2024 Legislative Update

C A R E P R O V I D E R S O F M I N N E S O TA

A R E P O R T O N T H E S E C O N D Y E A R O F T H E 9 3 R D L E G I S L AT I V E S E S S I O N

2024 LEGISLATIVE

UPDATE

#CPMADVOCATES | www.careproviders.org/advocacy

7851 Metro Parkway, Suite 200 Bloomington, MN 55425 952-854-2844 / 1-800-462-0024 www.careproviders.org

2024 LEGISLATIVE UPDATE A report to the membership on the second year of the 93rd Legislative Session Toby Pearson, President/CEO Prepared by: Care Providers of Minnesota Advocacy staff

This report does not constitute legal analyses of the changes in law reported herein. For legal opinions on the application of new statutory language to specific fact situations, contact your organization’s legal counsel. This publication may not be reproduced in whole or in part in any form without the written permission of Care Providers of Minnesota. © Care Providers of Minnesota, Inc., 2024

June 29, 2024 Welcome to the 2024 Legislative Update Book! We hope you find the contents useful as a reference to help you understand the laws that passed this year during the 2024 Legislative Session and to help you prepare for implementation. We encourage you to use the information you find in these pages to talk with your own staff, elected officials, customers, family members, and community leaders about topics of concern for you. This was one of the most productive legislative sessions in recent history, there are many new laws that will directly, as well as indirectly, impact your operations.

The good news is that the legislature is no longer in session and now is the time to educate them on the issues facing our profession. The bad news is that the 2024 Legislature, led by the Democratic Farmer Labor (DFL) party, chose not to extend the one-time investments in long term care.

It will take some time for the state agencies to fill staff positions to implement these new laws and to analyze some of the more complicated consequences of the laws passed. We have included as much information as we know now about the laws that passed but there are many questions that have been forwarded to the various state agencies and we are waiting for their responses. As we learn more about how some of the laws will be implemented, we will be sure to update you in our weekly newsletter. As you consider how to operationalize some of these new mandates/opportunities, don’t hesitate to ask us questions—there may be consequences we haven’t even thought about!

If you have any questions or need more information about anything you find in this book, do not hesitate to contact me at 952-851-2487. You may also access this book and/or individual pages in an electronic version on our website in the “Advocacy” section: www.careproviders.org/advocacy.

Sincerely,

Thomas (Toby) Pearson President/CEO tpearson@careproviders.org

Care Providers of Minnesota 7851 Metro Parkway, Suite 200 • Bloomington, MN 55425 • Phone 952/854-2844 • MN Toll-Free 800/462-0024 • Fax 952/854-6214 • www.careproviders.org Leading Members to Excellence

2024 Legislative Update Book Table of Contents

I. Session Summary ........................................................................................................................................... 9 II. Assisted Living .............................................................................................................................................. 13 a. Assisted living facilities with 6 or fewer units exempted from local rental requirements .................... 15 b. Two communities exempted from DHS size and age limitations ....................................................... 17 c. Assisted living director qualifications; ongoing training ...................................................................... 19 d. Assisted living correction orders ........................................................................................................ 21 e. Adult foster care and community residential setting license capacity ................................................ 23 f. Changes made to the MnCHOICES assessment timing ................................................................... 25 g. Elderly Waiver case management provided by counties and tribes .................................................. 27 h. Assisted technology lead agency partnerships .................................................................................. 29 i. License transition support for small disability waiver providers ......................................................... 31 j. Facility relocation................................................................................................................................ 33 k. Minimum requirements ....................................................................................................................... 37 l. Orientation of staff and supervisors ................................................................................................... 41 m. Mental illness and de-escalation training ........................................................................................... 43 n. Customized living relocation .............................................................................................................. 45 o. Financially distressed nursing facility loan program expanded to HCBS providers ........................... 49 p. Budget and rate exceptions process established for Elderly Waiver ................................................. 53 q. Elderly Waiver Disproportionate Share program sunsetted ............................................................... 55 r. Definition of licensed health professional ........................................................................................... 57 s. Protected Title: restriction on use “assisted living” ............................................................................. 59 t. Requirements for notice and transfer ................................................................................................. 61 III. Housing .......................................................................................................................................................... 63 a. Tenant updates .................................................................................................................................. 65 b. Construction delays ............................................................................................................................ 69 c. Tenant abandonment of dwelling ....................................................................................................... 71 d. Right to terminate-fear of violence ..................................................................................................... 73 e. Landlords cannot refuse to rent based solely on enrollment in medical cannabis program .............. 75 f. Contract for deed................................................................................................................................ 77 g. MHFA wage theft prevention .............................................................................................................. 81 IV. Nursing Facilities .......................................................................................................................................... 85 a. Related-party and lease costs reporting required for nursing facilities .............................................. 87 b. Modifications made to Nursing Home Workforce Standards Board .................................................. 91 c. Nursing facility employees are not eligible for LTSS workforce incentive grants............................... 93 d. Several nursing facilities receive special property rate increases ..................................................... 95 e. Additional round of Critical Access Nursing Facility Program funded ................................................ 97 f. Supplemental nursing services agency modifications ....................................................................... 99 g. Changes to nursing facility case mix ................................................................................................ 105 V. Workforce and Employment ...................................................................................................................... 113 a. Continuation of benefits for pregnancy accommodation leave ........................................................ 115 b. Restrictive employment covenants .................................................................................................. 117 c. Salary disclosure in job posting........................................................................................................ 119 d. Employee blood lead levels ............................................................................................................. 121 e. Worker misclassification updates ..................................................................................................... 123 f. Earned sick and safe time modifications .......................................................................................... 125 g. Nursing assistant competency evaluation language accommodation ............................................. 127 h. Background studies .......................................................................................................................... 129 i. Summer health care internship ........................................................................................................ 131 j. Health professional workforce advisory council ............................................................................... 135 Care Providers of Minnesota

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k.

Paid family leave updates ................................................................................................................ 139

VI. Cannabis ...................................................................................................................................................... 141 a. Alzheimer’s added to qualifying conditions for the medical cannabis program ............................... 143 b. Alternate medical cannabis application for veterans........................................................................ 145 c. Changes to the caregiver language for the medical cannabis program .......................................... 147 d. Cannabis-employee testing/employee drug policy .......................................................................... 149 e. Changes to reasonable restrictions on cannabis use ...................................................................... 151 VII. Miscellaneous .............................................................................................................................................. 153 a. Electronic medical records update includes penalty ........................................................................ 155 b. Senior LinkAge Line changes .......................................................................................................... 157 c. Medical Debt .................................................................................................................................... 159 d. Metro Mobility study ......................................................................................................................... 161 e. Energy conservation decarbonization and climate resiliency loans and grants............................... 163 f. Qualifying property for renewable energy and resiliency improvements ......................................... 165 g. Legislative taskforce on guardianship .............................................................................................. 167 h. $4 million appropriated for DHS response contingency account ..................................................... 169 i. Evaluation of statewide healthcare needs and capacity .................................................................. 171

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SESSION SUMMARY

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Session Overview The 2024 Legislative Session convened on February 12, 2024, and adjourned sine die on May 20, 2024. As a “policy and bonding year”, the legislative session started out as most even-year sessions have begun in the past. There was still a DFL trifecta with a Democrat governor, as well as Democrats holding a lean one-seat majority in the Senate and a 7-seat majority in the House. Session convened in mid-February and committee deadlines were set, with the first and second deadline being the same day this year. Then, policy and supplemental bills began to move forward, and the legislature was poised to move another $1 billion bonding bill.

There were unexpected twists despite a normal start to session. Due to ongoing health reasons, Senate Majority Leader Kari Dziedzic (DFL-Minneapolis) announced she would step down from her leadership position before session started in early February. At a pre-session DFL fundraiser, it was revealed that Erin Murphy (DFL-Saint Paul), would be the new Senate Majority Leader. The Minneapolis City Council further complicated DFL leaders’ agenda, enacting an unworkable Uber/Lyft ordinance and forcing legislative leaders to address the situation. To make matters more complicated, Senator Nicole Mitchell (DFL-Woodbury) was arrested and charged with first-degree felony burglary, stalling Senate business for several weeks at a critical point in session when bills are normally passed and moved to conference committees.

All these events culminated in the final weekend of the legislative session, where most of the legislation passed in the final hours of the session. The DFL majority moved swiftly to pass a substantial policy and supplemental budget agenda in one 1,400+ page omnibus bill with no available copies accessible in paper or online at the time of passage. The bonding bill, requiring a super majority vote, did not pass due to a lack of agreement with Republican legislative leaders. Governor Walz signed all remaining legislation on May 24, 2024.

Looking ahead to 2025 Legislative Session, the Executive Branch will begin the planning process for the next biennial budget for fiscal years 2026-2027. In addition, given the bonding bill did not pass this year, there will be continued planning for a possible bonding bill in 2025.

Governor Walz must present his two-year budget recommendations to the legislature by midJanuary 2025. The next Legislative Session will begin on January 14, 2025, and must conclude

by May 19, 2025. The next two-year budget must be enacted by July 1, 2025 to avoid a state government shutdown.

Budget Targets and the Governor’s Supplemental Budget Twice a year, every year, Minnesota Management and Budget (MMB) releases a budget forecast, in November and February. The February Forecast is the report the legislature and governor use to create a budget.

The February Forecast was released on Feb. 29th and on the following Monday, Gov. Tim Walz introduced his supplemental budget. Gov. Walz proposed leaving most, $3.5 billion, of a projected surplus untouched to avoid causing more pressure on Minnesota’s future finances.

Despite the Governor’s Budget being small, it was disheartening to see that funding for longterm care was absent in the Governor’s proposed supplemental budget. In addition to having no funding for long-term care, there was also a cut in the form of sunsetting the Disproportionate Share (DSH) program. DSH is a program that incentivizes assisted living providers to serve lowincome residents on Elderly Waiver.

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Each year, leaders in the House and Senate convene with the Governor to determine the state’s budget framework. The decision drives what the legislature will aim to spend each year, and how much money can go to each individual appropriation. Budget targets allow House and Senate committees to start with a common goal as they piece together their respective omnibus supplemental budget bills over the coming weeks. Differences between the bodies over how the appropriations are to be spent can then be worked out in conference committees. As a reminder, this was not a budget year. A historic budget was passed last session, and the legislature had no obligation to pass any budget bills this session.

Gov. Walz and legislative leaders released budget targets in mid-March. The DFL trifecta’s leadership budget totaled roughly $447M over the span of 2024-2025 with Human Services receiving a significant portion of the overall target.

Omnibus Bills In mid-April, both the House and Senate rolled out their various omnibus bills. These bills are tied to their respective body’s fiscal and policy priorities. The bodies first set their budget targets for spending, and then they put together bills that meet those targets.

The omnibus bills in the respective House and Senate committees did not line up perfectly. And there was some jurisdictional overlapping between Senate Health and Human services, Senate Human Services, House Health and House Human Services. While legislative leadership and staff worked on lining things up and deciding whether to combine Health and Human Services items, one thing was clear, none of the omnibus bills in the health and human services areas were identical and needed to go through the conference committee process.

In the chaotic final hours of session, the Omnibus Tax Bill was amended to include several other bills creating a “megabus” bill that ended up passing. It contained: • • • • • • • • •

HF5242 Transportation, Housing and Labor Omnibus HF4247 Scope of practice bill HF4024 Higher Education Omnibus HF2609 Straw purchasing/binary trigger ban SF4942 Agriculture/Energy Omnibus SF5335 Human Services Omnibus SF4699 Health and Human Services Omnibus HF5363 Paid Family Medical Leave changes.

Tax bill

In the final minutes of session, the Senate heard, and passed off the floor, SF5335, the Human Services Omnibus bill. Amongst the chaos and shouting within the House Chamber immediately following the vote on the megabus, SF5335 was also inaudibly voted on and passed off the House Floor. Because SF5335 was passed after the megabus, the provisions included in SF5335 are what takes effect.

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ASSISTED LIVING

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Assisted living facilities with 6 or fewer units exempted from local rental requirements 2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 1, Sections 1-2 Human Services Policy Bill Effective: Day following final enactment

Short description Assisted living facilities with 6 or fewer units that are licensed by the Minnesota Department of Health (MDH) and certain residential program settings licensed by the Minnesota Department of Human Services (DHS) are exempted from local licensing and rental requirements.

Summary This bill removes obsolete language and exempts licensed residential programs under the control of a service provider licensed under the chapter of statutes governing home and community-based standards and assisted living facilities, with a licensed capacity of six or fewer persons and actively serving residents for which they are licensed, from rental licensing regulations imposed by any town, municipality, or county.

Implications Home and community-based providers and assisted living facilities with a licensed capacity of six or fewer, are exempted from local rental or licensing restrictions.

Bill language Chapter 108, Article 1, Sections 1-2: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/ Section 1. Minnesota Statutes 2022, section 144G.45, subdivision 3, is amended to read: Subd. 3. Local laws apply. Assisted living facilities shall comply with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements, except a facility with a licensed resident capacity of six or fewer is exempt from rental licensing regulations imposed by any town, municipality, or county.

EFFECTIVE DATE. This section is effective the day following final enactment.

Sec. 2. Minnesota Statutes 2022, section 245A.11, subdivision 2, as amended by Laws 2024, chapter 85, section 55, is amended to read: Subd. 2. Permitted single-family residential use. (a) Residential programs with a licensed capacity of six or fewer persons shall be considered a permitted single-family residential use of property for the purposes of zoning and other land use regulations, except that a residential program whose primary purpose is to treat juveniles who have violated criminal statutes relating to sex offenses or have been adjudicated delinquent on the basis of conduct in violation of criminal statutes relating to sex offenses shall not be considered a permitted use. This exception shall not apply to residential programs licensed before July 1, 1995. Programs otherwise allowed under this subdivision shall not be prohibited by operation of restrictive covenants or similar restrictions, regardless of when entered into, which cannot be met because of the nature of the licensed program, including provisions which require the home's occupants be related, and that the home must be occupied by the owner, or similar provisions.

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(b) A community residential setting as defined in section 245D.02, subdivision 4a, with a licensed capacity of six or fewer persons that is actively serving residents for which it is licensed is exempt from rental licensing regulations imposed by any town, municipality, or county.

EFFECTIVE DATE. This section is effective the day following final enactment.

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Two communities exempted from DHS size and age limitations

2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 1, Section 29 Human Services Policy Bill Effective: August 1, 2024

Short description Two communities in Hennepin County that serve Medicaid beneficiaries enrolled in the Community Access for Disability Inclusion (CADI) waiver are exempted from the size and age limitations.

Summary Throughout the 2024 legislative session, the issues related to size, age, and location of licensed assisted living providers enrolled as a provider of CADI customized living (CL) and 24-hour customized living (24-hr CL) was discussed due to the Minnesota Department of Human Services’ enforcement of the setting restrictions. While these policies remain, the size and age limitations no longer apply to two settings in Hennepin County.

Implications The adopted language, while only applicable to these two settings, provides a template for future advocacy.

Bill language Chapter 108, Article 1, Section 29: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/ Sec. 29. COMMUNITY ACCESS FOR DISABILITY INCLUSION WAIVER CUSTOMIZED LIVING SERVICES PROVIDERS LOCATED IN HENNEPIN COUNTY. The community access for disability inclusion (CADI) waiver customized living and 24-hour customized living size and age limitation does not apply to two housing settings located in the city of Minneapolis that are financed by low-income housing tax credits created in calendar years 2005 and 2011 and in which 24-hour customized living services are provided to residents enrolled in the CADI waiver by Clare Housing.

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Assisted living director qualifications; ongoing training 2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 3, Section 1 Human Services Policy Effective: August 1, 2024

Short description The timeline to apply for licensure as an assisted living director went from six months to 30-days of hire. Some of the legacy license language removed under the qualifications section for nursing home administrator or qualified health services executive. Removed training and replaced with continuing education.

Summary Most changes were minimal language changes to provide clarity and streamline language throughout the chapter. Most significant change was decreasing the amount of time an individual has to apply for licensure as an assisted living director.

Implications Individuals will have less time to apply for licensure upon hire as an assisted living director.

Bill language Chapter 108, Article 3, Section 1: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/

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Assisted living correction orders

2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 3, Section 2, Subdivision 5 Human Services Policy Bill Effective: August 1, 2024 Short description Compels assisted living facilities to make available to residents and others the most recent plan of correction that documents actions taken by the facility to comply with health department survey correction orders.

Summary Amends 144G.30 regarding survey citations to include a process for assisted living facilities to make their correction orders available to residents and others, including a paper copy upon request.

Implications Assisted living facilities must have a process to post electronically or on paper and a process to provide a written copy to anyone that requests one.

Bill language Chapter 108, Article 3, Section 2: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/ Sec. 2.

Minnesota Statutes 2022, section 144G.30, subdivision 5, is amended to read: Subd. 5.

Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a facility, a managerial official, an agent of the facility, or an employee of the facility is not in compliance with this chapter. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction. (b) The commissioner shall mail or email copies of any correction order to the facility within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the facility and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the facility must: (1) document in the facility's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the facility's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed.; and (2) make available, in a manner readily accessible to residents and others, including provision of a paper copy upon request, the most recent plan of correction documenting the actions taken by the facility to comply with the correction order.

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(d) After the plan of correction is made available under paragraph (c), clause (2), the facility must provide a copy of the facility's most recent plan of correction to any individual who requests it. A copy of the most recent plan of correction must be provided within 30 days after the request and in a format determined by the facility, except the facility must make reasonable accommodations in providing the plan of correction in another format, including a paper copy, upon request.

EFFECTIVE DATE. This section is effective August 1, 2024, and applies to correction orders issued on or after that date.

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Adult foster care and community residential setting license capacity 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Section 5 Human Services Finance Bill Effective: August 1, 2024

Short description The commissioner may issue an adult foster care community residential setting license with a capacity of five or six adults to facilities meeting the criteria in section 245A.03, subdivision 1, paragraph (a), clause (5), and grant variances to paragraph (b) to allow the facility to admit an individual under the age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of the variance is recommended by the county in which the licensed facility is located.

Summary Gives an option to serve more clients for facilities meeting specific criteria and to admit an individual under the age of 55 if a variance is granted.

Bill language Chapter 125, Article 1, Section 5: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Subd. 2a. Adult foster care and community residential setting license capacity. (a) The commissioner shall issue adult foster care and community residential setting licenses with a maximum licensed capacity of four beds, including nonstaff roomers and boarders, except that the commissioner may issue a license with a capacity of five beds, including roomers and boarders, according to paragraphs (b) to (g) (h). (b) The license holder may have a maximum license capacity of five if all persons in care are age 55 or over and do not have a serious and persistent mental illness or a developmental disability. (c) The commissioner may grant variances to paragraph (b) to allow a facility with a licensed capacity of up to five persons to admit an individual under the age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of the variance is recommended by the county in which the licensed facility is located. (d) The commissioner may grant variances to paragraph (a) to allow the use of an additional bed, up to six, for emergency crisis services for a person with serious and persistent mental illness or a developmental disability, regardless of age, if the variance complies with section 245A.04, subdivision 9, and approval of the variance is recommended by the county in which the licensed facility is located. (e) The commissioner may grant a variance to paragraph (b) to allow for the use of an additional bed, up to six, for respite services, as defined in section 245A.02, for persons with disabilities, regardless of age, if the variance complies with sections 245A.03, subdivision 7, and 245A.04, subdivision 9, and approval of the variance is recommended by the county in which the licensed facility is located. Respite care may be provided under the following conditions: (1) staffing ratios cannot be reduced below the approved level for the individuals being served in the home on a permanent basis;

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(2) no more than two different individuals can be accepted for respite services in any calendar month and the total respite days may not exceed 120 days per program in any calendar year; (3) the person receiving respite services must have his or her own bedroom, which could be used for alternative purposes when not used as a respite bedroom, and cannot be the room of another person who lives in the facility; and (4) individuals living in the facility must be notified when the variance is approved. The provider must give 60 days' notice in writing to the residents and their legal representatives prior to accepting the first respite placement. Notice must be given to residents at least two days prior to service initiation, or as soon as the license holder is able if they receive notice of the need for respite less than two days prior to initiation, each time a respite client will be served, unless the requirement for this notice is waived by the resident or legal guardian. (f) The commissioner may issue an adult foster care or community residential setting license with a capacity of five adults if the fifth bed does not increase the overall statewide capacity of licensed adult foster care or community residential setting beds in homes that are not the primary residence of the license holder, as identified in a plan submitted to the commissioner by the county, when the capacity is recommended by the county licensing agency of the county in which the facility is located and if the recommendation verifies that: (1) the facility meets the physical environment requirements in the adult foster care licensing rule; (2) the five-bed living arrangement is specified for each resident in the resident's: (i) individualized plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if required; or (iii) individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart 19, if required; (3) the license holder obtains written and signed informed consent from each resident or resident's legal representative documenting the resident's informed choice to remain living in the home and that the resident's refusal to consent would not have resulted in service termination; and (4) the facility was licensed for adult foster care before March 1, 2016. (g) The commissioner shall not issue a new adult foster care license under paragraph (f) after December 31, 2020. The commissioner shall allow a facility with an adult foster care license issued under paragraph (f) before December 31, 2020, to continue with a capacity of five adults if the license holder continues to comply with the requirements in paragraph (f). (h) The commissioner may issue an adult foster care or community residential setting license with a capacity of five or six adults to facilities meeting the criteria in section 245A.03, subdivision 7, paragraph (a), clause (5), and grant variances to paragraph (b) to allow the facility to admit an individual under the age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of the variance is recommended by the county in which the licensed facility is located. (h) (i) Notwithstanding Minnesota Rules, part 9520.0500, adult foster care and community residential setting licenses with a capacity of up to six adults as allowed under this subdivision are not required to be licensed as an adult mental health residential program according to Minnesota Rules, parts 9520.0500 to 9520.0670.

