1.1.................... moves to amend H.F. No. 1233, the delete everything amendment
1.2(A13-0408), as follows:
1.3Page 322, line 30, delete "Dietician." and insert "Dietitian."
1.4Page 327, line 3, delete everything after "money"
1.5Page 327, line 4, delete "services" and delete "registrant and" and insert "licensee"
1.6Page 327, line 5, delete ", grants, bequests, gifts, donations," and insert "and"
1.7Page 327, line 6, delete everything after "money" and insert "for home care services."
1.8Page 340, line 19, delete "initial" and insert "a"
1.9Page 341, delete line 21, and insert:

1.10 1.11	"greater than $50,000 and no more than $100,000	$500
1.12 1.13	greater than $25,000 and no more than $50,000	$400"

1.14Page 341, line 22, delete "$166" and insert "$200"
1.15Page 341, after line 25, insert:
1.16"(e) At each annual renewal, a home care provider may elect to pay the highest
1.17renewal fee for its license category, and not provide annual revenue information to the
1.18commissioner."
1.19Page 341, line 26, delete "(e)" and insert "(f)"
1.20Page 341, line 30, delete "(f)" and insert "(g)"
1.21Page 341, after line 31, insert:
1.22"(h) The license renewal fee schedule in this subdivision is effective July 1, 2016."
1.23Page 343, line 13, before "Survey" insert "By June 30, 2016, the commissioner shall
1.24conduct a survey of home care providers on a frequency of at least once every three years."
1.25Page 343, after line 15, insert:
1.26    "Subd. 2. Types of home care surveys. (a) "Initial full survey" is the survey
1.27conducted of a new temporary licensee after the department is notified or has evidence that
1.28the licensee is providing home care services to determine if the provider is in compliance
2.1with home care requirements. Initial surveys must be completed within 14 months after
2.2the department's issuance of a temporary basic or comprehensive license.
2.3(b) "Core survey" means periodic inspection of home care providers to determine
2.4ongoing compliance with the home care requirements, focusing on the essential health and
2.5safety requirements. Core surveys are available to licensed home care providers who have
2.6been licensed for three years and surveyed at least once in the past three years with the
2.7latest survey having no widespread violations beyond Level 1 as provided in subdivision
2.811. Providers must also not have had any substantiated licensing complaints, substantiated
2.9complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
2.10Act, or an enforcement action as authorized in section 144A.475 in the past three years.
2.11(1) The core survey for basic license-level providers reviews compliance in the
2.12following areas:
2.13(i) reporting of maltreatment;
2.14(ii) orientation to and implementation of Home Care Client Bill of Rights;
2.15(iii) statement of home care services;
2.16(iv) initial evaluation of clients and initiation of services;
2.17(v) basic-license level client review and monitoring;
2.18(vi) service plan implementation and changes to the service plan;
2.19(vii) client complaint and investigative process;
2.20(viii) competency of unlicensed personnel; and
2.21(ix) infection control.
2.22(2) For comprehensive license-level providers, the core survey will include
2.23everything in the basic license-level core survey plus these areas:
2.24(i) delegation to unlicensed personnel;
2.25(ii) assessment, monitoring, and reassessment of clients; and
2.26(iii) medication, treatment, and therapy management.
2.27(c) "Full survey" means the periodic inspection of home care providers to determine
2.28ongoing compliance with the home care requirements that cover the core survey areas
2.29and all the legal requirements for home care providers. A full survey is conducted for all
2.30temporary licensees and for providers who do not meet the requirements needed for a core
2.31survey, and when a surveyor identifies unacceptable client health or safety risks during a
2.32core survey. A full survey will include all the tasks identified as part of the core survey
2.33and any additional review deemed necessary by the department, including additional
2.34observation, interviewing, or records review of additional clients and staff.
2.35(d) "Follow-up surveys" are conducted to determine if a home care provider has
2.36corrected deficient issues and systems identified during a core survey, full survey, or
3.1complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax,
3.2mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
3.3concluded with an exit conference and written information provided on the process for
3.4requesting a reconsideration of the survey results.
3.5(e) Upon receiving information that a home care provider has violated or is currently
3.6violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
3.7investigate the complaint according to sections 144A.51 to 144A.54.
