1 2 144A.43 Definitions Section I. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Subdivision 1. Applicability. The definitions in this section apply to sections 144A.xx to 144A.xx. Subd 2. Agent means one upon whom all notices and orders shall be served, and who is authorized to accept service of notices and orders on behalf of the home care provider. Subd 3. Applicant means an individual, organization, association, corporation, unit of government, or other entity that applies for a temporary license, license or renewal of their home care provider license under MS 144A.46. (Minnesota Rule 4669.0010 Subd 4. Assessment means a review by the home care provider of client s needs and preferences by the appropriate person employed by the home care provider to determine which services the home care provider will provide consistent with applicable licensing requirements and standards. Subd 5. Client means a person to whom a home care provider provides home care services. (Minnesota Rule 4668.0003) Subd 6. Client Representative means a person who, because of the client s needs, makes decisions about the client s care on behalf of the client. A client representative may be a guardian, conservator, attorney-in-fact, health care agent, family member or other agent of the client. Nothing in this section expands or diminishes the rights of persons to act on behalf of clients under other law. (Minnesota Rule 4668.0003) Subd 2. Subd 7. Commissioner means the commissioner of health. Minnesota Statute 144A.43 Subd 8. Department means the Minnesota Department of Health (Minnesota Rule 4668.0003) 21 22 23 Subd 9. Dietary supplement means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include: vitamins, minerals, herbs or other botanicals, amino acids, and enzymes. A dietary supplement is a product taken by mouth that contains a 1
24 25 26 27 28 "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. The Dietary Supplement Health and Education Act (DSHEA) of 1994 classifies dietary supplements as"foods," not drugs, and requires that every supplement be labeled a dietary supplement. 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Subd 10. Dietitian is a person licensed pursuant to Minnesota Statutes 148.621 to 148.633. Subd 11. Dietetics or Nutrition practice is performed by a licensed dietician or licensed nutritionist and includes the activities of assessment, setting priorities and objectives, providing nutrition counseling, developing and implementing nutrition care services and evaluating and maintaining appropriate standards of quality of nutrition care pursuant to Minn. Stat. sec. 148.621, et. seq. Subd 12. Home means the client s temporary or permanent place of residence. Subd 13. Home Care Aides Unlicensed Personnel are individuals not otherwise licensed or certified by a governmental health board or agency as home care aides who provide home care aide who provide home care services in the client s home. Subd 14. Home care aide services include: a) verbal or visual reminders to take medications, treatments and exercise; b) preparing modified diets and meal preparation; c) assistance with toileting, transfers, mobility, dressing, oral hygiene, grooming, hair care, bathing; d) assisting with laundry, housekeeping, meal preparation, shopping or other household chores along with another home care service; or e) services delegated by a registered nurse or other licensed health professional consistent with appropriate practice act. 2
47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Subd.15. Subd. 4. "Home care provider" means an individual, organization, association, corporation, unit of government, or other entity that is regularly engaged in the delivery of at least one home care service directly or by contractual arrangement, in a client s home of home care services for a fee and who has a valid current temporary license or license issued under chapter. Minnesota Statute 144A.46 Subd. 4.. At least one home care service must be provided directly, although additional home care services may be provided by contractual arrangements. "Home care provider" does not include: (1) any home care or nursing services conducted by and for the adherents of any recognized church or religious denomination for the purpose of providing care and services for those who depend upon spiritual means, through prayer alone, for healing; (2) an individual who only provides services to a relative; (3) an individual not connected with a home care provider who provides assistance with home management services or personal care needs if the assistance is provided primarily as a contribution and not as a business; (4) an individual not connected with a home care provider who shares housing with and provides primarily housekeeping or homemaking services to an elderly or disabled person in return for free or reduced-cost housing; (5) an individual or agency providing home-delivered meal services; (6) an agency providing senior companion services and other older American volunteer programs established under the Domestic Volunteer Service Act of 1973, Public Law 98-288; (7) an employee of a nursing home licensed under this chapter or an employee of a boarding care home licensed under sections 144.50 to 144.56 who responds to occasional emergency calls from individuals residing in a residential setting that is attached to or located on property contiguous to the nursing home or boarding care home; (8) a member of a professional corporation organized under chapter 319B that does not regularly offer or provide home care services as defined in subdivision 3; (9) the following organizations established to provide medical or surgical services that do not regularly offer or provide home care services as defined in subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit corporation organized under chapter 317A, a partnership organized under chapter 323, or any other entity determined by the commissioner; (10) an individual or agency that provides medical supplies or durable medical equipment, except when the provision of supplies or equipment is accompanied by a home care service; (11) an individual licensed under chapter 147; or (12) an individual who provides home care services to a person with a developmental disability who lives in a place of residence with a family, foster family, or primary caregiver.(moved) Subd. 3. Subd 16 "Home care service" means any of the following services when delivered in a place of residence clients home: to a person whose illness, disability, or physical condition creates a need for the 86 service: 3