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Changes made to the MnCHOICES assessment timing 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Sections 13-16 Human Services Finance Bill Effective: July 1, 2024 and July 1, 2025

Short description Effective July 1, 2025: 1) the duration of the validity of a MnCHOICES assessment is extended from 60 to 365 days, and 2) the length of time in which a person requesting long-term care consultation services must be visited by a long-term care consultation team is changed from 20 calendar days to 20 working days.

Summary A Minnesota waiver program beneficiary’s eligibility has always depended on the completion of a qualifying needs assessment (level of care) and being determined financially eligible for Medicaid. However, the assessment is only good for 60 days. If a beneficiary is not approved for Medicaid within 60 days of the needs assessment, then the assessment will need to be performed again.

Beginning July 1, 2025, assessments that are completed as part of an eligibility determination for the alternative care, elderly waiver, developmental disabilities, community access for disability inclusion, community alternative care, and brain injury waiver programs are now valid for establishing service eligibility for no more than 365 days.

The bill also extends the length of time in which a person requesting long-term care consultation services must be visited by a long-term care consultation team changed from 20 calendar days to 20 working days. This change will likely lengthen the number of days for a long-term care consultation to be completed.

Effective July 1, 2024, additional changes were made to lower the experience needed to be an assessor.

Implications These changes are not intended to speed up the assessment process. Instead, these changes are intended to allow statute to reflect the actual capacity of the assessment and financial determination processes. These changes will not likely improve issues that beneficiaries and providers are presently encountering.

Bill language Chapter 125, Article 1, Sections 13 to 16: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Elderly Waiver case management provided by counties and tribes

2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Section 27 Human Services Finance Bill Effective: August 1, 2024, and applies to procurement processes that commence on or after that date Short description If a county agency provides case management under contracts with other individuals or agencies and the county utilizes a competitive proposal process for the procurement of contracted case management services, the competitive proposal process must include evaluation criteria to ensure that the county maintains a culturally responsive program.

Summary “Culturally responsive program” means a case management services program that meets specific criteria.

Bill language Chapter 125, Article 1, Section 27: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 27. Minnesota Statutes 2022, section 256S.07, subdivision 1, is amended to read: Subdivision 1. Elderly waiver case management provided by counties and tribes. (a) For participants not enrolled in a managed care organization, the county of residence or tribe must provide or arrange to provide elderly waiver case management activities under section 256S.09, subdivisions 2 and 3. (b) If a county agency provides case management under contracts with other individuals or agencies and the county agency utilizes a competitive proposal process for the procurement of contracted case management services, the competitive proposal process must include evaluation criteria to ensure that the county maintains a culturally responsive program for case management services adequate to meet the needs of the population of the county. For the purposes of this section, "culturally responsive program" means a case management services program that: (1) ensures effective, equitable, comprehensive, and respectful quality care services that are responsive to individuals within a specific population's values, beliefs, practices, health literacy, preferred language, and other communication needs; and (2) is designed to address the unique needs of individuals who share a common language or racial, ethnic, or social background.

EFFECTIVE DATE. This section is effective August 1, 2024, and applies to procurement processes that commence on or after that date.

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Assisted technology lead agency partnerships 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Section 33 Human Services Finance Bill Effective: August 1, 2024

Short description Lead agencies are allowed to partner with enrolled Medical Assistance home and community based services providers to evaluate the benefits of informed choice in accessing assistive technology.

Summary Home and community-based services under the Alternative Care (AC), Elderly Waiver (EW), CADI,BI and DD waiver programs may partner with lead agencies to evaluate the benefits of informed choice in accessing the following existing assistive technology home and communitybased waiver services (HCBS): (1) assistive technology; (2) specialized equipment and supplies; (3) environmental accessibility adaptations; and (4) 24-hour emergency assistance.

This effort must allow beneficiaries to choose to participate.

Lead agencies may use the program to improve outcomes and efficiencies as well as collect and share feedback from recipients, family caregivers, and any other interested community partners.

Implications HCBS waivered service providers may be approached by lead agencies to partner on the use of assistive technology.

Bill language Chapter 125, Article 1, Section 33: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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License transition support for small disability waiver providers 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Section 43 Human Services Finance Bill Effective: Effective the day following final enactment

Short description Offers onetime payments to medical assistance disability waiver customized living and community residential providers to assist with the transition from small, customized living settings to licensed community residential services under Minnesota Statutes, chapter 245D and section 256B.49.

Summary Eligible providers are enrolled providers that received approval from the commissioner of human services for a corporate foster care moratorium exception related to transitioning between customized living services and community residential services. This approval must have been received between July 1, 2022, and December 31, 2023.

Implications License holders of eligible settings must apply for payments using an application process.

Payments are one time amounts of $15,000 per eligible setting. To be considered for a payment, eligible settings must submit a payment application no later than March 1, 2025.

Bill language Chapter 125, Article 1, Section 43: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Facility relocation

2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 1 Human Services Finance Bill Effective: March 15, 2025 (Facility Relocation) and January 1, 2025, except subdivision 2 is effective January 1, 2025, or 90 days after federal approval, whichever is later.

Short description An assisted living facility with a licensed resident capacity of five residents or fewer may operate under the licensee’s current license, if the facility is relocated, with the approval of the commissioner of health during the period the current license is valid. A licensee is not required to apply for a new license solely because the licensee received approval to relocate a facility.

Summary This will allow small, assisted living providers the ability to relocate, in certain circumstances, to a facility without having to apply for a new license as long as the statutory requirements are met.

It also addresses limited exemption from the customized living setting moratorium and 809.14 age limitations.

Implications Small, assisted living providers with five or fewer residents can relocate their program to another building once every three years within the geographic boundaries of the city they are in or a contiguous city. This new building must comply with all regulations governing assisted living services. This change will offer options for small, assisted living providers that don’t own, but rent the residential home and experiencing rent increases by landlords who knew the provider could not relocate due to the licensure requirements. In addition, it allows providers who are also enrolled with the Department of Human Services as a customized living setting to deliver 24-hour customized living services or customized living services to participants through the brain injury and community access for disability inclusion home and community-based services waiver plan of the intent to relocate. If the licensee at the time of the intended relocation is providing customized living, or 24-hour customized living services under the brain injury and community access for disability inclusion home and community-based services waiver plans and section 256B.49 to at least one individual, and the licensee intends to continue serving that individual in the new location, the licensee must inform the commissioner of human services of the licensee’s intention to do so and meet the requirements specified under section 256B.49, subdivision 28a.

Bill language Chapter 125, Article 2, Section 1: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Section 1. [144G.195] FACILITY RELOCATION. Subdivision 1. New license not required. (a) Beginning March 15, 2025, an assisted living facility with a licensed resident capacity of five residents or fewer may operate under the licensee's current license if the facility is relocated with the approval of the commissioner of health during the period the current license is valid. (b) A licensee is not required to apply for a new license solely because the licensee receives approval to relocate a facility. The licensee's license for the relocated facility remains

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valid until the expiration date specified on the existing license. The commissioner of health must apply the licensing and survey cycle previously established for the facility's prior location to the facility's new location. (c) A licensee must notify the commissioner of health, on a form developed by the commissioner, of the licensee's intent to relocate the licensee's facility and submit a nonrefundable relocation fee of $3,905. The commissioner must deposit all relocation fees in the state treasury to be credited to the state government special revenue fund. (d) The licensee must obtain plan review approval for the building to which the licensee intends to relocate the facility and a certificate of occupancy from the commissioner of labor and industry or the commissioner of labor and industry's delegated authority for the building. Upon issuance of a certificate of occupancy, the commissioner of health must review and inspect the building to which the licensee intends to relocate the facility and approve or deny the license relocation within 30 calendar days. (e) A licensee may only relocate a facility within the geographic boundaries of the municipality in which the facility is currently located or within the geographic boundaries of a contiguous municipality. (f) A licensee may only relocate one time in any three-year period, except that the commissioner may approve an additional relocation within a three-year period upon a licensee's demonstration of an extenuating circumstance, including but not limited to the criteria outlined in section 256B.49, subdivision 28a, paragraph (c). (g) A licensee that receives approval from the commissioner to relocate a facility must 809.4 provide each resident with a new assisted living contract and comply with the coordinated move requirements under section 144G.55. (h) A licensee denied approval by the commissioner of health to relocate a facility may continue to operate the facility in its current location, follow the requirements in section144G.57 and close the facility, or notify the commissioner of health of the licensee's intent to relocate the facility to an alternative new location. If the licensee notifies the commissioner of the licensee's intent to relocate the facility to an alternative new location, paragraph (c) applies, including the timelines for approving or denying the license relocation for the alternative new location.

Subd. 2.Limited exemption from the customized living setting moratorium and 809.14 age limitations. (a) A licensee that receives approval from the commissioner of health under subdivision 1 to relocate a facility that is also enrolled with the Department of Human Services as a customized living setting to deliver 24-hour customized living services or customized living services to participants through the brain injury and community access for disability inclusion home and community-based services waiver plans and under section 256B.49 must inform the commissioner of human services of the licensee's intent to relocate. (b) If the licensee at the time of the intended relocation is providing customized living or 24-hour customized living services under the brain injury and community access for disability inclusion home and community-based services waiver plans and section 256B.49 to at least one individual, and the licensee intends to continue serving that individual in the new location, the

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licensee must inform the commissioner of human services of the licensee's intention to do so and meet the requirements specified under section 256B.49, subdivision 28a.

EFFECTIVE DATE. This section is effective January 1, 2025, except subdivision 2 is effective January 1, 2025, or 90 days after federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

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Minimum requirements

2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 2-4 Human Services Finance Bill Effective: July 1, 2024 Short description Language has been amended in sections 2-4 and additional language added to various subdivisions to address minimum requirements; for required food services including changes for assisted living facilities with a licensed capacity of ten or fewer residents, and minimum requirements; for other required services.

Summary Changes will allow the assisted living facilities with a licensed capacity of ten or fewer to share a certified food protection manager with one other facility, kick plates that are not removable or cannot be rotated open are allowed, the facility is not required to provide integral drainboards, utensil racks, or tables large enough to accommodate soiled and clean items provided soiled items do not contaminate clean items, surfaces, or food, and clean equipment and dishes are air dried in a manner that prevents contamination before storage, the facility is not required to install a dedicated handwashing sink in its existing kitchen provided it designates one well of a two-compartment sink for use only as a handwashing sink, existing floor, wall, and ceiling finishes are allowed provided the facility keeps them clean and in good condition, shielded or shatter-resistant lightbulbs are not required, but if a light bulb breaks, the facility must discard all exposed food and fully clean all equipment, dishes, and surfaces. Lastly, toilet rooms are not required to be provided with a self-closing door.

Implications Grants a series of exceptions to commercial kitchen standards for smaller assisted living programs with ten or fewer residents.

Bill language Article 125, Article 2, Section 2-4: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 2. Minnesota Statutes 2022, section 144G.41, subdivision 1, is amended to read: Subdivision 1. Minimum requirements. All assisted living facilities shall: (1) distribute to residents the assisted living bill of rights; (2) provide services in a manner that complies with the Nurse Practice Act in sections 148.171 to 148.285; (3) utilize a person-centered planning and service delivery process; (4) have and maintain a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by the Nurse Practice Act in sections 148.171 to 148.285; (5) provide a means for residents to request assistance for health and safety needs 24 hours per day, seven days per week; (6) allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract; (7) permit residents access to food at any time;

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(8) allow residents to choose the resident's visitors and times of visits; (9) allow the resident the right to choose a roommate if sharing a unit; (10) notify the resident of the resident's right to have and use a lockable door to the resident's unit. The licensee shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. An assisted living facility must not lock a resident in the resident's unit; (11) develop and implement a staffing plan for determining its staffing level that: (i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled needs of each resident as required by the residents' assessments and service plans on a 24-hour per day basis; and (iii) ensures that the facility can respond promptly and effectively to individual resident emergencies and to emergency, life safety, and disaster situations affecting staff or residents in the facility; (12) ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time; (iii) capable of communicating with residents; (iv) capable of providing or summoning the appropriate assistance; and (v) capable of following directions; and (13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The following apply: (A) menus must be prepared at least one week in advance, and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served.

Residents must be informed in advance of menu changes; (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and (C) the facility cannot require a resident to include and pay for meals in their contract; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the resident, provide direct or reasonable assistance with arranging for transportation to medical and social services appointments, shopping, and other recreation, and provide the name of or other identifying information about the persons responsible for providing this assistance; (v) upon the request of the resident, provide reasonable assistance with accessing community resources and social services available in the community, and provide the name of or other identifying information about persons responsible for providing this assistance; (vi) provide culturally sensitive programs; and (vii) have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and that creates opportunities for active participation in the community at large; and

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(14) (13) provide staff access to an on-call registered nurse 24 hours per day, seven days per week.

Sec. 3. Minnesota Statutes 2022, section 144G.41, is amended by adding a subdivision to read: Subd. 1a. Minimum requirements; required food services. (a) All assisted living facilities must offer to provide or make available at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The menus must be prepared at least one week in advance, and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served.

Residents must be informed in advance of menu changes. The facility must not require a resident to include and pay for meals in the resident's contract. Except as provided in paragraph (b), food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626. (b) For an assisted living facility with a licensed capacity of ten or fewer residents: (1) notwithstanding Minnesota Rules, part 4626.0033, item A, the facility may share a certified food protection manager (CFPM) with one other facility located within a 60-mile radius and under common management provided the CFPM is present at each facility frequently enough to effectively administer, manage, and supervise each facility's food service operation; (2) notwithstanding Minnesota Rules, part 4626.0545, item A, kick plates that are not removable or cannot be rotated open are allowed unless the facility has been issued repeated correction orders for violations of Minnesota Rules, part 4626.1565 or 4626.1570; (3) notwithstanding Minnesota Rules, part 4626.0685, item A, the facility is not required to provide integral drainboards, utensil racks, or tables large enough to accommodate soiled and clean items that may accumulate during hours of operation provided soiled items do not contaminate clean items, surfaces, or food, and clean equipment and dishes are air dried in a manner that prevents contamination before storage; (4) notwithstanding Minnesota Rules, part 4626.1070, item A, the facility is not required to install a dedicated handwashing sink in its existing kitchen provided it designates one well of a two-compartment sink for use only as a handwashing sink; (5) notwithstanding Minnesota Rules, parts 4626.1325, 4626.1335, and 4626.1360, item A, existing floor, wall, and ceiling finishes are allowed provided the facility keeps them clean and in good condition; (6) notwithstanding Minnesota Rules, part 4626.1375, shielded or shatter-resistant lightbulbs are not required, but if a light bulb breaks, the facility must discard all exposed food and fully clean all equipment, dishes, and surfaces to remove any glass particles; and (7) notwithstanding Minnesota Rules, part 4626.1390, toilet rooms are not required to be provided with a self-closing door.

Sec. 4. Minnesota Statutes 2022, section 144G.41, is amended by adding a subdivision to read: Subd. 1b. Minimum requirements; other required services. All assisted living facilities must offer to provide or make available the following services to residents: (1) weekly housekeeping; (2) weekly laundry service; (3) upon the request of the resident, provide direct or reasonable assistance with arranging for transportation to medical and social services appointments, shopping, and other recreation, and provide the name of or other identifying information about the persons responsible for providing this assistance;

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(4) upon the request of the resident, provide reasonable assistance with accessing community resources and social services available in the community, and provide the name of or other identifying information about persons responsible for providing this assistance; (5) provide culturally sensitive programs; and (6) have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and that creates opportunities for active participation in the community at large.

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Orientation of staff and supervisors 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 5 Human Services Finance Bill Effective: July 1, 2025

Short description This allows portability of orientation if the staff person transfers from one licensed assisted living facility to another facility operated by the same licensee or by a licensee affiliated with the same corporate organization as the licensee of the first facility, or to another facility managed by the same entity managing the first facility.

Summary A staff person is not required to repeat the orientation training if they move from one facility to another under the same management. The staff person cannot transfer from an assisted living provider to an assisted living with dementia care provider without satisfying the additional training requirements.

Implications This can alleviate duplicative orientation and allow individuals who meet the requirements to work in multiple locations without repeating the same orientation over and over.

Bill language Chapter 125, Article 2, Section 5: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 5. Minnesota Statutes 2022, section 144G.63, subdivision 1, is amended to read: Subdivision 1. Orientation of staff and supervisors. (a) All staff providing and supervising direct services must complete an orientation to assisted living facility licensing requirements and regulations before providing assisted living services to residents. The orientation may be incorporated into the training required under subdivision 5. The orientation need only be completed once for each staff person and is not transferable to another facility, except as provided in paragraph (b). (b) A staff person is not required to repeat the orientation required under subdivision 2 if the staff person transfers from one licensed assisted living facility to another facility operated by the same licensee or by a licensee affiliated with the same corporate organization as the licensee of the first facility, or to another facility managed by the same entity managing the first facility. The facility to which the staff person transfers must document that the staff person completed the orientation at the prior facility. The facility to which the staff person transfers must nonetheless provide the transferred staff person with supplemental orientation specific to the facility and document that the supplemental orientation was provided. The supplemental orientation must include the types of assisted living services the staff person will be providing, the facility's category of licensure, and the facility's emergency procedures.

A staff person cannot transfer to an assisted living facility with dementia care without satisfying the additional training requirements under section 144G.83.

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Mental illness and de-escalation training 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 6-7 Human Services Finance Bill Effective: July 1, 2025

Short description Assisted living providers will need to make available mental illness and de-escalation training for all staff which include recognizing symptoms of common mental illness diagnoses, including but not limited to mood disorders, anxiety disorders, trauma-and stressor-related disorders, personality and psychotic disorders, substance use disorder, and substance misuse, deescalation techniques and communication, and crisis resolution and suicide prevention, including procedures for contacting county crisis response teams and 988 suicide and crisis lifelines.

Summary Training will prepare staff to care for and respond to individuals with mental illness in assisted living.

Implications This change will add an additional two hours of required training within 160 working hours of the employment for direct-care employees and within 120 working hours for supervisors of directcare employees and one additional hour of required training annually on mental illness and deescalation topics.

Bill language Chapter 125, Article 2, Section 6-7: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 6. Minnesota Statutes 2022, section 144G.63, subdivision 4, is amended to read: Subd. 4.Training required relating to dementia, mental illness, and de-escalation.

All direct care staff and supervisors providing direct services must demonstrate an understanding of the training specified in section 144G.64.

EFFECTIVE DATE. This section is effective July 1, 2025.

Sec. 7. Minnesota Statutes 2022, section 144G.64, is amended to read: 144G.64 TRAINING IN DEMENTIA CARE, MENTAL ILLNESS, AND DE-ESCALATION REQUIRED. (a) All assisted living facilities must meet the following dementia care, mental illness, and deescalation training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on dementia topics specified under paragraph (b), clauses (1) to (5), and two hours of initial training on mental illness and de-escalation topics specified under paragraph (b), clauses (6) to (8), within 120 working hours of the employment start date, and. Supervisors must have at least two hours of training on topics related to dementia care and one hour of training on topics related to mental illness and de-escalation for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on dementia topics specified under paragraph (b), clauses (1) to (5), and two hours of initial training on mental illness and de-escalation topics specified under paragraph (b), clauses (6) to (8),

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within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and the initial two hours of training on topics related to mental illness and de-escalation and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia and one hour of training on topics related to mental illness and de-escalation for each 12 months of employment thereafter; (3) for assisted living facilities with dementia care, direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 80 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and two hours of training on topics related to mental illness and de-escalation and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia and one hour of training on topics related to mental illness and deescalation for each 12 months of employment thereafter; (4) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b), clauses (1) to (5), and two hours of initial training on mental illness and de-escalation topics specified under paragraph (b), clauses (6) to (8), within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care and one hour of training on topics related to mental illness and de-escalation for each 12 months of employment thereafter; and (5) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required dementia, mental illness, and de-escalation training include: (1) an explanation of Alzheimer's disease and other dementias; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; (4) communication skills; and (5) person-centered planning and service delivery.; (6) recognizing symptoms of common mental illness diagnoses, including but not limited to mood disorders, anxiety disorders, trauma- and stressor-related disorders, personality and psychotic disorders, substance use disorder, and substance misuse; (7) de-escalation techniques and communication; and (8) crisis resolution and suicide prevention, including procedures for contacting county crisis response teams and 988 suicide and crisis lifelines. (c) The facility shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered.

EFFECTIVE DATE. This section is effective July 1, 2025.

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Customized living relocation

2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 15 Human Services Finance Bill Effective: January 1, 2025, or 90 days after federal approval, whichever is later.

Short description Licensed assisted living facilities providing CADI and BI customized living (CL), including 24hour (24HR-CL), services, may relocate their setting under specific circumstances.

Summary The relationship between the Assisted living license statute and payment for CL or 24-HR CL services in assisted living, created operational challenges for settings that needed to move locations due lease terminations.

Providers enrolled before January 11, 2021 may relocate their assisted living facility and continue to provide CL and 25-HR CL services if: • The provider renting the setting is being evicted, is not able to renew the lease, or the owner has sold the property.

• The provider that rents the property is unable to complete physical plant requirements.

• The provider’s monthly rent is increasing by more than 3 percent.

• The setting is damaged by wind, fire, flooding, etc.

• The provider purchases a new setting.

The statute provides the specific steps and obligations that a provider and the state must take to determine if a relocation is permissible.

Implications Creating a framework for licensed assisted living settings that are renting their setting to relocate to a new setting and keep their ALF license and CL and 24-HR CL enrollment is much needed addition to statute.

Care Providers of Minnesota will communicate to members the processes developed by the state to implement this statute.

