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2014 Legislative Report

General

Automatic External Defibrilators

Chapter 291, Article 6, Section 27
Creates MN Statutes 403.51
H.F. 2402, Liebling-DFL, Zerwas-R
S.F. 2087, Sheran-DFL
Effective: July 1, 2014

Background
Until this session, the state’s regulation of automatic external defibrillators (AED) had been restricted to the use in ambulances, protection under the Good Samaritan law, and certain provisions related to schools.

Bill Summary
The bill provides definitions that distinguish between “public access” AEDs, which are subject to the provisions of the bill, and “private use” and “mobile” AEDs, both of which are not. "Public access AED" means an AED that is intended, by its markings or display, to be used or accessed by the public for the benefit of the general public that may be in the vicinity or location of that AED. It does not include an AED that is owned or used by a hospital, clinic, business, or organization that is intended to be used by staff and is not marked or displayed in a manner to encourage public access.”

An entity that purchases a public access AED must register the device with an AED registry that requires a maintenance program or package. The owner must maintain the AED in good working order, and it is subject to inspection by any public safety organization that has jurisdiction over the location. The owner must develop an emergency response plan that is appropriate for the location. The bill neither creates any new civil liability for the owner nor prohibits civil liability under any other law.

Implications
Members that have AEDs intended for use by the general public will need to comply with the new requirements.

Staff Contact: Darrell Shreve

Background Studies

Chapter 250
Amends MN Statutes 245C.02 through 245C.07, 245C.13, 245C.17, 245C.20, and 245C.32, and adds 245C.051
H.F. 2467, Liebling-DFL
S.F. 2547, Latz-DFL
Effective: August 1, 2014

Background
The Minnesota Department of Human Services conducts 275,000 background studies per year. DHS received a $3 million grant from DHHS to modernize its system, which currently misses some convictions and requires multiple background studies on individuals who change health or human services jobs.

Bill Summary
The bill contains several features designed to streamline the DHS system and improve its accuracy:

DHS will replace NETStudy with NETStudy 2.0 to accommodate various new features.
Requiring fingerprints and photographs will improve the accuracy and avoid the necessity for many people to have multiple background studies.
Initial background studies will be faster because DHS will look only at the records of the specific individual, rather than reviewing records of all persons with the same name.
Once an individual has been cleared on a background study, future employers will be able to verify the person’s status online in most situations, rather than submitting a new background study.
Employers should be able to use this system to check the OIG exclusion list, professional licensure lists, and the nurse aide registry.
The Minnesota Court Information System will automatically forward conviction information to DHS, which will notify employers if a person is disqualified. Currently, another background study is required for DHS to get this information.
Individuals will be able to initiate their own background study and thereby present themselves to prospective employers as having already passed the study.

Implications
Although this system will provide many benefits to members, there may be serious problems of access to the fingerprint/photo locations in isolated rural areas. DHS expects to address those possible problems through its contract with its vendor. DHS plans on 50 locations, but the Twin Cities area will probably require half or more of the fifty, simply because of the volumes in the metro area. Travel distances of 30 or 40 or 50 miles to reach a fingerprint/photo location could easily persuade individuals to work in some other part of the economy.

For nursing homes, the costs are covered by the MDH license fees. For other employers, there will be higher costs, but the statute is silent on whether employers can shift some or all of those costs to prospective employees.

Staff Contact: Darrell Shreve

Common Entry Point (CEP)

Chapter 291, Article 8, Sec. 17
Amends MN Statutes Section 627.557, Subd. 9
H.F. 2402, Liebling-DFL, Zerwas-R
S.F. 2087, Sheran-DFL
Effective: May 22, 2014

Background
The plan to implement a statewide common entry point or CEP by July 1, 2014, ran into a number of difficulties in implementation. The Department of Human Services sought a one-year delay.

Bill Summary
The bill delays the implementation deadline for one year until July 1, 2015. The bill also inserts language that requires counties to designate a common entry point.

Implications
The delay probably means one more year before we have one statewide phone number for the common entry point. The inserted language mentioned above was necessary simply to maintain the status quo of counties designating a common entry point.

Staff Contact: Darrell Shreve

DHS Unsession Bill

Chapter 262
Amends and Repeals Numerous MN Statutes
H.F. 2950, Liebling-DFL
S.F. 2397, Hoffman-DFL
Effective: Aug. 1, 2014

Background
Prior to the start of the 2014 legislative session, Governor Dayton announced that the session should be an “unsession” that was focused on cleaning out old laws that are no longer needed. One aspect of the unsession was that each department reviewed their statutes and identified obsolete portions that could be deleted.

Bill Summary
The DHS unsession bill modifies and repeals a number of statutes to remove content that is no longer relevant. For example, most of the old care center rate increase language is repealed, as well as language providing for previous quality add-ons, language providing increases for rate disparities and for care centers in specific counties, and 2006 language calling for the development of a new payment system. Under the current rate system, none of that language is needed because each care center’s rate is determined by its current rate plus whatever amount of increase the Legislature adds each year, if any, so the previous increases are all built into the base rate and the legislative language providing for them is no longer needed.

Implications
These changes will have no real impact on providers or how DHS operates, because they were designed to clean up the statutes by removing portions that no longer are needed. One implication of this effort is that DHS statutes on nursing home and other provider payments will be a little clearer and shorter without the obsolete provisions, which will be somewhat helpful to anyone searching for current policy in the statutes.

Staff Contact: Jeff Bostic

License Suspensions by Health-Related Licensing Boards

Chapter 291, Article 4, Sec. 46
Creates new language at MN Statutes 214.077
H.F. 2402, Liebling—DFL, Zerwas--R
S.F. 2087, Sheran--DFL
Effective: July 1, 2014

Background
Newspaper stories about the disciplinary practices of certain professional licensing boards this year contributed to a desire to expedite their practices.

Bill Summary
The bill provides that a health-related licensing board shall temporarily suspend a person’s license when the board receives a complaint and has “probable cause” to believe that the individual will pose an “imminent risk of harm” if the person continues to practice. The bill provides for notice to the individual and requires the board to schedule a disciplinary hearing within 30 days of suspending the license, giving the person at least 10 days’ notice. The board has 30 days to complete its investigation and issue a final order, or else the suspension shall be lifted. However, if the person requests a delay in the disciplinary proceedings for any purpose, the temporary suspension remains in place until completion of the investigation.

Implications
The bill will speed up the disciplinary process when the thresholds of “probable cause” and “imminent risk of harm” are met.

Staff Contact: Darrell Shreve

MA Spenddown

Chapter 312, Article 24, Section 44
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
The MA spenddown process has been particularly challenging for waiver providers, who must collect waiver obligations and act, in their words, as the state’s bill collector. This is challenging because the waiver obligation may change from month to month, there may be multiple providers involved with the client, and clients may not have any money left to pay the waiver obligation at the end of the month.

Summary
This new provision requires DHS to consult with stakeholders and to review MA spenddown requirements and processes, including those used in other states. Based on this review, DHS is to make recommendations for alternative processes that:

Are practical for MA recipients, providers and the department;
Improve the MA payment process for providers; and
Allows MA recipients to obtain consistent and affordable medical coverage.

A report with recommendations and the projected cost is due to the legislature by February 15, 2015.

Implications
This review process could result in a very different way to capture medical spenddowns and waiver obligations. A change in the way waiver obligations are collected could be a great help to waiver providers.

Staff Contact: Mary Youle

Minimum Wage Increase

Chapter 166
Amends MN Statutes 177.24
H.F. 2091, Winkler-DFL
S.F. 1775, Hayden-DFL
Effective: Aug. 1, 2014

Background
In the 2013 session, one of the priorities of the new DFL majority in the Legislature was to pass an increase in the state’s minimum wage, which at $6.15 per hour was less than the $7.25 per hour federal minimum wage. The House and Senate were not able to agree on the amount and timetable for a phased-in minimum wage increase last year, leaving increasing the minimum wage as unfinished business for this session.

Bill Summary
This bill provides for a staged increase in the minimum wage to $9.50 per hour by 2016. The bill includes provisions that allow a lower rate for small employers (defined as those with revenue of less than $500,000 annually) and for new younger employees (defined as employees under twenty years old for the first ninety days of work). The table below shows the minimum wage increases over the next three years:

Beginning January 1, 2018 and each year after that, the minimum wage rates in the table will be indexed by inflation, with a maximum increase of 2.5%. The Commissioner of the Department of Labor and Industry can suspend the inflation increase if conditions indicate a “substantial downturn” in the state’s economy.

Implications
Most Aging Services of Minnesota members will meet the definition of “large employer” and will be subject to the highest minimum wage under this law. While most members pay relatively few employees below the new minimum wage, there are some that do have a substantial number at that level who will need to receive pay increases over the next few years. A bigger impact on members is likely to be the “ripple effect” where employers will need to give employees close to the new minimum an increase to maintain a gap between them and minimum wage employees.