87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 1. home care aide Unlicensed Personnel services, 2. services provided by a registered nurse or licensed practical nurse; physical therapist, respiratory therapist, occupational therapist, speech-language pathologist; dietitian or nutritionist, or social worker; (1) nursing services, including the services of a home health aide; (2) personal care services not included under sections 148.171 to 148.285; (3) physical therapy; (4) speech therapy; (5) respiratory therapy; (6) occupational therapy; (7) nutritional services; (8) home management services when provided to a person who is unable to perform these activities due to illness, disability, or physical condition. Home management services include at least two of the following services: housekeeping, meal preparation, and shopping; (9) medical social services; 3. medication and treatment management services; or 4. the provision of durable medical supplies and equipment services when accompanied by the provision of a provided with any of the above home care services. (11) other similar medical services and health-related support services identified by the commissioner in rule. "Home care service" does not include the following activities conducted by the commissioner of health or a board of health as defined in section 145A.02, subdivision 2: communicable disease investigations or testing; administering or monitoring a prescribed therapy necessary to control or prevent a communicable 4
110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 disease; or the monitoring of an individual's compliance with a health directive as defined in section 144.4172, subdivision 6 Subd 17, Legend Drug has the meaning given in Minn. Stat. 151.01, subd. 17. Minnesota Rule, 4668.0003. Subd 18. License means a Basic or Comprehensive Home Care license issued by the commissioner to a home care provider. Subd 19. Licensed Health Professionals means any other person, other than a registered nurse, a registered nurse or licensed practical nurse; physical therapist, respiratory therapist, occupational therapist, speech-language pathologist; dietitian or nutritionist, or social worker who provides home care services within the scope of practice of their health occupation license, registration, or certification as regulated and are licensed by the appropriate Minnesota governmental board or agency. Subd 20. Licensee means a home care provider that is licensed under MS 144A.xx to 144A.xx. (Minnesota Rule 4668.0003 Subd 21. Managerial official means an administrator, director, officer, trustee, or employee of a home care provider, however designated, who has the authority to establish or control business policy. Minnesota Rule 4668.0003 Subd 22. Medication means a legend or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements when prescribed by an authorized prescriber. Subd 23. Medication Administration means performing a task to ensure a client takes a medication, and includes the following: a) checking the client s medication record; b) preparing the medication for administration; (note need additional discussion on this appears too open for interpretation) 133 c) administering the medication to the client; 5
134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 d) documenting the administration or documenting the reason for not administering the medication; and e) reporting by licensed health professional or home care aide unlicensed personnel information to a nurse any concerns about the medication or the client s refusal to take the medication. (Minnesota Rule 4668.0003) Subd 24. Medication Management means the provision of any of the following medication-related services to a client: A. Medication set-up; B. Medication administration; C. Medication storage and security; D. Medication documentation and charting; E. Verification and monitoring of effectiveness of systems to ensure safe medication handling and administration; F. Coordination of medication refills; G. Handling changes to prescriptions and implementation of those changes; H. Communicating with the pharmacy; I. Coordination and communication with prescriber; Subd. 5.Medication reminder. "Medication reminder" means providing a verbal or visual reminder to a client to take medication. This includes bringing the medication to the client and providing liquids or nutrition to accompany medication that a client is self-administering. Subd 25. Medication set-up. Medication set-up means arranging medications for later administration. Subd 26. Nurse is a person licensed under Minn. Stat. sec. 148.171 to 148.285. 6
157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 Subd. 27 Occupational Therapist is a person licensed pursuant to Minnesota Statutes, 148.6401 to 148.6450.(4668.0003) Subd 28 Over the counter drug means a drug that is not required by federal law to bear the statement Caution: Federal law prohibits dispensing without prescription (4668.0003) Subd 29. Owner means a proprietor, general partner, limited partner who has five percent or more of equity interest in a limited partnership, a person who owns or controls voting stock in a corporation in an amount equal to or greater than five percent of the shares issued and outstanding; or a corporation that owns equity interest in a licensee or applicant for a license. (Minnesota Rule 4668.0003) Subd 30. Pharmacist means a person licensed under Minnesota Statutes, chapter 151. (Minnesota Rule 4668.0003) Subd 31. Physical Therapist means a person licensed under Minnesota Statutes, chapter 148.65 to 148.78. Subd. 32. Physician means a person licensed under MS Chapter 147. (Minnesota Rule 4668.0003 Subd 33. Prescriber means a person authorized by MS 151.01 subd 23 and 151.37 to prescribe legend drugs. Minnesota Rule 4668.0003 Subd 34 Regularly scheduled means ordered or planned to be completed at predetermined times or according to a predetermined routine. Minnesota Rule 4668.0003 Subd 35 Reminder means providing a verbal or visual reminder to a client. Subd 36 Respiratory Therapist means a person licensed pursuant to Minnesota Statutes, 147C. Subd 37 Service Plan means the written agreement plan between the client or client s representative and the temporary licensee or licensee about the services that will be provided to the client. A service plan may be different from a home care contract when one exists. Subd 38 Social worker means a person licensed pursuant to Minn Statutes, sections 148D, after 180 August 1, 2011 MS sections 148E ( Minnesota Rules 4668.0080, 4668.0180, 4668.0820 7