Bill language Chapter 125, Article 2, Section 15: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 15.

Minnesota Statutes 2022, section 256B.49, is amended by adding a subdivision to read: Subd. 28a. Transfer of customized living enrollment dates. (a) For the purposes of this subdivision, "operational" has the meaning given in subdivision 28. (b) This paragraph applies only to customized living settings enrolled and operational on or before June 30, 2021, and customized living settings that have previously transferred their customized living enrollment date under this paragraph. A provider that receives approval from the commissioner of health under section 144G.195, subdivision 1, to relocate a licensed assisted living facility that was enrolled prior to January 11, 2021, to deliver medical assistance

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24-hour customized living services, or customized living services as defined by the brain injury and community access for disability inclusion federally approved home and community-based services waiver plans, may continue to operate the customized living setting under the original setting's customized living enrollment date if all of the requirements under this subdivision are met. (c) A transfer of enrollment date is allowed under this subdivision only if the facility relocation is due to: (1) a provider that rents the original setting being unable to continue to rent the original setting because of eviction, nonrenewal of its lease by the property owner, or sale of the property by the owner; (2) a provider that rents the original setting being unable to make the necessary updates or improvements to the original setting to comply with the physical plant and other requirements under state or federal law, including but not limited to chapter 144G; (3) a provider's monthly rent increasing more than three percent in a 12-month period; (4) the original setting being destroyed or damaged by fire, lightning, flood, wind, ground shifts, or other such hazards, including environmental hazards, to such an extent that the original setting cannot be repaired and the safety of residents would be jeopardized by continuing to reside in the original setting; or (5) a provider or an entity that directly or indirectly through one or more intermediaries is controlled by, is under common control with, or controls the entity enrolled to provide customized living services at the current setting purchases a new setting and the commissioner of health approves the relocation of the provider's assisted living facility license to the newly purchased setting. (d) When a relocation is necessitated by a qualifying situation under paragraph (c), clauses (1) to (5), the provider must submit a notification to the commissioner of human services, the ombudsman of long-term care, the ombudsperson of mental health and developmental disabilities, relevant lead agencies, each resident's case manager, and either each person receiving services at the setting or the person's legal representative. The notification must be made at least 30 days prior to the relocation date and on forms and in the manner prescribed by the commissioner of human services. (e) A provider proposing to transfer a customized living setting enrollment date to a new setting must submit, with the provider's notification to the commissioner of human services under paragraph (d), the following information: (1) the addresses of the vacating location and of the proposed new location; (2) the anticipated date of the move to the new location; (3) contacts for the lead agency and each resident's waiver case manager; (4) documentation that the Department of Health has received an application to relocate pursuant to section 144G.195, subdivision 1, for the new location; and (5) documentation that the customized living provider's assisted living facility license is not conditional. (f) The commissioner of human services has 30 days to approve or deny requests to transfer the original setting's customized living enrollment date to the new setting. (g) The commissioner of human services must deny requests to transfer a customized living enrollment date to a new setting if: (1) the new setting approved by the commissioner of health under section 144G.195, subdivision 1, is adjoined to or on the same property as an institution as defined in Code

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of Federal Regulations, title 42, section 441.301(c), or one or more licensed assisted living facilities; (2) the requesting provider fails to notify the commissioner of human services of the proposed relocation within the time frames required under this subdivision; (3) the requesting provider's assisted living facility license is conditional; or (4) the requesting provider is changing ownership at the same time as the proposed relocation. (h) The setting to which the original customized living enrollment date is transferred must: (1) comply with setting requirements in the brain injury and community access for disability inclusion federally approved home and community-based services waiver plans and under this section as the requirements existed on the customized living enrollment date of the original setting; (2) have a resident capacity less than or equal to the resident capacity of the original setting; (3) not require or coerce any resident of the original setting to move to the new setting, consistent with informed choice and independent living policies under section 256B.4905, subdivisions 1a, 2a, 3a, and 8; and (4) provide each resident with a new assisted living contract and comply with the coordinated move requirements under section 144G.55.

EFFECTIVE DATE. This section is effective January 1, 2025, or 90 days after federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

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Financially distressed nursing facility loan program expanded to HCBS providers 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 16 Human Services Finance Bill Effective: July 1, 2024, except that subdivision 8a is effective retroactively from July 1, 2023.

Short description The $100 million interest free loan program for financially distressed nursing facilities that was passed by the 2023 legislature was expanded to include Home and Community Based Service (HCBS) providers.

Summary The concept of providing interest free loans to nursing facilities surfaced near the end of the 2023 legislative session. While the Minnesota Department of Human Services (DHS) has received over 50 nursing facility applications, the state has not approved any loans yet.

Terms: • Interest free • Disbursement may be made as a lump sum or over defined schedule • Repayment must not begin until 18-months after disbursement • Repayment term must not exceed 72 months • The state may withhold payment for Medicaid services if provider is delinquent by 60 calendar days • Subject to DHS audit • The language places the State of Minnesota at the front of the line with regard to creditors and repayment.

With expansion of the program, the following HCBS providers are now eligible: • Home and community-based services under chapter 245D • Personal care assistance services under section 256B.0659 • Community first services and supports under section 256B.85 • Early intensive developmental and behavioral intervention services under section 256B.0949 • Home care services as defined under section 256B.0651, subdivision 1, paragraph (d) • Customized living services as defined in section 256S.02 The Nursing Facility Criteria to be used by DHS remains the same. The program provides interest free loans to eligible nursing facilities that demonstrate: 1. The total net income of the nursing facility is not generating sufficient revenue to cover the nursing facility's operating expenses; 2. The nursing facility is at risk of closure; and 3. Additional operating revenue is necessary to either preserve access to nursing facility services within the community or support people with complex, high-acuity support needs.

HCBS Provider Criteria to be used by DHS is different.

Additional operating revenue is necessary to: • Preserve access to services within the community, • Expand services to people within the community, • Expand services to new communities, or

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•

Support people with complex, high-acuity support needs

Finally, repayments will now return to the loan fund and be used for new loans.

Implications While DHS is still evaluating which nursing facilities that applied will be granted a loan, DHS will now need to develop applications and processes for HCBS providers.

Care Providers of Minnesota will continue to monitor the program development and inform members once more is known.

Bill language Chapter 125, Article 2, Section 16: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ 256R.55 FINANCIALLY DISTRESSED NURSING FACILITY LONG-TERM SERVICES AND SUPPORTS LOAN PROGRAM. Subdivision 1.Financially distressed nursing facility loans Long-term services and supports loan program. The commissioner of human services shall establish a competitive financially distressed nursing facility loan program to provide operating loans to eligible nursing long-term services and supports providers and facilities. The commissioner shall initiate the application process for the loan described in this section at least once annually if money is available. A second application process may be initiated each year at the discretion of the commissioner.

Subd. 2. Eligibility.

To be an eligible applicant for a loan under this section, a nursing facility provider must submit to the commissioner of human services a loan application in the form and according to the timelines established by the commissioner. In its loan application, a loan applicant must demonstrate that the following: (1) for nursing facilities with a medical assistance provider agreement that are licensed as a nursing home or boarding care home according to section 256R.02, subdivision 33: (1) (i) the total net income of the nursing facility is not generating sufficient revenue to cover the nursing facility's operating expenses; (2) (ii) the nursing facility is at risk of closure; and (3) (iii) additional operating revenue is necessary to either preserve access to nursing facility services within the community or support people with complex, high-acuity support needs.; and (2) for other long-term services and supports providers: (i) demonstration that the provider is enrolled in a Minnesota health care program and provides one or more of the following services in a Minnesota health care program: (A) home and community-based services under chapter 245D; (B) personal care assistance services under section 256B.0659; (C) community first services and supports under section 256B.85; (D) early intensive developmental and behavioral intervention services under section 256B.0949; (E) home care services as defined under section 256B.0651, subdivision 1, paragraph (d); or (F) customized living services as defined in section 256S.02; and (ii) additional operating revenue is necessary to preserve access to services within the community, expand services to people within the community, expand services to new communities, or support people with complex, high-acuity support needs.

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Subd. 2a. Allowable uses of loan money. (a) A loan awarded to a nursing facility under subdivision 2, clause (1), must only be used to cover the facility's short-term operating expenses. Nursing facilities receiving loans must not use the loan proceeds to pay related organizations as defined in section 256R.02, subdivision 43. (b) A loan awarded to a long-term services and supports provider under subdivision 2, clause (2), must only be used to cover expenses related to achieving outcomes identified in subdivision 2, clause (2), item (ii).

Subd. 3. Approving loans.

The commissioner must evaluate all loan applications on a competitive basis and award loans to successful applicants within available appropriations for this purpose. The commissioner's decisions are final and not subject to appeal.

Subd. 4. Disbursement schedule.

Successful loan applicants under this section may receive loan disbursements as a lump sum, or on an agreed upon disbursement schedule, or as a time-limited line of credit. The commissioner shall approve disbursements to successful loan applicants through a memorandum of understanding. Memoranda of understanding must specify the amount and schedule of loan disbursements.

Subd. 5. Loan administration.

The commissioner may contract with an independent third party to administer the loan program under this section.

Subd. 6. Loan payments.

The commissioner shall negotiate the terms of the loan repayment, including the start of the repayment plan, the due date of the repayment, and the frequency of the repayment installments. Repayment installments must not begin until at least 18 months after the first disbursement date. The memoranda of understanding must specify the amount and schedule of loan payments. The repayment term must not exceed 72 months. If any loan payment to the commissioner is not paid within the time specified by the memoranda of understanding, the late payment must be assessed a penalty rate of 0.01 percent of the original loan amount each month the payment is past due. For nursing facilities, this late fee is not an allowable cost on the department's cost report. The commissioner shall have the power to abate penalties when discrepancies occur resulting from but not limited to circumstances of error and mail delivery.

Subd. 7. Loan repayment. (a) If a borrower is more than 60 calendar days delinquent in the timely payment of a contractual payment under this section, the provisions in paragraphs (b) to (e) apply. (b) The commissioner may withhold some or all of the amount of the delinquent loan payment, together with any penalties due and owing on those amounts, from any money the department owes to the borrower. The commissioner may, at the commissioner's discretion, also withhold future contractual payments from any money the commissioner owes the provider as those contractual payments become due and owing. The commissioner may continue this withholding until the commissioner determines there is no longer any need to do so. (c) The commissioner shall give prior notice of the commissioner's intention to withhold by mail, facsimile, or email at least ten business days before the date of the first payment period for which the withholding begins. The notice must be deemed received as of the date of mailing or receipt of the facsimile or electronic notice. The notice must: (1) state the amount of the delinquent contractual payment;

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(2) state the amount of the withholding per payment period; (3) state the date on which the withholding is to begin; (4) state whether the commissioner intends to withhold future installments of the provider's contractual payments; and (5) state other contents as the commissioner deems appropriate. (d) The commissioner, or the commissioner's designee, may enter into written settlement agreements with a provider to resolve disputes and other matters involving unpaid loan contractual payments or future loan contractual payments. (e) Notwithstanding any law to the contrary, all unpaid loans, plus any accrued penalties, are overpayments for the purposes of section 256B.0641, subdivision 1. The current owner of a nursing home or, boarding care home, or long-term services and supports provider is liable for the overpayment amount owed by a former owner for any facility sold, transferred, or reorganized.

Subd. 8. Audit. Loan money allocated under this section is subject to audit to determine whether the money was spent as authorized under this section.

Subd. 8a. Special revenue account.

A long-term services and supports loan account is created in the special revenue fund in the state treasury. Money appropriated for the purposes of this section must be transferred to the long-term services and supports loan account. All payments received under subdivision 6, along with fees, penalties, and interest, must be deposited into the special revenue account and are appropriated to the commissioner for the purposes of this section.

Subd. 9. Carryforward. Notwithstanding section 16A.28, subdivision 3, any appropriation money in the long-term services and supports loan account for the purposes under this section carries forward and does not lapse until the close of the fiscal year in which this section expires.

Subd. 10. Expiration.This section expires June 30, 2029.

EFFECTIVE DATE. This section is effective July 1, 2024, except that subdivision 8a is effective retroactively from July 1, 2023.

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Budget and rate exceptions process established for Elderly Waiver 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 17 Human Services Finance Bill Effective: January 1, 2026, or upon federal approval, whichever is later.

Short description Elderly waiver recipients with high support needs that are residing in the hospital due to lack of community options may receive a budget and rate exception.

Summary The Governor’s supplemental budget recommendations to fund several strategies to address systemic barriers for people with disabilities and complex support needs, such as co-occurring behavioral health conditions or medical complexity, who are residing in hospitals because appropriate community-based services are not available or cannot meet their needs. These strategies include allowing disability waiver services in hospitals, supporting elderly waiver (EW) recipients with high support needs, creating a vulnerable adult/developmental disability case management benefit for Tribal nations, addressing the backlog of MnChoices assessments, and adding transition planning as a service under the Alternative Care program.

The final bill included about $7 million in funding. Of this amount, $2.6 million was allocated to EW. Implications This creates an opportunity for Medicaid beneficiaries that are unable to be discharged from a hospital. The next steps will be for the Minnesota Department of Human Services to develop the process, policy, and format by which a beneficiary may apply.

Care Providers of Minnesota will communicate these to members when they are developed.

Bill language Chapter 125, Article 2, Section 17: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/ Sec. 17.

[256S.191] ELDERLY WAIVER BUDGET AND RATE EXCEPTIONS; HIGH-NEED PARTICIPANTS. Subdivision 1. Eligibility for budget and rate exceptions.

A participant is eligible to request an elderly waiver budget and rate exception when: 1) hospitalization of the participant is no longer medically necessary but the participant has not been discharged to the community due to lack of community care options; (2) the participant requires a support plan that exceeds elderly waiver budgets and rates due to the participant's specific assessed needs; and (3) the participant meets all eligibility criteria for the elderly waiver.

Subd. 2. Requests for budget and rate exceptions. (a) A participant eligible under subdivision 1 may request, in a format prescribed by the commissioner, an elderly waiver budget and rate exception when requesting an eligibility

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determination for elderly waiver services. The participant may request an exception to the elderly waiver case mix caps, the customized living service rate limits, service rates, or any combination of the three. (b) The participant must document in the request that the participant's needs cannot be met within the existing case mix caps, customized living service rate limits, or service rates and how an exception to any of the three will meet the participant's needs. (c) The participant must include in the request the basis for the underlying costs used to determine the overall cost of the proposed service plan. (d) The commissioner must respond to all exception requests, whether the request is granted, denied, or granted as modified. The commissioner must include in the response the basis for the action and provide notification of the right to appeal. (e) Participants granted exceptions under this section must apply annually in a format prescribed by the commissioner to continue or modify the exception. (f) A participant no longer qualifies for an exception when the participant's needs can be met within standard elderly waiver budgets and rates.

EFFECTIVE DATE. This section is effective January 1, 2026, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

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Elderly Waiver Disproportionate Share program sunsetted 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Sections 18-22 Human Services Finance Bill Effective: January 1, 2025

Short description The EW Disproportionate Share Program (DPS) will be sunsetted on December 31, 2025. The rate floor is set at $141. While no new participants will be allowed, existing participants may reapply for the 2025 calendar year.

Summary The Governor recommended sunsetting the Disproportionate Share Program, which provides a rate floor for customized living services in the Elderly Waiver (EW) program. The rate floor applies to services for residents of eligible facilities that serve a high proportion of waiver participants. According to the Governor’s budget: • The program was designed to be temporary and intended to sunset once the EW rates were fully phased in, however the statute as drafted does not enable the sunset to occur as intended.

• Rate methodologies need to be consistent across all EW recipients and service rates will be based on the level of need and amount of support each person receives.

While the Senate was open to extending the program, the House adopted the Governor’s language. The agreed upon language does the following: • The program is sunsetting on December 31, 2025.

• No new applicants are allowed.

• The rate is set at $141 for the 2025 calendar year with the previous methodology removed.

• Currently designated DPS settings will need to reapply this fall for the 2025 calendar year.

• $8.9 million in Savings for FY2025 to FY2027.

Implications Two important considerations for members.

First, existing DPS settings will need to re-apply for the 2025 calendar year. Care Providers of Minnesota will let me members know when the application materials are available.

Second, the legislature will have the opportunity to revisit the decision in 2025. The challenge now will be one of funding since the sunset generates significant budget savings.

Bill language Chapter 125, Article 2, Sections 18 to 22: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Definition of licensed health professional 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Section 41 Tax Bill Effective: July 1, 2024

Short description Provides clarity for other licensed health professionals.

Summary This allows other licensed health professionals the ability to provide services within a licensed assisted living facility as long as the services provided are within the scope of practice of that individual’s license, registration, or certification.

Bill language Chapter 127, Article 59: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Subd. 29. Licensed health professional. "Licensed health professional" means a person licensed in Minnesota to practice a profession described in section 214.01, subdivision 2, other than a registered nurse or licensed practical nurse, who provides assisted living services within the scope of practice of that person's health occupation license, registration, or certification as a regulated person who is licensed by an appropriate Minnesota state board or agency.

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Protected Title; restriction on use “assisted living”

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Section 42 Tax Bill Effective: January 1, 2026

Short description Provides clarity when the phrase “assisted living” may be used. Furthermore, it will restrict a new assisted living facility licensee’s name from using the terms “home care” or “nursing home” within the name.

Summary A person or entity entitled to use the phrase “assisted living” shall use the phrase only in the context of its participation that meets the requirements of this chapter.

Implications Helps avoid confusion with naming conventions for different Minnesota Department of Health licensed settings.

Bill language Chapter 127, Article 59, Section 42: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 42. Minnesota Statutes 2022, section 144G.10, is amended by adding a subdivision to read: Subd. 5. Protected title; restriction on use .(a) Effective January 1, 2026, no person or entity may use the phrase "assisted living," whether alone or in combination with other words and whether orally or in writing, to: advertise; market; or otherwise describe, offer, or promote itself, or any housing, service, service package, or program that it provides within this state, unless the person or entity is a licensed assisted living facility that meets the requirements of this chapter. A person or entity entitled to use the phrase "assisted living" shall use the phrase only in the context of its participation that meets the requirements of this chapter. (b) Effective January 1, 2026, the licensee's name for a new assisted living facility may not include the terms "home care" or "nursing home."

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Requirements for notice and transfer

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Section 43 Tax Bill Effective: July 1, 2024

Short description Provides clarification when a provisional license denial is upheld by the reconsideration process, the licensee must submit a closure plan.

Summary Defines clear timelines in which the closure plan must be drafted, submitted, and finalized.

Bill language Chapter 127, Article 59, Section 43: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 43. Minnesota Statutes 2022, section 144G.16, subdivision 6, is amended to read: Subd. 6. Requirements for notice and transfer. A provisional licensee whose license is denied must comply with the requirements for notification and the coordinated move of residents in sections 144G.52 and 144G.55. If the license denial is upheld by the reconsideration process, the licensee must submit a draft closure plan as required by section 144G.57 within ten calendar days of receipt of the reconsideration decision, must work with the commissioner on any revisions needed to the draft plan, and must have a final closure plan submitted and approved within 30 calendar days of receipt of the reconsideration decision.

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HOUSING

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Tenant updates

2024 Regular Session SF 3492/HF 3591 Chapter 118, Article 1, Sections 2,3,5,6,7,13, 21 and 23 Housing Policy Bill Effective: August 1, 2024 Short description Various technical and definition updates to landlord/tenant 504B. Summary Section 2- Defines tenant association as a group of tenants from two or more rental units owned or operated by the same landlord who form an organization to improve housing conditions.

Section 3- Defines tenant organizer as a tenant or other individual that assists residential tenants in establishing and operating a tenant association.

Section 5- Defines abandonment of tenancy as voluntary relinquishment of premises by resident tenant. Defines abandonment of personal property as leaving some personal effects on the premises after permanently vacating the property.

Section 6- Requires landlord to disclose additional fees, charges or deposits pursuant to a pet policy and allows tenant to recover fees if the landlord fails to disclose.

Section 7- Requires landlords to provide the option for prospective tenants to provide individual taxpayer identification number OR a social security number in rental applications.

Section 13- Late fees states that late fees charged to a tenant with housing assistance payments contracted federal or state entities must only be calculated on the tenants portion of the rent.

Section 21- States that Residential tenants of a residential building have the right to establish and operate a tenant association to address issues related to their living environment.

Section 23- Makes changes to the tenant report and remedies.

Bill language Chapter 118, Article 1, Sections 2,4,5,6, 7,13, 21 and 23: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/118/ Sec. 2.

Minnesota Statutes 2022, section 504B.001, is amended by adding a subdivision to read: Subd. 13a.

Tenant association.

"Tenant association" means a group of tenants from two or more rental units that are owned or operated by the same landlord who form or maintain an organization, whether incorporated or unincorporated, to improve housing conditions, amenities, community life, or the contractual position of the member tenants.

Sec. 3.

Minnesota Statutes 2022, section 504B.001, is amended by adding a subdivision to read: Subd. 13b.

Tenant organizer.

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"Tenant organizer" means a tenant or another who assists residential tenants in establishing and operating a tenant association and is not an employee or representative of the current or prospective landlord, property owner, manager, or agent of the landlord.

Sec. 4.

Minnesota Statutes 2022, section 504B.001, subdivision 14, is amended to read: Subd. 14.

Violation.

"Violation" means: (1) a violation of any state, county or city health, safety, housing, building, fire prevention, or housing maintenance code applicable to the building; (2) a violation of any of the covenants set forth in section 504B.161, subdivision 1, clause (1) or (2), or in section 504B.171, subdivision 1 this chapter; or (3) a violation of any federal, state, county, or city laws protecting tenants from discrimination; (4) a violation of any applicable tenant rights and landlord obligations for public and subsidized tenancies under local, state, or federal law; or (3) (5) a violation of an oral or written agreement, lease, or contract for the rental of a dwelling in a building.