Housing members will have to cover these increases by increasing revenue wherever they can. Because of their dependence on Medicaid funding nursing home members will receive a staged rate increase over the next three years to address the impact of the minimum wage increase including the ripple effect (see the article on “Care Center Minimum Wage Rate Adjustment.”)

Staff Contact: Jeff Bostic

Non-Emergency Medical Transportation

Chapter 312, Article 24, Sections 28-33 and 45
Amends 2012 Minnesota Statutes, Section 256B.0625. subd. 17, 18b, 18d, 18e and 18g
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: August 1, 2014

Background
Non-emergency medical transportation paid for by Medical Assistance has been an issue for years, and particularly so in rural areas. The distances, small number of transportation providers, and costs meant that nursing facilities and Elderly Waiver providers often had difficulty securing transportation for their residents or clients. This year the legislature tried a new approach.

Summary
The bill establishes the category of “nonemergency medical transportation services” and a Nonemergency Medical Transportation Advisory Committee, directs the commissioner to develop a single administrative assessment tool that is Web-based, creates requirements for the providers of these services, and prohibits the use of a broker except for establishing a level of service process. Most importantly, Medical Assistance can now pay clients, family members, and volunteers; and the modes of transportation can include their own vehicles, taxicabs, public transport, stretcher-accessible vehicles, lift/ramp equipped vehicles, and vehicles designed to transport ten or fewer individuals.

In the near future, MA will cover transportation in a protected vehicle that is not an ambulance or a police car but has safety locks, a video recorder, and a transparent thermoplastic partition between the passenger and the driver. The commissioner will have to develop a new rate structure for these new modes of transportation.

Implications
These new modes of transportation and the MA payments for them should improve the options available to MA recipients and reduce the problems that recipients have faced.

Staff Contact: Darrell Shreve

Pharmacy Changes

Chapter 291, Article 5
Amends MN Statutes Section 151, various subdivisions, and adds new language
H.F. 2402, Liebling-DFL, Zerwas-R
S.F. 2087, Sheran-DFL
Effective: August 1, 2014

Background
The Board of Pharmacy spent two years or more developing language that makes significant revisions in their statute. Most of the revisions will not affect care centers or senior housing, but a few may.

Bill Summary
The bill defines for the first time in statute a “chart order”. Chart orders are limited to long-term care facilities and hospitals. The order must contain the resident’s name, another patient identifier such as birth date or medical record number, the drug ordered, and “any directions that the practitioner may prescribe concerning strength, dosage, frequency, and route of administration.” The prescribing practitioner must sign the chart order when it is written or manually or electronically later when the chart order is given verbally.

The bill allows a pharmacist to engage in collaborative practice with a nurse practitioner. This could allow a NP to give the consultant pharmacist authority to manage patient medications, including initiating, modifying or discontinuing resident medication orders. The requirement for the nurse practitioner to work collaboratively with a physician remains.

Implications
In addition to legitimizing the long-standing use of chart orders, the bill eliminates many of the technical requirements for a prescription, like the resident’s address, the quantity to dispense, and refills.

Some nurse practitioners may take advantage of their new authority to work collaboratively with the consultant pharmacist to manage residents’ medications.

Staff Contact: Darrell Shreve

Prescription Monitoring Program Modifications

Chapter 291, Article 2, Sec. 3
Amends MN Statutes 152.126
H.F. 2402, Liebling-DFL, Zerwas-R
S.F. 2087, Sheran-DFL
Effective: August 1, 2014

Background
Under the state’s electronic reporting system for controlled substances, dispensers (e.g., pharmacists) did not have to report prescriptions dispensed to residents of nursing homes or persons receiving assisted living services.

Bill Summary
As part of an effort to enhance the reporting system, the bill provides for various reporting and monitoring activities. The exclusions for prescriptions dispensed to nursing home residents or recipients of assisted living services (as well as several others) are eliminated. There is a new exclusion for nursing home residents when the drug is distributed through an automated drug distribution system approved by the state.

A dispenser must provide to the resident or client for whom the prescription was written a conspicuous notice of the reporting requirements and notice that the information may be used for program administration purposes.

Implications
Members will need to explain to residents, clients, and families that the dispensers are required to file information about the individual’s prescription for a controlled substance and to give them the notice.

Staff Contact: Darrell Shreve

Reporting Diversion of Controlled Substances

Chapter 291, Article 4, Section 55
Amends MN Statutes 214.33 by adding a subdivision
H.F. 2402, Liebling-DFL, Zerwas-R
S.F. 2087, Sheran-DFL
Effective: July 1, 2014

Background
Health-related licensing boards have operated health professionals services programs for health professionals suffering from chemical dependency and other ailments, including the diversion on controlled substances, for up to 20 years. Individuals have been able to self-report and enroll in the programs. Licensing statutes for health professionals have included a reporting obligation, and professionals could meet that obligation by reporting the individual to the program or the licensing board. This year the legislature broadened who is responsible for reporting to include employers.

Bill Summary
The bill requires employers or health care institutions or other organizations where a regulated person is employed or provides services to report the diversion of narcotics or other controlled substances to the person’s health-related licensing board. There are three exclusions to this reporting requirement, as follows:

The individual is self-employed,
A professional learned of the diversion from his or her patient, or
The knowledge of the diversion first stems from the individual’s participation in a health professional services program.

Implications
Members will have to report the diversion of controlled substances to the health-related licensing boards of their licensed employees unless any of the exceptions apply. Administrators of care centers and managers of senior housing will need to report these diversions, rather than relying on their licensed employees to report them.

Staff Contact: Darrell Shreve

Triclosan Ban on Sales and Study

Chapter 277, Section 8
Creates new language at MN Statutes 145.945
S.F. 2192, Marty-DFL
H.F. 2542, Hortman-DFL
Effective: January 1, 2017

Background
Triclosan is an antibacterial ingredient in hundreds of products, but in recent years its effectiveness and safety have been challenged. Some challengers have claimed that the antibacterial product is no more effective than regular soap and water. This year a legislative effort to ban the chemical achieved partial success.

Bill Summary
The bill prohibits the retail sale of any cleaning product containing triclosan and is used by consumers for sanitizing or hand and body cleansing in Minnesota, effective January 1, 2017. The use will not be illegal—just the sale or purchase within Minnesota. Products that receive specific FDA approval for consumer use are exempt from the prohibition. Here is the language:

Sec. 8. [145.945] CERTAIN SALES OF CLEANING PRODUCTS PROHIBITED.
Subdivision 1. Prohibition. In order to prevent the spread of infectious disease and avoidable infections and to promote best practices in sanitation, no person shall offer for retail sale in Minnesota any cleaning product that contains triclosan and is used by consumers for sanitizing or hand and body cleansing.
Subd. 2. Exception. The prohibition in subdivision 1 shall not apply to individual products for which specific United States Food and Drug Administration approval for consumer use has been secured.

Implications
The 2017 effective date gives manufacturers plenty of time to remove triclosan from their cleaning products, and some have already done so. Providers who feel that cleaning products containing triclosan are superior or necessary will need to purchase from a vendor located outside Minnesota. In the meantime, there is ample opportunity to test other products without triclosan to compare to those with the agent.

In Chapter 291, Article 6, Section 36 contains this language:
Sec. 36. DIRECTION TO COMMISSIONER; TRICLOSAN HEALTH RISKS.
The commissioner of health shall develop recommendations on ways to minimize triclosan health risks.

Staff Contact: Darrell Shreve

Vulnerable Adult Act Reports by MDH and DHS

Chapter 192, Article 2, Section 1
Amends MN Statutes 626.557, subd. 12b
H.F. 2874, Liebling-DFL
S.F. 2367, Wicklund-DFL
Effective: August 1, 2014

Background
Current statutes require the commissioners of the Minnesota Departments of Health and Human Services each to prepare a report annually containing data about Vulnerable Adult Act investigations and results conducted by their separate departments.

Bill Summary
The bill requires the two commissioners to post their reports on their websites annually, and it eliminates the requirement that the reports must be separate. The bill requires a report to the legislature and the governor every two years, and the report must address the topics required in the bill.

Implications
The two departments will now issue a combined report, posting it each year on their websites and providing a written report to the legislature and governor every other year.

Staff Contact: Darrell Shreve

Women’s Economic Security Act (WESA)

Chapter 239
Amends Various Sections of MN Law
H.F. 2536, Melin-DFL
S.F. 2050, Pappas-DFL
Effective: Various-See Below

DLI WESA Fact Sheets

Background
Just prior to the start of session, the House and Senate DFL released a package of bills designed to help women in the workplace. In addition to employment provisions, the proposal included an attempt to reduce the gender pay gap, funding for workforce programs designed to help women in non-traditional jobs and encourage women entrepreneurs. It was an aggressive package and many changes were made throughout the legislative process to address concerns of the business community, including removing a new proposal for paid sick leave. But pieces of the bill remained controversial throughout the session, despite bipartisan efforts to secure more workable language. The bill eventually passed and was signed into law on Mother’s Day.