181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 Subd 39. Speech Language Pathologist means a person licensed pursuant to 148.512. Subd 40. Substantial Compliance means complying with the health and safety related statutory requirements in this chapter which when not complied with create unacceptable health or safety risks to the home care client. Subd 41 Survey means an inspection of a licensee or applicant for licensure for compliance with Minnesota Statutes, sections 144A.xx to 144A.xx. (Minnesota Rule 4668.0003 Subd 42 Surveyor means a staff person of the department authorized to conduct surveys of home care providers and applicants. (Minnesota Rule 4668.0003) Subd 43 Temporary License means the initial Basic or Comprehensive Home Care License the department issues after approval of a complete written application and before the department completes the Temporary License survey and determines that the Temporary Licensee is in substantial compliance. Subd 44 Treatment" means a therapy prescribed by a licensed health professional. Subd 45 Unit of Government means every city, county, town, school district, other political subdivisions of the state, and any agency of the state or the United States, and includes any instrumentality of a unit of government. (Minnesota Rule 4668.0003 Subd 46 Verbal means oral and not in writing. (Minnesota Rule 4668.0003 Section II. Minnesota Statute 144A.44 HOME CARE BILL OF RIGHTS. Subdivision 1. Statement of rights. A person who receives home care services has these rights: (1) the right to receive written information about rights in advance of before receiving care or during the initial evaluation visit before the initiation of treatment services, including what to do if rights are violated; 8
204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 (2) the right to receive care and services according to a suitable and up-to-date plan, and subject to accepted health care, medical or nursing standards, to take an active part in creating and changing the plan developing, modifying and evaluating the plan care and services; (3) the right to be told in advance of before receiving care about the services that will be provided, the type of staff who will be providing the services, the disciplines that will furnish care, the frequency of visits proposed to be furnished, other choices that are available for addressing home care needs, and the consequences of these choices including the potential consequences of refusing these services; (4) the right to be told in advance of any recommended changes by the provider in the service plan of care and to take an active part in any decisions about changes to the service plan; (5) the right to refuse services or treatment; (6) the right to know, before in advance of receiving services or during the initial visit, any limits to the services available from a home care provider, and the provider's grounds reasons for a termination of services; (7) the right to know in advance of receiving care whether the services are covered by health insurance, medical assistance, or other health programs, the charges for services that will not be covered by Medicare, and the charges that the individual may have to pay; (8) the right to be told know before services are initiated what the provider charges are for services, no matter who will be paying the bill; and if known to what extent payment may be expected from health insurance, public programs or other sources, and what charges that the client may be responsible for paying; (9) the right to know that there may be other services available in the community, including other home care services and providers, and to know where to go for find information about these services; (10) the right to choose freely among available providers and to change providers after 9
227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 services have begun, within the limits of health insurance, payor, Mmedical Aassistance, or other health programs; (11) the right to have personal, financial, and medical information kept private, and to be advised of the provider's policies and procedures regarding disclosure of such information; (12) the right to be allowed access to the person s own records and written information from those records in accordance with sections 144.291 to 144.298; (13) the right to be served by people who are properly trained and competent to perform their duties; (14) the right to be treated with courtesy and respect, and to have the patient's client s property treated with respect; (15) the right to be free from physical and verbal abuse, neglect, financial exploitation and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment of Minors Act; (16) the right to reasonable, advance notice of changes in services or charges, including at least ten days' advance notice of the termination of a service by a provider except in cases where: i. the client recipient of services engages in conduct that significantly alters the conditions of employment as specified in the employment contract between terms of the service plan with the home care provider and the individual providing home care services; ii. or the client or person who lives with the client creates an abusive or unsafe work environment for the person individual providing home care services; or ii. (iii) an emergency for the informal caregiver or a significant change in the recipient s client s condition has resulted in service needs that exceed the current service provider agreement plan and that cannot be safely met by the home care provider; (17) the right to a coordinated transfer when there will be a change in the provider of services; 10