Sec. 5.

Minnesota Statutes 2022, section 504B.001, is amended by adding a subdivision to read: Subd. 16.

Abandonment. (a) "Abandonment of tenancy" means the intentional and voluntary absolute relinquishment of premises by the residential tenant. (b) "Abandonment of personal property" means a residential tenant leaving some of the tenant's personal property on the premises after permanently vacating the property.

Sec. 6.

Minnesota Statutes 2022, section 504B.113, subdivision 3, is amended to read: Subd. 3.

Additional fees or deposits prohibited; disclosure required. (a) A landlord must not require a tenant with a reasonable accommodation under this section to pay an additional fee, charge, or deposit for the service or support animal. A tenant is liable to the landlord for any damage to the premises caused by the service or support animal. (b) If a landlord requires an additional fee, charge, or deposit pursuant to a pet policy, the landlord must disclose in the lease the prohibition on additional fees, charges, or deposits for service or support animals under this section.

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(c) A tenant may bring an action to recover any fees, charges, or deposits paid to a landlord pursuant to a pet policy if: (1) the landlord fails to provide the disclosure required in paragraph (b); and (2) the tenant demonstrates that the tenant would have requested a reasonable accommodation and would likely have received a reasonable accommodation had the landlord provided the disclosure under paragraph (b).

Sec. 7.

[504B.117] INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER. A landlord must provide on a rental application the option for a prospective tenant to submit an individual taxpayer identification number or a Social Security number as follows: "SSN or ITIN:

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Construction delays

2024 Regular Session SF 3492/HF 3591 Chapter 118, Article 1, Section 9 Housing Policy Bill Effective: August 1, 2024 Short description Provides a process for if there is delayed occupancy availability due to delays in construction.

Summary Landlords must provide notice prior to new tenants within seven days of being notified by builder of construction issues that will delay occupancy. Landlord must notify potential tenants prior to move-in and provide alternative housing options, payment for equivalent housing or the ability to terminate a lease agreement and refund any deposits or fees paid by the tenant to the landlord.

Implications Possible implications for new construction facilities to provide notice to new tenants.

Bill language Chapter 118, Article, Section 9: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/118/ Sec. 9.

[504B.153] NEW CONSTRUCTION DELAYS; TENANT REMEDIES. Subdivision 1.

Definition; new construction.

For purposes of this section, "new construction" means a new building, rehabilitation, modification, reconstruction, any physical changes altering the use or occupancy of the dwelling units, or an addition to a building.

Subd. 2.

Requirements if landlord cannot deliver occupancy. (a) If a landlord is informed by a builder or otherwise knows that a new construction for rental occupancy will not be available for occupancy by the move-in date established in the lease agreement, the landlord must, within seven days and prior to the move-in date, notify every tenant affected and offer the following choices to the tenant to be accepted at the tenant's option: (1) alternative housing provided by the landlord that is reasonably equivalent in size, amenities, and location to the unit described in the lease agreement, unless otherwise agreed upon by the tenant, until the unit may be lawfully inhabited; (2) payment from the landlord to the tenant, equivalent to the cost of rent established in the lease agreement, to mitigate the costs of alternative housing secured by the tenant until the unit described in the lease agreement may be lawfully inhabited; or (3) termination of the lease agreement and a return to the tenant of all amounts paid to the landlord, including any rent, deposit, and other payments incurred in entering the lease agreement. (b) If a tenant exercises options under paragraph (a), clause (1) or (2), the landlord must provide the tenant with reimbursements related to security deposits, application fees, parking fees, pet fees, and any other fees reasonably associated with securing alternative housing.

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(c) Tenants exercising options under paragraph (a), clause (1) or (2), may terminate their lease agreement under paragraph (a), clause (3), if the new construction for rental occupancy is not available for tenant occupancy within 90 days of the move-in date established in the lease agreement.

Subd. 3.

Waiver.

Any provision, whether oral or written, of any lease or other agreement, whereby any provision of this section is waived by a tenant, is contrary to public policy and void.

Subd. 4.

Remedies. (a) A violation by the landlord of subdivision 2 is a violation of section 504B.375. A tenant aggrieved by a violation by the landlord of subdivision 2 may elect the following remedy: (1) recovery under section 504B.231; or (2) recover the greater of one month's rent, $1,000, or actual damages, plus reasonable attorney fees and court costs. (b) The remedies available under this section are in addition to any other remedies available at equity or law.

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Tenant abandonment of dwelling 2024 Regular Session SF 3492/HF 3591 Chapter 118, Article 1, Section 10 Housing Policy Bill Effective: August 1, 2024

Short description Provides that a tenant’s lease obligations cease when a new tenant begins a new tenancy for a unit. Requires a landlord to fill a vacancy if a tenant leaves before their lease is up. Also provides the amount of rent a tenant could owe if the tenancy abandoned was a tenancy at will or a periodic tenancy.

Summary If a tenant abandons a dwelling, the landlord shall make reasonable efforts to rent it, once rented the tenant agreement terminates and they are not liable for rent after the termination of the tenancy. If the rental agreement was for a periodic tenancy or tenancy at will, the maximum rent liability for the tenant is the notice period required to end the lease from the date the landlord has notice of the abandonment.

Implications Notice of abandonment may be nebulous in assisted living settings, given constraints posed by emergent hospital stays.

Bill language Chapter 118, Article 1, Section 10: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/118/ Sec. 10.

[504B.154] TENANT ABANDONMENT OF DWELLING. Subdivision 1.

Abandonment. (a) If a residential tenant abandons a dwelling unit during the lease term, the landlord shall make reasonable efforts to rent it at a fair rental value. If the landlord rents the dwelling unit for a term beginning before the expiration of the rental agreement, the agreement is terminated on the date the new tenancy begins. The rental agreement is terminated by the landlord on the date the landlord has notice of the abandonment if the landlord fails to use reasonable efforts to rent the dwelling unit at a fair rental value or if the landlord accepts the abandonment as a surrender. The tenant shall not be liable for rent after the termination of the tenancy. (b) If the rental agreement was for a periodic tenancy or tenancy at will, the maximum rent liability for the tenant is the notice period required to end the lease from the date the landlord has notice of the abandonment.

Subd. 2.

Waiver prohibited.

Any waiver of the rights provided by this section shall be void and unenforceable.

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Right to terminate-fear of violence 2024 Regular Session SF 3492/HF 3591 Chapter 118, Article 1, Section 17 Housing Policy Bill Effective: June 25, 2024

Short description Clarifies the procedure to terminate a lease when the tenant has been the victim of domestic violence or sexual assault or harassment.

Summary Clarifies when tenancy terminates, and that vacating property prior to the date given in their notice does not constitute termination of tenancy.

Bill language Chapter 118, Article 1, Section 17: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/118/

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Landlords cannot refuse to rent based solely on enrollment in medical cannabis program 2024 General Session HF 4757/SF 4782 Chapter 121, Article 2, Section 116 Cannabis Bill Effective July 1, 2024

Short Description Landlords cannot refuse to lease to someone, a patient or person, based on them being enrolled in the registry program.

Summary Sec. 116 Minnesota Statutes 2023 Supplement, section 342.57, subdivision 3 (b) No landlord may refuse to lease to a patient or person enrolled in the registry program or otherwise penalize a patient or person enrolled in the registry program solely because the patient or person is enrolled in the registry program, unless failing to do so would violate federal law or regulations or cause the landlord to lose a monetary or licensing-related benefit under federal law or regulations.

Implications Providers must be aware that as landlords’ providers cannot refuse to lease to someone solely because they are enrolled in the registry program.

Bill language Chapter 121, Article 2, Section 116: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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Contract for deed

2023 Regular Session HF 5216/SF 5337 Chapter 123, Article 16 Judiciary and Public Safety Bill Effective: Various Short description These sections of the bill modify requirements governing contracts for deeds. This bill defines and prohibits churning; requires investor sellers to make certain disclosures to purchasers prior to the execution of a contract for deed, including disclosure of balloon payments; provides the purchaser with a right to cancel the purchase agreement and receive a refund of all payments; permits the purchaser to bring an action against the investor seller; and permits enforcement by the attorney general.

Summary Section 2. Requirements of vendor. Requires, that within four months of the execution of a contact for deed, the vendor must pay any delinquent taxes necessary for the recording of the contract for deed; and must record the contract for deed in the office of the county recorder or registrar of titles in the county in which the land is located. Requires the vendor to make a good faith effort to remove any impediments to recordation.

Section 4. Private transfer fee. Removes from the prohibition on private transfer fees, as exemption for consideration paid by a contract for deed vendee to a vendor pursuant to the terms of a recorded contract for deed.

Section 5. Provides that for contracts for deeds executed on or after August 1, 2024, the seller’s notice to terminate must state that the purchaser pay, prior to termination, an amount to apply on the attorney’s fees actually expended or incurred of $1,000 in order to avoid termination of the contract.

Section 6. Provides that a contract for deed executed by an investor seller terminates with 90 days’ notice. No notice may be given unless at least 30 days prior to service of the notice to terminate, conditions of default existed and the investor seller notified the purchaser of the conditions of default.

Section 7. Termination prohibited for certain transfers regarding residential real property. Provides that no notice of termination may be given under section 559.21 for any contract for deed based on certain transfers.

Section 8. Termination prohibited if vendor fails to record contracts for deed involving residential real property. Prohibits termination under 559.21 if the contract for deed was not recorded or the vendor failed to make a good faith effort to correct defects to recordation.

Section 9. Affidavit of seller constituting prima facie evidence. Provides when a seller’s affidavit constitutes prima facie evidence.

Section 10. Order; proceedings; security. Permits award of reasonable attorney fees and cost to the purchaser if the vendor made an appearance and the injunction was granted.

Section 11. Prima facie evidence of termination. Provides that it is not necessary to pay current or delinquent taxes owed on property subject to a contract for deed to record required documents, as long as the documents are presented to the county auditor for entry upon the transfer record and have the appropriate notation entered.

Section 12. Contracts for deed involving investor sellers and residential real property; definitions.

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Subd. 1. Application. Provides definition for purposes of sections 559A.01 to 559A.05 (sections 12 to 16 of this bill).

Subd. 2. Balloon payment. Defines “balloon payment” as a schedule payment under a CFD that is significantly larger than regularly scheduled payments.

Subd. 3. Churning. Defines “churning.”

Subd. 4. Contract for deed. Defines “contract for deed.”

Subd. 5. Investor seller. Defines “investor seller” as a person entering into a contract for deed to sell residential real property. Includes a list of persons or entities who are not "investor sellers."

Subd. 6. Person. Defines “person” to include natural persons and business entities.

Subd. 7. Purchase agreement. Defines “purchase agreement.”

Subd. 8. Purchaser. Defines “purchaser.”

Subd. 9. Residential real property. Defines “residential real property” as real property consisting of one to four family dwelling units, one of which is intended to be occupied as the principal residence of the purchaser.

Section 13. Applicability. Provides that this chapter applies to residential real property where a purchaser is entering into a contract for deed with an investor seller. Provides statements that may be used as a prima facie evidence that this chapter does not apply.

Section 14. Contracts for deed involving investor sellers and residential real property; disclosures.

Subd. 1. Disclosures required. Requires disclosures that must be affixed to the front of any purchase agreement. Prohibits the investor seller from entering into a contract for deed within ten days of the execution of the purchase agreement and provision of the required disclosures and cancellation instructions. If there is no purchase agreement, the disclosures must be provided ten days before the execution of a contract for deed in a separate document. The parties much acknowledge delivery and receipt of the disclosure.

Subd. 2. Disclosure of balloon payment. Requires disclosure of all balloon payments in a specific form and type.

Subd. 3. Disclosure of price paid by investor seller to acquire property. Requires the investor seller to disclose the purchase price and date of earliest acquisition of the property by the investor seller, unless the acquisition occurred more than one year prior to the section of the contract for deed.

Describes when a person is deemed to be the same person as the investor seller, including if they are under common ownership. Provides the specific form and type for the disclosure.

Subd. 4. Disclosure of other essential terms. Requires disclosure of the purchase price, the annual interest rate, the amount of any downpayment, and whether the purchaser is responsible for any other payments. Provides the specific form and type for the disclosure.

Subd. 5. General disclosure. Requires a general disclosure about contract for deeds and provides the specific form and type for the disclosure.

Subd. 6. Amortization schedule. Requires the investor seller to provide an amortization schedule to the purchaser in a separate document, Subd. 7. Disclosures in other languages. Requires the investor seller to provide the disclosure in another language if a language other than English was used to advertise or negotiate with the purchaser.

Subd. 8. No waiver. Prohibits waiver of this section.

Subd. 9. Effects of violation. In general, a violation of this section has no effect on the validity of the contract for deed.

Section 15. Contracts for deed involving investor sellers and residential real property; rights and requirements.

Subd. 1. Requirement of investor seller if property subject to mortgage. Prohibits an investor seller from executing a contract for deed on property that is subject to a mortgage and not expressly assumed by the contract for deed purchaser unless the investor seller meets certain requirements, including obtaining the mortgage holder’s consent to the sale and promising to perform all obligations under the mortgage.

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Subd. 2. Right to cancel purchase agreement. Permits a prospective purchaser to cancel a purchase agreement prior to the execution of a contract for deed or within ten days of receiving required disclosures, whichever is earlier. Requires the investor seller to provide the purchaser with information about where a cancellation may be sent. In the event of cancellation, the investor seller may not impose a penalty or fee and must refund all payments made by the prospective purchaser.

Subd. 3. Duty of investor seller to account. Requires the investor seller to inform the purchaser, in separate writing, of the right to request an annual accounting.

Subd. 4. Churning prohibited. Prohibits an investor seller from engaging in churning. Creates a rebuttable presumption that the investor seller engaged in churning if on or after August 1, 2024, the investor seller executes a CFD and within the previous 48 months, the investor seller completed a certain number of termination proceedings. Provides when persons are deemed to be the same investor seller for purposes of determining if the same investor seller engaged in churning.

Subd. 5. Duty of investor seller to refund down payments. Provides a refund to the purchaser of any portion of the down payment that exceeded ten percent of the purchase price if an investor seller terminates a contract for deed within 48 months of executing the contract.

Section 16. Contracts for deed involving investor sellers and residential real property; remedies for violation.

Subd. 1. Definition. Defines “material violation of section 559A.03.”

Subd. 2. Remedy for violation of disclosure requirements or churning. Permits the purchaser to bring an action within two years of the execution of the contract for deed for material violations or for churning. Permits a prevailing purchaser to rescind the contract and recover an amount equal to all payments made, reasonable value of improvements made, damages, and reasonable attorney’s fees and cost.

Subd. 3. Remedy for failure of investor seller to procure agreement with mortgage holder. If a mortgage holder commences foreclosure of its mortgage based on the sale to the purchaser under the contract for deed, a purchaser may bring an action against the investor seller for failure to procure the required agreement from the mortgage holder. A prevailing purchaser may rescind the contract and recover an amount equal to payments made by the purchaser, reasonable value of any improvements, damages, and reasonable attorneys fees and costs.

Subd. 4. Defense termination. Provides that a purchaser’s right to remedy under this section constitutes grounds for injunctive relief under section 559.211.

Subd. 5. Effect of action on title. Provides that an action under subdivision 2 or 3 is personal to the purchaser only and does not constitute an interest separate from the purchaser’s interest in the contract for deed.

Subd. 6. Rights cumulative. Provides that the rights provided under this section do not limit other rights.

Subd. 7. Public enforcement. Provides that the attorney general may investigate and prosecute violations of sections 559A.03 (required disclosures) and 559A.04, subdivision 4 (prohibition on churning).

Implications If you are buying or selling a property on a contract for deed, you must comply with the new requirements of the law.

Bill language Chapter 123, Article 16 https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/123/

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MHFA wage theft prevention

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 9, Section 5, Subdivision 1-8 Tax Bill Effective: August 1, 2024 Short description Requires Minnesota Housing Finance (MHFA) funded projects to have a wage theft prevention plan and disclose any labor law violations occurring within five years of the application.

Summary Requires applicants for assistance from MHFA to disclose any of a broad range of labor law violations occurring within the five years preceding the application. Requires applicants to disclose the information to a member of the public who requests the data within 14 days of the request. Requires that applicants for financial assistance from MHFA use responsible contractors, as defined by law, for their projects. Proscribes penalties for noncompliance with this section and for contractors who fail to pay statutorily required wages on projects receiving financial assistance from MHFA. Implications For organizations engaged in a project using Minnesota Housing Finance Agency, or other federal low-income housing credits, risk financing ramifications, including loss of funding, if failing to pay statutorily required wages.

Bill language Chapter 127, Article 9, Section 5: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 5.

[462A.051] WAGE THEFT PREVENTION AND USE OF RESPONSIBLE CONTRACTORS. Subdivision 1.

Definitions. (a) For the purposes of this section, the following terms have the meanings given. (b) "Project sponsor" means an individual, legal entity, or nonprofit board that exercises control, financial responsibility, and decision-making authority over a housing development. (c) "Developer" means an individual, legal entity, or nonprofit board that is responsible for the coordination of financing and building of a housing development. (c) "Funding" means all forms of financial assistance or the allocation or award of federal low-income housing tax credits.

Subd. 2.

Application.

This section applies to all forms of financial assistance provided by the Minnesota Housing Finance Agency, as well as the allocation and award of federal low-income housing credits, for the development, construction, rehabilitation, renovation, or retrofitting of multiunit residential housing, including loans, grants, tax credits, loan guarantees, loan insurance, and other financial assistance.

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Subd. 3.

Disclosures.

An applicant for funding under this chapter shall disclose in the application any conviction, court judgment, agency determination, legal settlement, ongoing criminal or civil investigation, or lawsuit involving alleged violations of sections 177.24, 177.25, 177.32, 177.41 to 177.44, 181.03, 181.101, 181.13, 181.14, 181.722, 181.723, 181A.01 to 181A.12, or 609.52, subdivision 2, paragraph (a), clause (19), or United States Code, title 29, sections 201 to 219, or title 40, sections 3141 to 3148, arising or occurring within the preceding five years on a construction project owned or managed by the developer, project sponsor, or owner of the proposed project, the intended general contractor for the proposed project, or any of their respective parent companies, subsidiaries, or other affiliated companies. An applicant for funding shall make the disclosures required by this subdivision available within 14 calendar days to any member of the public who submits a request by mail or electronic correspondence. The applicant shall designate a public information officer who will serve as a point of contact for public inquiries.

Subd. 4.

Responsible contractors required.

As a condition of receiving funding from the agency during the application process, the project sponsor shall verify that every contractor or subcontractor of any tier performing work on the proposed project meets the minimum criteria to be a responsible contractor under section 16C.285, subdivision 3. This verification must meet the criteria defined in section 16C.285, subdivision 4.

Subd. 5.

Certified contractor lists.

As a condition of receiving funding, the project applicant shall have available at the development site main office, a list of every contractor and subcontractor of any tier that performs work or is expected to perform work on the proposed project, as described in section 16C.285, subdivision 5, including the following information for each contractor and subcontractor: business name, scope of work, Department of Labor and Industry registration number, business name of the entity contracting its services, business telephone number and email address, and actual or anticipated number of workers on the project. The project sponsor shall establish the initial contractor list 30 days before the start of construction and shall update the list each month thereafter until construction is complete. The project sponsor shall post the contractor list in a conspicuous location at the project site and make the contractor list available to members of the public upon request.

Subd. 6.

Wage theft remedy.

If any contractor or subcontractor of any tier is found to have failed to pay statutorily required wages under section 609.52, subdivision 1, clause (13), on a project receiving funding from or through the agency, the contractor or subcontractor with the finding is responsible for correcting the violation.

Subd. 7.

Wage theft prevention plans; disqualification. (a) If any contractor or subcontractor of any tier fails to pay statutorily required wages on a project receiving funding from or through the agency as determined by an enforcement entity, the project sponsor of the project must have a wage theft prevention plan to be eligible for further funding from the agency. The project sponsor's wage theft prevention plan must describe detailed measures that the project sponsor and its general contractor have taken and are committed to take to prevent wage theft on the project, including provisions in any construction contracts and

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subcontracts on the project. The plan must be submitted to the Department of Labor and Industry for review. The Department of Labor and Industry may require the project sponsor to amend the plan or adopt policies or protocols in the plan. Once approved by the Department of Labor and Industry, the wage theft prevention plan must be submitted by the project sponsor to the agency with any subsequent application for funding from the agency. Such wage theft prevention plans shall be made available to members of the public by the agency upon request. (b) A project sponsor is disqualified from receiving funding from or through the agency for three years if any of the project sponsor's contractors or subcontractors of any tier are found by an enforcement agency to have, within three years after entering into a wage theft prevention plan under paragraph (a), failed to pay statutorily required wages on a project receiving financial assistance from or through the agency for a total underpayment of $50,000 or more.

Subd. 8.

Enforcement.

The agency must deny an application for funding that does not comply with this section or if the project sponsor refuses to enter into the agreements required by this section. The agency may withhold funding that has been previously approved if the agency determines that the project sponsor has engaged in unacceptable practices by failing to comply with this section until the violation is cured.

EFFECTIVE DATE. This section is effective for applications for funding submitted after August 1, 2024.

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NURSING FACILITIES

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Related-party and lease costs reporting required for nursing facilities

2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 3, Sections 5 and 6 Human Services Policy Bill Effective: August 1, 2024

Short description Nursing facility owners and operators are required to report related-party transactions and their costs associated with leases, rent, and use of land or other real property.

Summary The 2024 legislative session saw the Minnesota Department of Human Services (DHS) seek additional statutory authority to collect related-party and costs associated with leases, rent, and use of land or other real property. Care Providers of Minnesota worked with DHS to modify the initial language and removed a provision to post the collected information on the state’s website.