Bill Summary
This bill has multiple sections and covers many areas of employment law. Below is a summary of the key provisions, organized by effective date:

Provisions effective May 12, 2014:
Pregnancy Accommodations: Employers who have 21 or more employees at a site must provide reasonable accommodation to pregnant employees who have worked 12 consecutive months and on average half of a full-time schedule as defined by the employer if an employee requests one, with the advice of her healthcare provider. Such a request for a reasonable accommodation requires employers to engage in the interactive process with the employee.

The employer must provide more frequent restroom, food, and water breaks, seating, and lifting limits over 20 pounds, without proof of medical necessity.

A temporary transfer to a less strenuous or hazardous position may be required where other accommodations are not possible. Employees are not required to accept an accommodation or take a leave due to pregnancy.

Protections for Familial Status: “Familial status” is a new protected class for purposes of employment under the Minnesota Human Rights Act. “Familial status” is “the condition of one or more minors being domiciled with (1) their parent or parents or the minor's legal guardian or (2) the designee of the parent or parents or guardian with the written permission of the parent or parents or guardian.” The prohibition against discrimination based on familial status also protects pregnant women and anyone “in the process of securing legal custody of an individual who has not attained the age of majority.”
Labor organizations, employers and employment agencies are all prohibited from discriminating on the basis of familial status. Employees and applicants cannot be required to provide information regarding their familial status.

Provisions effective July 1, 2014:
Minnesota Parenting Leave Law: WESA amends the Minnesota Parenting Leave Law to provide 12 weeks of unpaid leave (up from 6) for pregnancy and parenting, and brings Minnesota law generally into accordance with the federal Family and Medical Leave Act with respect to eligibility for leave. The law expands use of leave to cover prenatal care, incapacity due to pregnancy, childbirth, or related health conditions for female employees only.

The law also modifies requirements regarding timing of leave, which may now begin anytime within 12 months after the birth or adoption of a child, or within 12 months after the child leaves the hospital, if the child remains in the hospital longer than the mother.

Use of Paid Sick Leave: Employees may now use accrued personal sick leave benefits provided by the employer for absences due to an illness of or injury to the employee's mother-in-law, father-in-law, and grandkids (including step-grandchildren, biological, adopted or foster grandchildren). Previously, employees could use accrued personal sick leave for absence due to an illness of or injury to the employee's child, spouse, sibling, parent, grandparent, or stepparent under the sick leave statute.

Under the new law, employees may also use accrued personal sick leave time for “safety leave”, which is “leave for the purpose of providing or receiving assistance because of sexual assault, domestic abuse, or stalking.” As noted above, employees may take safety leave to obtain their own assistance or to obtain assistance for a relative covered under the sick leave statute.

This provision only applies to those employers that do provide sick leave benefits and does not require employers to provide paid sick leave.

Nursing Mother Accommodations: Under WESA, employers must provide nursing mothers with a room or other location that: (1) is not a bathroom or bathroom stall; (2) is shielded from view, free from intrusion; and (3) includes access to an electrical outlet for expressing milk. Employers may not retaliate against employees for asserting this right. Additionally, employees may bring a civil action against employers for violating these provisions, seeking damages and attorney’s fees.

Wage Disclosure Protection: Under the new law, employers cannot prohibit employees from disclosing their wages as a condition of employment or take adverse action against an employee for discussing their wages. Employees can bring civil action against employers for violating these provisions, and seek back pay, reinstatement, restoration of lost service credit and attorney fees. WESA explicitly requires a notice of these rights, protections, and remedies in an employer handbook, if the employer provides a handbook.

Equal Pay Certification: WESA amends the Minnesota Human Rights Act (MHRA) to require certain state contractors to obtain a certificate periodically from the Minnesota Department of Human Rights (MDHR) regarding compliance with equal pay laws. This requirement will apply to businesses with state contracts for goods or services in excess of $500,000 and 40 or more full-time employees. This requirement will not apply, however, to most contracts with the state regarding insurance, health care, or the reimbursement of health care services.

As a condition of doing business with the state, contractors have long been required to obtain certificates of compliance from the MDHR confirming that the contractor has filed an affirmative action plan and related reports. Under this new law, covered businesses will also now be required to obtain a separate equal pay certificate. The employer will need to certify that it is in compliance with Title VII of the Civil Rights Act of 1964, Equal Pay Act of 1963, MHRA, and Minnesota Equal Pay for Equal Work Law.

As part of its equal pay compliance statement, the business is also required to identify and describe the "approach" that it uses to set compensation and benefits.

The new statute requires state contractors to compare periodically the compensation being paid to women versus men performing the same jobs and within the broader job categories utilized for EEO-1 reporting. Such an exercise will reveal the extent to which men and women may tend to be concentrated in different jobs and suggest opportunities to increase pay equity by seeking to recruit and retain women in higher-paying jobs.

Aside from this new reporting, WESA does not change existing pay equity laws.

Other Provisions:
Unemployment Insurance: The new law makes changes to Minnesota unemployment law to make it more likely that victims of sexual assault and stalking will qualify for benefits. WESA will provide unemployment compensation if “the applicant quit because domestic abuse, sexual assault, or stalking of the applicant or immediate family member of the applicant necessitated the applicant’s quitting employment.” The law defines employment misconduct to exclude employment misconduct that was a result of being a victim of sexual assault or stalking. These provisions apply to determinations and appeal decisions issued on or after the effective date of October 5, 2014.

Grant Programs: There are one-time appropriations to establish grant programs to increase the number of women in high wage, high demand nontraditional occupations and to promote the creation and expansion of women-owned businesses. These programs are one-time appropriations for fiscal year 2015.

Retirement Savings Plan: The law also requires a report to the Legislature by January 1, 2015 on the feasibility of a state-administered retirement savings plan available to employees without access to either an automatic enrollment payroll deduction IRA maintained or offered by their employer, or a multiemployer retirement plan or qualifying retirement plan. While this section is effective immediately, there are no substantive changes that employers need to be aware of at this time.

Implications
These provisions will require members to review their employee policies, handbooks and affirmative action statements.

Staff Contact: Kari Thurlow

Housing/HCBS

245D Amendments

Chapter 291, Article 8, Sections 1-5, 12 and 14
Amends MN Statutes 2013 Supplement, section 245D.071, subd. 1 and 4, 245D.09, subd. 4, 4a, 5, MN Statutes 2012, section 256D.01, subd. 1e and 256G.02, subd. 6
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: August 1, 2014
Chapter 312, Article 27, Section 5-48
Amends MN Statutes 2013 Supplement, section 245, 245A and 245D
H.F. 3172, Carlson--DFL
S.F. 2785, Cohen--DFL
Effective: July 1, 2014

Background
The 245D licensing requirements were implemented beginning January 1, 2014, but some revisions were needed this year to clarify the requirements. Given the wide range of provider types that now fall under this license, it would not be surprising if more clarifications are needed in future years.

Summary
The 2014 245D amendments from Chapter 291 address the following topics:

Some 245D license holders providing intensive support services (BI/CADI behavioral support services, DD crisis respite and specialist services and various in-home support services) must now comply with the service planning requirements for “basic services” contained in 245D.03, subd. 2 instead of other requirements in that section;
New language has been added regarding the coordinated service and support plan addendum developed by the licensee. Under the amendment, if the client or the client’s legal representative or the case manager has not signed and returned this document or has not proposed written modifications to the license holder’s submission within ten working days, the licensee’s submission is “deemed” approved and is effective until the legal representative or case manager submits a written request to revise the plan;
Clarifications have been added that orientation to program requirements must be within 60 days of hire and orientation must cover ten hours for direct support staff providing basic services and 30 hours for staff providing intensive services. Orientation must now include safe and correct use of manual restraint on an emergency basis and what constitutes use of restraints, basic first aid and staff responsibilities related to prohibited procedures under section 245D.06, subd. 5;
Some changes have been made to the orientation requirements for community residential services, and staff orientation to individual service recipient needs must include instructions on monitoring a medication condition that could become life-threatening without proper use of the medical equipment, such as ventilators;
Some changes have been made to the annual training requirements for staff. More annual training is required for staff providing basic services that have less than five years of documented experience; and
The definition of “excluded time” under MN Statutes 2012, section 256G.02, now includes time in a community residential setting licensed under 245D.

Chapter 312 makes a number of technical changes as well as more extensive substantive changes to the 245D requirements. These amendments address:

Prohibitions and limits on restrictive interventions and new language explaining what is not considered a mechanical restraint, as well as revisions to the definition of “seclusion;”
New timelines and requirements related to the service initiation and service planning requirements;
Revisions to the definition of “time out;”
Changes have been made to provisions related to medication set-up, medication assistance and medication administration, including injectable medications and use and monitoring of psychotropic medications;
New language prohibits a license holder or staff person from accepting an appointment as guardian;
New language explains the limits when a restricted procedure is allowed;
Required assessments that the license holder must, at minimum, complete before the 45-day planning meeting;
New language requires that the staff person reviews and receives instruction on mental health crisis response, de-escalation techniques, and suicide intervention when providing direct support to a person with a serious mental illness; and
Qualifications for behavior professionals, behavior analysts and behavior specialist.

