise might result from making the report, or from failure to comply with the reporting obligation or from participating in the investigation. (d) The identity of any reporter may not be disclosed, except as provided in subdivision 12b. (e) For purposes of this subdivision, "person" includes a natural person or any form of a business or legal entity. Subd. 5a. Financial institution cooperation. Financial institutions shall cooperate with a lead investigative agency, law enforcement, or prosecuting authority that is investigating maltreatment of a vulnerable adult and comply with reasonable requests for the production of financial records as authorized under section 13A.02, subdivision 1. Financial institutions are immune from any civil or criminal liability that might otherwise result from complying with this subdivision. Subd. 6. Falsified reports. A person or facility who intentionally makes a false report under the provisions of this section shall be liable in a civil suit for any actual damages suffered by the reported facility, person or persons and for punitive damages up to $10,000 and attorney fees. Subd. 7. Failure to report. A mandated reporter who negligently or intentionally fails to report is liable for damages caused by the failure. Nothing in this subdivision imposes vicarious liability for the acts or omissions of others. Subd. 8. Evidence not privileged. No evidence regarding the maltreatment of the vulnerable adult shall be excluded in any proceeding arising out of the alleged maltreatment on the grounds of lack of competency under section 595.02. Subd. 9. Common entry point designation. (a) Each county board shall designate a common entry point for reports of suspected maltreatment, for use until the commissioner of human services establishes a common entry point. Two or more county boards may jointly designate a single common entry point. The commissioner of human services shall establish a common entry point effective July 1, 2015. The common entry point is the unit responsible for receiving the report of suspected maltreatment under this section.

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(b) The common entry point must be available 24 hours per day to take calls from reporters of suspected maltreatment. The common entry point shall use a standard intake form that includes: (1) the time and date of the report; (2) the name, address, and telephone number of the person reporting; (3) the time, date, and location of the incident; (4) the names of the persons involved, including but not limited to, perpetrators, alleged victims, and witnesses; (5) whether there was a risk of imminent danger to the alleged victim; (6) a description of the suspected maltreatment; (7) the disability, if any, of the alleged victim; (8) the relationship of the alleged perpetrator to the alleged victim; (9) whether a facility was involved and, if so, which agency licenses the facility; (10) any action taken by the common entry point; (11) whether law enforcement has been notified; (12) whether the reporter wishes to receive notification of the initial and final reports; and (13) if the report is from a facility with an internal reporting procedure, the name, mailing address, and telephone number of the person who initiated the report internally. (c) The common entry point is not required to complete each item on the form prior to dispatching the report to the appropriate lead investigative agency. (d) The common entry point shall immediately report to a law enforcement agency any incident in which there is reason to believe a crime has been committed. (e) If a report is initially made to a law enforcement agency or a lead investigative agency, those agencies shall take the report on the appropriate common entry point intake forms and immediately forward a copy to the common entry point. (f) The common entry point staff must receive training on how to screen and dispatch reports efficiently and in accordance with this section. (g) The commissioner of human services shall maintain a centralized database for the collection of common entry point data, lead investigative agency data including maltreatment report disposition, and appeals data. The common entry point shall have access to the centralized database and must log the reports into the database and immediately identify and locate prior reports of abuse, neglect, or exploitation. (h) When appropriate, the common entry point staff must refer calls that do not allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations that might resolve the reporter's concerns. (i) A common entry point must be operated in a manner that enables the commissioner of human services to:

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(1) track critical steps in the reporting, evaluation, referral, response, disposition, and investigative process to ensure compliance with all requirements for all reports; (2) maintain data to facilitate the production of aggregate statistical reports for monitoring patterns of abuse, neglect, or exploitation; (3) serve as a resource for the evaluation, management, and planning of preventative and remedial services for vulnerable adults who have been subject to abuse, neglect, or exploitation; (4) set standards, priorities, and policies to maximize the efficiency and effectiveness of the common entry point; and (5) track and manage consumer complaints related to the common entry point. (j) The commissioners of human services and health shall collaborate on the creation of a system for referring reports to the lead investigative agencies. This system shall enable the commissioner of human services to track critical steps in the reporting, evaluation, referral, response, disposition, investigation, notification, determination, and appeal processes. Subd. 9a. Evaluation and referral of reports made to common entry point. (a) The common entry point must screen the reports of alleged or suspected maltreatment for immediate risk and make all necessary referrals as follows: (1) if the common entry point determines that there is an immediate need for emergency adult protective services, the common entry point agency shall immediately notify the appropriate county agency; (2) if the report contains suspected criminal activity against a vulnerable adult, the common entry point shall immediately notify the appropriate law enforcement agency; (3) the common entry point shall refer all reports of alleged or suspected maltreatment to the appropriate lead investigative agency as soon as possible, but in any event no longer than two working days; (4) if the report contains information about a suspicious death, the common entry point shall immediately notify the appropriate law enforcement agencies, the local medical examiner, and the ombudsman for mental health and developmental disabilities established under section 245.92. Law enforcement agencies shall coordinate with the local medical examiner and the ombudsman as provided by law; and (5) for reports involving multiple locations or changing circumstances, the common entry point shall determine the county agency responsible for emergency adult protective services and the county responsible as the lead investigative agency, using referral guidelines established by the commissioner. (b) If the lead investigative agency receiving a report believes the report was referred by the common entry point in error, the lead investigative agency shall immediately notify the common entry point of the error, including the basis for the lead investigative agency's belief that the referral was made in error. The common entry point shall review the information submitted by the lead investigative agency and immediately refer the report to the appropriate lead investigative agency. Subd. 9b. Response to reports. Law enforcement is the primary agency to conduct investigations of any incident in which there is reason to believe a crime has been committed. Law enforcement shall initiate a response immediately. If the common entry point notified a county agency for emergency adult protective services, law enforcement shall cooperate with that county agency when both agencies are involved and shall exchange data to the extent authorized in subdivision 12b, paragraph (g). County adult protection shall initiate a response immediately. Each lead investigative agency shall complete the investigative process for

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reports within its jurisdiction. A lead investigative agency, county, adult protective agency, licensed facility, or law enforcement agency shall cooperate with other agencies in the provision of protective services, coordinating its investigations, and assisting another agency within the limits of its resources and expertise and shall exchange data to the extent authorized in subdivision 12b, paragraph (g). The lead investigative agency shall obtain the results of any investigation conducted by law enforcement officials. The lead investigative agency has the right to enter facilities and inspect and copy records as part of investigations. The lead investigative agency has access to not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, that are maintained by facilities to the extent necessary to conduct its investigation. Each lead investigative agency shall develop guidelines for prioritizing reports for investigation. Subd. 9c. Lead investigative agency; notifications, dispositions, determinations. (a) Upon request of the reporter, the lead investigative agency shall notify the reporter that it has received the report, and provide information on the initial disposition of the report within five business days of receipt of the report, provided that the notification will not endanger the vulnerable adult or hamper the investigation. (b) Upon conclusion of every investigation it conducts, the lead investigative agency shall make a final disposition as defined in section 626.5572, subdivision 8. (c) When determining whether the facility or individual is the responsible party for substantiated maltreatment or whether both the facility and the individual are responsible for substantiated maltreatment, the lead investigative agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were in accordance with, and followed the terms of, an erroneous physician order, prescription, resident care plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible for the issuance of the erroneous order, prescription, plan, or directive or knows or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) the comparative responsibility between the facility, other caregivers, and requirements placed upon the employee, including but not limited to, the facility's compliance with related regulatory standards and factors such as the adequacy of facility policies and procedures, the adequacy of facility training, the adequacy of an individual's participation in the training, the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a consideration of the scope of the individual employee's authority; and (3) whether the facility or individual followed professional standards in exercising professional judgment. (d) When substantiated maltreatment is determined to have been committed by an individual who is also the facility license holder, both the individual and the facility must be determined responsible for the maltreatment, and both the background study disqualification standards under section 245C.15, subdivision 4, and the licensing actions under section 245A.06 or 245A.07 apply. (e) The lead investigative agency shall complete its final disposition within 60 calendar days. If the lead investigative agency is unable to complete its final disposition within 60 calendar days, the lead investigative agency shall notify the following persons provided that the notification will not endanger the vulnerable adult or hamper the investigation: (1) the vulnerable adult or the vulnerable adult's guardian or health care agent, when known, if the lead investigative agency knows them to be aware of the investigation; and (2) the facility, where applicable. The notice shall contain the reason for the delay and the projected completion date. If the lead investigative agency is unable to complete its final disposition by a subsequent projected completion date, the lead investigative agency shall again notify the vulnerable adult or the vulnerable adult's guardian or health care agent, when known if the lead investigative agency knows them to be aware of the investigation, and the facility, where applicable, of the reason for the delay and the revised projected

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completion date provided that the notification will not endanger the vulnerable adult or hamper the investigation. The lead investigative agency must notify the health care agent of the vulnerable adult only if the health care agent's authority to make health care decisions for the vulnerable adult is currently effective under section 145C.06 and not suspended under section 524.5-310 and the investigation relates to a duty assigned to the health care agent by the principal. A lead investigative agency's inability to complete the final disposition within 60 calendar days or by any projected completion date does not invalidate the final disposition. (f) Within ten calendar days of completing the final disposition, the lead investigative agency shall provide a copy of the public investigation memorandum under subdivision 12b, paragraph (b), clause (1), when required to be completed under this section, to the following persons: (1) the vulnerable adult, or the vulnerable adult's guardian or health care agent, if known, unless the lead investigative agency knows that the notification would endanger the well-being of the vulnerable adult; (2) the reporter, if the reporter requested notification when making the report, provided this notification would not endanger the well-being of the vulnerable adult; (3) the alleged perpetrator, if known; (4) the facility; and (5) the ombudsman for long-term care, or the ombudsman for mental health and developmental disabilities, as appropriate. (g) If, as a result of a reconsideration, review, or hearing, the lead investigative agency changes the final disposition, or if a final disposition is changed on appeal, the lead investigative agency shall notify the parties specified in paragraph (f). (h) The lead investigative agency shall notify the vulnerable adult who is the subject of the report or the vulnerable adult's guardian or health care agent, if known, and any person or facility determined to have maltreated a vulnerable adult, of their appeal or review rights under this section or section 256.021. (i) The lead investigative agency shall routinely provide investigation memoranda for substantiated reports to the appropriate licensing boards. These reports must include the names of substantiated perpetrators. The lead investigative agency may not provide investigative memoranda for inconclusive or false reports to the appropriate licensing boards unless the lead investigative agency's investigation gives reason to believe that there may have been a violation of the applicable professional practice laws. If the investigation memorandum is provided to a licensing board, the subject of the investigation memorandum shall be notified and receive a summary of the investigative findings. (j) In order to avoid duplication, licensing boards shall consider the findings of the lead investigative agency in their investigations if they choose to investigate. This does not preclude licensing boards from considering other information. (k) The lead investigative agency must provide to the commissioner of human services its final dispositions, including the names of all substantiated perpetrators. The commissioner of human services shall establish records to retain the names of substantiated perpetrators. Subd. 9d. Administrative reconsideration; review panel. (a) Except as provided under paragraph (e), any individual or facility which a lead investigative agency determines has maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on behalf of the vulnerable adult, regardless of the lead investigative agency's determination, who contests the lead investigative agency's final disposition of an allegation of maltreatment, may request the lead investigative agency to reconsider its final disposition. The request for reconsideration must be submitted in writing to the lead investigative agency within 15 calendar days after receipt of notice of final disposition or, if the request is made by an interested person who is not entitled to notice, within 15 days after receipt of the notice by the vulnerable adult or the vulnerable adult's guardian or health care agent. If mailed, the request for reconsideration must be postmarked and sent to the

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lead investigative agency within 15 calendar days of the individual's or facility's receipt of the final disposition. If the request for reconsideration is made by personal service, it must be received by the lead investigative agency within 15 calendar days of the individual's or facility's receipt of the final disposition. An individual who was determined to have maltreated a vulnerable adult under this section and who was disqualified on the basis of serious or recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration of the maltreatment determination and the disqualification. The request for reconsideration of the maltreatment determination and the disqualification must be submitted in writing within 30 calendar days of the individual's receipt of the notice of disqualification under sections 245C.16 and 245C.17. If mailed, the request for reconsideration of the maltreatment determination and the disqualification must be postmarked and sent to the lead investigative agency within 30 calendar days of the individual's receipt of the notice of disqualification. If the request for reconsideration is made by personal service, it must be received by the lead investigative agency within 30 calendar days after the individual's receipt of the notice of disqualification. (b) Except as provided under paragraphs (e) and (f), if the lead investigative agency denies the request or fails to act upon the request within 15 working days after receiving the request for reconsideration, the person or facility entitled to a fair hearing under section 256.045, may submit to the commissioner of human services a written request for a hearing under that statute. The vulnerable adult, or an interested person acting on behalf of the vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review Panel under section 256.021 if the lead investigative agency denies the request or fails to act upon the request, or if the vulnerable adult or interested person contests a reconsidered disposition. The lead investigative agency shall notify persons who request reconsideration of their rights under this paragraph. The request must be submitted in writing to the review panel and a copy sent to the lead investigative agency within 30 calendar days of receipt of notice of a denial of a request for reconsideration or of a reconsidered disposition. The request must specifically identify the aspects of the lead investigative agency determination with which the person is dissatisfied. (c) If, as a result of a reconsideration or review, the lead investigative agency changes the final disposition, it shall notify the parties specified in subdivision 9c, paragraph (f). (d) For purposes of this subdivision, "interested person acting on behalf of the vulnerable adult" means a person designated in writing by the vulnerable adult to act on behalf of the vulnerable adult, or a legal guardian or conservator or other legal representative, a proxy or health care agent appointed under chapter 145B or 145C, or an individual who is related to the vulnerable adult, as defined in section 245A.02, subdivision 13. (e) If an individual was disqualified under sections 245C.14 and 245C.15, on the basis of a determination of maltreatment, which was serious or recurring, and the individual has requested reconsideration of the maltreatment determination under paragraph (a) and reconsideration of the disqualification under sections 245C.21 to 245C.27, reconsideration of the maltreatment determination and requested reconsideration of the disqualification shall be consolidated into a single reconsideration. If reconsideration of the maltreatment determination is denied and the individual remains disqualified following a reconsideration decision, the individual may request a fair hearing under section 256.045. If an individual requests a fair hearing on the maltreatment determination and the disqualification, the scope of the fair hearing shall include both the maltreatment determination and the disqualification. (f) If a maltreatment determination or a disqualification based on serious or recurring maltreatment is the basis for a denial of a license under section 245A.05 or a licensing sanction under section 245A.07, the license holder has the right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided for under section 245A.08, the scope of the contested case hearing must include

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the maltreatment determination, disqualification, and licensing sanction or denial of a license. In such cases, a fair hearing must not be conducted under section 256.045. Except for family child care and child foster care, reconsideration of a maltreatment determination under this subdivision, and reconsideration of a disqualification under section 245C.22, must not be conducted when: (1) a denial of a license under section 245A.05, or a licensing sanction under section 245A.07, is based on a determination that the license holder is responsible for maltreatment or the disqualification of a license holder based on serious or recurring maltreatment; (2) the denial of a license or licensing sanction is issued at the same time as the maltreatment determination or disqualification; and (3) the license holder appeals the maltreatment determination or disqualification, and denial of a license or licensing sanction. Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment determination or disqualification, but does not appeal the denial of a license or a licensing sanction, reconsideration of the maltreatment determination shall be conducted under sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the disqualification shall be conducted under section 245C.22. In such cases, a fair hearing shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d. If the disqualified subject is an individual other than the license holder and upon whom a background study must be conducted under chapter 245C, the hearings of all parties may be consolidated into a single contested case hearing upon consent of all parties and the administrative law judge. (g) Until August 1, 2002, an individual or facility that was determined by the commissioner of human services or the commissioner of health to be responsible for neglect under section 626.5572, subdivision 17, after October 1, 1995, and before August 1, 2001, that believes that the finding of neglect does not meet an amended definition of neglect may request a reconsideration of the determination of neglect. The commissioner of human services or the commissioner of health shall mail a notice to the last known address of individuals who are eligible to seek this reconsideration. The request for reconsideration must state how the established findings no longer meet the elements of the definition of neglect. The commissioner shall review the request for reconsideration and make a determination within 15 calendar days. The commissioner's decision on this reconsideration is the final agency action. (1) For purposes of compliance with the data destruction schedule under subdivision 12b, paragraph (d), when a finding of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, the date of the original finding of a substantiated maltreatment must be used to calculate the destruction date. (2) For purposes of any background studies under chapter 245C, when a determination of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, any prior disqualification of the individual under chapter 245C that was based on this determination of maltreatment shall be rescinded, and for future background studies under chapter 245C the commissioner must not use the previous determination of substantiated maltreatment as a basis for disqualification or as a basis for referring the individual's maltreatment history to a health-related licensing board under section 245C.31. Subd. 9e. Education requirements. (a) The commissioners of health, human services, and public safety shall cooperate in the development of a joint program for education of lead investigative agency investigators in the appropriate techniques for investigation of complaints of maltreatment. This program must be developed

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by July 1, 1996. The program must include but need not be limited to the following areas: (1) information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4) conclusions based on evidence; (5) interviewing skills, including specialized training to interview people with unique needs; (6) report writing; (7) coordination and referral to other necessary agencies such as law enforcement and judicial agencies; (8) human relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family systems and the appropriate methods for interviewing relatives in the course of the assessment or investigation; (10) the protective social services that are available to protect alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by which lead investigative agency investigators and law enforcement workers cooperate in conducting assessments and investigations in order to avoid duplication of efforts; and (12) data practices laws and procedures, including provisions for sharing data. (b) The commissioner of human services shall conduct an outreach campaign to promote the common entry point for reporting vulnerable adult maltreatment. This campaign shall use the Internet and other means of communication. (c) The commissioners of health, human services, and public safety shall offer at least annual education to others on the requirements of this section, on how this section is implemented, and investigation techniques. (d) The commissioner of human services, in coordination with the commissioner of public safety shall provide training for the common entry point staff as required in this subdivision and the program courses described in this subdivision, at least four times per year. At a minimum, the training shall be held twice annually in the seven-county metropolitan area and twice annually outside the seven-county metropolitan area. The commissioners shall give priority in the program areas cited in paragraph (a) to persons currently performing assessments and investigations pursuant to this section. (e) The commissioner of public safety shall notify in writing law enforcement personnel of any new requirements under this section. The commissioner of public safety shall conduct regional training for law enforcement personnel regarding their responsibility under this section. (f) Each lead investigative agency investigator must complete the education program specified by this subdivision within the first 12 months of work as a lead investigative agency investigator. A lead investigative agency investigator employed when these requirements take effect must complete the program within the first year after training is available or as soon as training is available. All lead investigative agency investigators having responsibility for investigation duties under this section must receive a minimum of eight hours of continuing education or in-service training each year specific to their duties under this section. Subd. 10. Duties of county social service agency. (a) When the common entry point refers a report to the county social service agency as the lead investigative agency or makes a referral to the county social service agency for emergency adult protective services, or when another lead investigative agency requests assistance from the county social service agency for adult protective services, the county social service agency shall immediately assess and offer emergency and continuing protective social services for purposes of preventing further maltreatment and for safeguarding the welfare of the maltreated vulnerable adult. The county shall use a standardized tool made available by the commissioner. The information entered by the county into the standardized tool must be accessible to the Department of Human Services. In cases of suspected sexual abuse, the county social service agency shall immediately arrange for and make available to the vulnerable adult appropriate medical examination and treatment. When necessary in order to protect the vulnerable adult from further harm, the county social service agency shall seek authority to remove the vulnerable adult from the situation in which the maltreatment occurred. The county social service agency