250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 (18) the right to voice grievances complain about regarding treatments or services, or care that is are provided, or fail to be provided, furnished or regarding, and the lack of courtesy or respect to the patient client or the patient's client s property; (19) the right to know how to contact an individual associated with the home care provider who is responsible for handling problems and to have the home care provider investigate and attempt to resolve the grievance or complaint; (20) the right to know the name and address of the state or county agency to contact for additional information or assistance; and (21) the right to assert these rights personally, or have them asserted by the patient's family or,guardian when the patient has been judged incompetent client s representative or by anyone on behalf of the client, without retaliation. Subd. 2. Interpretation and enforcement of rights. These rights are established for the benefit of persons clients who receive home care services. Home care services means home care services as defined in section 144a.43, subdivision 3 and unlicensed personal care assistance services, including services covered by medical assistance under section 256B.0625, subd 19a. All home care providers, including those exempted under Minn. Stat. sec. Section VII must comply with this part. The department shall enforce this part and the home care bill of rights requirement against home care providers exempt from licensure in the same manner as against for licensees. A home care provider may not request or require a person client to surrender any of these rights as a condition of receiving services. A guardian or conservator or, when there is no guardian or conservator, a designated person, may seek to enforce these rights. This statement of rights does not replace or diminish other rights and liberties that may exist relative to persons clients receiving home care services, persons providing home care services, or providers licensed under Laws 1987, chapter 378. MS 11
273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 A copy of these rights must be provided to an individual at the time home care services, including personal care assistance services, are initiated. The copy shall also contain the address and phone number of the Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care and a brief statement describing how to file a complaint with these offices. Information about how to contact the Office of Ombudsman for Long-Term Care shall be included in notices of change in client fees and in notices where home care providers initiate transfer or discontinuation of services. ( inserted following so we can see what it says and also to ensure we chg stat and rule ref if needed.) 144A.441 ASSISTED LIVING BILL OF RIGHTS ADDENDUM. Assisted living clients, as defined in section 144G.01, subdivision 3, shall be provided with the home care bill of rights required by section 144A.44, except that the home care bill of rights provided to these clients must include the following provision in place of the provision in section 144A.44, subdivision 1, clause (16): "(16) the right to reasonable, advance notice of changes in services or charges, including at least 30 days' advance notice of the termination of a service by a provider, except in cases where: (i) the recipient of services engages in conduct that alters the conditions of employment as specified in the employment contract between the home care provider and the individual providing home care services, or creates an abusive or unsafe work environment for the individual providing home care services; (ii) an emergency for the informal caregiver or a significant change in the recipient's condition has resulted in service needs that exceed the current service provider agreement and that cannot be safely met by the home care provider; or (iii) the provider has not received payment for services, for which at least ten days' advance notice of the termination of a service shall be provided." 144A.442 ASSISTED LIVING CLIENTS; SERVICE TERMINATION. If an arranged home care provider, as defined in section 144D.01, subdivision 2a, who is not also Medicare certified terminates a service agreement or service plan with an assisted living client, as defined in section 144G.01, subdivision 3, the home care provider shall provide the assisted living client and the legal or designated representatives of the client, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the reason for termination; (3) without extending the termination notice period, an affirmative offer to meet with the assisted living client or client representatives within no more than five business days of the date of the termination notice to discuss the termination; (4) contact information for a reasonable number of other home care providers in the geographic area of the assisted living client, as required by Minnesota Rules, part 4668.0050; (5) a statement that the provider will participate in a coordinated transfer of the care of the client to another provider or caregiver, as required by section 144A.44, subdivision 1, clause (17); (6) the name and contact information of a representative of the home care provider with whom the client may discuss the notice of termination; (7) a copy of the home care bill of rights; and 12