Implications
The 245D license covers a variety of services for disabled waiver recipients, but does not include Customized Living services and adult day services among others, so these 245D changes many not affect many Aging Services members. However, home care providers that offer services that are covered by 245D, such as CADI respite services, should review these changes and watch for additional information on the HCBS designation being developed jointly by MDH and DHS for home care providers that provide some services that otherwise must be licensed under 245D.

Staff Contact: Mary Youle

Affordable Housing

Chapter 294, Article 1, Section 23
H.F. 2490, Hausman-DFL
S.F. 2605, Stumpf-DFL
Chapter 295, Sections 18-20
Amends MN Statutes 2012, section 462A
H.F. 1068, Hausman-DFL
S.F. 882, Stumpf-DFL
Chapter 312, Article 2, Section 16
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
As is typical in non-budget years, a major focus of the 2014 legislative session was putting together a capital investment package/bonding bill. These bills included funding for housing programs through the Minnesota Housing Finance Agency.

Summary
Chapter 294, the General Obligation (GO) Bond Bill, includes $20 million in GO bonds for public housing rehabilitation. These funds will be awarded by Minnesota Housing Finance Agency (MHFA) to public housing authorities across the state through a competitive application process. Public housing authorities will be able to use the funds for health, safety and energy efficiency upgrades to aging public housing stock. The Agency anticipates more than 3,000 units of public housing could be rehabilitated with this funding.

Chapter 295, Sections 18, 19 and 20, authorizes MHFA to issue $80 million in Housing Infrastructure Bonds. The bill includes an appropriation from the General Fund to pay the debt service for the life of the bonds. The appropriation is $6.4 million per year for 22 years.

Housing Infrastructure Bond proceeds can be used for three primary purposes:

to construct or acquire and rehabilitate housing that will be used as permanent supportive housing for those who have experienced homelessness,
to preserve existing federally-assisted housing, or
to acquire and rehabilitate foreclosed rental housing or for new construction of rental housing on parcels that have been foreclosed.

In addition, bond proceeds may be used by community land trusts for the cost of acquiring the land that will be held by the land trusts for single family housing.

MHFA will award the Housing Infrastructure Bond proceeds through its annual competitive request for proposal process. The Agency estimates that more than 1,500 units of housing will be constructed or preserved with the Housing Infrastructure Bond proceeds.

The Supplemental Budget Bill, Chapter 312, includes appropriations in addition to the FY2014-15 biennial budget approved by the Legislature in the 2013 session, and also makes modifications to appropriations made in the biennial budget as follows:

$2.2 million is appropriated to MHFA for up to two grants for housing projects in communities that have low vacancy rates and education and training centers for jobs in the natural resources or aviation maintenance fields. Funds not committed by the end of calendar year 2015 may be transferred to the Agency’s Economic Development and Housing Challenge program.
The bill creates a $500,000 set-aside of existing funds within the Economic Development and Housing Challenge (Challenge) program for creating homeownership opportunities for families with children with disabilities who have faced eviction because of the child’s disabilities. If the funds are not expended by October 31, 2014, they will return to the Challenge program. The Agency will issue a notice of these funds as part of the current RFP.
$250,000 is appropriated to MHFA for up to five housing needs assessments for veterans in communities across the state. The studies may examine the need for scattered site housing for veterans who are homeless or have experienced homelessness.
In addition to these appropriations, the supplemental budget bill includes a provision requiring MHFA to notify the Chairs of Committees with jurisdiction over the Agency of its Affordable Housing Plan and requiring the Agency to report to the Legislature on its efforts to reduce the homeownership gap between households of color and white households.

Some other housing-related provisions related to home ownership were included in the tax bill but are not covered in this report.

Implications
MHFA’s priorities continue to emphasize family housing and support for people who are homeless or at risk of homelessness, but older adults will benefit from the improvements to public housing and the preservation of federally-assisted housing and foreclosed properties.

Staff Contact: Mary Youle

Disability Waiver Rate Calculations and Rate Adjustments

Chapter 312, Article 27, Sections 61-69 and 76
Amends MN Statutes 2013 Supplement, section 256B
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
The methodology for calculating rates for disability waiver services has been changed in recent years, and this methodology is very different than the Customized Living Rate Setting Tool. When the new disability waiver rate calculation methodology took effect last year, there was confusion on how to implement it by older adult providers serving a younger waiver clients.

Summary
The new amendments make some technical modifications to “banding period,” day service, unit-based service with or without programming and residential service recipients. DHS must review all changes to rates that were in effect on December 1, 2013 to verify that the rates in effect produce the equivalent level of spending and service unit utilization on an annual basis as those in effect on October 31, 2013. Adjustments to rates to provide equivalent annual spending must be made by December 31, 2014.

Additional changes include new definitions of “individual staffing” and “shared staffing.” New language describes what a “unit of service” is for various types of services—residential support services, day services, unit-based services with programming, and unit-based services without programming. The changes also address determination of service levels based on the client’s needs. Staffing ratios are added as a component of payments for services with day programs.

A number of new provisions have been added related to the need for more research and evaluation of rates. Based on the DHS evaluation and data, DHS is required to make recommendations by January 15, 2015, to address any issued identified during the first year of implementation of the disability waiver rate methodology. DHS may make additional recommendations after that date. A final provision directs DHS to adjust rates based on the 1 percent increase for HCBS providers that was effective on April 1, 2014, and for the 5 percent rate increase enacted during the 2014 session.

Implications
Adjustments to rates by the end of 2014 to provide equivalent annual spending will be helpful to some providers who lost revenue under the new methodology. Based on the data collection and evaluation that DHS will be conducting, it is certainly possible that more changes to this methodology will be made in the future, and implementation of these changes would benefit from improved training and communications from DHS.

Staff Contact: Mary Youle

Essential Community Supports

Chapter 291, Article 8, Section 8
Amends MN Statutes 2013 Supplement, section 256B.0922, subd. 1
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: August 1, 2014

Background
Adding adult day services as an eligible service under the Essential Community Supports (ESC) program was a high priority for the Minnesota Adult Day Services Association (MADSA), and Aging Services assisted MADSA with this amendment. This program has not yet been implemented but is expected to be in place when the Level of Care (LOC) changes are implemented in January, 2015. ECS is designed as a safety net for individuals who lose eligibility for Medical Assistance when the LOC changes become effective.

Summary
With the addition of adult day services, services that can be covered by Essential Community Supports include:

Adult day services
Caregiver support
Homemaker support
Chores
A personal emergency response device or system
Home-delivered meals, or
Community living assistance as defined by DHS.

“Community living assistance” has not yet been defined, but it is likely that DHS will issue a bulletin with details on Essential Community Supports when that program is about to be implemented.

Implications
This amendment means that adult day providers will be able to continue to serve clients that lose their eligibility for Medical Assistance waiver services after the implementation of the LOC changes.

Staff Contact: Mary Youle

Group Residential Housing

Chapter 291, Article 8, Sections 15 and 16
Amends MN Statutes 2012, section 256I.03, subd. 3 and 256I.04, subd. 2a
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: August 1, 2014

Background
The Minnesota Department of Human Services initiated legislation several years ago to create a new type of residential license for “community residential settings.” Now that the 245D licensing requirements became effective on January 1, 2014, to cover these community residential settings, DHS is developing conforming language to enable these settings to qualify for Group Residential Housing payments

Summary
Under the amended language, community residential settings may now receive Group Residential Housing (GRH) payments if these settings are licensed under section 245D.02, subd. 4a.

Implications
Although the 2014 GRH changes are technical changes to address settings that are now being licensed under MN Statute 245D, more major reforms to the GRH program are expected in 2015. DHS currently has a stakeholder group that is meeting to advise the department on changes to simplify and streamline the GRH program.

Staff Contact: Mary Youle

HCBS Designation; Integrated License

Chapter 312, Article 23, Section 5
Creates new section of law, 144A.484
H.F. 3172, Carlson--DFL
S.F. 2785, Cohen--DFL
Effective: July 1, 2015

Background
As the new 245D license was being developed and the home care licensing requirements were being revised, MDH and DHS found that some providers might fall under both sets of licensing requirements. In order to avoid duplicate licensing by two departments, these state agencies agreed to work together to develop an “integrated” home care/245D license. As a result, providers who would otherwise need both licenses will be able to have a home and community-based “designation” in addition to their home care licenses.

Summary
Although initially we were told that the home care license would be sufficient for home care providers also covered by 245D until the “integrated” license became available, the new statutory language says that the 245D requirements will be enforced from January 1, 2014, until June 30, 2015. However, the new language requires DHS to provide technical assistance to help providers comply with the 245D requirements. If a survey finds that a provider does not comply with any of the 245D requirements, but the failure does not endanger the health, safety or rights of the client, DHS may issue a report with recommendations for achieving compliance. We interpret this to mean DHS will take a lenient approach toward minor infractions during this initial period.