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may also investigate to determine whether the conditions which resulted in the reported maltreatment place other vulnerable adults in jeopardy of being maltreated and offer protective social services that are called for by its determination. (b) County social service agencies may enter facilities and inspect and copy records as part of an investigation. The county social service agency has access to not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, that are maintained by facilities to the extent necessary to conduct its investigation. The inquiry is not limited to the written records of the facility, but may include every other available source of information. (c) When necessary in order to protect a vulnerable adult from serious harm, the county social service agency shall immediately intervene on behalf of that adult to help the family, vulnerable adult, or other interested person by seeking any of the following: (1) a restraining order or a court order for removal of the perpetrator from the residence of the vulnerable adult pursuant to section 518B.01; (2) the appointment of a guardian or conservator pursuant to sections 524.5-101 to 524.5-502, or guardianship or conservatorship pursuant to chapter 252A; (3) replacement of a guardian or conservator suspected of maltreatment and appointment of a suitable person as guardian or conservator, pursuant to sections 524.5-101 to 524.5-502; or (4) a referral to the prosecuting attorney for possible criminal prosecution of the perpetrator under chapter 609. The expenses of legal intervention must be paid by the county in the case of indigent persons, under section 524.5-502 and chapter 563. In proceedings under sections 524.5-101 to 524.5-502, if a suitable relative or other person is not available to petition for guardianship or conservatorship, a county employee shall present the petition with representation by the county attorney. The county shall contract with or arrange for a suitable person or organization to provide ongoing guardianship services. If the county presents evidence to the court exercising probate jurisdiction that it has made a diligent effort and no other suitable person can be found, a county employee may serve as guardian or conservator. The county shall not retaliate against the employee for any action taken on behalf of the ward or protected person even if the action is adverse to the county's interest. Any person retaliated against in violation of this subdivision shall have a cause of action against the county and shall be entitled to reasonable attorney fees and costs of the action if the action is upheld by the court. Subd. 10a. [Repealed, 1995 c 229 art 1 s 24] Subd. 10b. Investigations; guidelines. Each lead investigative agency shall develop guidelines for prioritizing reports for investigation. When investigating a report, the lead investigative agency shall conduct the following activities, as appropriate: (1) interview of the alleged victim; (2) interview of the reporter and others who may have relevant information; (3) interview of the alleged perpetrator; (4) examination of the environment surrounding the alleged incident;

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(5) review of pertinent documentation of the alleged incident; and (6) consultation with professionals. Subd. 11. [Repealed, 1995 c 229 art 1 s 24] Subd. 11a. [Repealed, 1995 c 229 art 1 s 24] Subd. 12. [Repealed, 1995 c 229 art 1 s 24] Subd. 12a. [Repealed, 1983 c 273 s 8] Subd. 12b. Data management. (a) In performing any of the duties of this section as a lead investigative agency, the county social service agency shall maintain appropriate records. Data collected by the county social service agency under this section are welfare data under section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data under this paragraph that are inactive investigative data on an individual who is a vendor of services are private data on individuals, as defined in section 13.02. The identity of the reporter may only be disclosed as provided in paragraph (c). Data maintained by the common entry point are confidential data on individuals or protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, the common entry point shall maintain data for three calendar years after date of receipt and then destroy the data unless otherwise directed by federal requirements. (b) The commissioners of health and human services shall prepare an investigation memorandum for each report alleging maltreatment investigated under this section. County social service agencies must maintain private data on individuals but are not required to prepare an investigation memorandum. During an investigation by the commissioner of health or the commissioner of human services, data collected under this section are confidential data on individuals or protected nonpublic data as defined in section 13.02. Upon completion of the investigation, the data are classified as provided in clauses (1) to (3) and paragraph (c). (1) The investigation memorandum must contain the following data, which are public: (i) the name of the facility investigated; (ii) a statement of the nature of the alleged maltreatment; (iii) pertinent information obtained from medical or other records reviewed; (iv) the identity of the investigator; (v) a summary of the investigation's findings; (vi) statement of whether the report was found to be substantiated, inconclusive, false, or that no determination will be made; (vii) a statement of any action taken by the facility; (viii) a statement of any action taken by the lead investigative agency; and (ix) when a lead investigative agency's determination has substantiated maltreatment, a statement of whether an individual, individuals, or a facility were responsible for the substantiated maltreatment, if known.

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The investigation memorandum must be written in a manner which protects the identity of the reporter and of the vulnerable adult and may not contain the names or, to the extent possible, data on individuals or private data listed in clause (2). (2) Data on individuals collected and maintained in the investigation memorandum are private data, including: (i) the name of the vulnerable adult; (ii) the identity of the individual alleged to be the perpetrator; (iii) the identity of the individual substantiated as the perpetrator; and (iv) the identity of all individuals interviewed as part of the investigation. (3) Other data on individuals maintained as part of an investigation under this section are private data on individuals upon completion of the investigation. (c) After the assessment or investigation is completed, the name of the reporter must be confidential. The subject of the report may compel disclosure of the name of the reporter only with the consent of the reporter or upon a written finding by a court that the report was false and there is evidence that the report was made in bad faith. This subdivision does not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except that where the identity of the reporter is relevant to a criminal prosecution, the district court shall do an in-camera review prior to determining whether to order disclosure of the identity of the reporter. (d) Notwithstanding section 138.163, data maintained under this section by the commissioners of health and human services must be maintained under the following schedule and then destroyed unless otherwise directed by federal requirements: (1) data from reports determined to be false, maintained for three years after the finding was made; (2) data from reports determined to be inconclusive, maintained for four years after the finding was made; (3) data from reports determined to be substantiated, maintained for seven years after the finding was made; and (4) data from reports which were not investigated by a lead investigative agency and for which there is no final disposition, maintained for three years from the date of the report. (e) The commissioners of health and human services shall annually publish on their websites the number and type of reports of alleged maltreatment involving licensed facilities reported under this section, the number of those requiring investigation under this section, and the resolution of those investigations. On a biennial basis, the commissioners of health and human services shall jointly report the following information to the legislature and the governor: (1) the number and type of reports of alleged maltreatment involving licensed facilities reported under this section, the number of those requiring investigations under this section, the resolution of those investigations, and which of the two lead agencies was responsible; (2) trends about types of substantiated maltreatment found in the reporting period;

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(3) if there are upward trends for types of maltreatment substantiated, recommendations for addressing and responding to them; (4) efforts undertaken or recommended to improve the protection of vulnerable adults; (5) whether and where backlogs of cases result in a failure to conform with statutory time frames and recommendations for reducing backlogs if applicable; (6) recommended changes to statutes affecting the protection of vulnerable adults; and (7) any other information that is relevant to the report trends and findings. (f) Each lead investigative agency must have a record retention policy. (g) Lead investigative agencies, prosecuting authorities, and law enforcement agencies may exchange not public data, as defined in section 13.02, if the agency or authority requesting the data determines that the data are pertinent and necessary to the requesting agency in initiating, furthering, or completing an investigation under this section. Data collected under this section must be made available to prosecuting authorities and law enforcement officials, local county agencies, and licensing agencies investigating the alleged maltreatment under this section. The lead investigative agency shall exchange not public data with the vulnerable adult maltreatment review panel established in section 256.021 if the data are pertinent and necessary for a review requested under that section. Notwithstanding section 138.17, upon completion of the review, not public data received by the review panel must be destroyed. (h) Each lead investigative agency shall keep records of the length of time it takes to complete its investigations. (i) A lead investigative agency may notify other affected parties and their authorized representative if the lead investigative agency has reason to believe maltreatment has occurred and determines the information will safeguard the well-being of the affected parties or dispel widespread rumor or unrest in the affected facility. (j) Under any notification provision of this section, where federal law specifically prohibits the disclosure of patient identifying information, a lead investigative agency may not provide any notice unless the vulnerable adult has consented to disclosure in a manner which conforms to federal requirements. Subd. 13. [Repealed, 1995 c 229 art 1 s 24] Subd. 14. Abuse prevention plans. (a) Each facility, except home health agencies and personal care attendant services providers, shall establish and enforce an ongoing written abuse prevention plan. The plan shall contain an assessment of the physical plant, its environment, and its population identifying factors which may encourage or permit abuse, and a statement of specific measures to be taken to minimize the risk of abuse. The plan shall comply with any rules governing the plan promulgated by the licensing agency. (b) Each facility, including a home health care agency and personal care attendant services providers, shall develop an individual abuse prevention plan for each vulnerable adult residing there or receiving services from them. The plan shall contain an individualized assessment of: (1) the person's susceptibility to abuse by other individuals, including other vulnerable adults; (2) the person's risk of abusing other vulnerable adults; and (3) statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. For the purposes of this paragraph, the term "abuse" includes self-abuse.

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(c) If the facility, except home health agencies and personal care attendant services providers, knows that the vulnerable adult has committed a violent crime or an act of physical aggression toward others, the individual abuse prevention plan must detail the measures to be taken to minimize the risk that the vulnerable adult might reasonably be expected to pose to visitors to the facility and persons outside the facility, if unsupervised. Under this section, a facility knows of a vulnerable adult's history of criminal misconduct or physical aggression if it receives such information from a law enforcement authority or through a medical record prepared by another facility, another health care provider, or the facility's ongoing assessments of the vulnerable adult. Subd. 15. [Repealed, 1995 c 229 art 1 s 24] Subd. 16. [Repealed, 2014 c 262 art 4 s 9] Subd. 17. Retaliation prohibited. (a) A facility or person shall not retaliate against any person who reports in good faith suspected maltreatment pursuant to this section, or against a vulnerable adult with respect to whom a report is made, because of the report. (b) In addition to any remedies allowed under sections 181.931 to 181.935, any facility or person which retaliates against any person because of a report of suspected maltreatment is liable to that person for actual damages, punitive damages up to $10,000, and attorney fees. (c) There shall be a rebuttable presumption that any adverse action, as defined below, within 90 days of a report, is retaliatory. For purposes of this clause, the term "adverse action" refers to action taken by a facility or person involved in a report against the person making the report or the person with respect to whom the report was made because of the report, and includes, but is not limited to: (1) discharge or transfer from the facility; (2) discharge from or termination of employment; (3) demotion or reduction in remuneration for services; (4) restriction or prohibition of access to the facility or its residents; or (5) any restriction of rights set forth in section 144.651. Subd. 18. Outreach. The commissioner of human services shall maintain an aggressive program to educate those required to report, as well as the general public, about the requirements of this section using a variety of media. The commissioner of human services shall print and make available the form developed under subdivision 9. Subd. 19. [Repealed, 1995 c 229 art 1 s 24] Subd. 20. Cause of action for financial exploitation; damages. (a) A vulnerable adult who is a victim of financial exploitation as defined in section 626.5572, subdivision 9, has a cause of action against a person who committed the financial exploitation. In an action under this subdivision, the vulnerable adult is entitled to recover damages equal to three times the amount of compensatory damages or $10,000, whichever is greater. (b) In addition to damages under paragraph (a), the vulnerable adult is entitled to recover reasonable attorney fees and costs, including reasonable fees for the services of a guardian or conservator or guardian ad litem incurred in connection with a claim under this subdivision.

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(c) An action may be brought under this subdivision regardless of whether there has been a report or final disposition under this section or a criminal complaint or conviction related to the financial exploitation. Subd. 21. Contested case hearing. When an appeal of a lead investigative agency determination results in a contested case hearing under chapter 245A or 245C, the administrative law judge shall notify the vulnerable adult who is the subject of the maltreatment determination and, if known, a guardian of the vulnerable adult appointed under section 524.5-310, or a health care agent designated by the vulnerable adult in a health care directive that is currently effective under section 145C.06, and whose authority to make health care decisions is not suspended under section 524.5-310, of the hearing. The notice must be sent by certified mail and inform the vulnerable adult of the right to file a signed written statement in the proceedings. A guardian or health care agent who prepares or files a written statement for the vulnerable adult must indicate in the statement that the person is the vulnerable adult's guardian or health care agent and sign the statement in that capacity. The vulnerable adult, the guardian, or the health care agent may file a written statement with the administrative law judge hearing the case no later than five business days before commencement of the hearing. The administrative law judge shall include the written statement in the hearing record and consider the statement in deciding the appeal. This subdivision does not limit, prevent, or excuse the vulnerable adult from being called as a witness testifying at the hearing or grant the vulnerable adult, the guardian, or health care agent a right to participate in the proceedings or appeal the administrative law judge's decision in the case. The lead investigative agency must consider including the vulnerable adult victim of maltreatment as a witness in the hearing. If the lead investigative agency determines that participation in the hearing would endanger the well-being of the vulnerable adult or not be in the best interests of the vulnerable adult, the lead investigative agency shall inform the administrative law judge of the basis for this determination, which must be included in the final order. If the administrative law judge is not reasonably able to determine the address of the vulnerable adult, the guardian, or the health care agent, the administrative law judge is not required to send a hearing notice under this subdivision. History: 1980 c 542 s 1; 1981 c 311 s 39; 1982 c 393 s 3,4; 1982 c 424 s 130; 1982 c 545 s 24; 1982 c 636 s 5,6; 1983 c 273 s 1-7; 1984 c 640 s 32; 1984 c 654 art 5 s 58; 1985 c 150 s 1-6; 1985 c 293 s 6,7; 1Sp1985 c 14 art 9 s 75; 1986 c 444; 1987 c 110 s 3; 1987 c 211 s 2; 1987 c 352 s 11; 1987 c 378 s 17; 1987 c 384 art 2 s 1; 1988 c 543 s 13; 1989 c 209 art 2 s 1; 1991 c 181 s 2; 1994 c 483 s 1; 1994 c 636 art 2 s 60-62; 1Sp1994 c 1 art 2 s 34; 1995 c 189 s 8; 1995 c 229 art 1 s 1-21; 1996 c 277 s 1; 1996 c 305 art 2 s 66; 2000 c 465 s 3-5; 1Sp2001 c 9 art 5 s 31; art 14 s 30,31; 2002 c 289 s 4; 2002 c 375 art 1 s 22,23; 2002 c 379 art 1 s 113; 2003 c 15 art 1 s 33; 2004 c 146 art 3 s 45; 2004 c 288 art 1 s 80; 2005 c 56 s 1; 2005 c 98 art 2 s 17; 2005 c 136 art 5 s 5; 1Sp2005 c 4 art 1 s 55,56; 2006 c 253 s 21; 2007 c 112 s 55,56; 2007 c 147 art 7 s 75; art 10 s 15; 2009 c 119 s 11-16; 2009 c 142 art 2 s 46,47; 2009 c 159 s 107; 2010 c 329 art 2 s 6; 2010 c 352 art 1 s 23; 2010 c 382 s 81; 2011 c 28 s 9-14,17; 2012 c 216 art 9 s 30,31; 2013 c 63 s 17; 2013 c 108 art 2 s 41-43; art 8 s 57; 2014 c 192 art 2 s 1; 2014 c 291 art 8 s 17; 2015 c 78 art 6 s 23-25; 2019 c 50 art 1 s 128

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626.5572 DEFINITIONS. Subdivision 1. Scope. For the purpose of section 626.557, the following terms have the meanings given them, unless otherwise specified. Subd. 2. Abuse. "Abuse" means: (a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate, or aiding and abetting a violation of: (1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224; (2) the use of drugs to injure or facilitate crime as defined in section 609.235; (3) the solicitation, inducement, and promotion of prostitution as defined in section 609.322; and (4) criminal sexual conduct in the first through fifth degrees as defined in sections 609.342 to 609.3451. A violation includes any action that meets the elements of the crime, regardless of whether there is a criminal proceeding or conviction. (b) Conduct which is not an accident or therapeutic conduct as defined in this section, which produces or could reasonably be expected to produce physical pain or injury or emotional distress including, but not limited to, the following: (1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable adult; (2) use of repeated or malicious oral, written, or gestured language toward a vulnerable adult or the treatment of a vulnerable adult which would be considered by a reasonable person to be disparaging, derogatory, humiliating, harassing, or threatening; (3) use of any aversive or deprivation procedure, unreasonable confinement, or involuntary seclusion, including the forced separation of the vulnerable adult from other persons against the will of the vulnerable adult or the legal representative of the vulnerable adult; and (4) use of any aversive or deprivation procedures for persons with developmental disabilities or related conditions not authorized under section 245.825. (c) Any sexual contact or penetration as defined in section 609.341, between a facility staff person or a person providing services in the facility and a resident, patient, or client of that facility. (d) The act of forcing, compelling, coercing, or enticing a vulnerable adult against the vulnerable adult's will to perform services for the advantage of another. (e) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult or a person with authority to make health care decisions for the vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C or 252A, or section 253B.03 or 524.5-313, refuses consent or withdraws consent, consistent with that authority and within the boundary of reasonable medical practice, to any therapeutic conduct, including any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition of the vulnerable adult or, where permitted under law, to provide nutrition and hydration parenterally or through intubation. This paragraph does not enlarge or diminish rights otherwise held under law by:

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(1) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an involved family member, to consent to or refuse consent for therapeutic conduct; or (2) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct. (f) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult, a person with authority to make health care decisions for the vulnerable adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care, provided that this is consistent with the prior practice or belief of the vulnerable adult or with the expressed intentions of the vulnerable adult. (g) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional dysfunction or undue influence, engages in consensual sexual contact with: (1) a person, including a facility staff person, when a consensual sexual personal relationship existed prior to the caregiving relationship; or (2) a personal care attendant, regardless of whether the consensual sexual personal relationship existed prior to the caregiving relationship. Subd. 3. Accident. "Accident" means a sudden, unforeseen, and unexpected occurrence or event which: (1) is not likely to occur and which could not have been prevented by exercise of due care; and (2) if occurring while a vulnerable adult is receiving services from a facility, happens when the facility and the employee or person providing services in the facility are in compliance with the laws and rules relevant to the occurrence or event. Subd. 4. Caregiver. "Caregiver" means an individual or facility who has responsibility for the care of a vulnerable adult as a result of a family relationship, or who has assumed responsibility for all or a portion of the care of a vulnerable adult voluntarily, by contract, or by agreement. Subd. 5. Common entry point. "Common entry point" means the entity responsible for receiving reports of alleged or suspected maltreatment of a vulnerable adult under section 626.557. Subd. 6. Facility. (a) "Facility" means a hospital or other entity required to be licensed under sections 144.50 to 144.58; a nursing home required to be licensed to serve adults under section 144A.02; a facility or service required to be licensed under chapter 245A; an assisted living facility required to be licensed under chapter 144G; a home care provider licensed or required to be licensed under sections 144A.43 to 144A.482; a hospice provider licensed under sections 144A.75 to 144A.755; or a person or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under sections 256B.0625, subdivision 19a, 256B.0651 to 256B.0654, 256B.0659, or 256B.85. (b) For services identified in paragraph (a) that are provided in the vulnerable adult's own home or in another unlicensed location, the term "facility" refers to the provider, person, or organization that offers, provides, or arranges for personal care services, and does not refer to the vulnerable adult's home or other location at which services are rendered. Subd. 7. False. "False" means a preponderance of the evidence shows that an act that meets the definition of maltreatment did not occur.