DHS likely had the authority to collect this information already. According to DHS, the collection of the information will work better with the statutory authority. The new language specifies that nursing facilities must provide DHS with: • Information regarding any relationship where the licensee or a general partner, director, or officer of the licensee controls or has an ownership interest of five percent or more in a related organization that provides any services, facilities, or supplies to the nursing facility. o If yes, then the licensee is required to disclose all services, facilities, or supplies provided to the nursing facility; the number of individuals who provide services, facilities, or supplies at the nursing facility; and any other information requested by the state agency.

• Information on the nursing facility’s cost associated with leases, rent, and use of land or other real property.

Implications Nursing facilities will be required to report additional information on the annual Medicaid statistical cost report. A nursing facility that violates these provisions is subject to the penalties under: 256R.04 Subd. 7. Violations and penalties. For a period not to exceed 180 days, the commissioner may continue to make medical assistance payments to a nursing facility which is in violation of this section if extreme hardship to the residents would result. In these cases the commissioner shall issue an order requiring the nursing facility to correct the violation. The nursing facility shall have 20 days from its receipt of the order to correct the violation. If the violation is not corrected within the 20-day period the commissioner may reduce the payment rate to the nursing facility by up to 20 percent.

The amount of the payment rate reduction shall be related to the severity of the violation and shall remain in effect until the violation is corrected. The nursing facility may appeal the commissioner's action pursuant to the provisions of chapter 14 pertaining to contested cases. An appeal shall be considered timely if written notice of appeal is received by the commissioner within 20 days of notice of the commissioner's proposed action.

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Bill language Chapter 108, Article 3, Sections 5 and 6: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/ Sec. 5.

Minnesota Statutes 2022, section 256R.08, subdivision 1, is amended to read: Subdivision 1. Reporting of financial statements. (a) No later than February 1 of each year, a nursing facility must: (1) provide the state agency with a copy of its audited financial statements or its working trial balance; (2) provide the state agency with a copy of its audited financial statements for each year an audit is conducted; (2) (3) provide the state agency with a statement of ownership for the facility; (3) (4) provide the state agency with separate, audited financial statements or and working trial balances for every other facility owned in whole or in part by an individual or entity that has an ownership interest in the facility; (5) provide the state agency with information regarding whether the licensee or a general partner, director, or officer of the licensee controls or has an ownership interest of five percent or more in a related organization that provides any services, facilities, or supplies to the nursing facility; (4) (6) upon request, provide the state agency with separate, audited financial statements or and working trial balances for every organization with which the facility conducts business and which is owned in whole or in part by an individual or entity which has an ownership interest in the facility; (5) (7) provide the state agency with copies of leases, purchase agreements, and other documents related to the lease or purchase of the nursing facility; and (6) (8) upon request, provide the state agency with copies of leases, purchase agreements, and other documents related to the acquisition of equipment, goods, and services which are claimed as allowable costs. (b) If the licensee or the general partner, director, or officer of the licensee controls or has an interest as described in paragraph (a), clause (5), the licensee must disclose all services, facilities, or supplies provided to the nursing facility; the number of individuals who provide services, facilities, or supplies at the nursing facility; and any other information requested by the state agency. (b) (c) Audited financial statements submitted under paragraph paragraphs (a) and (b) must include a balance sheet, income statement, statement of the rate or rates charged to private paying residents, statement of retained earnings, statement of cash flows, notes to the financial statements, audited applicable supplemental information, and the public accountant's report.

Public accountants must conduct audits in accordance with chapter 326A. The cost of an audit must not be an allowable cost unless the nursing facility submits its audited financial statements in the manner otherwise specified in this subdivision. A nursing facility must permit access by the state agency to the public accountant's audit work papers that support the audited financial statements submitted under paragraph paragraphs (a) and (b). (c) (d) Documents or information provided to the state agency pursuant to this subdivision must be public unless prohibited by the Health Insurance Portability and Accountability Act or any other federal or state regulation. Data, notes, and preliminary drafts of reports created, collected, and maintained by the audit offices of government entities, or persons performing audits for government entities, and relating to an audit or investigation are confidential data on individuals or protected nonpublic data until the final report has been published or the audit or

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investigation is no longer being pursued actively, except that the data must be disclosed as required to comply with section 6.67 or 609.456. (d) (e) If the requirements of paragraphs (a) and, (b), and (c) are not met, the reimbursement rate may be reduced to 80 percent of the rate in effect on the first day of the fourth calendar month after the close of the reporting period and the reduction must continue until the requirements are met. (f) Licensees must provide the information required in this section to the commissioner in a manner prescribed by the commissioner. (g) For purposes of this section, "related organization" and "control" have the meanings given in section 256R.02, subdivision 43.

EFFECTIVE DATE. This section is effective August 1, 2024.

Sec. 6. Minnesota Statutes 2022, section 256R.08, is amended by adding a subdivision to read: Subd. 5. Notice of costs associated with leases, rent, and use of land or other real property by nursing homes. (a) Nursing homes must annually report to the commissioner, in a manner determined by the commissioner, their cost associated with leases, rent, and use of land or other real property and any other related information requested by the state agency. (b) A nursing facility that violates this subdivision is subject to the penalties and procedures under section 256R.04, subdivision 7.

EFFECTIVE DATE. This section is effective August 1, 2024.

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Modifications made to Nursing Home Workforce Standards Board

2023 Regular Session SF 3852/HF 3947 Chapter 110, Article 2, Sections 7-8, Labor Policy Bill Effective: August 1, 2024

Short description The August 1, 2024 deadline for establishing initial standards for wages for nursing home workers was moved to November 1, 2024. While a vote by the board to take action requires 5 affirmative votes, two of these votes must be cast by the state agency board members.

Summary The Nursing Home Workforce Standards Board (NHWSB) was created by the 2023 legislature and charged with the following of statutory duties: • Adopt rules establishing: o Minimum nursing home employment standards for nursing home workers o Certifying worker organizations to provide training to nursing home workers, and o Establishing curriculum requirements for training.

• It also requires nursing home employers to post notices informing nursing home workers of their rights and obligations under the minimum nursing home employment standards and prohibits nursing home employers from retaliating against nursing home workers for certain conduct.

• The bill authorizes the commissioner of labor and industry to investigate violations and enforce minimum nursing home employment standards and authorizes civil actions by nursing home workers.

The NHWSB began its work during September 2023. One of the peculiarities of the statute is that had to adopt minimum wage standards by August 1, 2024. By February 2024, it was apparent that the NHWSB was not going to meet this deadline and risked losing the assigned expedited rule making power. As a result, the unions and Minnesota Department of Labor and Industry worked to amend the statutory deadline to November 1, 2024.

In addition, the requirement that at least two of the state agency board members must vote affirmatively when action is taken was added to ensure that the interests of the state are always considered.

Implications The NHWSB will issue unfunded minimum wage standards and other requirements impacting nursing facilities.

Bill language Chapter 110, Article 2, Sections 7 and 8: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/110/

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Nursing facility employees are not eligible for LTSS workforce incentive grants 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 1, Section 10 Human Services Finance Bill Effective: Retroactively from July 1, 2023.

Short description Language excludes nursing facility employees from the long-term services & supports workforce grants passed by the 2023 legislature.

Summary The 2023 legislature authorized two workforce incentive grant programs.

The nursing facility workforce incentive grant program provided up to $3,000 per eligible nursing facility employee earning less than $30.00 per hour.

The LTSS workforce incentive grant program provided up to $1,000 per eligible nursing facility employee earning less than $30.00 per hour.

• Eligible employers include home- and community-based services providers, facilities certified as an intermediate care for persons with developmental disabilities, nursing facilities, providers of personal care assistance services, and providers of home care services.

• Grantees must develop a distribution plan that outlines how money will be used. Funds may be used to provide payments to eligible workers (those making $30 per hour or less and currently employed) for the following purposes: (1) retention, recruitment, and incentive payments; (2) postsecondary loan and tuition payments; (3) child care costs; (4) transportation-related costs; (5) personal care assistant background study costs; and (6) other costs associated with retaining and recruiting workers, as approved by the commissioner.

Implications While it was generally clear that nursing facility employees would not qualify for the LTSS workforce incentive grant, this language closes the possibility.

Unlike the nursing facility workforce incentive grant program, the Minnesota Department of Human Services has not yet implemented the LTSS workforce incentive grants.

LTSS providers, including assisted living, should be prepared to apply when DHS announces the program.

Bill language Chapter 125, Article 1, Section 10: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Several nursing facilities receive special property rate increases 2024 Regular Session SF 5335/HF 5280 Chapter 125, Article 2, Section 14 Human Services Finance Bill Effective: January 1, 2025

Short description Four nursing facilities will receive property rate increases prior to transitioning to the fair rental property rate system.

Summary The legislation provides property rate increases that end upon the effective date of the transition of the facility's property rate to a fair rental value property payment rate or May 31, 2026, whichever is earlier.

• The property rate of a nursing facility located in the city of St. Paul at 1415 Almond Avenue in Ramsey County will increase by $10.65 on January 1, 2025.

• The property rate of a nursing facility located in the city of Duluth at 3111 Church Place in St. Louis County will increase by $20.81 on January 1, 2025.

• The property rate of a nursing facility located in the city of Chatfield at 1102 Liberty Street SE in Fillmore County will increase by $21.35 on January 1, 2025.

• Effective January 1, 2025, through June 30, 2025, the property rate of a nursing facility located in the city of Fergus Falls at 1131 South Mabelle Avenue in Ottertail County will increase by $38.56.

Bill language Chapter 125, Article 2, Section 14: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Additional round of Critical Access Nursing Facility Program funded 2024 Regular Session SF 5335/HF 5280 Chapter 125 Human Services Finance Bill Effective: January 1, 2025

Short description The Minnesota Department of Human Services received an appropriation to fund an additional round of the Critical Access Nursing Facility Program. A request for proposal was announced on June 25, 2024.

Summary The Minnesota legislature provided additional funding equal to $576,000 state share for the current fiscal year for the Critical Access Nursing Facility (CANF) Program.

• These additional funds are being used to provide a short-term rate add-on that will be distributed to eligible facilities that apply to the CANF program.

• This short-term rate add-on is available for up to a maximum of 11 months and may take effect as soon as August 1, 2024, for facilities that meet all program and statutory requirements and are designated as a CANF through the competitive application process.

• This short-term CANF rate increase will expire on June 30, 2025.

• Facilities currently participating in the CANF program are not eligible to apply for this additional funding.

If you intend to apply, make sure to: • If a facility intends to apply for CANF funding, a private pay notice must be sent out 30 days before August 1, 2024, if the facility is requesting a rate increase to take effect on August 1, 2024.

• A delay in the issuance of the required 30-day advance notice will result in a delay of this time-limited rate increase.

Note the application for a new two-year CANF cycle for the period July 1, 2025, through June 30, 2027, will be published in January 2025 at which time any eligible facility will be able to apply for designation as a CANF facility for the next two-year cycle.

Implications Applications must be submitted to the DHS NFRP mailbox by midnight July 22nd, 2024: dhs.nfrp.costreport@state.mn.us.

Please contact Todd Bergstrom at the Association office for more details if you are interested.

Bill language Chapter 125: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/125/

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Supplemental nursing services agency modifications 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 58, Sections 12-20 Tax Bill Effective: August 1, 2025

Short description Modifications to statutes 144A.70, 144A.71, 144A.72 and 144A.73 regarding registration of Supplemental Nursing Services Agencies (SNSA) and the corresponding complaint system for SNSAs. Summary Changes to existing SNSA statute include adding limited liability companies (LLCs) to the list of entities definition. Changing SNSA survey process from annually to semi-annually and including follow-up surveys. Upon application SNSAs are required to provide: evidence of malpractice insurance, surety bond and workers compensation insurance; evidence that the name and address of a bank in which tax holdings for employees are kept was provided to commissioner of revenue, and names and addresses of any individuals the SNSA purports. Policy and procedure on how records will be kept will be made available to facilities. Additionally, SNSA renewal applications now must be submitted 60 days prior to the expiration of current registration. The department now has penalty enforcement abilities for non-compliance issues, including a $3,000 fine for failure to verify staff competency and if it is found to restrict staff employment opportunities. Background studies for SNSA owners and controlling persons must be completed before registering.

Implications Greater enforcement capabilities for the department and ability to hold SNSAs accountable for violations of statute.

Bill language Chapter 127, Article 58, Sections 12-20: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 12.

Minnesota Statutes 2022, section 144A.70, subdivision 3, is amended to read: Subd. 3.

Controlling person.

"Controlling person" means a business entity or entities, officer, program administrator, or director, whose responsibilities include the direction of the management or policies of a supplemental nursing services agency the management and decision-making authority to establish or control business policy and all other policies of a supplemental nursing services agency. Controlling person also means an individual who, directly or indirectly, beneficially owns an interest in a corporation, partnership, or other business association that is a controlling person.

Sec. 13.

Minnesota Statutes 2022, section 144A.70, subdivision 5, is amended to read:

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Subd. 5.

Person.

"Person" includes an individual, firm, corporation, partnership, limited liability company, or association.

Sec. 14.

Minnesota Statutes 2022, section 144A.70, subdivision 6, is amended to read: Subd. 6.

Supplemental nursing services agency.

"Supplemental nursing services agency" means a person, firm, corporation, partnership, limited liability company, or association engaged for hire in the business of providing or procuring temporary employment in health care facilities for nurses, nursing assistants, nurse aides, and orderlies. Supplemental nursing services agency does not include an individual who only engages in providing the individual's services on a temporary basis to health care facilities. Supplemental nursing services agency does not include a professional home care agency licensed under section 144A.471 that only provides staff to other home care providers.

Sec. 15.

Minnesota Statutes 2022, section 144A.70, subdivision 7, is amended to read: Subd. 7.

Oversight.

The commissioner is responsible for the oversight of supplemental nursing services agencies through annual semiannual unannounced surveys and follow-up surveys, complaint investigations under sections 144A.51 to 144A.53, and other actions necessary to ensure compliance with sections 144A.70 to 144A.74.

Sec. 16.

Minnesota Statutes 2022, section 144A.71, subdivision 2, is amended to read: Subd. 2.

Application information and fee.

The commissioner shall establish forms and procedures for processing each supplemental nursing services agency registration application. An application for a supplemental nursing services agency registration must include at least the following: (1) the names and addresses of the owner or owners all owners and controlling persons of the supplemental nursing services agency; (2) if the owner is a corporation, copies of its articles of incorporation and current bylaws, together with the names and addresses of its officers and directors;

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(3) satisfactory proof of compliance with section 144A.72, subdivision 1, clauses (5) to (7) if the owner is a limited liability company, copies of its articles of organization and operating agreement, together with the names and addresses of its officers and directors; (4) documentation that the supplemental nursing services agency has medical malpractice insurance to insure against the loss, damage, or expense of a claim arising out of the death or injury of any person as the result of negligence or malpractice in the provision of health care services by the supplemental nursing services agency or by any employee of the agency; (5) documentation that the supplemental nursing services agency has an employee dishonesty bond in the amount of $10,000; (6) documentation that the supplemental nursing services agency has insurance coverage for workers' compensation for all nurses, nursing assistants, nurse aides, and orderlies provided or procured by the agency; (7) documentation that the supplemental nursing services agency filed with the commissioner of revenue: (i) the name and address of the bank, savings bank, or savings association in which the supplemental nursing services agency deposits all employee income tax withholdings; and (ii) the name and address of any nurse, nursing assistant, nurse aide, or orderly whose income is derived from placement by the agency, if the agency purports the income is not subject to withholding; (4) (8) any other relevant information that the commissioner determines is necessary to properly evaluate an application for registration; (5) (9) a policy and procedure that describes how the supplemental nursing services agency's records will be immediately available at all times to the commissioner and facility; and (6) (10) a nonrefundable registration fee of $2,035.

If a supplemental nursing services agency fails to provide the items in this subdivision to the department, the commissioner shall immediately suspend or refuse to issue the supplemental nursing services agency registration. The supplemental nursing services agency may appeal the commissioner's findings according to section 144A.475, subdivisions 3a and 7, except that the hearing must be conducted by an administrative law judge within 60 calendar days of the request for hearing assignment.

Sec. 17.

Minnesota Statutes 2022, section 144A.71, is amended by adding a subdivision to read: Subd. 2a.

Renewal applications.

An applicant for registration renewal must complete the registration application form supplied by the department. An application must be submitted at least 60 days before the expiration of the current registration.

Sec. 18.

[144A.715] PENALTIES. Subdivision 1.

Authority.

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The fines imposed under this section are in accordance with section 144.653, subdivision 6.

Subd. 2.

Fines.

Each violation of sections 144A.70 to 144A.74, not corrected at the time of a follow-up survey, is subject to a fine. A fine must be assessed according to the schedules established in the sections violated.

Subd. 3.

Failure to correct.

If, upon a subsequent follow-up survey after a fine has been imposed under subdivision 2, a violation is still not corrected, another fine shall be assessed. The fine shall be double the amount of the previous fine.

Subd. 4.

Payment of fines.

Payment of fines is due 15 business days from the registrant's receipt of notice of the fine from the department.

Sec. 19.

Minnesota Statutes 2022, section 144A.72, subdivision 1, is amended to read: Subdivision 1.

Minimum criteria. (a) The commissioner shall require that, as a condition of registration: (1) all owners and controlling persons must complete a background study under section 144.057 and receive a clearance or set aside of any disqualification; (1) (2) the supplemental nursing services agency shall document that each temporary employee provided to health care facilities currently meets the minimum licensing, training, and continuing education standards for the position in which the employee will be working and verifies competency for the position. A supplemental nursing services agency that violates this clause may be subject to a fine of $3,000; (2) (3) the supplemental nursing services agency shall comply with all pertinent requirements relating to the health and other qualifications of personnel employed in health care facilities; (3) (4) the supplemental nursing services agency must not restrict in any manner the employment opportunities of its employees;. A supplemental nursing services agency that violates this clause may be subject to a fine of $3,000; (4) the supplemental nursing services agency shall carry medical malpractice insurance to insure against the loss, damage, or expense incident to a claim arising out of the death or injury of any person as the result of negligence or malpractice in the provision of health care services by the supplemental nursing services agency or by any employee of the agency;

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(5) the supplemental nursing services agency shall carry an employee dishonesty bond in the amount of $10,000; (6) the supplemental nursing services agency shall maintain insurance coverage for workers' compensation for all nurses, nursing assistants, nurse aides, and orderlies provided or procured by the agency; (7) the supplemental nursing services agency shall file with the commissioner of revenue: (i) the name and address of the bank, savings bank, or savings association in which the supplemental nursing services agency deposits all employee income tax withholdings; and (ii) the name and address of any nurse, nursing assistant, nurse aide, or orderly whose income is derived from placement by the agency, if the agency purports the income is not subject to withholding; (8) (5) the supplemental nursing services agency must not, in any contract with any employee or health care facility, require the payment of liquidated damages, employment fees, or other compensation should the employee be hired as a permanent employee of a health care facility;. A supplemental nursing services agency that violates this clause may be subject to a fine of $3,000; (9) (6) the supplemental nursing services agency shall document that each temporary employee provided to health care facilities is an employee of the agency and is not an independent contractor; and (10) (7) the supplemental nursing services agency shall retain all records for five calendar years. All records of the supplemental nursing services agency must be immediately available to the department. (b) In order to retain registration, the supplemental nursing services agency must provide services to a health care facility during the year in Minnesota within the past 12 months preceding the supplemental nursing services agency's registration renewal date.

Sec. 20.

Minnesota Statutes 2022, section 144A.73, is amended to read: 144A.73 COMPLAINT SYSTEM. The commissioner shall establish a system for reporting complaints against a supplemental nursing services agency or its employees. Complaints may be made by any member of the public. Complaints against a supplemental nursing services agency shall be investigated by the Office of Health Facility Complaints commissioner of health under sections 144A.51 to 144A.53.

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Changes to nursing facility case mix 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Section 9-16 Tax Bill Effective: June 21, 2024

Short description Changes were made to assessment requirements, data privacy and reconsiderations, and general phrasing of statute due to October 1, 2025 implementation of PDPM nursing case mix system for Medicaid and private pay.

Summary First, the use of the Optional State Assessment (OSA) to support RUG-IV Medicaid case mix classification in Minnesota due to the abandonment of RUG-IV by the Centers for Medicare and Medicaid Services (CMS) created unnecessary assessment requirements. The Significant Change in Status Assessment (SCSA) is no longer required to determine the MN reimbursement classification, when therapy and/or isolation ends.

What does this mean for MDS Coordinators and staff who complete the MDS? Staff will continue to complete the standalone Optional State Assessment (OSA), to determine the reimbursement classification, when therapy and/or isolation ends. Remember, if the most recent OSA completed did not result in a rehabilitation or isolation case mix classification, the OSA is not required. The standalone OSA will likely remain in effect until CMS retires the form on 10/1/25.

As for an SCSA, revert to completion requirements only as stated in the CMS’s RAI 3.0 Manual.

An SCSA must be completed when the IDT determines there is a major decline or improvement in a resident’s status, and when a terminally ill resident enrolls in or revokes a hospice program.

Second, the data collected as part of the reconsideration process now is classified as private data on individuals and nonpublic data, except when MDH is required to submit to CMS. Third, a number of changes were made to reflect the October 1, 2025 transition to PDPM nursing case mix system for Medicaid and private pay.

Fourth, assessments are now due on their due date as listed in the case mix review manual.

Previously, there was a seven day grace period before the rate penalty was enforced.

Implications Nursing facilities need to update their minimum data set (MDS) assessment policies and procedures.