3.8    Subd. 3. Survey process. (a) The survey process for core surveys shall include the
3.9following as applicable to the particular licensee and setting surveyed:
3.10(1) presurvey review of pertinent documents and notification to the ombudsman
3.11for long-term care;
3.12(2) an entrance conference with available staff;
3.13(3) communication with managerial officials or the registered nurse in charge, if
3.14available, and ongoing communication with key staff throughout the survey regarding
3.15information needed by the surveyor, clarifications regarding home care requirements, and
3.16applicable standards of practice;
3.17(4) presentation of written contact information to the provider about the survey staff
3.18conducting the survey, the supervisor, and the process for requesting a reconsideration of
3.19the survey results;
3.20(5) a brief tour of a sample of the housing with services establishments in which the
3.21provider is providing home care services;
3.22(6) a sample selection of home care clients;
3.23(7) information-gathering through client and staff observations, client and staff
3.24interviews, and reviews of records, policies, procedures, practices, and other agency
3.25information;
3.26(8) interviews of clients' family members, if available, with clients' consent when the
3.27client can legally give consent;
3.28(9) except for complaint surveys conducted by the Office of Health Facilities
3.29Complaints, exit conference, with preliminary findings shared and discussed with the
3.30provider and written information provided on the process for requesting a reconsideration
3.31of the survey results; and
3.32(10) postsurvey analysis of findings and formulation of survey results, including
3.33correction orders when applicable."
3.34Page 343, line 16, delete "2" and insert "4"
3.35Page 343, line 20, delete "3" and insert "5"
3.36Page 343, line 23, delete "4" and insert "6"
4.1Page 343, line 27, delete "5" and insert "7"
4.2Page 343, delete subdivision 6
4.3Page 344, line 1, delete "7" and insert "8"
4.4Page 344, line 3, delete "controlling person" and insert "managerial official"
4.5Page 344, line 4, delete ", 626.556, or 626.557"
4.6Page 344, line 5, delete "rule or"
4.7Page 344, line 7, after "order" insert "within 30 calendar days after exit survey"
4.8Page 344, delete lines 17 to 36 and insert:
4.9    "Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations
4.10or any violations determined to be widespread, the department shall conduct a follow-up
4.11survey within 90 calendar days of the survey. When conducting a follow-up survey, the
4.12surveyor will focus on whether the previous violations have been corrected and may also
4.13address any new violations that are observed while evaluating the corrections that have
4.14been made. If a new violation is identified on a follow-up survey, no fine will be imposed
4.15unless it is not corrected on the next follow-up survey.
4.16    Subd. 10. Performance incentive. A licensee is eligible for a performance
4.17incentive if there are no violations identified in a core or full survey. The performance
4.18incentive is a ten percent discount on the licensee's next home care renewal license fee."
4.19Page 345, delete lines 1 to 10 and insert:
4.20    "Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be
4.21assessed based on the level and scope of the violations described in paragraph (c) as follows:
4.22(1) Level 1, no fines or enforcement;
4.23(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
4.24mechanisms authorized in section 144A.475 for widespread violations;
4.25(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
4.26mechanisms authorized in section 144A.475; and
4.27(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
4.28enforcement mechanisms authorized in section 144A.475.
4.29(b) Correction orders for violations are categorized by both level and scope as
4.30follows and fines will be assessed accordingly:
4.31(1) Level of violation:
4.32(i) Level 1. A violation that has no potential to cause more than a minimal impact on
4.33the client and does not affect health or safety.
4.34(ii) Level 2. A violation that did not harm the client's health or safety, but had the
4.35potential to have harmed a client's health or safety, but was not likely to cause serious
4.36injury, impairment, or death.
5.1(iii) Level 3. A violation that harmed a client's health or safety, not including serious
5.2injury, impairment, or death, or a violation that has the potential to lead to serious injury,
5.3impairment, or death.
5.4(iv) Level 4. A violation that results in serious injury, impairment, or death.
5.5(2) Scope of violation:
5.6(i) Isolated. When one or a limited number of clients are affected, or one or a limited
5.7number of staff are involved, or the situation has occurred only occasionally.
5.8(ii) Pattern. When more than a limited number of clients are affected, more than
5.9a limited number of staff are involved, or the situation has occurred repeatedly but is
5.10not found to be pervasive.