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Subd. 8. Final disposition. "Final disposition" is the determination of an investigation by a lead investigative agency that a report of maltreatment under Laws 1995, chapter 229, is substantiated, inconclusive, false, or that no determination will be made. When a lead investigative agency determination has substantiated maltreatment, the final disposition also identifies, if known, which individual or individuals were responsible for the substantiated maltreatment, and whether a facility was responsible for the substantiated maltreatment. Subd. 9. Financial exploitation. "Financial exploitation" means: (a) In breach of a fiduciary obligation recognized elsewhere in law, including pertinent regulations, contractual obligations, documented consent by a competent person, or the obligations of a responsible party under section 144.6501, a person: (1) engages in unauthorized expenditure of funds entrusted to the actor by the vulnerable adult which results or is likely to result in detriment to the vulnerable adult; or (2) fails to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult. (b) In the absence of legal authority a person: (1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult; (2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult; (3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud; or (4) forces, compels, coerces, or entices a vulnerable adult against the vulnerable adult's will to perform services for the profit or advantage of another. (c) Nothing in this definition requires a facility or caregiver to provide financial management or supervise financial management for a vulnerable adult except as otherwise required by law. Subd. 10. Immediately. "Immediately" means as soon as possible, but no longer than 24 hours from the time initial knowledge that the incident occurred has been received. Subd. 11. Inconclusive. "Inconclusive" means there is less than a preponderance of evidence to show that maltreatment did or did not occur. Subd. 12. Initial disposition. "Initial disposition" is the lead investigative agency's determination of whether the report will be assigned for further investigation. Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary administrative agency responsible for investigating reports made under section 626.557. (a) The Department of Health is the lead investigative agency for facilities or services licensed or required to be licensed as hospitals, home care providers, nursing homes, boarding care homes, hospice providers, residential facilities that are also federally certified as intermediate care facilities that serve people with developmental disabilities, or any other facility or service not listed in this subdivision that is licensed or required to be licensed by the Department of Health for the care of vulnerable adults. "Home care provider" has the meaning provided in section 144A.43, subdivision 4, and applies when care or services are delivered

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in the vulnerable adult's home, whether a private home or a housing with services establishment registered under chapter 144D, including those that offer assisted living services under chapter 144G. (b) The Department of Human Services is the lead investigative agency for facilities or services licensed or required to be licensed as adult day care, adult foster care, community residential settings, programs for people with disabilities, family adult day services, mental health programs, mental health clinics, chemical dependency programs, the Minnesota sex offender program, or any other facility or service not listed in this subdivision that is licensed or required to be licensed by the Department of Human Services. (c) The county social service agency or its designee is the lead investigative agency for all other reports, including, but not limited to, reports involving vulnerable adults receiving services from a personal care provider organization under section 256B.0659. Subd. 14. Legal authority. "Legal authority" includes, but is not limited to: (1) a fiduciary obligation recognized elsewhere in law, including pertinent regulations; (2) a contractual obligation; or (3) documented consent by a competent person. Subd. 15. Maltreatment. "Maltreatment" means abuse as defined in subdivision 2, neglect as defined in subdivision 17, or financial exploitation as defined in subdivision 9. Subd. 16. Mandated reporter. "Mandated reporter" means a professional or professional's delegate while engaged in: (1) social services; (2) law enforcement; (3) education; (4) the care of vulnerable adults; (5) any of the occupations referred to in section 214.01, subdivision 2; (6) an employee of a rehabilitation facility certified by the commissioner of jobs and training for vocational rehabilitation; (7) an employee or person providing services in a facility as defined in subdivision 6; or (8) a person that performs the duties of the medical examiner or coroner. Subd. 17. Neglect. "Neglect" means: (a) The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to, food, clothing, shelter, health care, or supervision which is: (1) reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult; and (2) which is not the result of an accident or therapeutic conduct. (b) The absence or likelihood of absence of care or services, including but not limited to, food, clothing, shelter, health care, or supervision necessary to maintain the physical and mental health of the vulnerable adult which a reasonable person would deem essential to obtain or maintain the vulnerable adult's health, safety, or comfort considering the physical or mental capacity or dysfunction of the vulnerable adult. (c) For purposes of this section, a vulnerable adult is not neglected for the sole reason that: (1) the vulnerable adult or a person with authority to make health care decisions for the vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C, or 252A, or sections 253B.03 or 524.5-101 to 524.5-502, refuses consent or withdraws consent, consistent with that authority and within the boundary of reasonable medical practice, to any therapeutic conduct, including any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition of the vulnerable adult, or, where permitted under law, to provide nutrition and hydration parenterally or through intubation; this paragraph does not enlarge or diminish rights otherwise held under law by:

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(i) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an involved family member, to consent to or refuse consent for therapeutic conduct; or (ii) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct; or (2) the vulnerable adult, a person with authority to make health care decisions for the vulnerable adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care, provided that this is consistent with the prior practice or belief of the vulnerable adult or with the expressed intentions of the vulnerable adult; (3) the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional dysfunction or undue influence, engages in consensual sexual contact with: (i) a person including a facility staff person when a consensual sexual personal relationship existed prior to the caregiving relationship; or (ii) a personal care attendant, regardless of whether the consensual sexual personal relationship existed prior to the caregiving relationship; or (4) an individual makes an error in the provision of therapeutic conduct to a vulnerable adult which does not result in injury or harm which reasonably requires medical or mental health care; or (5) an individual makes an error in the provision of therapeutic conduct to a vulnerable adult that results in injury or harm, which reasonably requires the care of a physician, and: (i) the necessary care is provided in a timely fashion as dictated by the condition of the vulnerable adult; (ii) if after receiving care, the health status of the vulnerable adult can be reasonably expected, as determined by the attending physician, to be restored to the vulnerable adult's preexisting condition; (iii) the error is not part of a pattern of errors by the individual; (iv) if in a facility, the error is immediately reported as required under section 626.557, and recorded internally in the facility; (v) if in a facility, the facility identifies and takes corrective action and implements measures designed to reduce the risk of further occurrence of this error and similar errors; and (vi) if in a facility, the actions required under items (iv) and (v) are sufficiently documented for review and evaluation by the facility and any applicable licensing, certification, and ombudsman agency. (d) Nothing in this definition requires a caregiver, if regulated, to provide services in excess of those required by the caregiver's license, certification, registration, or other regulation. (e) If the findings of an investigation by a lead investigative agency result in a determination of substantiated maltreatment for the sole reason that the actions required of a facility under paragraph (c), clause (5), item (iv), (v), or (vi), were not taken, then the facility is subject to a correction order. An individual will not be found to have neglected or maltreated the vulnerable adult based solely on the facility's not having taken the actions required under paragraph (c), clause (5), item (iv), (v), or (vi). This must not alter the lead investigative agency's determination of mitigating factors under section 626.557, subdivision 9c, paragraph (c).

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Subd. 18. Report. "Report" means a statement concerning all the circumstances surrounding the alleged or suspected maltreatment, as defined in this section, of a vulnerable adult which are known to the reporter at the time the statement is made. Subd. 19. Substantiated. "Substantiated" means a preponderance of the evidence shows that an act that meets the definition of maltreatment occurred. Subd. 20. Therapeutic conduct. "Therapeutic conduct" means the provision of program services, health care, or other personal care services done in good faith in the interests of the vulnerable adult by: (1) an individual, facility, or employee or person providing services in a facility under the rights, privileges and responsibilities conferred by state license, certification, or registration; or (2) a caregiver. Subd. 21. Vulnerable adult. (a) "Vulnerable adult" means any person 18 years of age or older who: (1) is a resident or inpatient of a facility; (2) receives services required to be licensed under chapter 245A, except that a person receiving outpatient services for treatment of chemical dependency or mental illness, or one who is served in the Minnesota sex offender program on a court-hold order for commitment, or is committed as a sexual psychopathic personality or as a sexually dangerous person under chapter 253B, is not considered a vulnerable adult unless the person meets the requirements of clause (4); (3) receives services from a home care provider required to be licensed under sections 144A.43 to 144A.482; or from a person or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under section 256B.0625, subdivision 19a, 256B.0651, 256B.0653, 256B.0654, 256B.0659, or 256B.85; or (4) regardless of residence or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction: (i) that impairs the individual's ability to provide adequately for the individual's own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and (ii) because of the dysfunction or infirmity and the need for care or services, the individual has an impaired ability to protect the individual's self from maltreatment. (b) For purposes of this subdivision, "care or services" means care or services for the health, safety, welfare, or maintenance of an individual. History: 1995 c 229 art 1 s 22; 2000 c 319 s 3; 1Sp2001 c 9 art 14 s 32; 2002 c 252 s 23,24; 2002 c 379 art 1 s 113; 2004 c 146 art 3 s 46; 2006 c 212 art 3 s 41; 2007 c 112 s 57; 2008 c 326 art 2 s 15; 2009 c 79 art 6 s 20,21; art 8 s 75; 2009 c 119 s 17; 2009 c 142 art 2 s 48; 2011 c 28 s 16,17; 2012 c 216 art 9 s 32; 2013 c 108 art 8 s 58; 2014 c 262 art 4 s 9; art 5 s 6; 2015 c 78 art 6 s 26-28; 2016 c 158 art 1 s 210,211; 2019 c 60 art 1 s 47; art 4 s 33

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144.6502

144.6502 ELECTRONIC MONITORING IN CERTAIN FACILITIES. Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Commissioner" means the commissioner of health. (c) "Department" means the Department of Health. (d) "Electronic monitoring" means the placement and use of an electronic monitoring device by a resident in the resident's room or private living unit in accordance with this section. (e) "Electronic monitoring device" means a camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident's room or private living unit and is used to monitor the resident or activities in the room or private living unit. (f) "Facility" means a facility that is: (1) licensed as a nursing home under chapter 144A; (2) licensed as a boarding care home under sections 144.50 to 144.56; (3) until August 1, 2021, a housing with services establishment registered under chapter 144D that is either subject to chapter 144G or has a disclosed special unit under section 325F.72; or (4) on or after August 1, 2021, an assisted living facility. (g) "Resident" means a person 18 years of age or older residing in a facility. (h) "Resident representative" means one of the following in the order of priority listed, to the extent the person may reasonably be identified and located: (1) a court-appointed guardian; (2) a health care agent as defined in section 145C.01, subdivision 2; or (3) a person who is not an agent of a facility or of a home care provider designated in writing by the resident and maintained in the resident's records on file with the facility. Subd. 2. Electronic monitoring authorized. (a) A resident or a resident representative may conduct electronic monitoring of the resident's room or private living unit through the use of electronic monitoring devices placed in the resident's room or private living unit as provided in this section. (b) Nothing in this section precludes the use of electronic monitoring of health care allowed under other law. (c) Electronic monitoring authorized under this section is not a covered service under home and community-based waivers under chapter 256S and sections 256B.0913, 256B.092, and 256B.49. (d) This section does not apply to monitoring technology authorized as a home and community-based service under chapter 256S or section 256B.0913, 256B.092, or 256B.49. Subd. 3. Consent to electronic monitoring. (a) Except as otherwise provided in this subdivision, a resident must consent to electronic monitoring in the resident's room or private living unit in writing on a notification and consent form. If the resident has not affirmatively objected to electronic monitoring and the

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resident's medical professional determines that the resident currently lacks the ability to understand and appreciate the nature and consequences of electronic monitoring, the resident representative may consent on behalf of the resident. For purposes of this subdivision, a resident affirmatively objects when the resident orally, visually, or through the use of auxiliary aids or services declines electronic monitoring. The resident's response must be documented on the notification and consent form. (b) Prior to a resident representative consenting on behalf of a resident, the resident must be asked if the resident wants electronic monitoring to be conducted. The resident representative must explain to the resident: (1) the type of electronic monitoring device to be used; (2) the standard conditions that may be placed on the electronic monitoring device's use, including those listed in subdivision 6; (3) with whom the recording may be shared under subdivision 10 or 11; and (4) the resident's ability to decline all recording. (c) A resident, or resident representative when consenting on behalf of the resident, may consent to electronic monitoring with any conditions of the resident's or resident representative's choosing, including the list of standard conditions provided in subdivision 6. A resident, or resident representative when consenting on behalf of the resident, may request that the electronic monitoring device be turned off or the visual or audio recording component of the electronic monitoring device be blocked at any time. (d) Prior to implementing electronic monitoring, a resident, or resident representative when acting on behalf of the resident, must obtain the written consent on the notification and consent form of any other resident residing in the shared room or shared private living unit. A roommate's or roommate's resident representative's written consent must comply with the requirements of paragraphs (a) to (c). Consent by a roommate or a roommate's resident representative under this paragraph authorizes the resident's use of any recording obtained under this section, as provided under subdivision 10 or 11. (e) Any resident conducting electronic monitoring must immediately remove or disable an electronic monitoring device prior to a new roommate moving into a shared room or shared private living unit, unless the resident obtains the roommate's or roommate's resident representative's written consent as provided under paragraph (d) prior to the roommate moving into the shared room or shared private living unit. Upon obtaining the new roommate's signed notification and consent form and submitting the form to the facility as required under subdivision 5, the resident may resume electronic monitoring. (f) The resident or roommate, or the resident representative or roommate's resident representative if the representative is consenting on behalf of the resident or roommate, may withdraw consent at any time and the withdrawal of consent must be documented on the original consent form as provided under subdivision 5, paragraph (d). Subd. 4. Refusal of roommate to consent. If a resident of a facility who is residing in a shared room or shared living unit, or the resident representative of such a resident when acting on behalf of the resident, wants to conduct electronic monitoring and another resident living in or moving into the same shared room or shared living unit refuses to consent to the use of an electronic monitoring device, the facility shall make a reasonable attempt to accommodate the resident who wants to conduct electronic monitoring. A facility has met the requirement to make a reasonable attempt to accommodate a resident or resident representative who wants to conduct electronic monitoring when, upon notification that a roommate has not consented to the use of an electronic monitoring device in the resident's room, the facility offers to move the resident to

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another shared room or shared living unit that is available at the time of the request. If a resident chooses to reside in a private room or private living unit in a facility in order to accommodate the use of an electronic monitoring device, the resident must pay either the private room rate in a nursing home setting, or the applicable rent in a housing with services establishment or assisted living facility. If a facility is unable to accommodate a resident due to lack of space, the facility must reevaluate the request every two weeks until the request is fulfilled. A facility is not required to provide a private room, a single-bed room, or a private living unit to a resident who is unable to pay. Subd. 5. Notice to facility; exceptions. (a) Electronic monitoring may begin only after the resident or resident representative who intends to place an electronic monitoring device and any roommate or roommate's resident representative completes the notification and consent form and submits the form to the facility. (b) Notwithstanding paragraph (a), the resident or resident representative who intends to place an electronic monitoring device may do so without submitting a notification and consent form to the facility for up to 14 days: (1) if the resident or the resident representative reasonably fears retaliation against the resident by the facility, timely submits the completed notification and consent form to the Office of Ombudsman for Long-Term Care, and timely submits a Minnesota Adult Abuse Reporting Center report or police report, or both, upon evidence from the electronic monitoring device that suspected maltreatment has occurred; (2) if there has not been a timely written response from the facility to a written communication from the resident or resident representative expressing a concern prompting the desire for placement of an electronic monitoring device and if the resident or a resident representative timely submits a completed notification and consent form to the Office of Ombudsman for Long-Term Care; or (3) if the resident or resident representative has already submitted a Minnesota Adult Abuse Reporting Center report or police report regarding the resident's concerns prompting the desire for placement and if the resident or a resident representative timely submits a completed notification and consent form to the Office of Ombudsman for Long-Term Care. (c) Upon receipt of any completed notification and consent form, the facility must place the original form in the resident's file or file the original form with the resident's housing with services contract. The facility must provide a copy to the resident and the resident's roommate, if applicable. (d) If a resident is conducting electronic monitoring according to paragraph (b) and a new roommate moves into the room or living unit, the resident or resident representative must submit the signed notification and consent form to the facility. In the event that a resident or roommate, or the resident representative or roommate's resident representative if the representative is consenting on behalf of the resident or roommate, chooses to alter the conditions under which consent to electronic monitoring is given or chooses to withdraw consent to electronic monitoring, the facility must make available the original notification and consent form so that it may be updated. Upon receipt of the updated form, the facility must place the updated form in the resident's file or file the original form with the resident's signed housing with services contract. The facility must provide a copy of the updated form to the resident and the resident's roommate, if applicable. (e) If a new roommate, or the new roommate's resident representative when consenting on behalf of the new roommate, does not submit to the facility a completed notification and consent form and the resident conducting the electronic monitoring does not remove or disable the electronic monitoring device, the facility must remove the electronic monitoring device.