313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 (8) a statement that the notice of termination of home care services by the home care provider does not constitute notice of termination of the housing with services contract with a housing with services establishment. Section III. Minnesota Statute 144A.45 REGULATION OF HOME CARE SERVICES Subdivision 1. Rules. The commissioner shall adopt rules for the regulation of regulate home care providers pursuant to sections 144A.43 to 144A.47. The rules regulations shall include the following: (1) provisions to assure, to the extent possible, the health, safety and well-being, and appropriate treatment of persons who receive home care services while respecting clients autonomy and choice and to ensure a high quality of life for each client; (2) requirements that home care providers furnish the commissioner with specified information necessary to implement sections 144A.43 to 144A.47; (3) standards of training of home care provider personnel, which may vary according to the nature of the services provided or the health status of the consumer; (4) standards for provision of home cares services; (5) standards for medication and treatment management which may vary according to the nature of the services provided, the setting in which the services are provided, or the status of the consumer. Medication management includes the central storage, handling, distribution, and administration of medications; (6) standards for supervision of home care services; requiring supervision by a registered nurse or other appropriate health care professional which must occur on site at least every 62 days, or more frequently if indicated by a clinical assessment, and in accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a person performing home care aide tasks for a class B licensee providing paraprofessional services does not require nursing supervision; 13
337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 (7) standards for client evaluation or and assessment which may vary according to the nature of the services provided or the status of the consumer; (8) requirements for the involvement of a consumer s physician, client s health care provider, the documentation of physicians health care providers orders, if required, and the consumer s treatment client s service plan, and (9) the maintenance of accurate, current health clinical records; (10) the establishment of different classes Basic and Comprehensive levels of licenses for different types of providers and different standards and requirements for different kinds of home care based on services provided; and (11) provisions to enforce these regulations and operating procedures required to implement the home care bill of rights. Subd. 1a.Home care aide tasks. Notwithstanding the provisions of Minnesota Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting toileting, transfers, and ambulation if the client is ambulatory and if the client has no serious acute illness or infectious disease. Subd. 1b.Home health aide qualifications. Notwithstanding the provisions of Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks if the person maintains current registration as a nursing assistant on the Minnesota nursing assistant registry. Maintaining current registration on the Minnesota nursing assistant registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110, subpart 3. Subd. 2. Regulatory functions. (a)the commissioner shall: (1) evaluate, monitor, and license, survey and monitor without advance notice, home care providers in accordance with sections 144A.45 to 144A.47; (2) inspect the office and records of a provider during regular business hours without advance notice to the home care provider; 14
364 365 366 367 368 369 (2) survey every Temporary licensee within one year of the Temporary license issuance date subject to the Temporary licensee providing home care services to a client or clients. (3) survey all licensed home care providers on an interval that will ensure promote the health and safety of clients; (4) (3)with the consent of the consumer client, visit the home or location where services are being provided; 370 (5) (5) (4) issue a conditional license, issue correction orders and assess civil penalties in accordance with 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 section 144.653, subdivisions 5 to 8, for violations of sections 144A.43 to 144A.47 or the rules adopted under those sections; (6) (4) take action as authorized in section 144A.46, subdivision 3: and (7) (5) take other action reasonably required to accomplish the purposes of sections 144A.43 to 144A.47. (b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the commissioner shall comply with the applicable requirements of section 144.122, the Government Data Practices Act, and the Administrative Procedure Act. Subd. 3. [Repealed, 1997 c 113 s 22] Subd. 4.Medicaid reimbursement. Notwithstanding the provisions of section 256B.37 or state plan requirements to the contrary, certification by the federal Medicare program must not be a requirement of Medicaid payment for services delivered under section 144A.4605. Subd. 5.Home care providers; services for Alzheimer's disease or related disorder. (a) If a home care provider licensed under section 144A.46 or 144A.4605 markets or otherwise promotes services for persons with Alzheimer's disease or related disorders, the facility's direct care staff and their supervisors must be trained in dementia care. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and related disorders; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; and (4) communication skills. 15
396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 (c) The licensee shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. Section IV Data Practices Subd 1. The following data collected, created or maintained by the commissioner are classified as private data as defined in section 13.02, subdivision 12: data submitted by or on behalf of applicants for licenses prior to issuance of the license; the identity of complainants who have made reports concerning licensees or applicants unless the complainant consents to the disclosure; the identity of individuals who provide information as part of surveys and investigations; social security numbers; and health record data. Subd 2. The following data collected, created or maintained by the commissioner are classified as public data as defined in section 13.02, subdivision 15: all application data on licensees, license numbers, license status; licensing information about licenses previously held under this chapter; correction orders, including information about compliance with the order and whether the fine was paid; final enforcement actions pursuant to Minn. Statutes, Ch. 14; orders for hearing, findings of fact, conclusions of law; and when the licensee and department agree to resolve the matter without a hearing, the agreement and specific reasons for the agreement are public data. Subd 3. The following data collected, created or maintained by the department of health are classified as confidential data as defined in section 13.02, subdivision 3: 16