5.11(iii) Widespread. When problems are pervasive or represent a systemic failure that
5.12has affected or has the potential to affect a large portion or all of the clients."
5.13Page 345, line 12, delete "identified" and insert "by the date specified in the
5.14correction order or conditional license resulting from"
5.15Page 345, line 13, delete "in" and delete everything after "investigation"
5.16Page 345, line 14, delete "conditional license"
5.17Page 345, delete lines 17 to 20
5.18Page 345, line 21, delete "(e)" and insert "(d)"
5.19Page 345, line 24, delete everything after "fine"
5.20Page 345, delete line 25
5.21Page 345, line 26, delete everything before "A"
5.22Page 345, line 28, delete "(f)" and insert "(e)" and delete everything after "writing"
5.23Page 345, line 29, delete "by e-mail," and delete "to forfeit a fine"
5.24Page 345, line 31, delete "to forfeit a fine"
5.25Page 345, line 35, delete "(g)" and insert "(f)"
5.26Page 345, line 36, before "hearing" insert "reconsideration or a"
5.27Page 346, line 1, delete "(h)" and insert "(g)"
5.28Page 346, line 3, delete "personally" and delete "In the case"
5.29Page 346, delete lines 4 and 5
5.30Page 346, line 6, delete "(i)" and insert "(h)"
5.31Page 346, line 9, delete "(j)" and insert "(i)"
5.32Page 346, line 13, delete "regulations" and insert "in Minnesota"
5.33Page 346, after line 13, insert:
5.34    "Subd. 12. Reconsideration. The commissioner shall make available to home
5.35care providers a correction order reconsideration process. This process may be used
5.36to challenge the correction order issued, including the level and scope described in
6.1subdivision 9, and any fine assessed. During the correction order reconsideration request,
6.2the issuance for the correction orders under reconsideration are not stayed, but the
6.3department will post in formation on the Web site with the correction order that the
6.4licensee has requested a reconsideration required and that the review is pending.
6.5(a) A licensed home care provider may request from the commissioner, in writing,
6.6a correction order reconsideration regarding any correction order issued to the provider.
6.7The correction order reconsideration shall not be reviewed by any surveyor, investigator,
6.8or supervisor that participated in the writing or reviewing of the correction order being
6.9disputed. The correction order reconsiderations may be conducted in person by telephone,
6.10by another electronic form, or in writing, as determined by the commissioner. The
6.11commissioner shall respond in writing to the request from a home care provider for
6.12a correction order reconsideration within 60 days of the date the provider requests a
6.13reconsideration. The commissioner's response shall identify the commissioner's decision
6.14regarding each citation challenged by the home care provider.
6.15The findings of a correction order reconsideration process shall be one or more of
6.16the following:
6.17(1) Supported in full. The correction order is supported in full, with no deletion of
6.18findings to the citation.
6.19(2) Supported in substance. The correction order is supported, but one or more
6.20findings are deleted or modified without any change in the citation.
6.21(3) Correction order cited an incorrect home care licensing requirement. The
6.22correction order is amended by changing the correction order to the appropriate statutory
6.23reference.
6.24(4) Correction order was issued under an incorrect citation. The correction order is
6.25amended to be issued under the more appropriate correction order citation.
6.26(5) The correction order is rescinded.
6.27(6) Fine is amended. It is determined the fine assigned to the correction order was
6.28applied incorrectly.
6.29(7) The level or scope of the citation is modified based on the reconsideration.
6.30(b) If the correction order findings are changed by the commissioner, the
6.31commissioner shall update the correction order Web site accordingly.
6.32    Subd. 13. Home care surveyor training. Before conducting a home care survey,
6.33each home care surveyor must receive training on the following topics:
6.34(1) Minnesota home care licensure requirements;
6.35(2) Minnesota Home Care Client Bill of Rights;
6.36(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
7.1(4) principles of documentation;
7.2(5) survey protocol and processes;
7.3(6) Offices of the Ombudsman roles;
7.4(7) Office of Health Facility Complaints;
7.5(8) Minnesota landlord-tenant and housing with services laws;
7.6(9) types of payors for home care services; and
7.7(10) Minnesota Nurse Practice Act for nurse surveyors.