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(f) If a roommate, or the roommate's resident representative when withdrawing consent on behalf of the roommate, submits an updated notification and consent form withdrawing consent and the resident conducting electronic monitoring does not remove or disable the electronic monitoring device, the facility must remove the electronic monitoring device. Subd. 6. Form requirements. (a) The notification and consent form completed by the resident must include, at a minimum, the following information: (1) the resident's signed consent to electronic monitoring or the signature of the resident representative, if applicable. If a person other than the resident signs the consent form, the form must document the following: (i) the date the resident was asked if the resident wants electronic monitoring to be conducted; (ii) who was present when the resident was asked; (iii) an acknowledgment that the resident did not affirmatively object; and (iv) the source of authority allowing the resident representative to sign the notification and consent form on the resident's behalf; (2) the resident's roommate's signed consent or the signature of the roommate's resident representative, if applicable. If a roommate's resident representative signs the consent form, the form must document the following: (i) the date the roommate was asked if the roommate wants electronic monitoring to be conducted; (ii) who was present when the roommate was asked; (iii) an acknowledgment that the roommate did not affirmatively object; and (iv) the source of authority allowing the resident representative to sign the notification and consent form on the roommate's behalf; (3) the type of electronic monitoring device to be used; (4) a list of standard conditions or restrictions that the resident or a roommate may elect to place on the use of the electronic monitoring device, including but not limited to: (i) prohibiting audio recording; (ii) prohibiting video recording; (iii) prohibiting broadcasting of audio or video; (iv) turning off the electronic monitoring device or blocking the visual recording component of the electronic monitoring device for the duration of an exam or procedure by a health care professional; (v) turning off the electronic monitoring device or blocking the visual recording component of the electronic monitoring device while dressing or bathing is performed; and (vi) turning off the electronic monitoring device for the duration of a visit with a spiritual adviser, ombudsman, attorney, financial planner, intimate partner, or other visitor; (5) any other condition or restriction elected by the resident or roommate on the use of an electronic monitoring device;

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(6) a statement of the circumstances under which a recording may be disseminated under subdivision 10; (7) a signature box for documenting that the resident or roommate has withdrawn consent; and (8) an acknowledgment that the resident consents to the Office of Ombudsman for Long-Term Care and its representatives disclosing information about the form. Disclosure under this clause shall be limited to: (i) the fact that the form was received from the resident or resident representative; (ii) if signed by a resident representative, the name of the resident representative and the source of authority allowing the resident representative to sign the notification and consent form on the resident's behalf; and (iii) the type of electronic monitoring device placed. (b) Facilities must make the notification and consent form available to the residents and inform residents of their option to conduct electronic monitoring of their rooms or private living unit. (c) Notification and consent forms received by the Office of Ombudsman for Long-Term Care are classified under section 256.9744. (d) A facility that contacts the Office of Ombudsman for Long-Term Care regarding an electronic monitoring device presumably placed in accordance with subdivision 5, paragraph (a) or (b), must provide the office with the type, make, and model number of the electronic monitoring device discovered by the facility. Subd. 7. Costs and installation. (a) A resident or resident representative choosing to conduct electronic monitoring must do so at the resident's own expense, including paying purchase, installation, maintenance, and removal costs. (b) If a resident chooses to place an electronic monitoring device that uses Internet technology for visual or audio monitoring, the resident may be responsible for contracting with an Internet service provider. (c) The facility shall make a reasonable attempt to accommodate the resident's installation needs, including allowing access to the facility's public-use Internet or Wi-Fi systems when available for other public uses. A facility has the burden of proving that a requested accommodation is not reasonable. (d) All electronic monitoring device installations and supporting services must be UL-listed. Subd. 8. Notice to visitors. (a) A facility must post a sign at each facility entrance accessible to visitors that states: "Electronic monitoring devices, including security cameras and audio devices, may be present to record persons and activities." (b) The facility is responsible for installing and maintaining the signage required in this subdivision. Subd. 9. Obstruction of electronic monitoring devices. (a) A person must not knowingly hamper, obstruct, tamper with, or destroy an electronic monitoring device placed in a resident's room or private living unit without the permission of the resident or resident representative. Checking the electronic monitoring device by facility staff for the make and model number does not constitute tampering under this subdivision. (b) It is not a violation of paragraph (a) if a person turns off the electronic monitoring device or blocks the visual recording component of the electronic monitoring device at the direction of the resident or resident representative, or if consent has been withdrawn.

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Subd. 10. Dissemination of recordings. (a) No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or resident representative. (b) Except as required under other law, a recording or copy of a recording made as provided in this section may only be disseminated for the purpose of addressing health, safety, or welfare concerns of one or more residents. (c) A person disseminating a recording or copy of a recording made as provided in this section in violation of paragraph (b) may be civilly or criminally liable. Subd. 11. Admissibility of evidence. Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring under this section may be admitted into evidence in a civil, criminal, or administrative proceeding. Subd. 12. Liability. (a) For the purposes of state law, the mere presence of an electronic monitoring device in a resident's room or private living unit is not a violation of the resident's right to privacy under section 144.651 or 144A.44. (b) For the purposes of state law, a facility or home care provider is not civilly or criminally liable for the mere disclosure by a resident or a resident representative of a recording. Subd. 13. Immunity from liability. The Office of Ombudsman for Long-Term Care and representatives of the office are immune from liability for conduct described in section 256.9742, subdivision 2. Subd. 14. Resident protections. (a) A facility must not: (1) refuse to admit a potential resident or remove a resident because the facility disagrees with the decision of the potential resident, the resident, or a resident representative acting on behalf of the resident regarding electronic monitoring; (2) retaliate or discriminate against any resident for consenting or refusing to consent to electronic monitoring, as provided in section 144.6512, 144G.07, or 144G.92; or (3) prevent the placement or use of an electronic monitoring device by a resident who has provided the facility or the Office of Ombudsman for Long-Term Care with notice and consent as required under this section. (b) Any contractual provision prohibiting, limiting, or otherwise modifying the rights and obligations in this section is contrary to public policy and is void and unenforceable. Subd. 15. Employee discipline. (a) An employee of the facility or an employee of a contractor providing services at the facility, including an arranged home care provider as defined in section 144D.01, subdivision 2a, who is the subject of proposed disciplinary action based upon evidence obtained by electronic monitoring must be given access to that evidence for purposes of defending against the proposed action. (b) An employee who obtains a recording or a copy of the recording must treat the recording or copy confidentially and must not further disseminate it to any other person except as required under law. Any copy of the recording must be returned to the facility or resident who provided the copy when it is no longer needed for purposes of defending against a proposed action. Subd. 16. Penalties. (a) The commissioner may issue a correction order as provided under section 144A.10, 144A.45, 144A.474, or 144G.30, upon a finding that the facility has failed to comply with:

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(1) subdivision 5, paragraphs (c) to (f); (2) subdivision 6, paragraph (b); (3) subdivision 7, paragraph (c); or (4) subdivision 8, 9, 10, or 14. (b) For each violation of this section, the commissioner may impose a fine of up to $500 upon a finding of noncompliance with a correction order issued under this subdivision. (c) The commissioner may exercise the commissioner's authority under section 144D.05 to compel a housing with services establishment to meet the requirements of this section. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 47; art 3 s 1; 1Sp2019 c 9 art 11 s 105

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325F.72

325F.72 DISCLOSURE OF SPECIAL CARE STATUS REQUIRED. Subdivision 1. Persons to whom disclosure is required. Only assisted living facilities with dementia care licenses under chapter 144G may advertise, market, or otherwise promote the facility as providing specialized care for dementia or related disorders. All assisted living facilities with dementia care licenses shall provide a written disclosure to the following: (1) the commissioner of health, if requested; (2) the Office of Ombudsman for Long-Term Care; and (3) each person seeking placement within a residence, or the person's legal and designated representatives, as those terms are defined in section 144G.08, before an agreement to provide the care is entered into. [See Note.] Subd. 2. Content. Written disclosure shall include, but is not limited to, the following: (1) a statement of the overall philosophy and how it reflects the special needs of residents with Alzheimer's disease or other dementias; (2) the criteria for determining who may reside in the secured dementia care unit as defined in section 144G.08, subdivision 62; (3) the process used for assessment and establishment of the service plan, including how the plan is responsive to changes in the resident's condition; (4) staffing credentials, job descriptions, and staff duties and availability, including any training specific to dementia; (5) physical environment as well as design and security features that specifically address the needs of residents with Alzheimer's disease or other dementias; (6) frequency and type of programs and activities for residents of the assisted living facility with dementia care; (7) involvement of families in resident care and availability of family support programs; (8) fee schedules for additional services to the residents of the secured dementia care unit; and (9) a statement that residents will be given a written notice 30 calendar days prior to changes in the fee schedule. [See Note.] Subd. 3. Duty to update. Substantial changes to disclosures must be reported to the parties listed in subdivision 1 at the time the change is made. Subd. 4. Remedy. The attorney general may seek the remedies set forth in section 8.31 for repeated and intentional violations of this section. However, no private right of action may be maintained as provided under section 8.31, subdivision 3a. History: 1Sp2001 c 9 art 1 s 57; 2002 c 379 art 1 s 113; 2007 c 147 art 7 s 75; 2019 c 60 art 1 s 47; art 4 s 31,32

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NOTE: The amendments to subdivisions 1 and 2 by Laws 2019, chapter 60, article 4, sections 31 and 32, are effective August 1, 2021. Laws 2019, chapter 60, article 4, sections 31 and 32, the effective dates.

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Statement of Home Care Services Comprehensive Home Care Provider Comprehensive Home Care Provider Name: Below is a list of all services that may be provided with a Comprehensive Home Care License. Each service that is offered by this provider is indicated by a check in the box next to the service. Advanced Practice Nurse Services

Complex or Specialty Healthcare Services

Registered Nurse Services

Assistance with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing

Licensed Practical Nurse Services Physical Therapy Services Occupational Therapy Services Speech Language Pathologist Services Respiratory Therapy Services Social Worker Services Services by a Dietitian or Nutritionist Medication Management Services Delegated tasks to unlicensed personnel Hands-on assistance with transfers and mobility Providing eating assistance for clients with complicating eating problems (i.e. difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube, parenteral or intravenous instruments)

Providing standby assistance within arm’s reach for safety while performing daily activities Providing verbal or visual reminders to take regularly scheduled medication (includes bringing clients previously set-up medication, medication in original containers, or liquid or food to accompany the medication) Providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises Preparing modified diets ordered by licensed health professional Laundry Housekeeping/Other household chores Meal preparation Shopping

I have received a copy of this Statement of Home Care Services: Client Signature: ____________________________________________ Date: ___________________

Statement of Home Care Services – Comprehensive Home Care Provider (12/13)

2021 HOUSING MANAGERS’ EDUCATION SERIES

Select MDH Website References Housing with Services Housing with Services Registration form http://www.health.state.mn.us/divs/fpc/profinfo/lic/fpc926_1.pdf Local Requirements Addendum to the HWS Registration form http://www.health.state.mn.us/divs/fpc/profinfo/lic/hwsaddendum.pdf Uniform Consumer Information Guide (UCIG) http://www.health.state.mn.us/divs/fpc/profinfo/lic/UCIguide.html Related Housing with Services/Assisted Living/UCIG Statutes 144D ‐ http://www.revisor.leg.state.mn.us/stats/144D/ 144G ‐ http://www.revisor.leg.state.mn.us/stats/144G/ Special Care Units ‐ https://www.revisor.mn.gov/statutes/?id=325F.72

Comprehensive and Basic Home Care Comprehensive Home Care Licensing http://www.health.state.mn.us/divs/fpc/homecare/index.html Comprehensive Home Care Statement of Home Care Services http://www.health.state.mn.us/divs/fpc/homecare/providers/compstatementserv.pdf Basic Home Care Licensing http://www.health.state.mn.us/divs/fpc/homecare/index.html Basic Home Care Statement of Home Care Services http://www.health.state.mn.us/divs/fpc/homecare/providers/basicstatementserv.pdf Forms for Home Care Providers http://www.health.state.mn.us/divs/fpc/homecare/providers/forms.html

Bill of Rights http://www.health.state.mn.us/divs/fpc/consumerinfo/index.html

2021 HOUSING MANAGERS’ EDUCATION SERIES

MN Vulnerable Adults Act Reporting Refer to Appendix A for the current Minnesota Vulnerable Adults Act statute.

However, note that effective July 1, 2015, the referenced Common Entry Point (CEP) system has been replaced with the Minnesota Adult Abuse Reporting Center (MAARC).

Statewide 24/7/365 contact information for MAARC is:

mn.gov.dhs/reportadultabuse

2021 HOUSING MANAGERS’ EDUCATION SERIES

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 DHS 02/11/2020

SD# 1

EW RS Rates

Information from Individual's Screening Document FALSE

SD# 4

Version

PMI

Client Last Name

Assigned SD#

Client First Name

Assessment/Change Date

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Assess. Effective Date

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County of Residence

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Zip

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DOB

Primary Diagnosis Health Plan

Case Manager's Name

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Dressing

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Grooming

SD# 40

Bathing

Eating

Bed Mobility

Transferring

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Behavior

Toileting

Clinical Monitoring

Current Case Mix

Orientation

Self Preservation

Hearing

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Telephone Calling

Shopping

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Light Housekeeping

Heavy Housekeeping

Laundry

Medication

Money Management

Transportation

Insulin Dependency

Wheeling

Special Treatment

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Case Mix Last Assessment

Vent Dependent

Are you making a correction?

Get Client's Previous Data

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0000

Last Case Mix value is from the PREVIOUS, not the current assessment

Authorize Rate As CL:T2030/T2030 TG

Exited/Failed to Enter CL Date Reason .

Authorize Type Valid

Dwelling License/Registration

Waiver Type

Waiver Type Valid

Additional Required Information Delegate Agency

Case Manager's Phone# Case Manager's E-Mail Re-Type CM E-Mail

Optional Information Cc… Email Re-Type Cc… Email

Client's Legal Name: Legal Guardian: Print Client Name As: Print Case Mngr Name As: Print Provider Name As: Print Provider Address As:

Printed Notes:

Documentary Notes:

Confidential

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Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Individualized EW - Customized Living Plan

Ver. 11.1.9 DHS 02/11/2020 Client Last Name

Client First Name

Housing with Services Provider Name

PMI 0

Housing with Services - Street Address

County/Tribe

Housing with Services - City

Case Manager

Housing with Services - ZIP Code

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Recipient Health Plan ID 00000000000000000000 Start Date for CL Service Mental Status Evaluation Self Preservation

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Community Budget Cap $

In CL Plan?

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Dependency Description

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Score

Can get in and out of bed or chair without human help

Can move in bed without assistance

Select Housing Type

Enter the number of individuals sharing the space

Uses toilet w/o help

Transferring Dependency

Positioning Dependency

Active Behavioral Support Dependency

Behavior requires no intervention

Orientation Dependency

Oriented

Hearing

No hearing impairment

Vision

Has no vision impairment

Communication

Communicates needs

N/A

Select food prep facilities location

Month no

Less that once a day

Provider Meets Standards for EW 24 hr CL.

Name: Address: City: ZipCode: Taxonomy Code(if Applicable):

N/A

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no Toileting Dependency

Foster Care Monthly Rate Limit

CL/RC Monthly Rate Limit $

Independent

24 Hour Support Needed for: SD Ref

MDH Provider HFID Web Site

Individual Eligible for 24 Hr CL

24 Hr CL Monthly Rate Limit

Clinical Monitoring Dependency Med Admin + 50 hrs/mo of service

Bring in Client's Address

NPI/UMPI

Case Mix

Year

Please enter the Month and Year the Client first moved in, or will move in, to any Residential Services residence.

Sensory and Communication Status

Confidential

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Light housekeeping

Heavy housekeeping

Laundry - personal

Laundry-linens

Shopping

In CL Plan?

Dependency Description

SD Ref

In CL to meet need?

Homemaking

Need Documen ted?

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Service Description

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Monthly Rate per Component

0.00

Sub-total homemaking $

Food Preparation Service Description 62

Score 62

no no

Lunch prep and serve

Supper prep and serve

Snack prep and serve

Score

Supportive Services SD Ref Making appts

Arrange Non-medical Transportat

Money Mgt

Dependency Description

Hrs/ Mo

Total Hours/ Month

0.00 Service Description

Need Documen ted?

Breakfast prep and serve

Min/ Week

In CL Plan?

Food Preparation and Service

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Individual Assistance w Meal Prep in Own Apartment

Min/ Day

Service Description

Meals per Month

Min/ Day

Min/ Week

Hrs/ Mo

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Total Hours/ Month

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Socialization with given Ratio of Staff/Resident Socialization - Individual Group Socialization: 1 Staff to 25 Residents Group Socialization: 1 Staff to 6 12 Residents Group Socialization: 1 Staff to 13 - 20 Residents Group Socialization: 1 Staff to over 20 Residents

no no no no no Standardized Total Monthly Hours

Confidential

2/26/2020 Not Valid for Rates or Plan

Sub-total Supportive Services $

0.00

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Group Transportation: Group Transportation: riders Group Transportation: riders Group Transportation: riders

69 2 riders 3-5

Score

Dependency Description

0 0

6 - 10 Over 10 69

In CL Plan?

SD Ref

Driver 1:1 Non-medical Transportation

In CL to meet need?

Non-Medical Transportation

Need Docum ented?

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Service Description

Total Hours/ Month

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0.00 Total Miles/Mo

1:1 mileage

N/A

0.00

Group Mileage 2 riders

N/A

0.00

Group Mileage 3 - 5 riders

N/A

0.00

Group Mileage 6 - 10 riders

N/A

0.00

Group Mileage over 10 riders

N/A

0.00

In CL Plan?

Miles Per Week

Hrs/ Mo

In CL to meet need?

Day

Min/ Week

Need Docume nted?

Mileage

Min/ Day

Personal Care

SD Ref

Score

Dressing

Grooming

Dependency Description Can dress w/o help of any kind Can comb hair, wash face, shave or brush their teeth w/o help of any kind

Bathing

Eating

Continence Care Walking Assistance With Use of Wheelchair

Service Description

Min/ Day

Min/ Week

Hrs/ Mo

Total Hours/ Month

0.00

Independent

0.00

Eats w/o help

0.00

Uses toilet w/o help

0.00

None

0.00

Transferring

0.00

Positioning

Walks w/o help Does not use wheelchair, or receives no personal help Can get in and out of bed or chair without human help Can move in bed without assistance

0.00

2/26/2020 Not Valid for Rates or Plan

Monthly Rate per Component

Confidential

Sub-total Nonmedical Transportation

Sub-total Personal Care $

Page 4

In CL Plan?

Dependency Description

In CL to meet need?

Other Delegated Health Services

Need Docume nted?

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Min/ Day

Min/ Week

Hrs/ Mo

Total Hours/ Month

Monthly Rate per Component

SD Ref

Score

Med Administration or assistance with selfadministration

0.00

Verbal or Visual Medication Reminders Insulin Injections Therapeutic Exercises Delegated clinical monitoring Delegated nursing tasks

66 67 N/A 48 48

0 0 N/A 0 0

no no

no no no no no no no no no no

0.00 0.00 0.00 0.00

$ $ $ $ $ $ $ $ $ $

Less than once a day

Service Description

0.00 0.00 0.00 0.00 0.00 0.00

Score Med Set Ups and Monitoring Insulin Draws

66 67

Dependency Description

no no

0 0

In CL to meet need?

Medication Mgt by Licensed Nurse

Need Documen ted?

Other Delegated Total Monthly Hrs

Min/ Day

Service Description

Min/ Week

Hrs/ Mo

0.00

Total Hours/ Month

0.00 0.00

no no

Sub-total Other Delegated Health Services $

Monthly Rate per Component $ $

Sub-total Med Manage- ment $ -

Personal Security Awareness of need for assistance Will the person summon assistance when necessary?