420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 active investigative data relating to the investigation of potential violations of law by licensee including data from the survey process before the correction order is issued by the department. Subd 4. The department may release private or confidential data, except social security numbers, to the appropriate state, federal, or local agency and law enforcement office to enhance investigative or enforcement efforts or further public health protective process. Types of offices include but are not limited to: Adult Protective Services, Office of the ombudsmen for long term care and Office of the Ombudsmen for Mental Health and Developmental Disabilities, the health licensing boards, department of human services, county or city attorney s offices, police, and local or county public health offices. Section V. Minnesota Statute 144A.46 LICENSURE. Subdivision 1. License required. (a) A home care provider is an individual or business entity that is regularly engaged in the delivery of at least one home care service directly, in a client s home for a fee. A home care provider may not open, operate in the state manage, conduct, maintain, or advertise itself as a home care provider or provide home care services in Minnesota without a current home care provider license issued by the commissioner of health. A home care provider may hold a separate license for each class of home care licensure. (a). Determination of Direct Home Care Services. Direct service means a home care service provided to a client by the home care provider or its employees, and not by contract with an independent contractor. Factors that shall be considered in determining whether an individual or a business entity provides home care services directly include but are not limited to, whether the individual or business entity: i. has the right to control, and does control, the types of services provided; 442 ii. has the right to control and does control when and how the services are provided; 17
443 444 445 iii. iv. Final Draft for Revisor with Provider Association Comments establishes the charges; collects fees from the clients or receives payment from third party payers on the clients behalf; 446 v. pays compensation on an hourly, weekly, or similar basis; 447 448 449 450 vi. vii. treats the individuals as employees for the purposes of payroll taxes and worker s compensation insurance; and holds itself out as a provider of home care services or acts in a manner that leads clients or potential clients to believe that it is a home care provider providing home care services. 451 452 453 454 455 456 457 None of the factors listed is solely determinative. (Minnesota Rule 4668.0008 Subd 2) (b). Determination of regularly engaged. Regularly engaged means providing, or offering to provide, home care services as a regular part of a business. The following factors shall be considered by the commissioner in determining whether an individual or a business entity is regularly engaged in providing home care services: i. whether the individual or business entity holds themselves out or otherwise promotes that they provide home care services; 458 459 460 461 ii. iii. whether individuals receiving home care services constitute a substantial part of the individual s or the business entity s clientele; and whether the home care services provided are other than occasional or incidental to the provision of services other than home care services. 462 463 464 465 None of the factors listed is solely determinative.(minnesota Rule 4668.0008 Subd 5) 144A.465 Subd 2. Licensure; Penalty Penalties for Operating Without a License A person involved in the management, operation, or control of a home care provider who vilate sections 144A.46, subd 1, paragraph(2) that operates without an appropriate license is guilty of a misdemeanor. 18
466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 This section does not apply to a person who had no legal authority to affect or change decisions related to the management, operation, or control of a home care provider. (Minnesota Statute 144A.465) Subd 3. Basic and Comprehensive Levels of Licensure; An applicant may apply for either a Basic or Comprehensive Home Care License. A home care provider with a Basic Home Care License can provide home care services to clients who routinely: a) can move without assistance of another person either with or without assistive devices such as a wheelchair, cane, or walker; b) do not require two-person transfersis not routinely dependent on another person for transfer; c) do not utilize mechanical lifts; d) do not have complicated feeding eating problems identified in the health record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or require the use of tube or parenteral or intravenous instruments to be fed; e) do not requestneed medication or treatment management services. Home care services provided by a home care provider with a Basic Home Care License include: a) preparing meals for client s with modified diets such as diabetic, salt free, etc.; b) providing verbal or visual reminders to take regularly scheduled medication, which includes bringing to the client previously set up medications, medications in original container or liquids or food to accompany the medication; c) providing verbal or visual reminders to perform regularly scheduled treatments and exercises; d) providing stand-by assistance with toileting, transfers, and mobility; e) assisting with dressing, oral hygiene, hair care, grooming, and bathing; and 19