Resources • MN Case Mix Announcement: https://www.health.state.mn.us/facilities/regulation/casemix/index.html • MN Statute 144.0724 subd. 4 amended by Chapter 127, Article 59, Section 11: https://www.revisor.mn.gov/laws/2024/0/127/laws.59.11.0#laws.59.11.0 • Case Mix Review Frequently-Asked Questions: https://www.health.state.mn.us/facilities/regulation/casemix/faq.html

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• • •

Case Mix Review Manual (updated 6/20/24: https://www.health.state.mn.us/facilities/regulation/casemix/docs/cmrmanual.pdf State RAI Coordinator phone 651-201-4313 or email: health.mds@state.mn.us CMS’s RAI Version 3.0 Manual: https://www.cms.gov/files/document/finalmds-30-raimanual-v11811october2023.pdf

Bill language Chapter 127, Article 59, Sections 9 to 16: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 9.

Minnesota Statutes 2022, section 144.0724, subdivision 2, is amended to read: Subd. 2. Definitions.

For purposes of this section, the following terms have the meanings given. (a) "Assessment reference date" or "ARD" means the specific end point for look-back periods in the MDS assessment process. This look-back period is also called the observation or assessment period. (b) "Case mix index" means the weighting factors assigned to the RUG-IV case mix reimbursement classifications determined by an assessment. (c) "Index maximization" means classifying a resident who could be assigned to more than one category, to the category with the highest case mix index. (d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment, and functional status elements, that include common definitions and coding categories specified by the Centers for Medicare and Medicaid Services and designated by the Department of Health. (e) "Representative" means a person who is the resident's guardian or conservator, the person authorized to pay the nursing home expenses of the resident, a representative of the Office of Ombudsman for Long-Term Care whose assistance has been requested, or any other individual designated by the resident. (f) "Resource utilization groups" or "RUG" means the system for grouping a nursing facility's residents according to their clinical and functional status identified in data supplied by the facility's Minimum Data Set. (g) (f) "Activities of daily living" includes personal hygiene, dressing, bathing, transferring, bed mobility, locomotion, eating, and toileting. (h) (g) "Nursing facility level of care determination" means the assessment process that results in a determination of a resident's or prospective resident's need for nursing facility level of care as established in subdivision 11 for purposes of medical assistance payment of long-term care services for: (1) nursing facility services under section 256B.434 or chapter 256R; (2) elderly waiver services under chapter 256S; (3) CADI and BI waiver services under section 256B.49; and (4) state payment of alternative care services under section 256B.0913.

Sec. 10.

Minnesota Statutes 2022, section 144.0724, subdivision 3a, is amended to read: Subd. 3a. Resident reimbursement case mix reimbursement classifications beginning January 1, 2012. (a) Beginning January 1, 2012, Resident reimbursement case mix reimbursement classifications shall be based on the Minimum Data Set, version 3.0 assessment instrument, or its successor version mandated by the Centers for Medicare and Medicaid Services that nursing facilities are required to complete for all residents. The commissioner of health shall establish resident

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classifications according to the RUG-IV, 48 group, resource utilization groups. Resident classification must be established based on the individual items on the Minimum Data Set, which must be completed according to the Long Term Care Facility Resident Assessment Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare and Medicaid Services. Case mix reimbursement classifications shall also be based on assessments required under subdivision 4. Assessments must be completed according to the Long Term Care Facility Resident Assessment Instrument User's Manual Version 3.0 or a successor manual issued by the Centers for Medicare and Medicaid Services. The optional state assessment must be completed according to the OSA Manual Version 1.0 v.2. (b) Each resident must be classified based on the information from the Minimum Data Set according to the general categories issued by the Minnesota Department of Health, utilized for reimbursement purposes.

Sec. 11.

Minnesota Statutes 2022, section 144.0724, subdivision 4, is amended to read: Subd. 4. Resident assessment schedule. (a) A facility must conduct and electronically submit to the federal database MDS assessments that conform with the assessment schedule defined by the Long Term Care Facility Resident Assessment Instrument User's Manual, version 3.0, or its successor issued by the Centers for Medicare and Medicaid Services. The commissioner of health may substitute successor manuals or question and answer documents published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, to replace or supplement the current version of the manual or document. (b) The assessments required under the Omnibus Budget Reconciliation Act of 1987 (OBRA) used to determine a case mix reimbursement classification for reimbursement include: (1) a new admission comprehensive assessment, which must have an assessment reference date (ARD) within 14 calendar days after admission, excluding readmissions; (2) an annual comprehensive assessment, which must have an ARD within 92 days of a previous quarterly review assessment or a previous comprehensive assessment, which must occur at least once every 366 days; (3) a significant change in status comprehensive assessment, which must have an ARD within 14 days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition, whether an improvement or a decline, and regardless of the amount of time since the last comprehensive assessment or quarterly review assessment; (4) a quarterly review assessment must have an ARD within 92 days of the ARD of the previous quarterly review assessment or a previous comprehensive assessment; (5) any significant correction to a prior comprehensive assessment, if the assessment being corrected is the current one being used for RUG reimbursement classification; (6) any significant correction to a prior quarterly review assessment, if the assessment being corrected is the current one being used for RUG reimbursement classification; and (7) a required significant change in status assessment when: (i) all speech, occupational, and physical therapies have ended. If the most recent OBRA comprehensive or quarterly assessment completed does not result in a rehabilitation case mix classification, then the significant change in status assessment is not required.

The ARD of this assessment must be set on day eight after all therapy services have ended; and (ii) isolation for an infectious disease has ended. If isolation was not coded on the most recent OBRA comprehensive or quarterly assessment completed, then the significant

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change in status assessment is not required. The ARD of this assessment must be set on day 15 after isolation has ended; and (8) (7) any modifications to the most recent assessments under clauses (1) to (7) (6). (c) The optional state assessment must accompany all OBRA assessments. The optional state assessment is also required to determine reimbursement when: (i) all speech, occupational, and physical therapies have ended. If the most recent optional state assessment completed does not result in a rehabilitation case mix reimbursement classification, then the optional state assessment is not required. The ARD of this assessment must be set on day eight after all therapy services have ended; and (ii) isolation for an infectious disease has ended. If isolation was not coded on the most recent optional state assessment completed, then the optional state assessment is not required. The ARD of this assessment must be set on day 15 after isolation has ended. (c) (d) In addition to the assessments listed in paragraph paragraphs (b) and (c), the assessments used to determine nursing facility level of care include the following: (1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by the Senior LinkAge Line or other organization under contract with the Minnesota Board on Aging; and (2) a nursing facility level of care determination as provided for under section 256B.0911, subdivision 26, as part of a face-to-face long-term care consultation assessment completed under section 256B.0911, by a county, tribe, or managed care organization under contract with the Department of Human Services.

Sec. 12.

Minnesota Statutes 2022, section 144.0724, subdivision 6, is amended to read: Subd. 6. Penalties for late or nonsubmission. (a) A facility that fails to complete or submit an assessment according to subdivisions 4 and 5 for a RUG-IV case mix reimbursement classification within seven days of the time requirements listed in the Long-Term Care Facility Resident Assessment Instrument User's Manual when the assessment is due is subject to a reduced rate for that resident. The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the day of admission for new admission assessments, on the ARD for significant change in status assessments, or on the day that the assessment was due for all other assessments and continues in effect until the first day of the month following the date of submission and acceptance of the resident's assessment. (b) If loss of revenue due to penalties incurred by a facility for any period of 92 days are equal to or greater than 0.1 percent of the total operating costs on the facility's most recent annual statistical and cost report, a facility may apply to the commissioner of human services for a reduction in the total penalty amount. The commissioner of human services, in consultation with the commissioner of health, may, at the sole discretion of the commissioner of human services, limit the penalty for residents covered by medical assistance to ten days.

Sec. 13.

Minnesota Statutes 2022, section 144.0724, subdivision 7, is amended to read: Subd. 7. Notice of resident reimbursement case mix reimbursement classification. (a) The commissioner of health shall provide to a nursing facility a notice for each resident of the classification established under subdivision 1. The notice must inform the resident of the case mix reimbursement classification assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the

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commissioner, and the opportunity to request a reconsideration of the classification, and the address and telephone number of the Office of Ombudsman for Long-Term Care. The commissioner must transmit the notice of resident classification by electronic means to the nursing facility. The nursing facility is responsible for the distribution of the notice to each resident or the resident's representative. This notice must be distributed within three business days after the facility's receipt. (b) If a facility submits a modifying modified assessment resulting in a change in the case mix reimbursement classification, the facility must provide a written notice to the resident or the resident's representative regarding the item or items that were modified and the reason for the modifications. The written notice must be provided within three business days after distribution of the resident case mix reimbursement classification notice.

Sec. 14.

Minnesota Statutes 2022, section 144.0724, subdivision 8, is amended to read: Subd. 8. Request for reconsideration of resident classifications. (a) The resident, or the resident's representative, or the nursing facility, or the boarding care home may request that the commissioner of health reconsider the assigned reimbursement case mix reimbursement classification and any item or items changed during the audit process. The request for reconsideration must be submitted in writing to the commissioner of health. (b) For reconsideration requests initiated by the resident or the resident's representative: (1) The resident or the resident's representative must submit in writing a reconsideration request to the facility administrator within 30 days of receipt of the resident classification notice. The written request must include the reasons for the reconsideration request.

(2) Within three business days of receiving the reconsideration request, the nursing facility must submit to the commissioner of health a completed reconsideration request form, a copy of the resident's or resident's representative's written request, and all supporting documentation used to complete the assessment being considered reconsidered. If the facility fails to provide the required information, the reconsideration will be completed with the information submitted and the facility cannot make further reconsideration requests on this classification.

(3) Upon written request and within three business days, the nursing facility must give the resident or the resident's representative a copy of the assessment being reconsidered and all supporting documentation used to complete the assessment.

Notwithstanding any law to the contrary, the facility may not charge a fee for providing copies of the requested documentation. If a facility fails to provide the required documents within this time, it is subject to the issuance of a correction order and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order issued under this subdivision must require that the nursing facility immediately comply with the request for information, and as of the date of the issuance of the correction order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and an increase in the $100 fine by $50 increments for each day the noncompliance continues. (c) For reconsideration requests initiated by the facility: (1) The facility is required to inform the resident or the resident's representative in writing that a reconsideration of the resident's case mix reimbursement classification is being requested. The notice must inform the resident or the resident's representative: (i) of the date and reason for the reconsideration request;

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(ii) of the potential for a case mix reimbursement classification change and subsequent rate change; (iii) of the extent of the potential rate change; (iv) that copies of the request and supporting documentation are available for review; and (v) that the resident or the resident's representative has the right to request a reconsideration also.

(2) Within 30 days of receipt of the audit exit report or resident classification notice, the facility must submit to the commissioner of health a completed reconsideration request form, all supporting documentation used to complete the assessment being reconsidered, and a copy of the notice informing the resident or the resident's representative that a reconsideration of the resident's classification is being requested.

(3) If the facility fails to provide the required information, the reconsideration request may be denied and the facility may not make further reconsideration requests on this classification. (d) Reconsideration by the commissioner must be made by individuals not involved in reviewing the assessment, audit, or reconsideration that established the disputed classification. The reconsideration must be based upon the assessment that determined the classification and upon the information provided to the commissioner of health under paragraphs (a) to (c). If necessary for evaluating the reconsideration request, the commissioner may conduct on-site reviews. Within 15 business days of receiving the request for reconsideration, the commissioner shall affirm or modify the original resident classification. The original classification must be modified if the commissioner determines that the assessment resulting in the classification did not accurately reflect characteristics of the resident at the time of the assessment. The commissioner must transmit the reconsideration classification notice by electronic means to the nursing facility. The nursing facility is responsible for the distribution of the notice to the resident or the resident's representative. The notice must be distributed by the nursing facility within three business days after receipt. A decision by the commissioner under this subdivision is the final administrative decision of the agency for the party requesting reconsideration. (e) The case mix reimbursement classification established by the commissioner shall be the classification which applies to the resident while the request for reconsideration is pending. If a request for reconsideration applies to an assessment used to determine nursing facility level of care under subdivision 4, paragraph (c) (d), the resident shall continue to be eligible for nursing facility level of care while the request for reconsideration is pending. (f) The commissioner may request additional documentation regarding a reconsideration necessary to make an accurate reconsideration determination. (g) Data collected as part of the reconsideration process under this section is classified as private data on individuals and nonpublic data pursuant to section 13.02. Notwithstanding the classification of these data as private or nonpublic, the commissioner is authorized to share these data with the U.S. Centers for Medicare and Medicaid Services and the commissioner of human services as necessary for reimbursement purposes.

Sec. 15.

Minnesota Statutes 2022, section 144.0724, subdivision 9, is amended to read: Subd. 9. Audit authority. (a) The commissioner shall audit the accuracy of resident assessments performed under section 256R.17 through any of the following: desk audits; on-site review of residents and their

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records; and interviews with staff, residents, or residents' families. The commissioner shall reclassify a resident if the commissioner determines that the resident was incorrectly classified. (b) The commissioner is authorized to conduct on-site audits on an unannounced basis. (c) A facility must grant the commissioner access to examine the medical records relating to the resident assessments selected for audit under this subdivision. The commissioner may also observe and speak to facility staff and residents. (d) The commissioner shall consider documentation under the time frames for coding items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment Instrument User's Manual or OSA Manual version 1.0 v.2 published by the Centers for Medicare and Medicaid Services. (e) The commissioner shall develop an audit selection procedure that includes the following factors: (1) Each facility shall be audited annually. If a facility has two successive audits in which the percentage of change is five percent or less and the facility has not been the subject of a special audit in the past 36 months, the facility may be audited biannually. A stratified sample of 15 percent, with a minimum of ten assessments, of the most current assessments shall be selected for audit. If more than 20 percent of the RUG-IV case mix reimbursement classifications are changed as a result of the audit, the audit shall be expanded to a second 15 percent sample, with a minimum of ten assessments. If the total change between the first and second samples is 35 percent or greater, the commissioner may expand the audit to all of the remaining assessments.(2) If a facility qualifies for an expanded audit, the commissioner may audit the facility again within six months. If a facility has two expanded audits within a 24-month period, that facility will be audited at least every six months for the next 18 months.

(3) The commissioner may conduct special audits if the commissioner determines that circumstances exist that could alter or affect the validity of case mix reimbursement classifications of residents. These circumstances include, but are not limited to, the following: (i) frequent changes in the administration or management of the facility; (ii) an unusually high percentage of residents in a specific case mix reimbursement classification; (iii) a high frequency in the number of reconsideration requests received from a facility; (iv) frequent adjustments of case mix reimbursement classifications as the result of reconsiderations or audits; (v) a criminal indictment alleging provider fraud; (vi) other similar factors that relate to a facility's ability to conduct accurate assessments; (vii) an atypical pattern of scoring minimum data set items; (viii) nonsubmission of assessments; (ix) late submission of assessments; or (x) a previous history of audit changes of 35 percent or greater. (f) If the audit results in a case mix reimbursement classification change, the commissioner must transmit the audit classification notice by electronic means to the nursing facility within 15 business days of completing an audit. The nursing facility is responsible for distribution of the notice to each resident or the resident's representative. This notice must be distributed by the

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nursing facility within three business days after receipt. The notice must inform the resident of the case mix reimbursement classification assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the commissioner, the opportunity to request a reconsideration of the classification, and the address and telephone number of the Office of Ombudsman for Long-Term Care.

Sec. 16.

Minnesota Statutes 2022, section 144.0724, subdivision 11, is amended to read: Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance payment of long-term care services, a recipient must be determined, using assessments defined in subdivision 4, to meet one of the following nursing facility level of care criteria: (1) the person requires formal clinical monitoring at least once per day; (2) the person needs the assistance of another person or constant supervision to begin and complete at least four of the following activities of living: bathing, bed mobility, dressing, eating, grooming, toileting, transferring, and walking; (3) the person needs the assistance of another person or constant supervision to begin and complete toileting, transferring, or positioning and the assistance cannot be scheduled; (4) the person has significant difficulty with memory, using information, daily decision making, or behavioral needs that require intervention; (5) the person has had a qualifying nursing facility stay of at least 90 days; (6) the person meets the nursing facility level of care criteria determined 90 days after admission or on the first quarterly assessment after admission, whichever is later; or (7) the person is determined to be at risk for nursing facility admission or readmission through a face-to-face long-term care consultation assessment as specified in section 256B.0911, subdivision 17 to 21, 23, 24, 27, or 28, by a county, tribe, or managed care organization under contract with the Department of Human Services. The person is considered at risk under this clause if the person currently lives alone or will live alone or be homeless without the person's current housing and also meets one of the following criteria: (i) the person has experienced a fall resulting in a fracture; (ii) the person has been determined to be at risk of maltreatment or neglect, including self-neglect; or (iii) the person has a sensory impairment that substantially impacts functional ability and maintenance of a community residence. (b) The assessment used to establish medical assistance payment for nursing facility services must be the most recent assessment performed under subdivision 4, paragraph paragraphs (b) and (c), that occurred no more than 90 calendar days before the effective date of medical assistance eligibility for payment of long-term care services. In no case shall medical assistance payment for long-term care services occur prior to the date of the determination of nursing facility level of care. (c) The assessment used to establish medical assistance payment for long-term care services provided under chapter 256S and section 256B.49 and alternative care payment for services provided under section 256B.0913 must be the most recent face-to-face assessment performed under section 256B.0911, subdivisions 17 to 21, 23, 24, 27, or 28, that occurred no more than 60 calendar days before the effective date of medical assistance eligibility for payment of longterm care services.

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WORKFORCE AND EMPLOYMENT

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Continuation of benefits for pregnancy accommodation leave 2024 Regular Session SF 3852/HF 3947 Chapter 110, Article 2, Section 9 Labor Policy Bill Effective: July 1, 2024

Short description Amends existing statute regarding Pregnancy Accommodation Leave to include continuation of benefits.

Summary Aligns continuation of benefits language in the pregnancy accommodations and pregnancy and parenting leave sections in Chapter 181 with the Paid Family and Medical Leave law. Requires an employer to continue group insurance and health care benefits for the employee and any dependents while on a pregnancy or parental leave, provided the employee continues to pay for the employee share of benefits. Prohibits reducing the length of pregnancy and parental leave by any period of paid or unpaid leave taken for prenatal care medical appointments.

Implications Employers must coordinate and ensure continuation of insurance coverage, if applicable during qualifying leaves.

Bill language Chapter 110, Article 2, Section 9: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/110/ Sec. 9.

Minnesota Statutes 2023 Supplement, section 181.939, subdivision 2, is amended to read: Subd. 2.

Pregnancy accommodations. (a) An employer must provide reasonable accommodations to an employee for health conditions related to pregnancy or childbirth upon request, with the advice of a licensed health care provider or certified doula, unless the employer demonstrates that the accommodation would impose an undue hardship on the operation of the employer's business. A pregnant employee shall not be required to obtain the advice of a licensed health care provider or certified doula, nor may an employer claim undue hardship for the following accommodations: (1) more frequent or longer restroom, food, and water breaks; (2) seating; and (3) limits on lifting over 20 pounds. The employee and employer shall engage in an interactive process with respect to an employee's request for a reasonable accommodation. Reasonable accommodation may include but is not limited to temporary transfer to a less strenuous or hazardous position, temporary leave of absence, modification in work schedule or job assignments, seating, more frequent or longer break periods, and limits to heavy lifting.

Notwithstanding any other provision of this subdivision, an employer shall not be required to create a new or additional position in order to accommodate an employee pursuant to this subdivision and shall not be required to discharge an employee, transfer another employee with greater seniority, or promote an employee.

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(b) Nothing in this subdivision shall be construed to affect any other provision of law relating to sex discrimination or pregnancy or in any way diminish the coverage of pregnancy, childbirth, or health conditions related to pregnancy or childbirth under any other provisions of any other law. (c) An employer shall not require an employee to take a leave or accept an accommodation. (d) An employer shall not discharge, discipline, penalize, interfere with, threaten, restrain, coerce, or otherwise retaliate or discriminate against an employee for asserting rights or remedies under this subdivision. (e) For the purposes of this subdivision, "employer" means a person or entity that employs one or more employees and includes the state and its political subdivisions. (f) During any leave for which an employee is entitled to benefits or leave under this subdivision, the employer must maintain coverage under any group insurance policy, group subscriber contract, or health care plan for the employee and any dependents as if the employee was not on leave, provided, however, that the employee must continue to pay any employee share of the cost of the benefits.

Sec. 10.

Minnesota Statutes 2022, section 181.941, subdivision 4, is amended to read: Subd. 4.

Continued insurance.

The employer must continue to make coverage available to the employee while on leave of absence under any group insurance policy, group subscriber contract, or health care plan for the employee and any dependents. Nothing in this section requires the employer to pay the costs of the insurance or health care while the employee is on leave of absence. During any leave for which an employee is entitled to benefits or leave under this section, the employer must maintain coverage under any group insurance policy, group subscriber contract, or health care plan for the employee and any dependents as if the employee was not on leave, provided, however, that the employee must continue to pay any employee share of the cost of the benefits.

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Restrictive employment covenants

2024 Regular Session SF 3852/HF 3947 Chapter 110, Article 2, Section 53, Subdivision 1-3 Labor Policy Bill Effective: July 1, 2024 Short description Prohibits a company or partnership that provides services to a customer from restricting the customer from directly or indirectly soliciting or hiring one of their employees.

Summary Prohibits the use of restrictive employment covenants and makes such covenants void and unenforceable. Requires service providers to give notice to employees about this law if their contracts contain this type of restrictive provision. Provides an effective date of July 1, 2024, and applies to contracts entered into or amended on or after that date. This is from S.F. 3721 (Mann).

Implications Only applies to contracts and agreements entered into after July 1, 2024.