Summoning Device

If yes, how will they summon help? What mechanism will they use? Is the mechanism included in the CL Rate?

If no, how will staff know when the person needs assistance? Self-Preservation Self-Preservation Score

Can the person evacuate in an emergency?

Independent

If no, what is the emergency plan?

Emergency Backup Planning Hospital Name

Hospital Phone

Physician Name

Physician Phone

Emergency Contact Name

ER Contact Phone

Emergency Contact Relationship If Client needs emergency medical or psychiatric services, call 911, admit to the Hospital listed, notify the emergency contact

ER Backup Plan Details listed, and if necessary, the listed physician. In addition:

Confidential

2/26/2020 Not Valid for Rates or Plan

Page 5

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Active Cognitive or Behavioral Support

Score

Implementation of written individual plan to address: 51 0 Wandering 51 0 Orientation issues 45 0 Anxiety 45 0 Verbal aggression 45 0 Physical aggression 45 0 Repetitive behavior 45 0 Agitation 45 0 Self-injurious behavior 45 0 Property destruction Other need related to mental health or cognitive challenge 0 0 0

Dependency Description

In CL Plan?

SD Ref

In CL to meet need?

Allowable Component Service

Need Documente d?

Does the recipient need service at additional times over and above those specified above to address needs specified in the table below? If yes, please specify the amount and type of service needed below.

Min/ Day

Service Description

Min/ Week

Hrs/ Mo

Total Hours/ Month

Monthly Rate per Component

no no no no no no no no no

0.00

no no

0.00 0.00

$ $

0.00

Sub-total Active Cognitive or Behavioral Support $

0.00 Summary of Supervisory Support Frequency of contact. Indicate expected minimum as well as frequency at different times during the day/night. Mode of contact. Include description of how resident will request assistance or how staff will know when assistance is required. Competencies of Staff Providing Supervisory Support Training and Supervision of Staff Supervisory Support Scheduled Total CL Services (not final valid rate

Anticipated Days Absent Per Year? Go to new Prior Period Rate entry location Provider's equivalent non-public pay rate for these services if less than CL Rate --->

Confidential

2/26/2020 Not Valid for Rates or Plan

$0.00

Max Prior Rate is: N/A

You Must Select an Option --->

Page 6

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Projected Hours of CL Service by Component Type Per

Month Week Day

Home Management/Homemaking and Support Services:

0.00

Home Care Aide Services:

0.00

Home Health Aide Services:

0.00

Medication Setups by Licensed Nurse:

0.00

0 0.00

0.00

Total hours:

Total Hours For All Audited Services

EW - Customized Living Budget Recap at CL Start Date of 01/00/1900 CL Budget Recap Needs Start Date for CL Service to Proceed Monthly EW CL/24 CL Service $ Rate Limit Rate Proportion of EW Limit and Difference % & $$$

N/A

Proposed Customized Living Customized Living Rate with $ Adjustment for Days Absent

Individual Customized Living Customized Living Rate $ Limited to Private Pay Rate

Does temporary rate apply?

Full Rate*

Temporary Rate*

EW Community Budget $ Cap

Monthly Cost of Proposed $ Non CL EW Services

Amount of Proposed Monthly EW Budget including CL Rate

Monthly - Customized Living Rate

Daily CL Rate (For Information only)

Since Rate is withing $.50 of Limit, Rate has been Auto Rounded to exactly the Limit

Application of 50% difference $ to computed CL rate.

Temporary Rate - If applicable

Percent Transition Adjustment is of Final Rate

Warning! Prior Authorized rate and prior rate question are not consistent or either the Full Rate or the Prior Authorized rate is less than $25 . Please Verify

#DIV/0!

All monthly Service Rates are calculated based the Component Rates and Service Limits in effect on the Service Start Date. During the year this rate may change. After 09/30/2010 'Temporary' rates no longer apply. The 'Print Rate Guide' should be used to determine the Service Rate valid for payment during the authorization period. Use the rate that corresponds to the time period during which services will be provided and paid. In all cases, Providers are required to bill ONLY for the days of actual service. Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved

Confidential

2/26/2020 Not Valid for Rates or Plan

Page 7

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 EW - Customized Living and State Plan Home Care Services Authorized

DHS 02/11/2020

Ver. 11.1.9

EW Service Name Adult Day Care Adult Day Care FADS Adult Day Care Bath Family Caregiver Coaching/Counseling (plus assessment) Family Caregiver Training and Ed Family Caregiver Fam Memory Care Case Management Case Management Case Mgt - Paraprofessional CDCS Background Checks

Unit 15 minutes 15 minutes 15 minutes

15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes One print

CDCS Mandatory Case Mgt Chore Services Companion Services

15 minutes 15 minutes 15 minutes

CDCS Home Delivered Meal Home Health Aide Extended Homemaker Envir Accessibility Adapts -Home Install Envir Accessibility Adapts -Home Assess Envir Accessibility Adapts -Vehicle Install Envir Accessibility Adapts -Vehicle Assess Personal Care Assistant 1:1

Provider Name and Number

# of Units/ Month

Unit Rate

Totals $ $ $ -

Start Date

End Date

Up To Rate Limit as of 02/26/2020 $3.45 $3.45 $7.65

$ $ $ $ $ $

Per Service 1Meal/Day 15 minutes 15 minutes Per Waiver Yr

$ $ $

Per Assess Per Waiver Yr

Per Assess 15 minutes

$ $

$18.11 $18.11 $18.11 $25.46 $25.46 $9.39 $25.00 Up to Required Case MGT Cap Amount $4.15 $2.57 Up to CDCS Cap Case Mix Cap $7.06 $8.01 $4.84 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 $4.45

Personal Care Assistant - Shared 1:2 15 minutes

$3.34

Personal Care Assistant - Shared 1:3 LPN Complex Extended LPN Regular Extended LPN shared 1:2 Extended RN Complex Extended RN Regular Extended RN shared 1:2 Extended

15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes

$ $ $ $ $ $ $

Respite Certified Facility Respite, Hospital Respite, In-home Respite, In-home Respite, Out of home Respite, Out of home Supplies and Equipment Supplies and Equipment Supplies and Equipment Supplies and Equipment Supplies and Equipment Transitional Services Transportation Transportation, Non-commercial

Per Diem Per Diem 15 minutes Per Diem 15 minutes Per Diem Total/Month Total/Month Total/Month Total/Month Total/Month Per Occurs 1-way trip Per Mile

$ $ $ $ $ $ $ $

$2.93 $7.84 $6.69 $5.02 $10.44 $8.71 $6.53 NF's Per diem for the Recipient's case mix $147.85 $5.77 $103.85 $5.77 $103.85 Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap $20.21 $0.58

Total All EW Excluding CL Services

From 02/26/2020 $ -

CL Services Rate Summary by Effective Date Customized Living Services

Monthly

Estimated monthly total for proposed EW Services including CL Services

From 01/00/1900

From 10/01/2010

CL End Date

Confidential

2/26/2020 Not Valid for Rates or Plan

Page 8

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Request Approval to Exceed the CL Service Limit and/or the EW Case-mix Budget Cap Applies to All Residential Services Clients Clients leaving a Nursing Facility (NF) where they resided more than 30 days may qualify for a higher Community Case-mix EW Budget Cap (Conversion Budget Cap). Once established, this budget may be used for any combination of Residential Services. This means the client may exceed the standard RS Service Case–mix Rate Limits (CL or RC Limit). Once established, the Conversion Budget Cap may only increase by COLAs or legislative mandated. The Conversion Budget Cap coincides with the Waiver Span and must be reviewed each time the client is re-assessed. If the Conversion Budget Cap is reduced at re-assessment, this reduced value becomes the new Conversion Budget Cap. Complete this page for all clients exceeding the Community Casemix EW Budget Cap. A Conversion Budget Cap may never exceed the discharge NF Medicaid equivalent monthly rate, less the Maintenance Needs Allowance (MNA); or a lower amount approved at time of discharge. Any Conversion Budget Cap must be approved prior to authorization for payment. You may optionally set a Budget RS Limit for service planning which will be enforced. This Budget RS Limit may be changed at any time, but the total of all services may never exceed the Conversion Budget Cap. If the Conversion Budget Cap is new, begin by providing the NF daily rate. Next complete the CL Plan with necessary services and times. If the Error Report indicates the RS service limit or the EW Community Budget Cap is exceeded, return here to complete this form and request a Conversion Budget Cap. If the application is for a renewal and last year’s Conversion Budget Cap is blank, enter the largest Conversion Budget Cap approved in the past. Use last year’s value if that is all that is known. (This is imported from version 8.1.1 or later CL Tools.) If services will be paid by a Health Plan, follow their process for getting or reauthorizing the higher limits. Except for South County, use the ‘Validate Plan Approval’ button to approve the CL Tool for submission to DHS. Provide the Health Plan approved Conversion Budget Cap and the Budget CL Limit if given. If the entered limits are exceeded, you will need to adjust the RS Tool to stay within limits. Submit the RS Plan as usual. Once any submission errors have been corrected, the higher rate may be authorized. If the limits are to be approved by DHS, complete this page. You must complete the EW Services Authorized page in the Tool. You should provide justification for all RS services on the Audit Report, especially those indicating a warning. Once complete, submit the RS Tool in the standard way. There may be other documentation required beyond this RS Tool. Submit as you have in the past. The approved limits will be entered into the RS Tool and the Tool returned to you. If the approved limits are less than the rates developed, you will need to adjust the RS Tool to get the rates below the limits. Finally, verify the approved rate on the Error Report and re-submit the RS Plan for final acceptance.

Enter the NF Daily Rate at discharge

Current maximum combined CL and EW Services authorized Conversion Budget Cap

-$1,003.00

Date of Discharge

Maximum Non- CL EW Services to Authorize

-$1,003.00

Conversion Limit is Authorized

FALSE

Actual Non- CL Services Authorized

$0.00

Maximum CL Services to Authorize

-$1,003.00

Actual CL Services Authorized

$0.00

Total of all Authorized Services

$0.00

CL Services or Non- CL Services Over Maximum

$1,003.00

Community Case-mix EW Budget Cap (Conversion Budget Cap) Request Section Is Client making a new request to exceed the Case-mix Budget Cap?

Planned CL Rate is below the normal CL Limits for this Case Mix

CL Rate + EW Services are below the normal Budget Cap for this Case Mix

Is Client requesting an annual review to renew a previously approved Conversion Limit that exceeds the Case-mix Budget Cap?

Original approved Conversion EW Services Case-Mix Budget Cap limit

DHS Approval Required?

N/A

Health Plan Approval Required?

N/A

DHS Approved?

N/A

Health Plan Approval Status

DHS Approved CL Rate

N/A

Health Plan Approved CL Rate

N/A

Do Not Approve

DHS Approved EW Cap Submit to DHS along with other necessary documentation documentation for approval

Most Recent Health Plan Approved EW Cap

N/A

DHS Use Only Validate Plan

Confidential

2/26/2020 Not Valid for Rates or Plan

Page 9

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Monthly Rate Guide Printed February 26, 2020 DHS 02/11/2020

Ver. 11.1.9

EW - Customized Living Services Rate Summary by Effective Date Monthly Rate

Daily Rate $

Full monthly CL Rate on: ############# Max Prior Rate is $N/A

First month Current Rates

Prior Period Rate Start Date

From Date

To Date

2/1/2020

#############

Current Period Portion

1/0/1900

Total Rate For First Month

1/0/1900

Prior Period Portion

Authorize Rate

$0.00 $0.00 $

$0.00 Monthly $ ‐

Monthly

This is the CL Service Rate valid for payment during the authorization period. In all cases, Providers are required to bill ONLY for the days of actual service.

Client: Provider Name:

PMI:

Provider NPI: 0 Housing with Services Establishment Address: County/Tribe: Case Manager:

,MN Health Plan:

Recipient Health Plan ID: 0

Date: Rate Guide was Mailed/Given On:

Note: Monthly and Daily ratesRates shown here. You must authorize the monthly rate shown on this Rate Guide. In all cases, Providers are required to bill ONLY for the days of actual service. You may notice that the rates shown here may be a few cents different than the rate calculated taking an old tool's rate and multiplying by the COLA factor. This is due to rounding issues with the component rates. If slightly different rates are shown here, they are correct and may be authorized.

Page 17 of 34 Valid for Rate

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 VII. Budget Worksheet

DHS 02/11/2020

Ver. 11.1.9

Client: PMI: Service Adult Day Care Adult Day Care FADS Adult Day Care Bath Family Caregiver Coaching/Counseling (plus assessment)

Unit

Provider Name and Number

Start Date

End Date

# of Units/ Month

15 minutes 15 minutes 15 minutes 15 minutes

15 minutes Family Caregiver Training and Ed 15 minutes Family Caregiver Fam Memory Care 15 minutes Case Management 15 minutes Case Management 15 minutes Case Mgt - Paraprofessional Monthly Customized Living Services (planned for a month of service) 15 minutes Companion Services 15 minutes Home Health Aide Extended Visit Home Health Telehomecare Per Waiver Yr Envir Accessibility Adapts -Home Install Per Waiver Yr Envir Accessibility Adapts -Vehicle Install Per Assess Envir Accessibility Adapts -Vehicle Assess 15 minutes Personal Care Assistant - RN Supervision 15 minutes Personal Care Assistant 1:1 15 minutes Personal Care Assistant - Shared 1:2 15 minutes Personal Care Assistant - Shared 1:3 15 minutes LPN Complex Extended 15 minutes LPN Regular Extended 15 minutes LPN shared 1:2 Extended 15 minutes RN Complex Extended 15 minutes RN Regular Extended 15 minutes RN shared 1:2 Extended Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Per Occurs Transitional Services 1-way trip Transportation Per Mile Transportation, Non-commercial Notice: Any First Month Rate is subject to change once this RS Tool is submitted if the Prior Rate on file does not match the Prior Rate provided in this RS Tool.

Page 18 of 34 Valid for Rate and Plan

Unit Rate $ $ $ $ -

Cost Per Month $ $ $ $ -

$ $ $ $ $ $

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Total Cost Per Month From October 01, 2010 IX. Choosing Community Long Term Care

In all cases Providers are required to bill ONLY for the days of actual service Yes

Yes

You can choose to receive services in the community (your home) or in a nursing facility. Were you offered this choice? You can choose the provider you prefer for services. Did the person who helped you with this plan give you a list of providers, or tell you about different providers that you could choose for services in the plan? Did you have the chance to help develop this plan, including the kinds of services you want to receive? After reading the plan, do you agree with the services, and providers, as written? You have the right to apply for Minnesota Health Care Programs (MHCP) that may help pay for services planned here, including programs such as the Elderly Waiver Program, and the Alternative Care Program. Do you wish to apply for Minnesota Health Care Programs? Client signature:

Date

Signature of Person Completing this Plan

Printed: February 26, 2020

Date

Yes Application for MHCP Submitted?

Support Plan was Mailed/Given On: Note: A copy of the RS Plan must be attached to the CSSP and must be provided to the Client for this to constitute a complete plan. Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved

Page 19 of 34 Valid for Rate and Plan

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Individualized EW - Customized Living Customized Living Plan

DHS 02/11/2020

Client

Ver 11.1.9

Home Care Provider Name

PMI

Provider NPI 0 Housing with Services Address

County/Tribes

Health Plan 0

Case Manager

Primary Diagnosis 00000000

Case Manager Phone# -

, MN

Recipient 0

Case Manager Email Start Date for CL 1/0/1900

In CL Plan?

Score

Light housekeeping Heavy housekeeping

no no

N/A N/A

Total Hours/ Month 0.00 0.00

Laundry - personal

N/A

0.00

Laundry-linens

N/A

0.00

Shopping

N/A

0.00

In CL Plan?

Score

N/A

In CL Plan?

Score

Homemaking

Estimation of Time for Purposes of Rate Computation

HwS Consultation Verif. Code

Breakfast prep and serve

N/A

0.00

Lunch prep and serve

N/A

0.00

Supper prep and serve

N/A

0.00

Snack prep and serve

N/A

0.00

Food Preparation

Individual Assistance w Meal Prep in Own Apartment

Food Preparation and Service

Service Description

Client

Service Description

Total Hours/ Month 0.00

Service Description

Client

Page 20 of 34 Valid for Rate and Plan

# of Meals/ Snacks Month

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

In CL Plan?

Score

Making appts

N/A

0.00

Arrange Non-medical Transportation

N/A

0.00

Money Mgt

N/A

0.00

Socialization - Individual

N/A

0.00

Group Socialization: 1 Staff to 25 Residents

N/A

0.00

Group Socialization: 1 Staff to 6 12 Residents

N/A

0.00

Group Socialization: 1 Staff to 13 20 Residents

N/A

0.00

Group Socialization: 1 Staff to over 20 Residents

N/A

0.00

In CL Plan?

Score

Driver 1:1 Non-medical Transportation

N/A

0.00

Group Transportation: 2 riders

N/A

0.00

Group Transportation: 3 - 5 riders

N/A

0.00

Group Transportation: 6 - 10 riders

N/A

0.00

Group Transportation: Over 10 riders

N/A

0.00

In CL Plan?

Score

Supportive Services

Non-Medical Transportation

Mileage

1:1 mileage Group Mileage 2 riders Group Mileage 3 - 5 riders Group Mileage 6 - 10 riders Group Mileage over 10 riders

no no no no no

Service Description

Client

Service Description

Client

Service Description

Client

Total Hours/ Month

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

Page 21 of 34 Valid for Rate and Plan

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

In CL Plan?

Score

Dressing

N/A

Grooming

N/A

Bathing

N/A

0.00

Eating

N/A

0.00

Continence Care

N/A

0.00

Walking

N/A

0.00

Assistance With Use of Wheelchair

N/A

0.00

Transferring

N/A

0.00

Positioning

N/A

0.00

In CL Plan?

Score

Personal Care

Med Administration or assistance with self-administration

N/A

0.00

Verbal or Visual Medication Reminders

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

N/A

0.00

Other Delegated Health Services

Insulin Injections Therapeutic Exercises Delegated clinical monitoring Delegated nursing tasks

Service Description

Client

Total Hours/ Month 0.00

Service Description

Client

Page 22 of 34 Valid for Rate and Plan

Total Hours/ Month

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

In CL Plan?

Score

Medication Mgt by Licensed Nurse

Med Set Ups and Monitoring

N/A

0.00

Insulin Draws

N/A

0.00

In CL Plan?

Score

Sensory and Communication Status Hearing

N/A

Vision

N/A

Communication

N/A

Service Description

Total Hours/ Month

Client

Service Description

Client

Personal Security

Client

Awareness of need for assistance Will the person summon assistance when necessary?

If yes, how will they summon help?

What mechanism will they use?

no no

no If no, how will staff know when the person needs assistance?