Beginning July 1, 2015, a home care provider may apply to DHS for a home and community-based designation for the provision of “basic support services” that would otherwise require a 245D license. DHS will develop the application forms and procedures for applying for this designation. The 2014 amendments describe which of the 245D requirements are applicable to home care providers with the HCBS designation. Fees for the designation are based on the provider’s annual revenue from HCBS services that require a 245D license. The initial fee is $155 and after that, the fees range from $40 to $320, based on HCBS revenue from 245D services.

Apparently, MDH and DHS plan to develop a bill of rights that combines the home care bill of rights with the rights guaranteed for 245D clients for home care providers with the HCBS designation.

The new language describes the monitoring and enforcement of this designation by DHS and also creates an appeal process for home care providers that have their HCBS designation denied, suspended or revoked.

Implications
Aging Services will seek feedback from home care providers who must obtain this HCBS designation to determine if there is unnecessary duplication or any conflict when implementing the home care and 245D requirements. It is yet unknown how DHS will monitor the compliance with the HCBS designation requirements since DHS does not have survey staff located around the state.

Staff Contact: Mary Youle

HCBS Programs Rate Increase

Chapter 312
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
The 2013 Legislature only approved a 1% general rate increase effective April 1, 2014 for HCBS programs. As a result, HCBS provider organizations, including Aging Services of Minnesota, formed the 5% campaign to lobby for a 5% increase for HCBS programs. Despite the cost of more than $80 million in the first year support for the proposal was strong and, despite some discussion of reducing the increase to 4% because of the 1% increase occurring on April 1, this legislation included a 5% increase effective July 1, 2014.

Bill Summary
The 5% increase for HCBS will be provided on July 1 to a total of twenty-six HCBS waiver and grant programs, including the Elderly Waiver program. The increase is divided into two components- 1% tied to a quality improvement project, and 4% tied to a compensation plan.

The quality improvement component of the legislation requires that providers submit to the commissioner of DHS information about a project they will implement by June 30 of next year to improve the quality of services, improve resident quality of life, or to enhance efficiency. Providers who do not submit a plan by the date required by the commissioner (which is not specified in the legislation) shall have the quality portion of the rate increase removed from their rates on January 1, 2015.

Providers are also required to do a compensation plan that shows how they will spend 80% of the increase (4 of the 5%) to increase compensation for employees. Previous pay increases cannot be included in the plan, but costs that can be included, in addition to pay increases, are employer share of benefit cost increases and recruiting and training costs. The plan must be shared with the commissioner of DHS if requested, and it must be posted for employees for six weeks by January 1, 2015.

Implications
The increase in rates is much needed, especially for elderly waiver providers who have endured several years of cuts before this year. The quality requirement appears to be a first step into the quality area that will be easy for providers to comply with, but the compensation plan requirement is potentially more problematic, especially for providers who are part of larger organizations who do not plan pay increases this year because of the lack of an increase in care center rates.

Staff Contact: Jeff Bostic

HCBS Quality Add-On Revision

Chapter 312
Amends MN Statutes section 256B.439, subdivision 7
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2015

Background
The 2013 Legislature approved a 1% average quality add-on for HCBS programs effective July 1, 2015. Since that time, DHS has been working to develop a quality measurement system for HCBS programs that can be used to determine the amount of quality add-on that individual providers will receive. This language, which was brought forward by the department, makes some changes to the quality add on language that was passed last year.

Bill Summary
This language makes three substantive changes to the quality add-on that will be effective on July 1, 2015:

It clarifies that the quality add-on becomes part of the individual provider’s payment rate going forward, so the funding for the quality add on will not be redistributed each year
It adds language that indicates that all HCBS providers will receive a “minimum rate increase” (amount not specified) from the quality add-on pool
This language also gives the commissioner the power to limit the application of the quality add-on to certain provider types “based on availability of quality measures and outcomes data.”

Implications
The quality add-on clearly remains a work in progress, and it is important to remember that there is still another legislative session before it takes effect so it could be changed further. As DHS works to develop quality measures for HCBS providers, it appears that they do not expect to have an effective measurement system for all HCBS providers in place by July 1 of next year. As a result, it seems likely that for some providers the “minimum rate increase” under this language will be the average increase of 1%, because there is no quality data to calculate a quality add-on. For other programs, there will be a quality add on, which means that the minimum rate increase will be less than 1%, but the upside for providers with good quality scores will mean that they can earn increases that exceed the average of 1%.

Staff Contact: Jeff Bostic

HCBS Settings for Waiver Clients and DHS’ Transition Plan

Chapter 291, Article 8, Sections 10 and 11
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Chapter 312, Sections 70 and 74
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Amends Minnesota Statutes 2013 Supplement, section 256B.492
Effective: Various dates

Background
The disability waivers have included limitations on the number of waiver clients permitted in a single setting for a number of years, and various amendments have been made in the past to make these limits more flexible. One of these amendments initiated by the LTC Imperative permitted buildings with more than four units to have the greater of four or 25 percent of the units occupied by waiver clients. This year the Coalition for Choice in Housing worked to add even more flexibility to the language to accommodate some developments designed specifically for persons with various types of disabilities or diagnoses, but after many attempts at revisions to the language, the Coalition was only able to get approval of exception language for a single proposed project.

Summary

The amendments now include a “community residential setting of up to five people” in the list of settings where persons with disabilities may receive waiver services.
The language related to four units or 25 percent of units has been clarified to refer to individuals with disabilities “who receive services under a home and community-based waiver.”
New language exempts a new project in Hennepin County that is scheduled to open by July 1, 2016, from the restrictions on where waiver clients may reside. However, if this program does not ultimately meet the CMS rules for HCBS settings, the exemption is void. DHS will not know if this project meets the CMS requirements until it submits its transition plan to CMS for approval.
Under a new provision, the Department of Human Services will develop a transition plan to comply with the January 16, 2014, CMS rules defining HCBS settings. The plan must be submitted to CMS by December 31, 2014, and by January 15, 2015, DHS must provide a report about the plan and negotiations with CMS to the legislature. This report must include recommendations for any legislation and funding that will be necessary to implement the plan.

Implications
It is still unknown how flexible CMS will be in the application of its January 16 requirements for HCBS settings. Although housing projects designed specifically for people with disabilities, such as a project in the works for persons with developmental disabilities, will clearly be affected by DHS’ transition plan and CMS’ requirements, other non-residential services, such as adult day, may also be affected.

Staff Contact: Mary Youle

Home Care Amendments

Chapter 291, Article 6, Sections 13-18
Amends Minnesota Statutes 2013 Supplement, section 144A.474, subd. 8, 12, section 144A.475, subd. 3, adds new subdivisions. 3a and 3b, section 144A.4799, subd. 3
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: Provisions generally effective August 1, 2014, but some provisions for agencies licensed as of December 31, 2013, the effective date is on or after July 1, 2014, upon license renewal.

Background
The home care law was completely re-written in 2013, but the Minnesota Department of Health identified changes that would be helpful related to reconsideration of orders, hearings and temporary suspension expedited hearing. Aging Services of Minnesota, along with other provider associations, worked with MDH to craft the final language.

Summary
The 2014 amendments to the home care law address the following issues:

Correction orders may now be either scanned or emailed to the last known home care provider email address or mailed via snail mail within 30 calendar days after the survey exit date. This is effective August 1, 2014, and for agencies licensed as of December 31, 2013, this is effective upon license renewal on or after July 1, 2014.
A written request for reconsideration of a correction order must now be received by MDH within 15 calendar days of the correction order receipt date. This does not apply to agencies with a temporary license. This is effective August 1, 2014, and for agencies licensed as of December 31, 2013; this is effective upon license renewal on or after July 1, 2014.
A technical clarification was made regarding when MDH may temporarily suspend a license or prohibit delivery of services by a provider. The new language specifies that MDH may take this action when there are level 3 or 4 violations when the provider has failed to correct the problem, MDH has reason to believe that other administrative remedies are not likely to be effective and there is an opportunity for a contested case hearing within 30 days (reduced from 90 days) unless an administrative law judge (ALJ) grants an extension.
A new subdivision has been added with details about a hearing related to a licensee’s timely appeal of a sanction. Within 15 business days of the receipt of the request, MDH will request assignment of an ALJ, and the hearing must be conducted within 90 days of the request for assignment unless an extension is granted. There is a limit imposed on the number of extensions. If an agency continues to operate pending an appeal of an order for revocation, suspension or refusal to renew a license, MDH may immediately temporarily suspend its license if MDH identifies any new level 3 or 4 violations. This section is effective for appeals received on or after August 1, 2014.
A new subdivision has been added to provide for an expedited hearing related to a temporary suspension. Within five business days of receipt of the licensee’s timely appeal of a temporary suspension, MDH will request assignment of an ALJ, and a hearing must be conducted within 30 calendar days of the request of assignment unless either party requests and is granted an extension. MDH must issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. The ALJ must issues findings of fact, conclusions and a recommendation within ten business days from the date of the hearing. The parties then have ten calendar days to submit exceptions to the ALJ’s report. The MDH commissioner’s final order shall be issued within ten business days from the close of the record. The licensee is prohibited from operation during the temporary suspension. If the commissioner affirms the immediate suspension and the licensee appeals the sanction, the licensee is prohibited from operation pending a final order after the contested case hearing conducted under chapter 14. This is effective August 1, 2014.
Technical changes were made to the charge of the home care Advisory Council, which was given a new charge to advise MDH on “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.”