Bill language Chapter 110, Article 2, Section 53, Subdivision 1-3: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/110/ Sec. 53.

[181.9881] RESTRICTIVE EMPLOYMENT COVENANTS; VOID IN SERVICE CONTRACTS. Subdivision 1.

Definitions. (a) "Customer" means an individual, partnership, association, corporation, business, trust, or group of persons hiring a service provider for services. (b) "Employee," as used in this section, means any individual who performs services for a service provider, including independent contractors. "Independent contractor" has the meaning given in section 181.988, subdivision 1, paragraph (d). (c) "Service provider" means any partnership, association, corporation, business, trust, or group of persons acting directly or indirectly as an employer or manager for work contracted or requested by a customer.

Subd. 2.

Restrictive employment covenants; void and unenforceable. (a) No service provider may restrict, restrain, or prohibit in any way a customer from directly or indirectly soliciting or hiring an employee of a service provider. (b) Any provision of an existing contract that violates paragraph (a) is void and unenforceable. (c) When a provision in an existing contract violates this section, the service provider must provide notice to their employees of this section and the restrictive covenant in the existing contract that violates this section.

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Subd. 3.

Exemptions.

This section does not apply to workers providing professional business consulting for computer software development and related services who are seeking employment through a service provider with the knowledge and intention of being considered for a permanent position of employment with the customer as their employer at a later date.

EFFECTIVE DATE. This section is effective July 1, 2024, and applies to contracts and agreements entered into on or after that date.

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Salary disclosure in job posting 2024 Regular Session SF 3852/HF 3949 Chapter 110, Article 7, Section 42 Labor Policy Bill Effective: August 1, 2024

Short description Requires employers to disclose salary or rate of pay in all job postings.

Summary Employers with 30 or more employees at one given site must disclose salary range or hourly rate of pay in any advertisement for job opportunity.

Bill language Chapter 110, Article 7, Section 42: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/110/ Sec. 42.

[181.173] SALARY RANGES REQUIRED IN JOB POSTINGS. Subdivision 1.

Definitions. (a) For the purposes of this section, the following terms have the meanings given. (b) "Employer" means a person or entity that employs 30 or more employees at one or more sites in Minnesota and includes an individual, corporation, partnership, association, nonprofit organization, group of persons, state, county, town, city, school district, or other governmental subdivision. (c) "Posting" means any solicitation intended to recruit job applicants for a specific available position, including recruitment done directly by an employer or indirectly through a third party, and includes any postings made electronically or via printed hard copy, that includes qualifications for desired applicants. (d) "Salary range" means the minimum and maximum annual salary or hourly range of compensation, based on the employer's good faith estimate, for a job opportunity of the employer at the time of the posting of an advertisement for such opportunity.

Subd. 2.

Salary ranges in job postings required. (a) An employer must disclose in each posting for each job opening with the employer the starting salary range, and a general description of all of the benefits and other compensation, including but not limited to any health or retirement benefits, to be offered to a hired job applicant. (b) An employer that does not plan to offer a salary range for a position must list a fixed pay rate. A salary range may not be open ended.

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Employee blood lead levels

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 9, Section 6 Tax Bill Effective: July 1, 2024 Short description Rulemaking to lower acceptable blood lead levels for workers exposed to lead.

Summary Rulemaking for Department of Labor and Industry to work with the Department of Health to lower acceptable blood lead levels for workers exposed to lead.

Implications Potential compliance with new standards if employees are exposed to lead in the workplace.

Bill language Chapter 127, Article 9, Section 6: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

Sec. 6. RULEMAKING; ACCEPTABLE BLOOD LEAD LEVELS FOR WORKERS. The commissioner of labor and industry, in consultation with the commissioner of health, shall adopt rules to: (1) lower the acceptable blood lead levels above which require mandatory removal of workers from the lead exposure; and (2) lower the blood lead levels required before a worker is allowed to return to work.

The thresholds established must be based on the most recent public health information on the safety of lead exposure.

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Worker misclassification updates 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 10 Tax Bill Effective: July 1, 2024

Short description Updates to existing worker misclassification statute.

Summary This bill makes several changes to misclassification provisions in Minnesota’s existing labor laws, including significant new penalties and fines as well as individual and successor liability. It also creates a multi-agency Intergovernmental Misclassification Enforcement and Education Partnership, which allows for data sharing related to misclassification investigation, outreach, prevention and enforcement. Further, it establishes a new multi-part independent contractor test for building construction and improvement services. The amended law also states that individual liability may exist for an owner, partner, principal, member, officer, and agent, on behalf of the person, who knowingly or repeatedly engaged in employee misclassification. The penalty is up to $10,000 for each individual an employer failed to classify, represent, or treat as an employee.

Implications Additional penalties and enforcement for misclassification of employees, including individual and successor liability.

Bill language Chapter 127, Article 10: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Earned sick and safe time modifications

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 11 Tax Bill Effective: May 25, 2024 & January 1, 2025 for one provision, as noted Short description Existing earned sick and safe time (ESST) law updated to clarify who qualifies for ESST, the rate at which ESST must be paid, ESST application to other paid time off, notice to employees on earnings statements and more including increased compliance, rulemaking and remedies and the expansion of the scope of the mandate itself.

Summary • Earnings statement- Employers are no longer required to provide information about an employee's ESST hours available for use and ESST hours used during the pay period on earnings statements or paychecks. Instead, employers can choose a reasonable system for providing this information at the end of each pay period. While employers can still include this information on an earnings statement or paycheck, they could also choose to provide this information electronically. If an employer provides the information electronically, they must provide their employees with access to an employer-owned computer during regular working hours to review and print the information.

• Covered employees- The ESST law change clarifies that employees anticipated to work at least 80 hours in a year for an employer in Minnesota are covered by the ESST law. The changes to the law also establish that ESST requirements don’t apply to volunteer or paid on-call firefighters, volunteer ambulance attendants, paid-on-call ambulance service personnel, elected officials, individuals appointed to fill vacancies in elected offices, and individuals employed by a farmer, family farm, or family farm corporation who work for 28 days or less per year. Additionally, certain family caregivers can waive their ESST rights.

• Increment of time used- The ESST law change establishes that employees may use ESST in the same increment of time for which they are paid. Employers are not required to allow ESST use in less than 15-minute increments and cannot require use in more than four-hour increments.

• Base rate- Employers must provide employees who use ESST with pay equal to the base rate the employee earns from employment. For employees paid on an hourly basis, the base rate is the same rate the employee receives per hour of work. If an employee receives multiple hourly rates, the employee should receive the rate the employee would have been paid for the period of time during which the leave is taken. For employees paid on a salary basis, the employee should receive the same rate guaranteed to the employee as if they had not taken leave. Finally, for employees paid solely on a commission, piecework or any other basis other than hourly or a salary, the employer must pay the employee no less than the applicable local, state or federal minimum wage, whichever is greater. 

ESST application to other paid time off-- The effective date of this provision is Jan. 1, 2025. If an employer provides employees with paid time off (PTO) or other paid leave that is more than the amount required under the ESST law for absences due to personal illness or injury, the additional PTO must meet the same requirements as the ESST hours, other than the ESST accrual requirements. For example, if an employee receives

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50 hours of PTO in addition to the minimum requirement of 48 ESST hours per year, the employer must follow the ESST requirements about notice, documentation, antiretaliation, replacement workers and more for the PTO hours in addition to the ESST hours.

Employers can still apply their notice and documentation requirements that were in effect as of Dec. 31, 2023 when employees use PTO accrued on or before that date. However, employers cannot require employees to use PTO accrued on or after Jan. 1, 2024, before using PTO accrued before that date.

• •

•

•

Bereavement leave- As a result of the ESST law changes, ESST hours can now be used to make funeral arrangements, attend a funeral service or memorial or address financial or legal matters that arise after the death of a family member.

Documentation- The updated ESST law maintains the original documentation requirements (see “Using ESST hours”) but clarifies that the three consecutive days of ESST use that trigger the employer’s ability to require reasonable documentation refers to scheduled workdays. It also adds that acceptable documentation for employees using ESST for absences related to domestic abuse, sexual assault or stalking includes an employee's written statement if documentation cannot be obtained in a reasonable time or without added expense.

Weather-event exception for certain employees- Certain employees, such as firefighters, licensed peace officers, 911 dispatchers, correctional facility guards and public employees with commercial driver's licenses, cannot use their ESST hours for absences related to the closure of the employee's workplace or their family member’s school or care facility due to weather or public emergencies, except under certain circumstances.

Remedies for ESST violations- The updated ESST law establishes that an employer that fails to provide or allow ESST use as required is liable to employees for the amount of ESST they should have been provided or could have used, plus an equal amount as liquidated damages. If the exact ESST hours owed is unclear, employers are liable for 48 hours each year ESST was not provided, plus an equal amount as liquidated damages.

Implications Understanding application of earned sick and safe time within your organization and its intersection with existing leave.

Bill language Chapter 127, Article 11: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Nursing assistant competency evaluation language accommodation 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 58, Sec 11, Subdivision 3 Tax Bill Effective: January 1, 2025

Short description Compels the Department of Health to make the nursing assistant written competency examination available in languages other than English.

Summary To offer the written portion of the nursing assistant competency examination in languages other than English, the Department of Health may work with the state demographer or the Department of Employment and Economic Development to determine which languages are most commonly spoken.

Implications English language learner (ELL) students may have an easier time passing the written nursing assistant exam and numbers of individuals listed on the registry may increase.

Bill language Chapter 127, Article 58, Section 11: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Subd. 3a.

Competency evaluation program. (a) The commissioner of health shall approve the competency evaluation program. (b) A competency evaluation must be administered to persons who desire to be listed in the nursing assistant registry. The tests may only be administered by technical colleges, community colleges, or other organizations approved by the Department of Health commissioner of health. The commissioner must ensure any written portions of the competency evaluation are available in languages other than English that are commonly spoken by persons who desire to be listed in the nursing assistant registry. The commissioner may consult with the state demographer or the commissioner of employment and economic development when identifying languages that are commonly spoken by persons who desire to be listed in the nursing assistant registry. (c) The commissioner of health shall approve a nursing assistant for the registry without requiring a competency evaluation if the nursing assistant is in good standing on a nursing assistant registry in another state.

EFFECTIVE DATE. This section is effective January 1, 2025.

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Background studies

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Section 14 Tax Bill Effective: May 25, 2024 Short description Changes to Minnesota’s 245C Human Services Background Studies regulations. The changes include allowing the MN Department of Human Services to temporarily modify background study requirements in the event of an emergency, clarifying that information obtained from public webbased data or other sources that are not direct correspondence from DHS do not constitute a notice of disqualification, and modifying the list of crimes that fall under the fifteen, ten, and seven year disqualification criteria.

Summary Proposes coding for § 245C.041. Adds section to allow for the commissioner to temporarily waive or modify background study requirements in the event of an emergency identified by the commissioner. Lists provisions the commissioner cannot modify or waive, and what an emergency may include. Specifies requirements for entities when an emergency ends. Clarifies that information received from web-based data sources do not constitute notice of disqualification and modifies list of crimes that fall under seven, fifteen and ten year disqualification criteria.

Implications Allows department to react quickly and limit disruption in the event of an emergency.

Bill language Chapter 127, Article 59, Section 14: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 14.

[245C.041] EMERGENCY WAIVER TO TEMPORARILY MODIFY BACKGROUND STUDY REQUIREMENTS. (a) In the event of an emergency identified by the commissioner, the commissioner may temporarily waive or modify provisions in this chapter, except that the commissioner shall not waive or modify: (1) disqualification standards in section 245C.14 or 245C.15; or (2) any provision regarding the scope of individuals required to be subject to a background study conducted under this chapter. (b) For the purposes of this section, an emergency may include, but is not limited to a public health emergency, environmental emergency, natural disaster, or other unplanned event that the commissioner has determined prevents the requirements in this chapter from being met. This authority shall not exceed the amount of time needed to respond to the emergency and reinstate the requirements of this chapter. The commissioner has the authority to establish the process and time frame for returning to full compliance with this chapter. The commissioner shall determine the length of time an emergency study is valid. (c) At the conclusion of the emergency, entities must submit a new, compliant background study application and fee for each individual who was the subject of background

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study affected by the powers created in this section, referred to as an "emergency study" to have a new study that fully complies with this chapter within a time frame and notice period established by the commissioner.

EFFECTIVE DATE. This section is effective the day following final enactment.

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Summer health care internship

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 59, Sections 17-21 Tax Bill Effective: August 1, 2024 Short description Added Assisted Living Facilities (ALF) to list of entities that quality to participate in the summer health care internship program.

Summary The Summer Health Care Internship Program (SHCIP) brings students and healthcare employers together, giving students experience in a healthcare environment and employers the opportunity to become more involved in their community by encouraging student to choose healthcare careers. It’s a partially paid experience that’s administered by the Hospital Association on behalf of the Department of Health. Participating health care providers include: Minnesota hospitals, clinics, nursing facilities, home care providers and adult day programs who employ students between Memorial Day and Labor Day for 6 to 12 weeks and at minimum wage or above; up to half of the intern's hourly wages will be reimbursed.

Assisted Living Facilities were added to the list of providers who can host student interns, essentially a technical change to ensure the statute conforms with the intent of the program--to include long-term care providers.

Implications This change will allow more providers the opportunity to attract student interns that are entering the workforce in long-term care professions.

Bill language Chapter 127, Article 59, Sections 17-21: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 17.

Minnesota Statutes 2022, section 144.1464, subdivision 1, is amended to read: Subdivision 1.

Summer internships.

The commissioner of health, through a contract with a nonprofit organization as required by subdivision 4, shall award grants, within available appropriations, to hospitals, clinics, nursing facilities, assisted living facilities, and home care providers to establish a secondary and postsecondary summer health care intern program. The purpose of the program is to expose interested secondary and postsecondary pupils to various careers within the health care profession.

Sec. 18.

Minnesota Statutes 2022, section 144.1464, subdivision 2, is amended to read:

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Subd. 2.

Criteria. (a) The commissioner, through the organization under contract, shall award grants to hospitals, clinics, nursing facilities, assisted living facilities, and home care providers that agree to: (1) provide secondary and postsecondary summer health care interns with formal exposure to the health care profession; interns;

(2) provide an orientation for the secondary and postsecondary summer health care

(3) pay one-half the costs of employing the secondary and postsecondary summer health care intern; (4) interview and hire secondary and postsecondary pupils for a minimum of six weeks and a maximum of 12 weeks; and (5) employ at least one secondary student for each postsecondary student employed, to the extent that there are sufficient qualifying secondary student applicants. (b) In order to be eligible to be hired as a secondary summer health intern by a hospital, clinic, nursing facility, assisted living facility, or home care provider, a pupil must: (1) intend to complete high school graduation requirements and be between the junior and senior year of high school; and (2) be from a school district in proximity to the facility. (c) In order to be eligible to be hired as a postsecondary summer health care intern by a hospital or clinic, a pupil must: (1) intend to complete a health care training program or a two-year or four-year degree program and be planning on enrolling in or be enrolled in that training program or degree program; and (2) be enrolled in a Minnesota educational institution or be a resident of the state of Minnesota; priority must be given to applicants from a school district or an educational institution in proximity to the facility. (d) Hospitals, clinics, nursing facilities, assisted living facilities, and home care providers awarded grants may employ pupils as secondary and postsecondary summer health care interns beginning on or after June 15, 1993, if they agree to pay the intern, during the period before disbursement of state grant money, with money designated as the facility's 50 percent contribution towards internship costs.

Sec. 19.

Minnesota Statutes 2022, section 144.1464, subdivision 3, is amended to read: Subd. 3.

Grants.

The commissioner, through the organization under contract, shall award separate grants to hospitals, clinics, nursing facilities, assisted living facilities, and home care providers

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meeting the requirements of subdivision 2. The grants must be used to pay one-half of the costs of employing secondary and postsecondary pupils in a hospital, clinic, nursing facility, assisted living facility, or home care setting during the course of the program. No more than 50 percent of the participants may be postsecondary students, unless the program does not receive enough qualified secondary applicants per fiscal year. No more than five pupils may be selected from any secondary or postsecondary institution to participate in the program and no more than onehalf of the number of pupils selected may be from the seven-county metropolitan area.

Sec. 20.

Minnesota Statutes 2023 Supplement, section 144.1505, subdivision 2, is amended to read: Subd. 2.

Programs. (a) For advanced practice provider clinical training expansion grants, the commissioner of health shall award health professional training site grants to eligible physician assistant, advanced practice registered nurse, pharmacy, dental therapy, and mental health professional programs to plan and implement expanded clinical training. A planning grant shall not exceed $75,000, and a three-year training grant shall not exceed $150,000 for the first year, $100,000 for the second year, and $50,000 for the third year $300,000 per program project. The commissioner may provide a one-year, no-cost extension for grants. (b) For health professional rural and underserved clinical rotations grants, the commissioner of health shall award health professional training site grants to eligible physician, physician assistant, advanced practice registered nurse, pharmacy, dentistry, dental therapy, and mental health professional programs to augment existing clinical training programs to add rural and underserved rotations or clinical training experiences, such as credential or certificate rural tracks or other specialized training. For physician and dentist training, the expanded training must include rotations in primary care settings such as community clinics, hospitals, health maintenance organizations, or practices in rural communities. (c) Funds may be used for: (1) establishing or expanding rotations and clinical training; (2) recruitment, training, and retention of students and faculty; (3) connecting students with appropriate clinical training sites, internships, practicums, or externship activities; (4) travel and lodging for students; (5) faculty, student, and preceptor salaries, incentives, or other financial support; (6) development and implementation of cultural competency training; (7) evaluations; (8) training site improvements, fees, equipment, and supplies required to establish, maintain, or expand a training program; and model.

(9) supporting clinical education in which trainees are part of a primary care team

Sec. 21.

Minnesota Statutes 2022, section 144.1911, subdivision 2, is amended to read:

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Subd. 2.

Definitions. (a) For the purposes of this section, the following terms have the meanings given. (b) "Commissioner" means the commissioner of health. (c) "Immigrant international medical graduate" means an international medical graduate who was born outside the United States, now resides permanently in the United States or who has entered the United States on a temporary status based on urgent humanitarian or significant public benefit reasons, and who did not enter the United States on a J1 or similar nonimmigrant visa following acceptance into a United States medical residency or fellowship program. (d) "International medical graduate" means a physician who received a basic medical degree or qualification from a medical school located outside the United States and Canada. (e) "Minnesota immigrant international medical graduate" means an immigrant international medical graduate who has lived in Minnesota for at least two years. (f) "Rural community" means a statutory and home rule charter city or township that is outside the seven-county metropolitan area as defined in section 473.121, subdivision 2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud. (g) "Underserved community" means a Minnesota area or population included in the list of designated primary medical care health professional shortage areas, medically underserved areas, or medically underserved populations (MUPs) maintained and updated by the United States Department of Health and Human Services.

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Health professional workforce advisory council 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 66, Section 22-23 Tax Bill Effective: August 1, 2024

Short description Creation of an advisory council that will research and advise the legislature and Office of Higher Education regarding health workforce needs, trends, supply and demand, strategies for addressing shortages, recruitment and retention and investments needed, as such.

Summary The advisory council for health workforce shall submit a report to the legislature by February 1, 2025 regarding recommendations for: (1) membership of the advisory council; (2) funding sources and estimated costs for the advisory council; (3) existing sources of workforce data for the advisory council to perform its duties; (4) necessity for and options to obtain new data for the advisory council to perform its duties; (5) additional duties of the advisory council; (6) proposed legislation to establish the advisory council; (7) similar health workforce advisory councils in other states; and (8) advisory council reporting requirements. Additionally, department of health must publish a request for information to conduct a comprehensive evaluation of current health care needs and capacity.

Implications Providing information to the legislature regarding healthcare workforce needs and the opportunity to influence legislative policy.

Bill language Chapter 127: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/ Sec. 22.

DIRECTION TO COMMISSIONER OF HEALTH; HEALTH PROFESSIONS WORKFORCE ADVISORY COUNCIL. Subdivision 1.

Health professions workforce advisory council.

The commissioner of health, in consultation with the University of Minnesota and the Minnesota State HealthForce Center of Excellence, shall provide recommendations to the legislature for the creation of a health professions workforce advisory council to: (1) research and advise the legislature and the Minnesota Office of Higher Education on the status of the health workforce who are in training and on the need for additional or different training opportunities; (2) provide information and analysis on health workforce needs and trends, upon request, to the legislature, any state department, or any other entity the advisory council deems appropriate; (3) review and comment on legislation relevant to Minnesota's health workforce; and

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(4) study and provide recommendations regarding the following: (i) health workforce supply, including: (A) employment trends and demand; (B) strategies that entities in Minnesota are using or may use to address health workforce shortages, recruitment, and retention; and (C) future investments to increase the supply of health care professionals, with particular focus on critical areas of need within Minnesota; (ii) options for training and educating the health workforce, including: (A) increasing the diversity of health professions workers to reflect Minnesota's communities; (B) addressing the maldistribution of primary, mental health, nursing, and dental providers in greater Minnesota and in underserved communities in metropolitan areas; (C) increasing interprofessional training and clinical practice; and

(D) addressing the need for increased quality faculty to train an increased workforce; (E) developing advancement paths or career ladders for health care professionals;

(iii) increasing funding for strategies to diversify and address gaps in the health workforce, including: (A) increasing access to financing for graduate medical education; (B) expanding pathway programs to increase awareness of the health care professions among high school, undergraduate, and community college students and engaging the current health workforce in those programs; (C) reducing or eliminating tuition for entry-level health care positions that offer opportunities for future advancement in high-demand settings and expanding other existing financial support programs such as loan forgiveness and scholarship programs; (D) incentivizing recruitment from greater Minnesota and recruitment and retention for providers practicing in greater Minnesota and in underserved communities in metropolitan areas; and (E) expanding existing programs, or investing in new programs, that provide wraparound support services to the existing health care workforce, especially people of color and professionals from other underrepresented identities, to acquire training and advance within the health care workforce; and (iv) other Minnesota health workforce priorities as determined by the advisory council.