Self-Preservation Can the person evacuate in an emergency?

If no, what is the emergency plan?

Emergency Backup Planning Hospital Name Physician Name Emergency Contact Name

Hospital Phone Physician Phone ER Contact Phone

Emergency Contact Relationship ER Backup Plan Details

If Client needs emergency medical or psychiatric services, call 911, admit to the Hospital listed, notify the emergency contact listed, and if necessary, the listed physician. In addition:

Page 23 of 34 Valid for Rate and Plan

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Active Cognitive or Behavioral Support

In CL Plan?

Score

Implementation of written individual plan to address:

N/A

0.00

N/A

0.00

N/A

0.00

Wandering: Orientation issues : Anxiety: Verbal aggression: Physical aggression: Repetitive behavior: Agitation: Self-injurious behavior: Property destruction:

Service Description

Client

Total Hours/ Month 0.00

0.00

Summary of Supervisory Support Service Description

Client

Frequency of contact. Indicate expected minimum as well as frequency at different times during the day/night.

Mode of contact : Include description of how resident will summon assistance or how staff will know when assistance is required.

Competencies of Staff Implementing Active Cognitive and/or Behavioral Support

Training and Supervision of Staff Implementing Active Cognitive and/or Behavioral Support

Page 24 of 34 Valid for Rate and Plan

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Summary of Estimated Monthly Hours of Service Column1 By Type

24 Hour Support Needed for: Toileting Dependency

Transferring Dependency

Positioning Dependency

Active Behavioral Support Dependency

Orientation Dependency

Clinical Monitoring Dependency

Med Admin + 50 hrs/mo of service

Column2

Column3 Per Month

Per Week

Home Care Aide Services:

Home Health Aide Services: Medication Setups by Licensed Nurse: Estimated combined hours of customized living services:

$ $

Notice: Any First Month Rate is subject to change once this RS Tool is submitted if the Prior Rate on file does not match the Prior Rate provided in this RS Tool.

Cost of Customized Living Services per mo.

From 01/00/00 To 01/00/00

End Date

1/0/1900

Monthly Cost of Non- CL EW Services

In all cases, Providers are required to bill based on the amounts in the Rate Guide and ONLY for the days of actual service provided. Client Notes

Printed: February 26, 2020

Per Day

Home Management / Homemaking and Support Services:

Date

Customized Living Plan was Mailed/Given On:

Page 25 of 34 Valid for Rate and Plan

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

DHS 02/11/2020 Ver. 11.1.9

EW Residential Monthly Services Rate Limits Service Limit Effective Dates:

Case Mix A B C D E F G H I J K L L* V

Community Budget Cap as of $3,457 $3,931 $4,614 $4,763 $5,255 $5,415 $5,587 $6,302 $6,469 $6,897 $8,036 $3,457 $2,662 $29,237 Based on Assessment Change Date

24 Hr CL Rate Limit $2,872 $3,315 $3,899 $4,070 $4,528 $4,696 $4,884 $5,486 $5,640 $6,032 $7,046 $2,872 N/A $25,625

Wednesday, January 01, 2020

Customized Living (Not 24 Hr) Rate Limits Statewide $1,543 $1,754 $2,058 $2,261 $2,347 $2,420 $2,497 $2,815 $2,903 $3,080 $3,592 $1,543 $1,158 $13,871

Group 1 Group 2 $1,412 $1,446 $1,563 $1,612 $1,780 $1,865 $1,918 $1,967 $2,084 $2,122 $2,168 $2,168 $2,250 $2,305 $2,524 $2,571 $2,594 $2,664 $2,733 $2,804 $3,166 $3,199 $1,412 $1,446 $1,058 $1,086 $11,934 $12,231 Based on CL Start Date

Group 3 $1,683 $1,850 $2,222 $2,347 $2,566 $2,607 $2,746 $3,100 $3,184 $3,410 $3,890 $1,683 $1,263 $14,462

New/Assessed > 08/31/11 New/Assessed > 06/30/13

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

EW Residential Daily Services Rate Limits

Case Mix A B C D E F G H I J K L L* V

Wednesday, January 01, 2020 y Service Limit Effective Dates: Budget Cap 24 Hr CL Customized Living (Not 24 Hr) Rate Limits as of Rate Limit 02/26/2020 Statewide Group 1 Group 2 Group 3 $113.58 $94.36 $50.69 $46.39 $47.51 $55.29 $129.15 $108.91 $57.63 $51.35 $52.96 $60.78 $151.59 $128.10 $67.61 $58.48 $61.27 $73.00 $156.48 $133.72 $74.28 $63.01 $64.62 $77.11 $172.65 $148.76 $77.11 $68.47 $69.72 $84.30 $177.91 $154.28 $79.51 $71.23 $71.23 $85.65 $183.56 $160.46 $82.04 $73.92 $75.73 $90.22 $207.05 $180.24 $92.48 $82.92 $84.47 $101.85 $212.53 $185.30 $95.38 $85.22 $87.52 $104.61 $226.60 $198.18 $101.19 $89.79 $92.12 $112.03 $264.02 $231.49 $118.01 $104.02 $105.10 $127.80 $113.58 $94.36 $50.69 $46.39 $47.51 $55.29 $87.46 N/A $38.05 $34.76 $35.68 $41.49 $960.56 $841.89 $455.72 $392.08 $401.84 $475.14 Based on Based on CL Start Date Assessment Change Date

New/Assessed > 08/31/11 New/Assessed > 06/30/13

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Service Component Rates DHS 02/11/2020 Effective Date

Service Category

January 1, 2020

Ver. 11.1.9

Hourly Unit

Home Management/Homemaking and Support Services

$17.8400

Home Care Aide Services including Active Behavioral Support.

$23.7200

Home Health Care Aide Services/Delegated Nursing Services

$27.0400

Medication Setups by Licensed Nurse

$33.9700

Mileage rate

Per Mile $0.5200

Summoning Device

$29.0000

Breakfast

$3.6700

Lunch

$4.5700

Supper

$4.5700

Snack

$0.4500 Socialization Hourly Rate $5.1000

Shared Services Socialization 1 Staff to 2-5 Residents Socialization 1 Staff to 6 - 12 Residents

$1.9900

Socialization 1 Staff to 13 - 20 Residents

$1.0900

Socialization 1 Staff to over 20 Residents

$0.5900 Driver Hourly Rate $8.9200

/Month

Group Mileage Rate $0.2700

Group Transportation

# of Riders 2

Group Transportation

# of Riders 3 - 5

$4.4600

$0.1300

Group Transportation

# of Riders 6 - 10

$2.2400

$0.0800

Group Transportation

# of Riders - More than 10

$1.1900

$0.0400

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

DHS 02/11/2020

EW Service Name

Unit Adult Day Care 15 minutes Adult Day Care FADS 15 minutes Adult Day Care Daily Adult Day Care FADS Daily Adult Day Care Bath 15 minutes Caregiver Training and Ed 15 minutes Family Caregiver Coaching/Counseling (plus asses15 minutes Family Caregiver Training and Ed 15 minutes Family Caregiver Fam Memory Care 15 minutes Case Management 15 minutes Case Mgt - Paraprofessional 15 minutes CDCS Background Checks One print CDCS Mandatory Case Mgt 15 minutes Chore Services 15 minutes Companion Services 15 minutes CDCS Per Service Customized Living Services (planned for a month oMonthly Home Delivered Meal 1Meal/Day Home Health Aide Visit Home Health Aide Extended 15 minutes Home Health - Skilled Nursing Visit Home Health Telehomecare Visit Homemaker 15 minutes Homemaker Per Diem Per Waiver Yr Envir Accessibility Adapts -Home Install Per Assess Envir Accessibility Adapts -Home Assess Per Waiver Yr Envir Accessibility Adapts -Vehicle Install Per Assess Envir Accessibility Adapts -Vehicle Assess Personal Care Assistant - RN Supervision 15 minutes Personal Care Assistant 1:1 15 minutes Personal Care Assistant - Shared 1:2 15 minutes Personal Care Assistant - Shared 1:3 15 minutes LPN Complex Extended 15 minutes LPN Regular Extended 15 minutes LPN shared 1:2 Extended 15 minutes RN Complex Extended 15 minutes RN Regular Extended 15 minutes RN shared 1:2 Extended 15 minutes Respite Certified Facility Per Diem Per Diem Respite, Hospital Respite, In-home 15 minutes Respite, In-home Per Diem Respite, Out of home 15 minutes Respite, Out of home Per Diem Supplies and Equipment Total/Month Transitional Services Per Occurs Transportation 1-way trip Transportation, Non-commercial Per Mile

EW Service Information Proc Code S5100 S5100 S5102 S5102 S5100 S5116 S5115 S5115 S5115 T1016 T1016 T2040 T2041 S5120 S5135 T2028 T2030/ S5170 T1021 T1004 T1030 T1030 S5130 S5131 S5165 T1028 T2039 T2039 T1019 T1019 T1019 T1019 T1003 T1003 T1003 T1002 T1002 T1002 H0045 H0045 S5150 S5151 S5150 H0045 T2029 T2038 T2003 S0215

Mod Mod 1 2 U7 U7 TF TF TG UC TF

UD UA UC TT HQ TG UC TT TG UC TT

UC UC

Up To Rate Limit as of 02/26/2020 $ 3.45 $ 3.45 N/A N/A $ 7.65 N/A $ 18.11 $ 18.11 $ 18.11 $ 25.46 UC $ 9.39 $ 25.00 Up to Required Case MGT C $ 4.15 $ 2.57 Up to CDCS Cap Case Mix C See CL Service Limits $ 7.06 N/A $ 8.01 N/A N/A $ 4.84 N/A EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 N/A $ 4.45 UC $ 3.34 UC $ 2.93 UC $ 7.84 0 $ 6.69 UC $ 5.02 UC $ 10.44 $ 8.71 UC $ 6.53 NF's Per diem for the Recipie $ 147.85 $ 5.77 $ 103.85 $ 5.77 $ 103.85 Up to Budget Cap Up to Budget Cap $ 20.21 $ 0.58

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020

Estimated Hours of CL Services per Month

Ver. 11.1.9

DHS 02/11/2020 Client PMI 00000000

HM/SS Tasks housekeeping

RS Plan Form Ref 40

laundry

shopping

indiv meal prep

making appointments

arranging transportation

money management

congregate breakfast

congregate lunch

congregate supper

congregate snack

socialization

59-63

transportation

67-71

Confidential

Rate

Total Hours

Hours/Mo

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Home Health Aide-Like Tasks eating

RS Plan Form Ref Hours/Mo 84 0.00

continence care

walking

transferring

positioning

medication administration

insulin injections

therapeutic exercises

delegated clinical monitoring

other delegated tasks

100

other delegated tasks

101

other delegated tasks

102

2/26/2020 Not Valid for Rates or Plan

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

HM/SS

0.00

$17.84

HCA

0.00

$23.72

HHA Med Setup

0.00 0.00

$27.04 $33.97

Total Hrs

0.00

Page 33

Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Home management hours/month:

Home Care Tasks dressing, bathing and gro wheeling

RS Plan Form Ref 81-83 87

medication reminders 93 Active Behavioral or Cognitive Support Wandering 129 Orientation issues 130 Anxiety

131

Verbal aggression

132

Physical aggression

133

Repetitive behavior

134

Agitation

135

Self-injurious behavior

136

Property destruction

137

Other

139

Other

140

Other

141

Confidential

0.00

Home health aide-like hours/month: Med setups by licensed nurse Ref

Hours/Mo

Med set ups

105

0.00 0.00 0.00

Insulin draws

106

Med setup hours/month:

0.00 Hrs/Mo

0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2/26/2020 Not Valid for Rates or Plan

Page 34

2021 HOUSING MANAGERS’ EDUCATION SERIES

2019 Updates to Comprehensive Home Care Statutes The 2019 Minnesota legislature passed several “tweaks” to the comprehensive home care statutes. Most of the changes were made to improve the functionality of home care regulations. All these changes except one (noted below) go into effect on August 1, 2019. They then will be carried over and applied to the Assisted Living Licensure law that goes into effect on August 1, 2021. The new language affects 28 areas of home care regulations: 1. The definition of Medication Administration has been revised. The new definition is: "Medication administration" means performing a set of tasks to ensure a client takes medications, and includes that include the following: i. checking the client's medication record; ii. preparing the medication as necessary; iii. administering the medication to the client; iv. documenting the administration or reason for not administering the medication; and v. reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the client, or the client's refusal to take the medication. Implication: Verify your policy and procedure include this new definition. 2. There is a new definition of Medication Reconciliation: "Medication reconciliation" means the process of identifying the most accurate list of all medications the client is taking, including the name, dosage, frequency, and route by comparing the client record to an external list of medications obtained from the client, hospital, prescriber, or other provider. Implication: Create a Medication Reconciliation policy that includes this new definition. Medication Reconciliation is a new step required as part of any medication management that is conducted (see #20). 3. The definition of Standby Assistance has been modified: "Standby assistance" means the presence of another person within arm's reach to minimize the risk of injury while performing daily activities through physical intervention or cuing to assist a client with an assistive task by providing cues, oversight, and minimal physical assistance. Implication: Modify your definition of standby assistance that is included in any policy or procedure. This change will help Basic Home Care licenses to continue caring for certain clients who would fall under this expanded definition. 4. Clarification that an approved Change of Ownership (CHOW) results in the receipt of a full home care license, not a temporary home care license (unless the selling entity only had a temporary license at the time of the CHOW). Implication: None – this is what has been occurring but was not clear in current language. 5. Clarification that when a CHOW occurs, the new owner can treat the employees acquired as if nothing had changed, in respect to orientation, training, tuberculosis testing, background

studies, and competency testing and training on applicable home care policies, except for policies that differ from the prior license owner. Changes in policy must be trained and tested within 90 days after the date of the change in ownership. In other words, a CHOW includes the employee records such records are considered current for the new owner. Implication: None – This is what has been occurring but representatives from MDH gave varying answers at times, so we memorialized the correct answer in the update statute. 6. A new fine of $1,000 will be assessed if a temporary home care licensee fails to notify MDH within 5 days after they begin providing home care services to their first client. This is effective May 31, 2019. Implication: If you start a new home care agency, and you fail to inform MDH within 5 days after admitting your first home care client, you can expect to receive a $1,000 fine from MDH. The notification requirement is the same, but the fine is new. NOTE – in effect on 5-31-19. 7. Permits temporary licenses to be extended beyond one year under certain circumstances. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken. 8. Permits MDH to extend temporary licenses with conditions for up to 90 days when substantial compliance is not determined on the temporary license survey. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken. 9. Allows temporary licenses to submit reconsideration requests regarding licensing orders identified on the temporary license survey. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This allows providers caught in that situation to request a reconsideration of the survey findings. 10. Clarifies that when a temporary license has their “full” license denied, they are permitted to continue operating as a home care provider when (1) a reconsideration request is in process, (2) an extension of the temporary licenses is being negotiated, (3) the placement of conditions on the temporary license are being negotiated, or (4) the transfer of home care clients from the temporary license to a new home care provider is in progress. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken.

It also permits the provider to continue operating if the license has been revoked while clients are being moved or a new home care licensee is being brought in to take over the service plans. 11. Requires that MDH conduct a full home care survey within six months after the issuance of a new license resulting from a change of ownership (CHOW). Implication: Current language did not require any survey after a CHOW was executed. MDH had enough examples of sales resulting in substantial decreases in regulatory compliance that this language was added. 12. Clarifies that when a home care license has conditions applied to the license, or the license is being suspended or revoked, the licensee may continue operating during the period home care clients are being transferred to other providers. Implication: Permits continuity of care during these situations. 13. Requires that TB screening results are included in employee records. Implication: Providers may have these records in separate employee medical/health files. Surveyors are permitted to review for TB compliance but are not permitted to request employee medical or health files. 14. Throughout the home care regulations, replaces terms such as “initiation of” with “date that services are first provided to the client”. Examples include: notice of the bill of rights, statement of home care services, 30-day time limit to conduct supervision of new staff (after first performing delegated tasks for clients), 5 and 14-day deadlines for assessments, 14-day deadline for finalization of a written service plan, etc. Implication: None. This has been the communicated position of MDH, but at times surveyors were confused and tried to apply the date admission agreements were signed as the trigger for counting days. 15. Clarifies that if home care services are provided to a client prior to an assessment conducted by an RN, an RN must complete a temporary plan and orientate staff assigned to deliver the services identified in the temporary plan. Implication: None. This was not address in current statutes but has been the expectation of both providers and regulators. 16. Makes the following changes to elements required to be in the written service plan: Replaces: “the frequency of sessions of supervision of staff and type of personnel who will supervise staff” with “the schedule and methods of monitoring staff providing home care services”. The concept is the same, but the language is clearer.

Implication: You may need to change your policy and procedure, and possibly the description on your service plan. Provides additional clarify of what is required. 17. Eliminates the requirement to include “identification of and information as to who has authority to sign for the client in an emergency.” Note – The service plan must still include “names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in the client's condition.” Implication: Current language was very confusing and resulted in a significant number of correction orders during surveys. Therefore, the requirement was eliminated. Policies and procedures may need to be updated, as well as the format for service plans. 18. Clarifies that the requirement for the comprehensive home care provider to identify how it will ensure security and accountability for the overall management, control, and disposition of medications in compliance with state and federal regulations applies only to those medications that are being managed, stored, and secured by the comprehensive home care provider. Implication: Clarifies that this requirement only applies to those medications you have accepted responsibility for. 19. Adds a requirement that the comprehensive home care provider provide instructions to the client or client's representative on interventions to manage the client's medications and prevent diversion of medications. Implication: Documentation on the medication assessment or medication administration form, or similar, will need to indicate that you communicated to the client/family how controlled substances will be stored to prevent diversion. 20. Adds a requirement that for each client receiving medication management services from a comprehensive home care provider, a medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Implication: Policy and procedures for medication management services will need to be modified to include medication reconciliation (see definition in #2). Nurses will need to be trained on conducting and documenting medication reconciliation. 21. Expands the timeframe to provide medications for clients who will be away from home from 120 hours to seven calendar days. Implication: Extends the time from 5 days to 7 days. Uses days instead of hours for clarity. Policy and procedures will need to be updated.