488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 f) assisting with laundry, housekeeping, meal preparation, shopping or other household chores and services if the provider is also providing at least one of the above activities listed in a through e above. (MINNESOTA RULE 4668.0110) Comprehensive Home Care License. A home care provider with a Comprehensive Home Care license can provide home care services that include any of the basic home care services and one or more of the following: a) home care services provided by an advance practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech language pathologist, dietitian or nutritionist, or medical social worker. b) home care services delegated to an home care aide unlicensed personnel by a registered nurse or license health professional; c) medication or treatment management service. Section VI. Initial and Renewal Licensure Application Requirements Subd. 1. Initial License Applications. Each initial application for a home care provider license must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the applicant s name, e-mail and mailing address, including the name of the county in which the applicant resides and has its principal place of business; (2) e-mail and mailing address and telephone number of the principal administrative office; (3) e-mail and mailing address and telephone number of each branch office, if any; (4) names and e-mail and mailing addresses and telephone number of all owners and managerial officials; 20
510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 (5) documentation of compliance with the background study requirements of Minnesota Statutes, section 144.46, subd. 5, for all persons involved in the management, operation, or control of the home care a provider; and for any individual seeking employment, paid or volunteer, with the home care provider to submit to a background study as required by Minn. Stat. sec. 144.057. (6) evidence of workers compensation coverage as required by Minnesota Statutes, sections 176.181 and 176.182; (7) documentation of liability coverage if the provider has it; (8) identification of the license level the provider is seeking; (9) documentation that identifies the managerial official who is in charge of day to day operations and attestation that this person has reviewed and understands the home care provider regulations; (10) documentation that the applicant has designated one or more owners, managerial officials, or employees, as an agent. This designation under this provision shall not affect the legal responsibility of any other owner or managerial official under this chapter and Minnesota Statutes, sections 144A.xx to 144A.xx: (11) the signature of the officer or managing agent on behalf of an entity, corporation, association, or unit of government:(minnesota Rules 4668.0012, (12) information showing that all current staff that will be providing home care services are not contagious with tuberculosis or other communicable diseases consistent with current United States Centers for Disease Control standards; (13) Verification that all applicable training, competency requirements have been met for current staff; (14) Verification that the applicant has policies and procedures for the following, that if a license is issued the applicant will implement the policies and procedures and that these policies and procedures will be kept current and up-to-date: 21
533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 a) implementation of the requirements in Minn. Stat. sec. 626.557, Reporting of Maltreatment of Vulnerable Adults and Minn. Stat. sec. 626.556, Reporting of Maltreatment of Minors ; b) conducting and handling of background studies for new employees ; c) home care services staff orientation, training, competency evaluations and their process for evaluating staff performance; d) handling of complaints from clients, family members, or client representatives regarding staff or services provided by staff; e) conducting initial evaluation of clients needs and ability to provide services; f) conducting initial and ongoing assessments including for responding to and reporting changes in client s conditions among staff and with healthcare providers as appropriate; g) orientation to and implementation of the Home Care Client Bill of Rights; h) infection control practices; and i) reminders for medications, treatments or exercises, if provided; j) evidence of appropriate tuberculosis screenings, or documentation of prior screenings, to show that staff are free from turberculosis consistent with current Unites States Center for Disease Control standards (15) Other information deemed necessary by the department. Subd 2. Initial Comprehensive Home Care License Applications. In addition to the information required in Subd 1, items 1 to 15, applicants applying for a Comprehensive Home Care License must also provide verification that the applicant has policies and procedures for the following, that if a license is issued that the applicant they will be implemented and kept current and up- 556 to-date: 22
557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 a) conducting initial and ongoing assessments by registered nurse or appropriate licensed health professional of the client s needs, including how changes in client s conditions are identified, managed and communicated among staff and with other health care providers as appropriate; b) ensuring that nurses and licensed health professionals have current and valid license(s) to practice; c) medication and treatment management; d) delegation of home care services by registered nurse or licensed health professionals; e) supervision of nurses and licensed health professionals; and f) supervision of home care aides unlicensed personnel performing delegated home care services. Subd. 3. License Renewal Except as provided in Section VIII a license may be renewed for a period of one year if the licensee satisfies the following: a) Submits an application for renewal in format as provided by the commissioner at least 30 days before expiration of the license; b) submits the renewal fee in the amount provided by section xxx; c) has provided home care services within the past 12 months; d) complies with Minn. Statutes. 144A..43 to 144A.47 4668.0012, subp13; e) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under Subd 1, items (1) through (14); f) provides verification that all policies under Subd 1. item 14 are current; and g) provides any other information deemed necessary by the commissioner. 23