Implications
Receiving correction orders by email may speed up the process for both providers and MDH, although it will be important for MDH to verify that the emailed orders have been received by the agency. Aging Services will watch for feedback from members on this process. The clarifications regarding the timing of appeals and requests for reconsideration may be helpful, but again this is something that needs to be monitored and to see if providers have a fair appeals process. The new charge for the Advisory Council reflects internal discussions at MDH regarding how they can streamline the requirements for nursing homes who would like to provide some limited services to their apartment residents. The language that these services could be in an “independent living” apartment building suggests that this integrated license would not be able to provide services to residents of a registered housing-with-services establishment, but we will follow the discussions at the Advisory Council meeting for more information on how MDH may address this in future legislation.

Staff Contact: Mary Youle

Housing Courts

Chapter 205
Amends MN Statutes 2012, section 484.013, subdivision 3
H.F. 2407, Hilstrom-DFL
S.F. 2152, Latz-DFL
Effective: Aug. 1, 2014

Background
Delays in housing court can be expensive for providers, and it is possible that some attorneys might request a hearing by a judge as a delay tactic. If a hearing by a judge is requested, given how full the courts’ calendars are, the senior housing provider may be faced with a costly delay.

Bill Summary
This bill allows housing courts and housing calendars to use referees almost exclusively for landlord-tenant cases. The bill language says the chief judge of district court may appoint a referee for the housing calendar program and says that the provision in Section 484.70, subdivision 6, does not apply with regard to housing court. Section 484.70, subdivision 6 prohibits a referee from hearing a contested trial, hearing, motion or petition if a party or attorney objects in writing to the assignment of a referee to hear the matter, but this provision now will not apply to the housing calendar program under the 2014 amendment.

Implications
This bill is expected to speed up actions in housing court through the use of experienced, knowledgeable referees in place of judges.

Staff Contact: Mary Youle

Housing-with-Services Establishment Requirements for Dementia Training, Manager Training and Emergency Planning

Chapter 291, Article 6, Sections 19-21 and 35
Amends MN Statutes 2012, section 144D.065 and adds new sections 144D.10 and 144D.11
H.F. 2402, Liebling-FL
S.F. 2087, Sheran-FL
Effective: January 1, 2016, for new training and emergency planning requirements.

Background
Aging Services began working with our LTC Imperative partner on enhancements to the Housing-with-Services Contract Act in 2012 but our legislation dealing with dementia training, continuing education for housing managers and emergency planning and training was not introduced during the 2013 session.

As we began planning for the 2014 session, we had a number of meetings with a broad set of stakeholders, including the Alzheimer’s Association. In order to have this legislation passed, it was important to legislators that we reach consensus among providers and consumers on a single proposal.

We were able to negotiate compromise language as well as a delayed effective date and a study regarding whether additional requirements are needed.

Bill Summary
1) Dementia Training Requirements—Effective January 1, 2016
The dementia training requirements cover two types of housing-with-services settings and are different for these two types of buildings. The required training topics for employees in these establishments are:

An explanation of Alzheimer’s disease and related disorders;
Assistance with activities of daily living;
Problem solving with challenging behaviors; and
Communication skills.

A. For those housing-with-services establishments that have a special dementia program or care unit or establishments that advertise, market or otherwise promote themselves as providing dementia care services, the dementia training requirements for both the establishment’s employees and the staff of the arranged home care provider are:

Until this initial training is complete, direct care employees may not provide direct care unless there is another employee on site who has completed the eight hours of training and who can act as a resource and assist if issues arise. A person who provides the training listed above, or a supervisor who has had the initial training must be available for consultation until a new direct care employee has completed the eight hours of training.

New employees, including housing managers, may satisfy the initial training requirements if they have documentation of having completed the required training within the previous 18 months.

B. Housing-with-services establishments that offer assisted living services under MN Statute 144G but that do not have specialized dementia units or programs must provide staff with training on the topics listed above as follows:

New employees, including housing managers, may satisfy the initial dementia care training requirements if they have documentation of having completed the required training within the previous 18 months.

2) Summary of Housing Manager Continuing Education Requirements—Effective January 1, 2016
In addition to the dementia care training requirements for housing-with-services managers described above, under the new section of law, MN Statutes 144D.10, the person “primarily responsible for oversight and management of a housing-with-services establishment” (as designated by the building owner) must obtain at least 30 hours of continuing education every two years of employment as the manager. This continuing education requirement applies to all housing-with-services establishments, not just those that offer assisted living or specialized dementia care services.

The training topics are not specified, but must be relevant to the operations of the building and the needs of its tenants.
CEUs earned to maintain a professional license (e.g., nursing home administrator, nursing license, social worker license, real estate license) can be used to meet this requirement.
The continuing education credits do not need to be approved, but records must be kept for at least three years to document that the requirement has been met. The annual housing-with-services registration will include a statement that must be signed verifying that the requirement has been met.

3) Emergency Planning and Training of Staff and Tenants—Effective January 1, 2016
Under the new section of law, MN Statutes 144D.11, each registered housing-with-services establishment 1) must have an emergency plan, 2) must provide training to staff and make the training available to tenants and 3) must conduct drills.

The emergency plan must:

Include a plan for evacuation,
Address sheltering in place,
Identify temporary relocation sites, and
Detail staff assignments in the event of a disaster or emergency.

In addition, the building must:

Post an emergency disaster plan prominently,
Provide building emergency exit diagrams to all tenants upon signing a lease,
Post emergency exit diagrams on each floor, and
Have a written policy and procedure regarding missing tenants.

Staff must be trained on the emergency/disaster plan during the initial staff orientation and annually thereafter. New staff members that have not yet received the emergency/disaster training are allowed to work only when trained staff is working on-site. Emergency/disaster training must be available to all tenants annually. The term “available” was designed to accommodate tenants who cannot participate in training because of physical or cognitive disabilities.

Each registered housing-with-services establishment must conduct and document a fire drill or other emergency drill at least every six months, although most buildings are already required to do quarterly drills under the Minnesota fire code. To the extent possible, drills must be coordinated with local fire departments or other community emergency resources.

4) Study of the Need for Additional Dementia Care Education—Report and recommendations due to the Legislature no later than February 15, 2015

The LTC Imperative was able to limit the new dementia care training requirements to only some housing-with-services establishments based on an agreement to continue to work with the Alzheimer’s Association, the Ombudsman for LTC, the Minnesota HomeCare Association and other stakeholders to evaluate the following:

Whether additional settings, provider types, licensed and unlicensed personnel, or MDH-licensed health services should be required to comply with the new training requirements related to dementia care, housing managers and emergency planning;
Cost implications for these groups or individuals to comply with the training requirements;
Dementia education options available;
Existing dementia training mandates under federal and state laws and rules; and
The enforceability of the new requirements and methods to determine compliance with the training requirements.

Implications
The new dementia and housing manager training requirements may impose additional costs on housing-with-services establishments, but the delay in the effective date was designed to give providers time to make adjustments in their budgets to accommodate the additional costs. It will be helpful as we begin the discussion related to the required study and report if providers can give Aging Services staff an estimate of the cost of implementing the new requirements. The report and recommendations for the Legislature could result in additional providers falling under these new training requirements.

Staff Contact: Mary Youle

Landlord-Tenant Law and Victims of Violence

Chapter188
Amends MN Statutes 2012, Section 504B.171, 504B.206 and 504B.285, subd. 1.
H.F. 859, Simon-DFL
S.F. 771, Hayden-DFL
Effective: Aug. 1, 2014

Background
Previously, Minnesota’s landlord-tenant law allowed victims of domestic abuse to terminate their lease without penalty or liability if they need to move due to a fear of additional violence. This bill extends the same protection to tenants who are victims of other types of violence.

Bill Summary
The bill extends the current law that allows victims of domestic abuse to terminate a lease without penalty or liability to include victims of other types of violence. Under the 2014 amendment, if a tenant “or another authorized occupant” fears imminent violence after being subjected to domestic abuse, criminal sexual conduct, or stalking, the tenant may terminate the lease without penalty or liability.

To terminate the lease under these circumstances, the tenant must provide the landlord with a signed and dated advance written notice to terminate the lease. This notice must describe the fear of imminent violence, include the date by which the tenant will vacate the premises and include written instructions for the disposition of any remaining personal property. The notice must be accompanied by a “qualifying” document, which is:

a valid order for protection,
a no contact order,
a court document that verifies that the tenant or authorized occupant is a victim of domestic abuse, criminal sexual conduct or stalking, or
a statement by a qualified third party (a licensed health care professional, a domestic abuse advocate or a sexual assault counselor) using the form included in the law.

The landlord may request that the tenant disclose the name of the perpetrator, and if such a request is made, the landlord is to inform the tenant that the landlord wants the perpetrator’s name in order to protect other tenants in the building. However, the tenant is not required to disclose the perpetrator’s name to the landlord, and disclosure is not a precondition of terminating the lease.