22. Adds a new requirement for clients who will be away from home. The policy and procedure must now include how the unlicensed staff must document in the client's record any unused medications that are returned to the provider, including the name of each medication and the doses of each returned medication. Implication: You will need to update your policy and procedures. This was an identified weakness in current regulations. 23. Clarifies that treatment and therapy orders must be renewed every 12 months. Implication: You will need to update your policy and procedures. This was an identified weakness in current regulations. 24. Clarifies that orientation of new staff to the provider's policies and procedures related to the provision of home care services is limited to those policies and procedures that are applicable to the new staff person. No need to train in areas outside the scope of the new employees’ position! Implications: Clarifies the obvious. No need to train on policies and procedures that are not applicable to a new employee. 25. Creates a new section (144A.4798) titled Disease Prevention and Infection Control. This new section bundles the following topics that were previously spread out within the home care statues: i. TB infection control program ii. Reporting of communicable diseases iii. Establishing and maintaining an effective infection control program Implication: Consider creating a new Disease Prevention and Infection control binder that has all the applicable policies and procedures in it. None of the three elements are new – they are now being bundled together for clarify and accuracy of survey reports. 26. Clarifies that public members of the Home Care and Assisted Living Program Advisory Council may include persons who have received home care services within five years of the application date. Implication: Expands the scope of who can be a member of this advisory council. 27. Deletes the transition period for establishing integrated licenses (the period ended June 30, 2015). Implication: This transition period has expired, so we removed it from the statutes.

28. Deletes the home care license transition period that was in place between October 1, 2013 and June 30, 2015. Implication: This transition period has expired, so we removed it from the statutes.

2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

SENIORS AT THE CENTER OF THE

SOLUTIONS SAFETY

Seniors and their families should have confidence in the care they receive and the laws in place to protect older & vulnerable adults.

CHOICE

Seniors should be able to choose settings that promote independence and best meet their needs, interests, and lifestyles.

ACCESS

Seniors need access to senior services in all places they call home to remain connected to family and community.

GOALS

Together, with a broad coalition of consumer advocates, regulators, and senior living providers, we have worked to develop solutions that will lead to great TRANSPARENCY, ACCOUNTABILITY, AND CONFIDENCE THAT SENIORS ARE RECEIVING SAFE, QUALITY CARE.

WHAT’S NEXT The Minnesota Legislature has adjourned. Assuming that Governor Walz signs the bills into law, the implications of the 2020-2021 biennial budget and policy bills adopted this year are numerous. There will be many opportunities for you to find out more: June Region Forums (seven locations across the state) | www.careproviders.org/regions Legislative update webinar on June 19, 2019 | www.careproviders.org/learning Electronic monitoring webinar, Fall 2019 | www.careproviders.org/learning Care Providers of Minnesota 2019 Convention and Exposition | www.careproviders.org/convention

CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

ASSISTED LIVING LICENSURE

SUMMARY

ASSISTED LIVING LICENSURE FRAMEWORK

The licensure framework will apply to all assisted living settings; there are specific exemptions from this licensure such as transitional housing, residential settings under 245A, and privately-owned communities such as co-ops. There will be two levels of licensure: assisted living and assisted living with dementia care. The license will cover all services, unit lease, and physical plant requirements. Residents will still have the option to receive services from an outside provider. New licensure fees will begin in 2021 and are set at a level to support surveys every other year. Assisted living fees will be $2,000 per building plus $75.00 per resident. Assisted living with dementia care fees will be $3,000 plus $100.00 per resident. There will be a rule-making process starting on July 1, 2019 to detail out some of the specific provisions.

MIN NIMUM ASSISTEDD LIVING FACILITY QUIREMENTS REQ

AUGUST 1, 2021: ASSISTEDD LIVING LICENSSURE

The 150-page assisted living licensure bill is a compilation of current and new laws intended to establish clarity of expectations for assisted living facilities and guidance to the state agency responsible to license such entities and survey for compliance. Knowing all of the requirements will be essential prior to August 1, 2021, however, included are some key areas of change for your review— details about each of the sections and resources for compliance will be available long before implementation.

careproviders.org/advocacy

This section sets out general expectations of all assisted living facilities such as: distributing the bill of rights; providing service in compliance with the Nurse Practice Act; developing and implementing a staﬀing plan; ensuring one or more persons are available 24 hours/day who are awake; a listing of services that must be provided or made available such as food, housekeeping, and laundry; a list of policies and procedures; requiring an infection control program; requiring resident and family councils; and delineating a resident grievance procedure. It should be noted that many of these requirements are already in place under the comprehensive home care license law.

ASSISTED LIVING BILL OF RIGHTS

The comprehensive home care bill of rights was used as the base for the new assisted living bill of rights with a few additions/edits. For example, the right to organize and participate in resident and/or family councils was inserted as a right.

BUSINESS OPERATIONS

Several requirements can be found under this section of law. • Several provisions related to handling resident finances and property, including a requirement to provide a final statement and funds within 30 days of a termination or death • Facility must develop and implement an individualized abuse prevention plan for each resident • Specific employee records must be maintained • Facility must establish and maintain a comprehensive tuberculosis (TB) infection control program • Written emergency disaster plan and emergency disaster training for all staﬀ

CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

MEDICATION MANAGGEMENT

Much of the language regarding medication management for comprehensive home care settings was moved into the assisted living law. An assisted living facility that provides medication management services must develop, implement, and maintain specific medication management policies and procedures. The law specifies: who can delegate medication administration and how; documentation requirements; medication management for residents who will be away from home; and storage and disposition of medications.

ASSISTED LIVING LICENSURE

SUMMARY

LICEN NSE APPLICATIONS & CONTROLLING INDIVIDUAL RESTTRICTIONS

The new law gives the commissioner of health authorization to deny licensure—initial or renewal—under certain circumstances such as prior history with nursing facilities or other assisted living facilities; and establishes stays of revocations or non-renewals under certain conditions.

PHYSICAL PLANT

On or after August 21, 2021, MDH engineering will be reviewing & must approve architectural & engineering plans for new AL construction; MDH engineering will be conducting on-site inspections of each licensed AL building, on a frequency of at least once every two years. It is our assumption this building inspection will coincide with the survey of the licensed AL facility. On or after August 21, 2021, each licensed AL facility must have a comprehensive fire protection system to include the following: • Approved sprinkler system or smoke detectors in each occupied room • Portable fire extinguishers • Physical environment kept in a “continuous state of good repair and operation” • A maintenance & repair program must be in place • Fire drills conducted in accordance with Life Safety Code (one every two months, with two being at night) • Existing buildings must be maintained in a manner that does not constitute a distinct hazard to life • New construction must meeting the following requirements: • Facilities with six or more residents must meet the AL requirements in the Facility Guidelines Institute (FGI) “Guidelines for Design & Construction of Residential Health, Care & Support Facilities” • Facilities with six or more residents must comply with the Residential Board & Care Occupancy chapter of the NFPA 101 (Life Safety Code) • Licensed AL with dementia care facilities that have a secured unit have the following additional requirements: • Compliance with the Healthcare (limited care) chapter of the NFPA 101 • A hazard vulnerability analysis or safety risk assessment must be completed to identify property & ground risks for residents & mitigation strategies to protect residents from harm • Be fully sprinkled by August 1, 2029

ASSISTTED LIVING CONTRACT REQUIREMENTS

All current contracts with residents will need to be revised to take into account a singular license (rather than a separate lease and service agreement), as well as the specific provisions that must be included in the contract included in this law. The language in the bill does not preclude a facility from creating a two-part contract with one part describing the lease expectations and the other part delineating the services.

RESIDEN NT ASSESSM MENT & SERVICCES Key to ensuring we minimize the numbers of involuntary terminations or nonrenewals of housing is making sure those moving into our assisted living facilities can be served; that there is an awareness of service needs; and that there is a process in place for reassessments and communication as needs change. Each resident moving in who will be receiving services from the assisted living facility must have an assessment conducted by a registered nurse prior to the move-in date, or contract execution date, whichever is earlier. Resident reassessment needs to be conducted within two weeks after initiation of services and a written service plan developed.

CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

SURVEYSS & FINES

Surveys will be conducted at least once every two years, with details on when follow-up surveys will be required/optional. The law delineates the fines associated with non-compliance at each level and defines the level and scope of violations. The commissioner MAY issue immediate fines for level 3 and level 4 correction orders or findings of maltreatment. The law further specifies a reconsideration of correction orders and fines process and the various remedies available to the commissioner for enforcement.

ASSISTED LIVING LICENSURE

SUMMARY

NEW W PROCEDURES FOR CO ONTRACT TERMINATIONS & CONSUMER APPEAL RIGHTS There are new notice and discharge planning requirements for situations that require a contract termination and a new appeals process with the Office of Administrative Hearings for consumers wishing to contest a contract termination. There are separate terms and processes for termination for nonpayment, termination for violations of the contract, and expedited termination where there are health and safety issues involving other residents or facility staff. Emergency relocations are allowed with specific notice requirements; however, a facility shall not refuse to allow a resident to return if a termination of housing has not been effectuated. For situations where a facility just decides not to renew a resident’s housing under a contract, there are requirements that the facility either give 60 days’ notice of the nonrenewal and help with relocation planning or follow the termination procedure. Regardless of how a resident is moved from the facility (termination, service reduction, planned closure), there are requirements for facilities to help coordinate the move, including development of a relocation plan that includes a “safe location.”

RETALIATION PROHIBITED

Retaliation against residents/families/employees was an important issue for the consumer advocates as there were many examples provided where the families felt they were being retaliated against if they complained formally or informally; or placed an electronic monitoring device in a resident’s room. This new law states that an assisted living facility or agent of the facility may not retaliate against a resident, or employee if the resident, employee, or person acting on behalf of the resident files a good faith complaint; grievance; maltreatment report; or places an electronic monitoring device in the room. What constitutes retaliation against a resident is further defined and includes actions such as: discharges or transfers; restrictions or prohibition of access; restriction of rights; unauthorized removal or tampering of electronic monitoring devices. Retaliation against an employee for reporting complaints/grievances includes unwarranted discharge or transfer; demotions or refusal to promote; reduction in compensation; imposition of discipline. The commissioner can take enforcement action if it was determined that a retaliatory action took place within 30 days of a complaint or related activity happening.

RESIDENT QUALIITY OF CARE & OUTCO OMES IMPROVEMENT TAASK FORCE

The task force is to be established by July 1, 2020, with specified members and the goal of periodically providing recommendations on changes needed to promote safety and quality improvement practices in long-term care settings and with long-term care providers.

DEMENTIA CARE

Additional requirements are identified for assisted living facilities that advertise, market, or otherwise promote as providing specialized care for individuals with Alzheimer’s disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Facilities with this designation must demonstrate the capacity to manage residents with dementia, comply with the additional staﬀing and staﬀ training requirements, and provide some specific services as needed by each resident.

careproviders.org/advocacy CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

ASSISTED LIVING LICENSURE

SUMMARY

“I’M OKAY” CHECKS

Concerns about independent living settings providing services without accountability and transparency for consumers led to a section of law titled “I’m okay” check services. Unlicensed settings—which provide sleeping accommodations to one or more adults, at least 80 percent of whom are 55 years of age or older, and oﬀering or providing for a fee any supportive services (like housekeeping, meals, or laundry)—must disclose in a written contract whether they will or will not oﬀer “I’m okay” checks. If the resident contracts for “I’m okay” check services in this otherwise independent living setting, there must be details on the nature, extent, and frequency in the contract.

NEW QUALIFICATIONS FOR ASSISTED LIVING DIREECTORS

Assisted living directors will be ultimately in charge of the assisted living facility, so the law builds in initial requirements and ongoing training for this position. The examination and continuing education will be monitored by the Board of Executives for Long-Term Services and Supports (formerly the nursing home examiner board). In order to be qualified to serve as an assisted living director, an individual must: 1. have completed an approved training course and passed an examination approved by the board that is designed to test for competence and that includes assisted living facility laws in Minnesota; 2. (i) currently be licensed as a nursing home administrator or have been validated as a qualified health services executive by the National Association of Long-Term Care Administrator Boards; and (ii) have core knowledge of assisted living facility laws; or 3. apply for licensure by July 1, 2021, and satisfy one of the following: • have a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance; • have at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility; • have completed at least 1,000 hours of an executive-in-training program provided by an assisted living director licensed under this subdivision; or • have managed a housing with services establishment operating under assisted living title protection for at least three years.

Together, we developed solutions. Seniors should be able to live independently for as long as they are able, with access to the safe, quality care options they need, in the communities they call home. Protection of vulnerable adults lies at the very core of our work and is best accomplished through partnerships. We have worked to ensure that we have a system that balances the values of independence and choice with the values of safety and protection.

CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION

CARE PROVIDERS OF MINNESOTA’S

ADVOCACY TEAM

Toby Pearson

Vice President of Advocacy tpearson@careproviders.org 952-851-2480

Nicole Mattson

Vice President of Strategic Initiatives nmattson@careproviders.org 952-851-2482

Patti Cullen, CAE

Todd Bergstrom

Doug Beardsley

Jill Schewe

President/CEO pcullen@careproviders.org 952-851-2487

Vice President of Member Services pdbeardsl@careproviders.org 952-851-2489

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CARE PROVIDERS OF MINNESOTA 7851 Metro Parkway, Suite 200 Bloomington, MN 55425

Director of Research & Data Analysis tbergstrom@careproviders.org 952-851-2486

Director of Assisted Living, Housing & Home Care jschewe@careproviders.org 952-851-2484

Kaila May

Communications & Website Specialist kmay@careproviders.org 952-851-2495

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December 30, 2019

www.careproviders.org 1-952-854-2844 MN Toll-Free 1-800-462-0024

Retaliation Prohibited in Registered Housing with Services Establishments with Assisted Living Title Protection Effective August 1, 2019, and expires July 31, 2021 [144G.07] RETALIATION PROHIBITED. Subdivision 1. Definitions. For the purposes of this section: (1) "facility" means a housing with services establishment registered under section 144D.02 and operating under title protection under this chapter; and (2) "resident" means a resident of a facility. Subd. 2. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law; (6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or (9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 3. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; (7) an arbitrary increase in charges or fees;

(8) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or (9) any oral or written communication of false information about a person advocating on behalf of the resident. Subd. 4. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination. Subd. 5. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 3 within 30 days of an initial action described in subdivision 2, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred.

POLICY: RETALIATION PROHIBITED DATE ENACTED/REVIEWED: August 1, 2019 DATE WITHDRWAWN: July 31, 2021 AUTHORIZED SIGNATURE:___________________________________

It is the policy of XXXXXX to not retaliate against a resident or employee if the resident, employee, or any person acting on behalf of the client or tenant: 1. files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; 2. indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; 3. files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary 4. seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; 5. advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights; 6. takes or indicates an intention to take civil action; 7. participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; 8. contracts or indicates an intention to contract to receive services from a service provider of the client’s or tenant’s choice other than the facility; or 9. places or indicates an intention to place a camera or electronic monitoring device in the client’s private space as provided under section 144.6502. Retaliation against a client or tenant includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a client or tenant, or any person with a familial, personal, legal, or professional relationship with the client or tenant: 1. termination of a contract; 2. any form of discrimination; 3. restriction or prohibition of access: i. of the client or tenant to the facility or visitors; or ii. of a family member or a person with a personal, legal, or professional relationship with the client or tenant to the client or tenant, unless the restriction is the result of a court order;| 4. the imposition of involuntary seclusion or the withholding of food, care, or services; 5. restriction of any of the rights granted to residents under state or federal law; 6. restriction or reduction of access to or use of amenities, care, services, privileges, or living 7. arrangements; 8. unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or 9. any oral or written communication of false information about a person advocating on behalf of the client or tenant. Retaliation against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: 1. unwarranted discharge or transfer;

2. 3. 4. 5.

unwarranted demotion or refusal to promote; unwarranted reduction in compensation, benefits, or privileges; the unwarranted imposition of discipline, punishment, or a sanction or penalty; or any form of unwarranted discrimination.

Complaints of suspected retaliation should be brought to the attention of the community’s Director, Compliance Officer, or the Minnesota Commissioner of Health.

Do I need an Assisted Living Facility License or an Assisted Living Facility with Dementia Care License? YES

Are you a facility that provides sleeping accommodations to one or more adults

You are not required to have an AL License

YES

YES You need an AL

license

Does either of the following apply to your facility? You are required to have an Assisted Living Facility with Dementia Care license

You advertise, market, or otherwise promote yourself an assisted living as providing specialized care for dementia or related disorders.

YES

You are required to have an Assisted Living Facility License. You have the option to have an Assisted Living Facility with Dementia Care license.

OPTION 1 (to be developed)

OPTION 2

OPTION 3

(“grandfathering” options)

Apply for licensure by July 1, 2021 AND satisfy at least ONE of the following requirements

Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance

Has completed at least 1,000 hours of a director/ executive in training program provided by a licensed assisted living director

Has managed a registered housing with services establishment under assisted living title protection for at least three years

Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility

YES

The “I’m okay” statute does not apply to you.

YES

Effective with contracts entered into on or after August 21, 2021, you must comply with the following three requirements:

2021 HOUSING MANAGERS’ EDUCATION SERIES

FAQs ELECTRONIC MONITORING THE BASICS 1

When will this new law go into eﬀect? January 1, 2020.

What type of facilities are covered by this new law? • Nursing facilities licensed under chapter 144A • Boarding care homes licensed under sections 144.50 to 144.56 • Between January 1, 2020, and August 1, 2021, a registered (144D) housing with services establishment that is either subject to 144G (assisted living title protection) or has disclosed a special care unit under section 325F.72 • Beginning August 1, 2021, licensed assisted living facilities

Can my facility prohibit electronic monitoring? Eﬀective January 1, 2020—No.

Can my facility refuse to admit or initiate the discharge of a resident or client who intends to, or is, utilizing electronic monitoring? Eﬀective January 1, 2020—No.

Does the electronic monitoring law apply to facility-installed cameras in public areas of the building or in areas of the building only accessible by facility staﬀ ? No—The law applies to electronic monitoring initiated by the resident, client, or their representative, to be installed in the resident’s or client’s private living space.

Does this law apply to electronic monitoring outside of a resident’s private living space (e.g., meetings, conference rooms, etc.)? No—The law only applies to the resident’s or client’s private living space.

What is considered an “electronic monitoring device”? A camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident’s or client’s room or private living unit and is used to monitor the resident/client or activities in the room/private living unit.

Will my facility be required to purchase, install, or maintain an electronic monitoring device for a resident or client? No—It is the responsibility of the resident, client, or their representative to purchase, pay for installation, and pay for maintenance of an electronic monitoring device.

What are the consequences against a facility for not complying with this new electronic monitoring law? Failing to comply may result in a $500 ﬁne.

Is a facility allowed to share with staff when electronic monitoring is installed? The law is silent in this area. However, if the consent form indicates any restrictions or conditions that the facility directs staff to accommodate, applicable staff would need to be notified of such restrictions or conditions.

What happens with electronic monitoring devices in-place prior to January 1, 2020? Eﬀective January 1, 2020, such devices will need to have a consent and notiﬁcation form consistent with the new law. Facilities should provide residents and/or resident representatives with the MDH-approved consent forms (http://bit.ly/EMconsentforms) and notify them that proper consent must be received or the device will be disabled.