7.8Materials used for this training will be posted on the department Web site. Requisite
7.9understanding of these topics will be reviewed as part of the quality improvement plan
7.10in section 29."
7.11Page 351, line 3, delete "144.056" and insert "144.057"
7.12Page 362, line 22, before "For" insert "(a)"
7.13Page 362, line 24, after "written" insert "statement of the" and delete "plan. The
7.14written plan" and insert "services that will be provided to the client."
7.15Page 362, delete lines 25 and 26 and insert "The provider must develop and maintain
7.16a current individualized medication management record for each client based on the
7.17client's assessment that must contain the following:"
7.18Page 362, line 30, delete everything after "(3)" and insert "documentation of specific
7.19client instructions relating to the administration of medications;"
7.20Page 362, delete lines 31 to 33
7.21Page 362, line 34, delete "(6)" and insert "(4)"
7.22Page 363, line 1, delete "(7)" and insert "(5)"
7.23Page 363, line 2, delete "and"
7.24Page 363, line 3, delete "(8)" and insert "(6)"
7.25Page 363, line 4, delete the period and insert "; and"
7.26Page 363, after line 4, insert:
7.27"(7) any client-specific requirements relating to documenting medication
7.28administration, verifications that all medications are administered as prescribed, and
7.29monitoring of medication use to prevent possible complications or adverse reactions.
7.30(b) The medication management record must be current and updated when there
7.31are any changes."
7.32Page 363, line 13, delete "with respect to each client"
7.33Page 363, delete subdivision 10 and insert:
7.34    "Subd. 10. Medications management for clients who will be away from home.
7.35(a) A home care provider that is providing medication management services to the client
7.36and controls the client's access to the medications must develop and implement policies
8.1and procedures for giving accurate and current medications to clients for planned or
8.2unplanned times away from home according to the client's individualized medication
8.3management plan. The policy and procedures must state that:
8.4(1) for planned time away, the medications must be obtained from the pharmacy or
8.5set up by the registered nurse according to appropriate state and federal laws and nursing
8.6standards of practice;
8.7(2) for unplanned time away, when the pharmacy is not able to provide the
8.8medications, a licensed nurse or unlicensed personnel shall give the client or client's
8.9representative medications in amounts and dosages needed for the length of the anticipated
8.10absence, not to exceed 120 hours;
8.11(3) the client, or the client's representative, must be provided written information
8.12on medications, including any special instructions for administering or handling the
8.13medications, including controlled substances;
8.14(4) the medications must be placed in a medication container or containers
8.15appropriate to the provider's medication system and must be labeled with the client's name
8.16and the dates and times that the medications are scheduled; and
8.17(5) the client or client's representative must be provided in writing the home care
8.18provider's name and information on how to contact the home care provider.
8.19(b) For unplanned time away when the licensed nurse is not available, the registered
8.20nurse may delegate this task to unlicensed personnel if:
8.21(1) the registered nurse has trained the unlicensed staff and determined the
8.22unlicensed staff is competent to follow the procedures for giving medications to clients;
8.23(2) the registered nurse has developed written procedures for the unlicensed
8.24personnel, including any special instructions or procedures regarding controlled substances
8.25that are prescribed for the client. The procedures must address:
8.26(i) the type of container or containers to be used for the medications appropriate to
8.27the provider's medication system;
8.28(ii) how the container or containers must be labeled;
8.29(iii) the written information about the medications to be given to the client or client's
8.30representative;
8.31(iv) how the unlicensed staff will document in the client's record that medications
8.32have been given to the client or the client's representative, including documenting the date
8.33the medications were given to the client or the client's representative and who received the
8.34medications, the person who gave the medications to the client, the number of medications
8.35that were given to the client, and other required information;
9.1(v) how the registered nurse will be notified that medications have been given to
9.2the client or client's representative and whether the registered nurse needs to be contacted
9.3before the medications are given to the client or the client's representative; and
9.4(vi) a review by the registered nurse of the completion of this task to verify that this
9.5task was completed accurately by the unlicensed personnel."