The landlord is prohibited from disclosing to others the information s/he receives from a victim of violence who wishes to terminate the lease.

A tenant who is a sole tenant and who terminates a lease under these circumstances is responsible for the rent payment for the full month in which the tenancy terminates, and the tenant forfeits all claims for the return of the security deposit. Similar stipulations are included in situations where there are multiple tenants, one of whom is terminating the lease due to fear of violence. Any tenant whose tenancy was terminated under the language regarding multiple tenants may reapply for a new lease with the landlord.

The new language includes a provision that if this law conflicts with a federal statute, regulation or handbook regarding termination of a federally subsidized tenancy, the landlord must follow the federal requirement.

Another provision prohibits a landlord from beginning an eviction action against a tenant or authorized occupant solely on the basis that the tenant or authorized occupant has be the victim of domestic abuse, criminal sexual conduct or stalking.

Implications
This law should not have a significant impact on providers, since victims of domestic abuse already had the ability to terminate a lease without penalty or liability. It does extend the protection to additional people—to victims of criminal sexual conduct and victims of stalking, as well as “authorized occupants” in addition to the “tenant.” Landlords should find it helpful that the law now provides clear guidance on the information the tenant is to give the landlord when terminating the tenancy.

Staff Contact: Mary Youle

Personal Care Assistance and Community First Services and Supports

Chapter 291, Article 10, Sections 3 and 6
Amends MN Statutes 2013 Supplement, section 256B
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: August 1, 2014
Chapter 312, Article 26
Amends MN Statutes 2012, Section 245C, 256
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: Upon federal approval. CFSS will begin 90 days after federal approval.

Background
As part of the Reform 2020 initiative, the Minnesota Department of Human Services proposed to replace the Personal Care Assistance (PCA) program with Community First Services and Supports (CFSS). CFSS is still awaiting CMS approval, but when approved it will cover services now available under the PCA program as well as some additional services that have not been part of the PCA program. Persons who remain eligible for Medical Assistance basic service but who lose their eligibility for waiver services when the Level of Care changes become effective on January 1, 2015, may receive services under the CFSS program. This is a new program and is likely to see a number of legislative changes in its first few years of operation.

Summary
Most of the amendments deal with CFSS, which DHS hopes will be implemented early in 2015 when the Level of Care changes take effect. These amendments are:

Under these changes, both PCA and CFSS provider agencies are now required to have surety bonds rather than “performance” bonds.
New language covers the background study requirements and cost of background studies for CFSS organizations;
There is a new definition of “budget model,” which is one type of service delivery method and provisions related to the use of this model. The service budget for budget model participants is based on the assessed units of service as determined by the home care rating and an adjustment for administrative expenses. New language describes when DHS must dis-enroll or exclude participants from the budget model;
A new definition of worker training and development has been added;
New provisions address the consultation services provider and describes the duties, qualifications and requirements of these providers;
Qualified support workers who are the parent, stepparent or legal guardian of a participant under age 18, or who is the participant’s spouse may not provide any MA services in excess of 40 hours per seven-day period;
New items have been added to the items not covered by CFSS, such as sterile procedures, injections, home maintenance or chore services, home care services, including hospice services if elected by the participant;
New requirements and duties are listed for agency-providers and FMS contractors;
A new provision addresses the exception to the support worker requirements regarding enrollment with a different CFSS agency-provider in order to ensure continuity of services for a participant;
DHS is to develop the scope of tasks and functions, service standards and service limits for worker training and development services, and new language lists the worker training and development services.

Implications
Services under the CFSS must meet higher standards that were required previously for PCA services, including the new CMS requirements related to HCBS settings, so current PCA provider organizations will need to make changes to meet the new requirements. As some MA recipients lose their eligibility for waiver services when Level of Care is implemented, additional providers may want to explore the CFSS program as a new option for serving low income persons with some service needs.

Staff Contact: Mary Youle

Private Duty Nursing/Home Care Nursing

Chapter 291, Article 9, Sections 2 and 5
Amends MN Statutes 2012, section 256B0654, subd. 1
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: July 1, 2014

Background
This legislation was initiated by a group of private duty nursing providers that acted independently from the Minnesota HomeCare Association. We have been told that DHS supported this change in the term formerly used for private duty nursing, though it is difficult to understand why a term so easily confused with nursing services provided by a home care agency would be adopted in place of the original term.

Summary
The Medical Assistance service formerly called “complex private duty nursing care” has been re-named by this legislation as “complex home care nursing,” and the revisor has been instructed to change all Minnesota statutes and rules that include “private duty nursing” to the new term, “home care nursing/home care nurse.”

The changes in this section of law now define complex home care nursing as services provided to recipients who meet criteria for regular home care nursing and require life-sustaining interventions to reduce the risk of long-term injury or death. “Home care nursing” means ongoing physician-ordered hourly nursing services performed by a RN or LPN in order to maintain or restore a person’s health. “Regular home care nursing” is defined as home care nursing provided because:

The recipient requires more individual and continuous care than can be provided during a skilled nursing visit; or
The cares are outside of the scope of services that can be provided by a home health aide or personal care assistant.

Implications
This new term will be very easily confused with licensed home care services, which include services provided by RNs and LPNs. This may be confusing to clients as well as to providers.

Staff Contact: Mary Youle

Real Estate Brokers and Salespersons

Chapter 199
Amends MN Statutes 2012, Section 82
H.F. 2694, Lillie-DFL
S.F. 2340, Jensen, DFL
Effective: August 1, 2014

Background
The changes in this legislation are generally fairly technical in nature, and a number of them are specific to purchase of homes rather than rental.

Summary
The legislation includes the following provisions in addition to other technical changes:

New definitions are included for “buyer’s broker” and “seller’s broker.”
Technical changes are made to the override clause that allows a broker to receive compensation after the listing agreement has expired and the buyer has purchased the property. New language also permits a buyer’s broker agreement to include an override clause of up to two years,
An application for a brokerage license for a business entity now must only be verified by one responsible person for the business, rather than by “at least two.”
Changes have been made with regard to the issuance of a temporary broker’s permit. “Loss of license” is now added to the conditions of “death” or “incapacity” under which the commissioner may issue a 45-day temporary broker’s permit. Now that person requesting the temporary permit must have three years of experience as a licensed real estate salesperson instead of only two years’ experience previously required.
Language concerning “subagent” has been deleted.
Several changes clarify how payment is to be made or received by brokers, how earnest money is to be received, and how trust funds are to be disbursed.

Implications
Although most of these changes focus on transactions involving the purchase of property—not rental of senior housing—management companies that have brokers turnover because of death, incapacity or loss of license will need to note that an extra year of experience is now required for another staff to obtain a temporary broker’s license.

Staff Contact: Mary Youle

Residential Settings with Mental Health Certification

Chapter 291, Article 3, Sections 1 and 2
Amends MN Statutes 2012, Section 245A.03, subd. 6a and 245D.33
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: August 1, 2014

Background
Since a moratorium was imposed on corporate adult foster care homes several years ago, some exceptions have been permitted for those homes that receive a mental health certification. These amendments modify the training requirements for the certification and also include residential settings licensed under 245D in the training requirements.

Summary
This legislation modifies the mental health certification requirements for adult foster care homes and community residential settings licensed under 245D that serve people with mental illness. In addition to the previous training topics, staff in these settings must now have training on suicide intervention, identifying suicide warning signs, and appropriate responses. The training curriculum must be approved by DHS and must include a testing component.

New language says the training must be provided by:

A mental health professional or a mental health practitioner
An individual living with a mental illness or a family member of that individual, who is from a nonprofit organization that provides educational classes on mental illnesses approved by DHS.

Under the amendment, staff must receive three hours of training on mental health diagnoses and mental health crisis response and de-escalation techniques prior to working alone with residents. The remaining four hours of mandatory training, including a review of mental health crisis response and de-escalation techniques, must be completed within six months of the hire date. For 245D licensed settings, this training may be incorporated into the 30 hours of required staff orientation.

Previous language specifying the requirements for certification have been deleted.

Implications
These settings with a mental health certification may provide a helpful resource for Aging Services members who have residents with challenging mental illnesses and can no longer successfully live in their senior building.

Staff Contact: Mary Youle

Waiver Provider Enrollment Requirements

Chapter 291, Article 8, Section 9
Amends MN Statutes 2013 Supplement, section 256B.4912, subd. 10
H.F. 2402, Liebling-DFL
S.F. 2087, Sheran-DFL
Effective: May 22, 2014

Background
In the last several years, the Department of Human Services has made significant changes to the enrollment requirements for waiver providers. After a number of new requirements in the enrollment process, DHS this year developed language to eliminate some of the financial requirements for providers.