FAQs | ELECTRONIC MONITORING THE BASICS CONTINUED... 12

What should I do if my staff comes across an electronic monitoring device in a private living space? First, they should always be acting in a manner under which they assume they are being monitored. Second, they should contact the administrator or manager, so leadership can confirm if a consent form has, or has not, been provided to the facility. If a consent form has not been received by the facility, leadership should contact the Office of Ombudsman for Long-Term Care (OOLTC) to determine if OOLTC was provided a signed consent form. If the OOLTC confirms a consent form has been received, the facility should verify the consent is not dated more than 14 days prior and compare information regarding the electronic monitoring device provided by the OOLTC with the device that was discovered, to verify it is the correct device and consent form on file. If no consent was received, the facility should contact the resident representative to have the device removed or proper consent provided. The facility may disable the device until proper consent and notification is received but should not remove the device as it does not belong to the facility.

Nursing facilities are required to pull privacy curtains to maintain the dignity of residents during personal cares. If pulling the privacy curtain would block the electronic monitoring ﬁeld of view, what should staﬀ do? Representatives from the Minnesota Department of Health (MDH) have indicated if a resident has consented to having personal cares monitored electronically, which means the privacy curtain would NOT be pulled if the electronic device would be blocked by the curtain, the facility will not be cited for failing to pull the privacy curtain due to the directed request of the resident (person-centered care).

If an electronic monitoring device is installed, can it have an extension cord or surge protector strip utilized to reach an outlet? Not in a nursing facility—That would violate requirements in the NFPA Life Safety Codes and required referenced codes.

The webinar mentioned the potential issue of a resident/client moving around in public areas of the building with an electronic monitoring device in a teddy bear on his or her lap. How should this situation be handled? The law does not address this scenario. The facility response may depend on what is being streamed from the device. Is it an event like a picnic or activity that the resident wants to share, or is it simply streaming everything and anything that is within the device’s recording range? The main concern would be that the device is streaming images and audio of other residents who have not consented to having their images or audio streamed or recorded by an outside entity or person. This scenario would need to be discussed with the resident or resident’s representative to limit unintended privacy breaches.

A family has installed an electronic device consistent with the law, and the family is calling the facility a lot to address issues captured by the device (the question was unclear regarding the type of issues). As a result, staff are spending significant amounts of time checking on the resident and speaking with the family. Can the facility charge extra for this additional staff time? In a nursing facility—no. In a housing with services/assisted living—maybe, if the result is acknowledged increased care/service needs of the resident that are added to the service plan relating to their assessed needs. Charging the resident more as a result of the facility’s frequent interaction with the family would most likely be viewed as retaliation, which is prohibited.

Does this law include swing beds in hospitals? No—The law does not apply to swing beds in hospitals.

Will this law mean a change to the Bill of Rights? The Assisted Living Bill of Rights (http://bit.ly/MDH_AL_BOR) was modiﬁed to include electronic monitoring. The Nursing Facility Bill of Rights was not modiﬁed.

Will Care Providers of Minnesota be providing members with a sample electronic monitoring policy? Yes, we will! Each facility will need to modify the sample to ﬁt the approaches used by the facility.

FAQs | ELECTRONIC MONITORING CONSENT 1

Does the resident or client need to consent to the placement of an electronic monitoring device that will be installed in the resident’s or client’s private living space? Yes—A resident or client must consent to electronic monitoring in the resident’s/client’s room or private living unit in writing on a standardized notice and consent form. The forms were developed by the Minnesota Department of Health and are available here: http://bit.ly/EMconsentforms. There are exceptions permitting those legally authorized to act on behalf of a resident or resident-identiﬁed resident representative when a resident is unable to consent on his or her behalf (such as issues surrounding capacity of residents; or clients lacking the ability to understand and appreciate the nature and consequences of electronic monitoring).

How are “cognitive issues” defined? The law does not define cognition or capacity. Instead, the law states the following: A resident must consent to electronic monitoring in the resident’s room or private living unit in writing on a notification and consent form. If the resident has not affirmatively objected to electronic monitoring and the resident’s medical professional determines that the resident currently lacks the ability to understand and appreciate the nature and consequences of electronic monitoring, the resident representative may consent on behalf of the resident. For purposes of this subdivision, a resident affirmatively objects when the resident orally, visually, or through the use of auxiliary aids or services declines electronic monitoring.

Must a resident, client, or their authorized representative provide the facility with a copy of the executed consent form? Yes—Notice of the consent to authorize electronic monitoring must be provided to the facility in advance of the installation of electronic monitoring. The facility must place the original consent form in the resident’s or client’s ﬁle.

Are there exceptions to requiring the consent form be provided to the facility in advance of the installation of electronic monitoring? Yes—If a resident, client, or authorized representative reasonably fears retaliation against them as a result of the planned installation of electronic monitoring, they can instead provide the executed consent form to the Oﬀice of Ombudsman for LongTerm Care instead of to the facility. However, this exception has two additional requirements: 1. A er 14 days using this exception, the resident, client, or authorized representative must provide a copy of the executed consent form to the facility. 2. During the 14-day period, if the resident, client, or authorized representative obtains evidence from the electronic monitoring device that suspected maltreatment occurred, they must timely submit their maltreatment concern to the Minnesota Adult Abuse Center (MAARC), the police, or both.

Are there other exceptions to requiring the consent form be provided to the facility in advance of the installation of electronic monitoring? Yes—Two other exceptions exist in the law: 1. If there has not been a timely, written response from the facility to a written communication from the resident, client, or their authorized representative expressing a concern, they can provide the executed consent form to the Oﬀice of Ombudsman for Long-Term Care instead of to the facility (the 14-day maximum period before providing notice to the facility still applies) 2. If the resident, client, or their authorized representative has already submitted a concern to MAARC or police, they can provide the executed consent form to the Ombudsman for Long-Term Care instead of to the facility (the 14-day maximum period before providing notice to the facility still applies)

Can the resident, client, or their authorized representative put restrictions on when the electronic monitoring device can and cannot be used? Yes—The consent form has a standard list of situations where electronic monitoring may be restricted or prohibited, such as during dressing, bathing, medical exams, etc.

Does a facility need to allow limitations or conditions to be placed on the use of electronic monitoring? Yes—The law requires the consent form to provide the option to place conditions on the use of electronic monitoring, therefore, the facility cannot prohibit such limitations or conditions. It remains unclear whose responsibility it is to accommodate any conditions—it is something a facility should consider discussing with the resident or resident’s representative when a consent form is received. A facility is not prohibited from forbidding staﬀ or contractors to interact with the electronic monitoring device, even to accommodate conditions.

FAQs | ELECTRONIC MONITORING CONSENT CONTINUED... 8

If neither the ombudsman or facility has an executed consent and notification form, how much time does the resident or authorized representative have in order to come and remove the device or comply with the law? If they live 4–5 hours away it won’t be same day, so then do we let the device remain on? That could be days. A er communicating with the resident or authorized representative that the device is not permitted because the requirements of the law are not being followed (and explaining how the device could be used with proper consent and notification), it is reasonable for the facility to disable the device, but not remove it. This may mean turning it off, unplugging it, or removing the battery.

What if the resident representative is also a member of the facility staﬀ? Facility staﬀ are not be permitted to act in the capacity of a resident’s representative.

Will there be a consent withdrawal form? An area to document withdrawal of the consent is a required element on the consent form.

When will the approved consent and notiﬁcation form be available? On December 24, 2019, MDH published the approved consent and notiﬁcation forms, which are available online here: http://bit.ly/EMconsentforms

ROOMMATES—SHARED PRIVATE LIVING SPACE 1

If a resident or client lives in a double room or shared living space that will be monitored by an electronic monitoring device, must the roommate also give consent? Yes—The same consent procedures are required for roommates.

What happens when a roommate objects to the placement of an electronic monitoring device? The resident, client, or authorized representative is prohibited from installing the electronic monitoring device. If requested, the facility must make a reasonable attempt to accommodate the resident or client who wants to conduct electronic monitoring—this includes oﬀering the resident or client a move to another shared room with a roommate who gives consent for electronic monitoring or to a private room. The facility is not responsible to pay for the costs of the move or increased costs for the alternative room. The facility shall reevaluate the move request every two weeks until the request is fulﬁlled.

Is a spouse considered a roommate under this statute? The law does not address this question. “Roommate” is described in the statue as “any other resident residing in the shared room or shared private living unit,” therefore, it is assumed the roommate restrictions would apply even if the roommate was the spouse of a resident.

Who verifies that the roommate has the capacity to consent if the consent is going to the ombudsman? The law is silent on this issue. However, a facility should use caution to avoid the perception of putting up roadblocks or barriers to implementation of electronic monitoring. It is unclear what the Office of Ombudsman for Long-Term Care (OOLTC) will do with the consent and notification forms they receive. If a facility verifies with the OOLTC that consent was provided by the resident/ authorized representative and, when applicable, the roommate/roommate’s authorized representative, and the facility has concerns about the capacity of either to provide consent, the facility should request the OOLTC look into the validity of such consent and notification.

How will this affect shared rooms? If by “shared rooms” you mean bedrooms or living spaces with a roommate, then all the requirements of consent and notification apply to both the resident and roommate. If you define two private rooms with a shared bathroom as a shared room, the requirements would apply independently to each of the residents in their own private rooms.

FAQs | ELECTRONIC MONITORING WI-FI / INTERNET 1

Must I install or provide free internet access to residents or clients? No—However, if you do make internet access available to residents, tenants, clients, or visitors, you must also make it available for electronic monitoring purposes under the same terms.

Is a facility required to provide public Wi-Fi? No—The law states the following: • If a resident chooses to place an electronic monitoring device that uses internet technology for visual or audio monitoring, the resident may be responsible for contracting with an internet service provider. • The facility shall make a reasonable attempt to accommodate the resident’s installation needs, including allowing access to the facility’s public-use internet or Wi-Fi systems when available for other public uses. A facility has the burden of proving that a requested accommodation is not reasonable.

Do I need to make my “public” internet secure? No—Many facilities have a secure private/business internet service, and a separate unsecured public internet service. Note—If this is the case, persons who have access to the public internet service should be informed that the connection is not secure. If your public internet service is secure, you should follow and communicate standard best practices for secure sites—such as encrypting the secure connection by one or more security protocols (such as passwords and/or secure sockets layer/SSL) to ensure the security of data ﬂowing between two or more nodes.

What if the facility’s public Wi-Fi is not secure? This should be disclosed in your resident handbook or however you communicate your information regarding your public Wi-Fi. When a consent and notiﬁcation form is received, you may want to communicate that fact again to the resident or authorized representative (document such communication).

Are we allowed to limit the use of our public Wi-Fi to certain uses? If you have public Wi-Fi, and if a resident desires to utilize electronic monitoring within the terms of the law and wants to use the public Wi-Fi, the facility will have the burden of proving that allowing access to the facility’s public-use Wi-Fi is not a reasonable accommodation.

What does the word “reasonable” mean? The law does not define the term “reasonable” in this statute. Merriam-Webster® defines it as “not extreme or excessive.” Other definitions use statements such as “as much as is appropriate or fair,” or “fair and sensible.”

We provide free Wi-Fi for guests. We do not allow continued use of Wi-Fi for such things as Netﬂix® or streaming. We have made some exceptions for individuals on EW who cannot aﬀord their own Wi-Fi. Is this problematic? All users of Wi-Fi should be treated the same. If there is public Wi-Fi that all can use, that should remain the same. If there is a fee for faster or non-public Wi-Fi, then all should be charged the fee.

SIGNAGE 1

What type of signage must be used for electronic monitoring? A sign outside of the resident’s/tenant’s/client’s private living space is not required. However, the facility must post a sign at each facility entrance accessible to visitors that states the following: “Electronic monitoring devices, including security cameras & audio devices, may be present to record persons & activities.”

Does the electronic monitoring law prohibit a facility from posting signs at the doorway to a resident’s private living space indicating that electronic monitoring is occurring in the space? The law does not require or prohibit such signage at the entrance to a resident’s private living space. The signage posting requirement pertains to facility entrances from the outside that are available for public access into the building. Note—It is unclear in a nursing facility environment if surveyors would consider a posting outside a resident’s private living space as violating a “home-like atmosphere” or whether there would be an issue with “resident dignity.”

FAQs | ELECTRONIC MONITORING REPORTING 1

If a family puts an electronic monitoring device in a resident’s private living space against the resident’s wishes (or roommate’s wishes), should the facility report it under the Vulnerable Adults Act, call the police, or something else? The law does not address this situation. However, it sounds like a potentially volatile situation that should be addressed to protect the rights of the resident(s). Frankly, the police will not know what to do, so we would not advise calling them in as your first response. Same holds true for the VAA—while it may be appropriate for adult protection to be involved, they may determine that it is the facility’s responsibility to protect the resident(s) privacy rights in this situation. We would advise as your first step contacting the Office of Ombudsman for Long-Term Care and have them represent the interests of the resident(s).

If a resident with dementia wanders into a room where electronic monitoring is occurring, does the facility need to contact the wandering resident’s family because consent for audio or video recording had not been granted? The law does not address this scenario, but notiﬁcation of such an event does not seem necessary.

When would a facility be required to report an electronic device to the Minnesota Adult Abuse Reporting Center (MAARC) or the Oﬀice of Health Facility Complaints (OHFC)? The law does not identify failure to follow the electronic monitoring requirements as potential maltreatment, abuse, neglect, or exploitation. If a facility feels that the county adult protective services needs to be involved, they should contact MAARC. It is suggested that a facility work with the resident’s authorized representative and the OOLTC ﬁrst to get the issues resolved.

When would a facility be required to report an electronic device to law enforcement? The law identifies penalties against licensed providers for failing to comply with the law, but does not identify any legal ramifications for residents or authorized representatives, other than potential civil or criminal penalties for disseminating a recording or copy of a recording for purposes outside of addressing health, safety, or welfare concerns of one or more residents. It is suggested that a facility work with the resident’s authorized representative and the OOLTC first to get any issues resolved.

If the resident’s authorized representative witnesses maltreatment via the electronic monitoring device, are they required to report it? Yes—If it occurs during the 14-day period when the consent notice was provided to the Oﬀice of Ombudsman for Long-Term Care instead of to the facility.

MISCELLANEOUS 1

What happens to the recordings that are captured by electronic monitoring devices? The law is somewhat silent on this issue. However, the law does have the following restrictions in place: • No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or resident representative. • Except as required under other law, a recording or copy of a recording made as provided in the electronic monitoring law may only be disseminated for the purpose of addressing health, safety, or welfare concerns of one or more residents. A person disseminating a recording or copy of a recording made as provided in the electronic monitoring law may be civilly or criminally liable if it is disseminated for reasons other than the purpose of addressing health, safety, or welfare concerns of one or more residents. • Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring may be admitted into evidence in a civil, criminal, or administrative proceeding. • For the purposes of state law, the mere presence of an electronic monitoring device in a resident’s room or private living unit is not a violation of the resident’s right to privacy. • For the purposes of state law, a facility or home care provider is not civilly or criminally liable for the mere disclosure by a resident or a resident representative of a recording.

If a recording captured by an electronic monitoring device causes a facility to initiate employee disciplinary actions, who has access to the recorded images? An employee of the facility or an employee of a contractor providing services at the facility, including an arranged home care provider, who is the subject of proposed disciplinary action based upon evidence obtained by electronic monitoring must be given access to that evidence for purposes of defending against the proposed action. An employee who obtains a recording or a copy of the recording must treat the recording or copy conﬁdentially and must not further disseminate it to any other person except as required under law. Any copy of the recording must be returned to the facility or resident who provided the copy when it is no longer needed for purposes of defending against a proposed action.

FAQs | ELECTRONIC MONITORING MISCELLANEOUS CONTINUED... 3

If a family member purchases something like a baby monitoring device, and asks the facility to monitor it to identify falls or activity, is that electronic monitoring, and how should the facility respond? Interesting question! First, it appears a baby-monitoring type of device would be considered electronic monitoring, as it is a device that broadcasts audio, video, or both; placed in a resident’s room or private living space; and used to monitor the resident or activities in the resident’s room or private living space. Therefore, all components of the new electronic monitoring law would need to be met. The facility clearly has no duty to accept this obligation to monitor. If the facility did accept this responsibility, the facility should consider the following: • Have all components of the electronic monitoring law been met? • Can the facility continuously monitor the broadcast, if that is the expectation? • Can the broadcast be kept private, so that others cannot see/hear it? In most instances the answers would be no, indicating the facility may want to decline the monitoring of the broadcast.

Why would providers not want to be proactive and put cameras in the rooms or private living area for facility purposes and then market that to the public that the facility has nothing to hide? If a facility were to do this, the same consent notice and ability to elect restrictions would be applicable for all current and new residents/clients (and roommates). Having such recordings could place an additional regulatory or legal burden on the facility in terms of responsibility.

If we know there is a camera in a room, and we know that and accidentally break it, I understand we may be responsible to replace that. What if it is a hidden camera in a tissue box and we move that for cleaning, and it breaks…is that our responsibility to replace that device? The law is silent on this issue. We assume when you are referring to “hidden camera” you mean an electronic monitoring device that complies with the new law. How does your facility handle the replacement of other resident personal items that staﬀ unintentionally break?

What is a facility’s responsibility to maintain a resident’s electronic monitoring device/camera? The facility is not responsible for the maintenance of such device—It is the responsibility of the resident or resident’s authorized representative choosing to conduct the electronic monitoring.

Can we have rules about how devices are physically installed? The law is somewhat silent in this area, other than stating that installation costs are the responsibility of the resident. What limitations regarding the installation of other personal resident items, such as furnishings, pictures, TVs, mementos, or other belongings does your facility enforce?

Can a resident’s authorized electronic monitoring device be placed in a manner that it is also recording/transmitting images of common areas outside of the resident’s private living space? The law is somewhat silent in this area, but the consent and notiﬁcation form is designed to only cover electronic monitoring in the resident’s private living space.

CARE PROVIDERS OF MINNESOTA’S

ADVOCACY TEAM

Toby Pearson

Vice President of Advocacy tpearson@careproviders.org 952-851-2480

Nicole Mattson

Vice President of Strategic Initiatives nmattson@careproviders.org 952-851-2482

Patti Cullen, CAE

Todd Bergstrom

Doug Beardsley

Jill Schewe

President/CEO pcullen@careproviders.org 952-851-2487

Vice President of Member Services pdbeardsl@careproviders.org 952-851-2489

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CARE PROVIDERS OF MINNESOTA 7851 Metro Parkway, Suite 200 Bloomington, MN 55425

Director of Research & Data Analysis tbergstrom@careproviders.org 952-851-2486

Director of Assisted Living, Housing & Home Care jschewe@careproviders.org 952-851-2484

Kaila May

Communications & Website Specialist kmay@careproviders.org 952-851-2495

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December 30, 2019

www.careproviders.org 1-952-854-2844 MN Toll-Free 1-800-462-0024