9.6Page 364, delete lines 1 to 28
9.7Page 367, line 8, after "must" insert "prepare and" and delete "management"
9.8Page 367, delete line 9 and insert "statement of the treatment or therapy services
9.9that will be provided to the client. The provider must also develop and maintain a current
9.10individualized treatment and therapy management record for each client which must
9.11contain at least the following:"
9.12Page 367, delete lines 11 to 13 and insert:
9.13"(2) documentation of specific client instructions relating to the treatments or
9.14therapy administration;"
9.15Page 367, line 14, delete "(4)" and insert "(3)"
9.16Page 367, line 15, delete "and"
9.17Page 367, line 16, delete "(5)" and insert "(4)"
9.18Page 367, line 17, delete the period and insert "; and"
9.19Page 367, after line 17, insert:
9.20"(5) any client-specific requirements relating to documentation of treatment
9.21and therapy received, verification that all treatment and therapy was administered as
9.22prescribed, and monitoring of treatment or therapy to prevent possible complications or
9.23adverse reactions. The treatment or therapy management record must be current and
9.24updated when there are any changes."
9.25Page 374, line 5, delete "market, promote, or"
9.26Page 374, line 6, delete "their" and after "supervisors" insert "working with those
9.27clients"
9.28Page 374, line 8, delete ", how to assist clients with activities of daily living,"
9.29Page 377, line 13, delete "Initial" and insert "Temporary"
9.30Page 377, line 14, delete "October 1, 2013, all initial" and insert "January 1, 2014,
9.31all temporary"
9.32Page 377, line 16, delete "Initial" and insert "Temporary" and delete "or licenses"
9.33and delete "October" and insert "January"
9.34Page 377, line 17, delete "2013" and insert "2014"
9.35Page 377, line 19, delete "initial" in both places
10.1Page 377, line 20, delete "July 1, 2013, and October 1," and insert "October 1,
10.22013, and December 31,"
10.3Page 377, line 21, delete "July" and insert "October"
10.4Pate 377, line 23, delete "on" and insert "prior to"
10.5Page 377, line 24, delete "October 1, 2013" and insert "July 1, 2014" and delete
10.6"who are licensed"
10.7Page 377, line 25, delete "on July 1, 2013,"
10.8Page 377, line 27, delete "September 30, 2014" and insert "June 30, 2015"
10.9Page 377, after line 28, insert:
10.10    "Subd. 3. Renewal application of home care licensure during transition period.
10.11Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
10.12sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
10.13sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
10.14care licensure law in effect on June 30, 2013.
10.15The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
10.16shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
10.17increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
10.18For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
10.19and no more than $100,000 will be $313 and for providers with revenues no more than
10.20$25,000 the fee will be $125."
10.21Page 377, delete section 27
10.22Page 379, after line 6, insert:

10.23    "Sec. 29. AGENCY QUALITY IMPROVEMENT PROGRAM.
10.24    Subdivision 1. Annual legislative report on home care licensing. The
10.25commissioner shall establish a quality improvement program for the home care survey
10.26and home care complaint investigation processes. The commissioner shall submit to the
10.27legislature an annual report, beginning October 1, 2015, and each October 1 thereafter.
10.28Each report will review the previous state fiscal year of home care licensing and regulatory
10.29activities. The report must include, but is not limited to, an analysis of:
10.30(1) the number of FTE's in the Division of Compliance Monitoring, including the
10.31Office of Health Facility Complaints units assigned to home care licensing, survey,
10.32investigation and enforcement process;
10.33(2) numbers of and descriptive information about licenses issued, complaints
10.34received and investigated, including allegations made and correction orders issued,
10.35surveys completed and timelines, and correction order reconsiderations and results;
11.1(3) descriptions of emerging trends in home care provision and areas of concern
11.2identified by the department in its regulation of home care providers;
11.3(4) information and data regarding performance improvement projects underway
11.4and planned by the commissioner in the area of home care surveys; and
11.5(5) work of the Department of Health Home Care Advisory Council.
11.6    Subd. 2. Study of correction order appeal process. Starting July 1, 2015, the
11.7commissioner shall study whether to add a correction order appeal process conducted by
11.8an independent reviewer such as an administrative law judge or other office and submit a
11.9report to the legislature by February 1, 2016. The commissioner shall review home care
11.10regulatory systems in other states as part of that study. The commissioner shall consult
11.11with the home care providers and representatives."
11.12Renumber the sections in sequence and correct internal references
11.13Correct the title numbers accordingly