Summary
Under the 2014 amendments, certain providers will no longer need proof of surety bond coverage in the amount of $50,000 or 10 percent of the provider’s Medicaid payments in the previous year, whichever is greater. In addition the proof of fidelity bond coverage in the amount of $20,000 has been eliminated for these providers. Affected providers are:

245D waiver services providers
Foster care providers funded by Elderly Waiver or Alternative Care
Fiscal support entities
Adult day care providers
Customized living services providers
Residential care providers.

Implications
The elimination of surety bond and fidelity bond coverage should reduce some burdens on providers offering customized living, adult day services for waiver clients and EW/AC foster care providers.

Staff Contact: Mary Youle

Waiver Requests to CMS

Chapter 312, Article 24, Section 27
Amends MN Statutes 2012, section 256B.04
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
In the past, the Minnesota Department of Human Services has submitted requests to CMS to amend a waiver program without any notice to the public. In recent years, DHS has done a better job of communicating with stakeholders about its proposed changes, and this legislation will ensure that this type of communication with the public and with stakeholders occurs.

Summary
Under this legislation, DHS must post on its web site the text of a waiver request or MA state plan amendment, along with a summary and explanation of the change, and provide a 30-day comment period before submission to CMS. DHS must use its electronic subscription service to notify stakeholders of these requests. The law directs DHS to consider public comments when preparing the final request. Within 30 days of a CMS decision, DHS must also post on its web site notice of the federal decision, and the notice must describe any modifications to the state request that have been agreed to by DHS as a condition of receiving federal approval.

Implications
This new requirement will greatly improve the transparency of DHS’ requests to CMS regarding waiver amendments or changes to Minnesota’s MA state plan services. DHS often blames CMS for requirements that are problematic to providers, but these negotiations between CMS and DHS will now be more transparent with the posting of a description of modifications that have been made.

Staff Contact: Mary Youle

Care Centers

Case Mix Changes

Chapter 147
Amends MN Statutes 144.0724
S.F. 894, Wiklund-DFL
H.F. 1179, Schomacker-R
Effective: Aug. 1, 2014

Background
The state switched to the most recent RUGs system, RUG-IV, for case mix assessments on January 1, 2012. The state statute on case mix assessments contains details of the implementations of the previous RUGs systems, which are no longer relevant with the implementation of RUG-IV.

Bill Summary
This bill primarily deletes language that is no longer needed because it applies to previous RUGs systems. It also updates a number of references to use more current language or to match with terminology from the federal regulations. Most of this language does not change the implementation of any current assessment practices or payment policies. For example, this bill preserves the annual election for whether or not the facilities wants to submit case mix assessments for residents not covered by Medicare who stay less than fourteen days.

Implications
These changes for the most part will have no impact on providers as they are primarily just a clean-up of the case mix statutes. One substantive change is that the statute does now require that case mix determinations sent out by MDH have the address and telephone number of the Ombudsman’s office.

A version of this bill considered last year included language that allowed a reduction in the penalty for late submission of assessments at the discretion of the commissioner of DHS, but that language was pulled out and passed in a different bill in 2013. Without that language the actual impact of this bill is extremely limited.

Staff Contact: Jeff Bostic

Critical Access Nursing Facilities

Chapter 312
Amends MN Statutes 256B.441, subd. 63
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
The 2012 Legislature created the critical access nursing facility program, with the primary goal of preserving access to nursing facility services in deep rural parts of the state. The program was launched with one-time funding, which allowed seven facilities to receive the designation and the associated rate increase for a period of nine to ten months each. Funding for the program expired around the time of the start of the 2014 legislation session, so the program could only be restarted with a new appropriation this year.

Bill Summary
This legislation includes two primary components impacting the critical access nursing facilities program. One of those components is a permanent annual appropriation of $1.5 million, offering some assurance that the program will continue into the future. The bill also includes changes to the language that explains the benefits and the process for being designated as a critical access nursing home.

One change is that the rate for critical access nursing facilities, instead of having to be based on 60% of the cost-based rebasing rate, can now be up to 20% less than that. Also, the commissioner is to spread designations around the state to the extent that it is practicable. This language was added to address the concern of some legislators that six of the seven facilities chosen through the original process were in the northern part of the state.

Implications
The ongoing funding means that the critical access nursing facility program should be around into the future providing assistance to rural facilities that are key to maintaining access to services throughout the state. The increase in funding means that more facilities will be included in the program this time, possibly around fifteen. The original legislation calls for designations to last for two years, so facilities designated by the department later this year will receive a rate increase under the program for two years, with the possibility of receiving a continuing rate increase after that if they win designation again in 2016.

Staff Contact: Jeff Bostic

Minimum Wage Rate Increase for Care Centers

Chapter 312
Adds a Subdivision to MN Statutes 256B.441
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
The 2013 Legislature spent a lot of time debating an increase to the state’s minimum wage, only to end without an agreement between the House and Senate. Aging Services of Minnesota argued that care center rates needed to be raised to cover the impact of a new minimum wage. Knowing it was likely that the Legislature would approve a minimum wage increase this year, Aging Services and the Long Term Care Imperative entered session with a rate adjustment to cover the minimum wage as one of our key initiatives.

Bill Summary
The legislation introduced by Aging Services and the Long Term Care Imperative addressed both the direct impact of increasing the minimum wage to $9.50 per hour as well as the “ripple” effect that would impact employees above that level. To address the ripple effect, our proposal provided additional funding beyond the direct impact for all compensated hours with wage rates up to $13 per hour. Our proposal called for a rate increase on October 1 of this year that would address the full impact of moving the minimum wage to $9.50.

Because the minimum wage is being increased in phases over the next three years, the Legislature changed the final legislation to pay out rate increases over three years. Each year care centers will receive a rate adjustment that covers the direct impact of that year’s minimum wage increase, plus a portion of the ripple effect funding that is based on compensation in effect the first three months of this year. Each year care centers will have to do a compensation plan showing how the funding will be used. The legislation also provides funding for rate increases to address the direct impact of the indexing of the minimum wage that starts in 2018.

Implications
Passage of this legislation mitigates the impact of the minimum wage increase for care centers, which would fall particularly on those rural providers in relatively low wage labor markets. The alteration of our original proposal to pay our increases over three years is unfortunate, both because it delays provider’s opportunity to address their labor market needs and because it adds unnecessary administrative complexity, but the language will still ultimately lead to $3 million in additional state funding annually to address the need to improve wages for the care center workforce.

Staff Contact: Jeff Bostic

Moratorium Exceptions Process Funding

Chapter 312
Adds a Subdivision to MN Statutes 144A.073
H.F. 3172, Carlson-DFL
S.F. 2785, Cohen-DFL
Effective: July 1, 2014

Background
Occasionally the Legislature provides funding for the moratorium exceptions process, which is the primary vehicle for funding significant renovations and replacements of care centers in the MA program. The last time the state provided funding for moratorium exceptions was the 2012 session, when $1 million in funding was approved. The state investment in upgrading care centers is much needed to improve services to consumers, and is also a good investment for the state in that they budget for the annual state Medicaid cost of the upgrades, meaning for each million invested $100 million or more in construction is completed.

Bill Summary
One of Aging Services’ top priorities for the year was obtaining funding for moratorium exceptions projects, since the funding from 2012 was more than used up by application rounds in the last two years. The final supplemental budget includes another $1 million in funding, which will help address the backlog of needs for care center improvements.

Implications
The funding will support construction spending of $100 million or more, so it is both a good jobs investment and much needed to improve the quality of care center buildings around the state. Providers who are interested in applying for funding should be able to do so later this year, with project approvals likely to be made by MDH in early 2015.

Staff Contact: Jeff Bostic

2014 Legislative Report

Table of Contents

Overview: 2014 Session

Media Relations

General

Housing/HCBS

Care Centers

2015 Session Outlook

Our Process

General

Automatic External Defibrilators

Background Studies

Common Entry Point (CEP)

DHS Unsession Bill

License Suspensions by Health-Related Licensing Boards

MA Spenddown

Minimum Wage Increase

Non-Emergency Medical Transportation

Pharmacy Changes

Prescription Monitoring Program Modifications

Reporting Diversion of Controlled Substances

Triclosan Ban on Sales and Study

Vulnerable Adult Act Reports by MDH and DHS

Women’s Economic Security Act (WESA)

Housing/HCBS

245D Amendments

Affordable Housing

Disability Waiver Rate Calculations and Rate Adjustments

Essential Community Supports

Group Residential Housing

HCBS Designation; Integrated License

HCBS Programs Rate Increase

HCBS Quality Add-On Revision

HCBS Settings for Waiver Clients and DHS’ Transition Plan

Home Care Amendments

Housing Courts

Housing-with-Services Establishment Requirements for Dementia Training, Manager Training and Emergency Planning

Landlord-Tenant Law and Victims of Violence

Personal Care Assistance and Community First Services and Supports

Private Duty Nursing/Home Care Nursing

Real Estate Brokers and Salespersons

Residential Settings with Mental Health Certification

Waiver Provider Enrollment Requirements

Waiver Requests to CMS

Care Centers

Case Mix Changes

Critical Access Nursing Facilities

Minimum Wage Rate Increase for Care Centers

Moratorium Exceptions Process Funding

In this section

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