580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 A renewal applicant who holds a Comprehensive Home Care License must also provide verification that policies listed under Subd 2. a-f are current. (b) Within ten days after receiving an application for a license, the commissioner shall acknowledge receipt of the application in writing. The acknowledgment must indicate whether the application appears to be complete or whether additional information is required before the application will be considered complete. Within 90 days after receiving a complete application, the commissioner shall either grant or deny the license. If an applicant is not granted or denied a license within 90 days after submitting a complete application, the license must be deemed granted. An applicant whose license has been deemed granted must provide written notice to the commissioner before providing a home care service. Subd 4. Multiple Units. Multiple units or branches of a licensee must be separately licensed if the commissioner determines that the units cannot adequately share supervision and administration of services from the main office. (Minnesota Rule 4668.0012) Subd 5. Transfers prohibited; changes in ownership. Any home care license issued by the department may not be transferred to another party. Before acquiring ownership of a home care provider business, a prospective applicant must apply for a new license. A change of ownership is a transfer of operational control to a different business entity, and includes (note need additional language indicating a threshold for ownership change to trigger 50% or more?) A. transfer of the business to a different or new corporation; B. in the case of a partnership, the dissolution or termination of the partnership under Minnesota Statutes, chapter 323A, with the business continuing by a successor partnership or other entity; C. relinquishment of control of the provider to another party, including to a contract management firm that is not under the control of the owner of the business' assets; D. transfer of the business by a sole proprietor to another party or entity; or 24
603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 E. in the case of a privately held corporation, the change in ownership or control of 50 percent or more of the outstanding voting stock. (Minnesota Rule 4668.0012) Subd 6. Notification of Changes of Information. For all temporary licenses, initial and renewal licenses, the temporary licensee or licensee shall notify the commissioner in writing within ten working days thirty days after any change in the information required to be provided by Subd 1, subparts 1-13, except for information required by Subd 1, subitem 4 which will be required at the time of license renewal. (4668.0012) Section VII Subd 1. Issuance of Temporary License and Issuance of License The department shall review each application to determine the applicant s compliance with and knowledge about Minnesota home care regulations. Before granting a temporary license or renewing a license, the commissioner may further evaluate the applicant or licensee by requesting additional information, documentation or by conducting an on-site survey of the applicant to determine compliance with this chapter. 144A.46. Licensure Subd 1 (b) Within ten fourteen calendar days after receiving an application for a license, the commissioner shall acknowledge receipt of the application in writing. The acknowledgment must indicate whether the application appears to be complete or whether additional information is required before the application will be considered complete. Within 90 days after receiving a complete application, the commissioner shall grant issue a temporary license, renew or deny the license. If an applicant is not granted or denied a license within 90 days after submitting a complete application, the license must be deemed granted. An applicant whose license has been deemed granted must provide written notice to the commissioner before providing a home care service. 25
626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 The department shall issue a license that contains the home care provider s name, address, license level, expiration date of the license and the unique license number. Minnesota Rule 4668.0012) All licenses are valid for one year from the date of issuance.(minn. Statutes, 144A.46 Subd 2. Temporary License. For initial license applicants, the commissioner shall issue a Temporary license for either the Basic or Comprehensive Home Care level. A Temporary license is effective for one year from the date of issuance. During the Temporary license year, the commissioner shall survey the Temporary licensee after the Temporary licensee notifies the commissioner that it is providing home care services or when the commissioner has evidence that the Temporary licensee is providing home care services even if the Temporary licensee did not notify the commissioner. The Temporary licensee must notify the commissioner that it is serving clients within five days of beginning service. The notification to the commissioner can be mailed or e-mailed to the commissioner at the address (es) provided by the commissioner. If the Temporary licensee does not provide home care services during the Temporary license year, then the Temporary license expires at the end of the year and the Temporary licensee must reapply for a Temporary home care license. Temporary licensees are required to comply with all provisions of Minn. Stat. secs 144A.43, et seq. A Temporary Licensee may requires a changes in the level of licensure prior to being surveyed and granted a license by notifying the commissioner in writing and providing additional documentation or materials required to update or complete the changed temporary license application. No new fee is required for one change in the level of license. The Commissioner may extend the Temporary license for up to 60 days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits if the 26