Subd. 2.

Report to the legislature.

On or before February 1, 2025, the commissioner of health shall submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services and higher education finance and policy with recommendations for the creation of a health professions workforce advisory council as described in subdivision 1. The report must include recommendations regarding:

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(1) membership of the advisory council; (2) funding sources and estimated costs for the advisory council; (3) existing sources of workforce data for the advisory council to perform its duties; duties;

(4) necessity for and options to obtain new data for the advisory council to perform its (5) additional duties of the advisory council; (6) proposed legislation to establish the advisory council; (7) similar health workforce advisory councils in other states; and (8) advisory council reporting requirements.

Sec. 23.

REQUEST FOR INFORMATION; EVALUATION OF STATEWIDE HEALTH CARE NEEDS AND CAPACITY AND PROJECTIONS OF FUTURE HEALTH CARE NEEDS. (a) By November 1, 2024, the commissioner of health must publish a request for information to assist the commissioner in a future comprehensive evaluation of current health care needs and capacity in the state and projections of future health care needs in the state based on population and provider characteristics. The request for information: (1) must provide guidance on defining the scope of the study and assist in answering methodological questions that will inform the development of a request for proposals to contract for performance of the study; and (2) may address topics that include but are not limited to how to define health care capacity, expectations for capacity by geography or service type, how to consider health centers that have areas of particular expertise or services that generally have a higher margin, how hospital-based services should be considered as compared with evolving nonhospital-based services, the role of technology in service delivery, health care workforce supply issues, and other issues related to data or methods. (b) By February 1, 2025, the commissioner must submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over health care, with the results of the request for information and recommendations regarding conducting a comprehensive evaluation of current health care needs and capacity in the state and projections of future health care needs in the state.

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Paid family leave updates

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 73, Sections 1-51 Tax Bill Effective: Varies, May 25, 2024, November 1, 2025 or January 1, 2026 Short description Modifications and additions to the existing Paid Family Leave Statute.

Summary The 2023 Paid Family Leave Statute requires all Minnesota employers, beginning January 1, 2026, to provide most employees paid family and medical leave for up to twelve weeks with partial wage replacement for a single qualifying event. The program is funded by a payroll tax increase split between employers and employees, this amends the paid family leave law by increasing the payroll tax from 0.7 percent established in 2023 to 0.88 percent. There are several other “technical” changes to the statute, including adding or amending several definitions, including the terms “authorized representative,” “benefit year,” “financially eligible,” “initial paid week,” and others. The law also now requires employers to grant leave in minimum increments of one calendar day. Changes to leave prohibit applicants from applying for payment for benefits associated with intermittent leave until the applicant has eight hours of accumulated leave, unless more than thirty calendar days have lapsed since the initial taking of the leave.

There is also now an appeal process for the commissioner of the Department of Labor and Industry’s decision or determination.

Implications There will be payroll implications beginning January 1, 2026; the new payroll tax rate will be 0.88%, to be split evenly between employer and employee, although employers with fewer than 30 employees will have reduced rates. Employers can opt out of paying into the state program if their private benefit plan meets or exceeds the benefits provided under the state paid family leave plan.

Bill language Chapter 127, Article 73, Sections 1-51: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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CANNABIS

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Alzheimer’s added to qualifying conditions for the medical cannabis program 2024 Regular Session HF 4757/SF 4782 Chapter 121, Article 2, Section 13 Cannabis Bill Effective: July 1, 2024

Short description Sec. 13, Minnesota Statutes 2022, section 152.22, subdivision 14 is amended to read: Subd.14.

Qualifying medical condition means either a medical condition for which an individual’s health care practitioner has recommended, approved, or authorized the use of cannabis by that individual to treat the condition or a diagnosis of any of the following added conditions: Alzheimer’s disease, autism spectrum disorder that meets the requirements of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, chronic motor or vocal tic disorder, chronic pain, intractable pain as defined in section 152.125, subdivision1, paragraph 2, obstructive sleep apnea, post-traumatic stress disorder, irritable bowel syndrome, obsessive-compulsive disorder and sickle cell disease.

Summary The Medical Cannabis Program defines qualifying medical conditions as any medical condition that an individual’s health care practitioner has recommended, approved or authorized the use of cannabis by that individual for.

Implications Providers should be aware that the qualifying conditions for medical cannabis programs are any qualifying medical condition for which an individual health care practitioner has recommended, approved, or authorized the use of cannabis for.

Bill language Chapter 121, Article 2, Section 13: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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Alternate medical cannabis application for veterans 2024 Regular Session HF 4757/SF 4782 Chapter 121, Article 2, Section 19 Cannabis Bill Effective: July 1, 2024

Short description The 2024 session saw changes in Minnesota's cannabis law as it relates to the distribution of licenses: •

The merit-based system for obtaining a license was changed

•

Social Equity Applicants (SEAS)will be the focus of the license

•

Qualifying condition language was revised

Summary Sec. 19 Minnesota Statutes 2022, section 152.27, is amended by adding a subdivision to read: Subd.3a. Application procedure for veterans. (a) Beginning July 1, 2024, the office shall establish an alternative certification procedure for veterans to enroll in the registry program. (b) The office may request that a patient who is a veteran and is seeking to enroll in the registry program submit to the office a copy of the patient’s veteran identification card and an attestation that the veteran has been diagnosed with a qualifying medical condition listed in section 152.22, subdivision 14, clauses (1) to (19).

Potential social equity applicants should start the verification process early. The verification system will close to applicants on July 10. Eligibility requirements and technical support resources are posted on OCM’s website. Only those verified as a social equity applicant will be able to submit an application for a cannabis business license preapproval during the window beginning July 24 and closing Aug. 12, as required by law. There will be additional rounds to verify social equity status, as well as additional application rounds for licenses with and without social equity classification when general licensing opens in 2025.

The 2023 statute called for a "merit-based" system by which cannabis businesses would have a better chance of getting a license if they demonstrated the ability to operationalize a license.

Under the newly passed legislation, the merit-based system has been replaced by a lottery. The criteria for entering the lottery are primarily paper-based; there are no liquidity or real estate requirements, for example. Requirements include a business plan, standard operating procedures, security plan, and so forth. Licenses will be given out through a series of lottery rounds. License caps exist in statute for some, but not all, license types.

The initial licensing rounds are as follows: •

Pre-approval round: This round is for social equity applicants (SEAs) only and applications must begin to be accepted by July 24, 2024. The application period must end by August 12, 2024. There is a provision for license types that allow for cultivation to begin the cultivation of cannabis under an "early cultivation" provision. License preapprovals will become full licenses after rules are promulgated. The MN Office of Cannabis Management has indicated that rules may not be promulgated until late Q1 of 2025. License pre-approvals may not be transferred/sold to other entities.

•

Social equity round: This round will not commence until rules are promulgated, so exact timing of this round is unknown.

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•

General round: This round will not commence until rules are promulgated and the social equity round is complete.

SEAs are the focus of the new licensing system. Some important notes: •

To be considered an SEA, at least 65% of the controlling ownership of the business entity must qualify as a SEA.

•

All military veterans are now considered to be SEAs, not just those that received discharges for cannabis offenses.

•

Applicants not selected in a lottery round may have their application retained and be submitted in subsequent lotteries at no additional charge for up to one year.

Implications Providers should be aware of the variances for veterans seeking to enroll in the registry program.

Bill language Chapter 121, Article 2, Section 19: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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Changes to the caregiver language for the medical cannabis program 2024 Regular Session HF 4757/SF 4782 Chapter 121, Article 2, Section 21 Cannabis Bill Effective: July 1, 2024

Short description The office shall approve or deny a patient's application for participation in the registry program within 30 days after the office receives the patient's application. A patient's enrollment in the registry program shall only be denied if the patient does not have certification from a health care practitioner or, if the patient is a veteran, does not have the documentation requested by the office under subdivision 3a that the patient has been diagnosed with a qualifying medical condition.

Summary After receipt of a patient's application, application fees, and signed disclosure, the office shall enroll the patient in the registry program and issue the patient and patient's registered designated caregiver or parent, legal guardian, or spouse, if applicable, a registry verification.

The office shall approve or deny a patient's application for participation in the registry program within 30 days after the office receives the patient's application. A patient's enrollment in the registry program shall only be denied if the patient does not have certification from a health care practitioner or if the patient is a veteran and does not have the documentation requested by the office under subdivision 3a that the patient has been diagnosed with a qualifying medical condition.

Implications Providers should be aware of the variances for veterans seeking to enroll in the registry program.

Bill language Chapter 121, Article 2, Section 21: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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Cannabis-employee testing/employee drug policy 2024 Regular Session HF 4757/SF 4782 Chapter 121, Article 2, Section 26-31 Cannabis Bill Effective: July 1, 2024

Short description Employee drug testing policies must include cannabis Summary Sec. 2Minnesota Statutes 2022, section 181.950, subdivision 10: Positive test results include finding the presence of cannabis Sec. 27 Minnesota Statutes 2023 Supplement, section 181.951, subdivision 4: An employer may request or require employees to undergo random cannabis testing AND drug and alcohol testing Sec. 28 Minnesota Statutes 2023 Supplement, section 181.951, subdivision 5: Reasonable suspicion testing now includes cannabis and violated work rules include impairment Sec. 29. Minnesota Statutes 2023 Supplement, section 181.951, subdivision 8: An employer must not request or require a job applicant to undergo cannabis testing as a condition of employment unless otherwise required by state or federal law.

Sec. 30 Minnesota Statutes 2022, section 181.952, as amended by Laws 2023, chapter 63, article 6, section 38: Employer Drug/Alcohol policy Contents of the employer's drug and alcohol testing policies must specify and include cannabis and a copy of the policy must be provided to employees upon the adoption of the policy.

Sec. 31. Minnesota Statutes 2023 Supplement, section 181.954, subdivision1: A laboratory may only disclose to the employer test result data regarding the presence or absence of drugs, including cannabis.

Implications Providers employees’ drug and alcohol testing policies requires updated language to include cannabis.

Bill language Chapter 121, Article 2, Sections 26-31: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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Changes to reasonable restrictions on medical cannabis use 2024 General Session HF 4757/SF 4782 Chapter 121, Article 2, Section 113 Cannabis Bill Effective: July 1, 2024

Short Description Sec. 113 Changes to reasonable restrictions on medical cannabis use in health care facilities and refers to cannabis as a controlled substance, no longer a Schedule 1 drug.

Summary Health Care Facilities licensed under chapter 144A may unreasonably limit a patient's access to, or use of, medical cannabis flower or medical cannabinoid products to the extent that such is authorized, due solely to the fact that cannabis is a controlled substance, not a Schedule 1 drug, under the federal uniform-controlled substances act.

Implications Providers must be aware that medical cannabis and cannabinoid products are a controlled substance.

Bill language Chapter 121, Article 2, Section 113:

https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/121/

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MISCELLANEOUS

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Electronic medical records update includes penalty 2024 Regular Session HF 4661/SF 4745 Chapter 97, Section 13 Effective: August 1, 2024

Short description Minnesota Statutes § 176.135, subdivision 7, was amended to include penalties for violations of the law. A penalty of up to $500 may be assessed to the health care provider for each violation of the law by the health care provider or its agent.

Summary Minnesota Statutes § 176.135, subd. 7, includes specific payment rates for electronic medical records. The law applies to any request for copies of medical records that are required to be maintained in an electronic format by state or federal law.

If an authorized requestor submits a written request for advance notice of the cost of the copies requested, the health care provider must notify the requestor of the estimated cost before sending the copies. If the requestor approves the cost and copies of the records are provided, the payment is the applicable fee stated below. If the requestor does not pay for the records, the health care provider may charge a fee, which must not exceed $10.

For copies of electronic medical records, a health care provider or the health care provider's agent may not charge more than a total of: • • • • •

$10 if there are no records available; $30 for copies of records of up to 25 pages; $50 for copies of records of up to 100 pages; $50 plus an additional 20 cents per page for pages 101 and above; or $500 for any request.

Implications The health care provider or the health care provider's agent must provide copies of medical records in electronic format and the allowed charges for the electronic medical records include any fee for retrieval, download or other delivery. A health care provider or the health care provider's agent also cannot require prepayment for the costs of the medical records unless there is an outstanding past due notice for the requestor from a previous records request from the provider.

Bill language Chapter 97, Section 13: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/97/

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Senior LinkAge Line changes

2024 Regular Session SF 4399/HF 4392 Chapter 108, Article 3, Section 3 Human Services Policy Bill Effective Date: August 1, 2024

Short description A provision in the Human Services Policy Omnibus bill brings an end to the long-term care options counseling and verification code requirement for people considering moving into an assisted living.

Summary § 256.975, subd. 7e is amended and modifies the provision governing long-term care options counseling for assisted living to apply to critical care transitions. References to assisted living facilities is removed. The requirements assisted living facilities must meet at the facility tour for prospective residents has been changed. Hospitals will be required to refer older adults who are at risk of nursing home placement to the Senior LinkAge Line for long-term care options counseling prior to discharge. Counseling is to be delivered by the Senior LinkAge Line either by telephone or in-person and the requirements that the counseling must meet are changed.

Implications Senior LinkAge Line will continue to offer options counseling to those who choose to call in. The requirements for assisted living facilities have been simplified to reduce the administrative burden.

Bill language Chapter 108, Article 3, Section 3: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/108/

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Medical debt

2024 Regular Session SF 4097/HF 4077 Chapter 114, Article 3, Sections 77-81 Commerce Policy Bill Effective: October 1, 2024 Short description The Debt Fairness Act outlines medical debt reform.

Summary Outlines how providers can collect debt and limitations as such. These rules now apply to anyone collecting on debt, not just registered debt collectors.

Implications Outstanding debt collection efforts can no longer automatically transfer to spouses. Having a spouse assume financial liability along with the resident themselves on admission agreement or other contract may be a wise practice.

Medical Debt Reforms • Ending the automatic transfer of medical debt to a patient’s spouse; • Banning medical debt from being reported to credit bureaus; • Banning medical providers from withholding medically necessary care due to unpaid debt; • Establishing strong new protections from unethical medical debt collections practices; • Allowing people who successfully defend medical debt lawsuits to have their attorney's fees paid; • Requiring medical providers to publish their medical debt collection practices; • Creating a new process to help people dispute medical coding and billing errors; Judgment Collection Reforms • Establishing automatic income-based wage garnishment levels, ranging from 10% to 25%, rather than the flat 25% garnishment cap that previously existed; • Extending Minnesota’s wage garnishment protections to independent contractors; • Extending Minnesota’s wage garnishment protections to everyone living and working in Minnesota; Bankruptcy Reforms • Making bankruptcy more affordable for families by allowing them to keep more of their necessities through the process, including: o Doubling protection for vehicles from $5,000 to $10,000, with extra protection for persons with disabilities and for work vehicles; o $2,000 for sacred and religious possessions; o $3,000 for household tools like snowblowers and lawnmowers; o Low income-based tax credits; o Money received in personal injury lawsuits; o Protection for personal electronics and personal jewelry; and o $1,500 additional protection for any property.

Implications Providers must be aware of the process if there are collection issues that need to be addressed and proactively informing customers of their collection policy.

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Bill language Chapter 114, Article 3, Sections 77-81: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/114/

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Metro Mobility study

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 3, Section 125 Tax Bill Effective: By February 15, 2026, the commissioner must submit the report and findings to the chairs and ranking minority members of the legislative committees with jurisdiction over transportation policy and finance.

Short description A study on enhancements for Metro Mobility, consulting various disability organizations.

Summary This provision requires a study on improvements to the Metro Mobility service, a transportation service for people with disabilities in Minnesota. The study will be conducted by the commissioner of transportation in consultation with the Metropolitan Council.

The study will look at a number of factors, including: • • • • • • •

How well the Metropolitan Council is meeting the current demand for Metro Mobility services Whether the state's service requirements should be changed to allow Metro Mobility to deny fewer ride requests How the Metropolitan Council manages its reservation and dispatch system, including the possibility of a centralized system How the Metropolitan Council oversees the companies that provide rides for Metro Mobility The adequacy of the Metro Mobility complaints process The feasibility of using ride-sharing companies or taxis to provide an enhanced service option for Metro Mobility riders How to improve route coordination, call sequencing, customer service, and ride cataloging

The study must be completed by February 15, 2026 and submitted to chairs and ranking minority members of the legislative committees with jurisdiction over transportation policy and finance.

Implications: A report is required and legislative changes to Metro Mobility may result from that report.

Bill language Chapter 127, Article 3, Section 125: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Energy conservation decarbonization and climate resiliency loans and grants

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 15, Section 6-9 Tax Bill Effective: Immediately via application and applies to all comprehensive plans and amendments adopted by any local governmental unit Short description A bill to incentivize decarbonization, energy conservation and climate resiliency in housing.

Summary Persons, families and owners of rental property, that is occupied or intended to be occupied primarily by low- and moderate-income tenants, may apply for loans when financing is not otherwise available, in whole or in part, from private lenders upon equivalent terms and conditions. These loans are intended for use to reduce energy usage and assist in decarbonization and climate resiliency efforts. This could be anything from repairing existing windows to installing a geothermal heat pump.

Implications The adopted language may make it financially viable for those who would not otherwise be able to, to invest in infrastructure that reduces energy usage and rehabilitates a property.

Bill language Chapter 127, Article 15, Sections 6-9: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Qualifying property for renewable energy and resiliency improvements 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 42, Section 32 Tax Bill Effective: Immediately

Short description Defining qualifying property for renewable energy and resiliency improvements.

Summary This bill defines what properties qualify for renewable energy and resiliency improvement grants and loans.

Implications The adopted language may make it financially viable for those who would not otherwise be able to, to invest in infrastructure that reduces energy usage and/or rehabilitates a property. This language defines what property is eligible to apply.

Bill language Chapter 127, Article 42, Section 32: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Legislative task force on guardianship 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 46, Section 39 Tax Bill Effective: The day following final enactment Short description The task force on guardianship must be developed and convened by no later than September 1, 2025. The task force must make recommendations to address concerns and gaps related to guardianship and less restrictive alternatives to guardianship in MN. The task force must submit a report no later than January 15, 2027, which describes any concerns about the current guardianship system and recommends policy options to address concerns and promote less restrictive alternatives to guardianship.

Summary Task Force Members: • One member of the House of Representatives (appointed by the speaker of the house of representatives) • One member of the House of Representatives (appointed by the minority leader of the house of representatives) • One member of the senate (appointed by the senate majority leader) • One member of the senate (appointed by the senate minority leader) • One judge who has experience working on guardianship cases (appointed by the chief justice of the supreme court) • Two individuals presently or formerly under guardianship or emergency guardianship (appointed by the Minnesota Council on Disability) • One private, professional guardian, (appointed by the Minnesota Council on Disability) • One private, nonprofessional guardian (appointed by the Minnesota Council on Disability) • One representative of the Department of Human Services with knowledge of public guardianship issues (appointed by the commissioner of human services) • One member (appointed by the Minnesota Council on Disability) • Two members of two different disability advocacy organizations (appointed by the Minnesota Council on Disability) • One member of a professional or advocacy group representing the interests of the guardian who has experience working in the judicial system on guardianship cases (appointed by the Minnesota Council on Disability) • One member of a professional or advocacy group representing the interests of persons subject to guardianship who has experience working in the judicial system on guardianship cases (appointed by the Minnesota Council on Disability) • Two members of two different advocacy groups representing the interests of older Minnesotans who are or may find themselves subject to guardianship (appointed by the Minnesota Council on Disability) • One employee acting as the Disability System Planner in the Center for Health Equity at the Minnesota Department of Health (appointed by the commissioner of Health) • One member (appointed by the Minnesota Indian Affairs Council) • One member from the Commission of the Deaf, Deafblind, and Hard-of-Hearing (appointed by the executive director of the commission)

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• • • • • •

One member of the Council on Developmental Disabilities (appointed by the executive director of the council) One employee from the Office of Ombudsman for Mental Health and Developmental Disabilities (appointed by the ombudsman) One member appointed by the Minnesota Association of County Social Services Administrators (MACSSA) One employee from the Olmstead Implementation Office (appointed by the director of the office) One member representing an organization dedicated to supporting decision-making alternatives to guardianship (appointed by the Minnesota Council on Disability) Appointees to the task force must be named by each appointing authority by June 30, 2025. Appointments made by an agency or commissioner may also be made by a designee.

Task Force Appointees Duties • The Task Force Chair is a member of the Minnesota Council on Disability.

• The task force chair must designate a member to serve as secretary.

• Members of the task force may receive compensation and expense reimbursement as provided in Minnesota Statutes, section 15.059, subdivision 3.

• The task force shall submit a report to the chairs and ranking minority members of the legislative committee with jurisdiction over guardianship issues no later than January 15, 2027.

• The report must describe any concerns about the current guardianship system identified by the task force and recommend policy options to address the concerns to promote less restrictive alternatives to guardianship.

• The report must include draft legislation to implement the recommended policy.

• The task force expires upon submission for its reports, or January 16, 2027, whichever is earlier.

Implications Providers should be aware of the guardianship task force and recommendations in order to address concerns and gaps and promote a less restrictive alternative to guardianship, according to findings, reports and legislation.

Bill language Chapter 127, Article 46, Section 39: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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$4 million appropriated for DHS response contingency account 2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 52, Section 1 Tax Bill Effective: July 1, 2024

Short description The Minnesota Department of Human Services (DHS) received $4 million to use for contingency responses.

Summary DHS may use the funding to respond to emerging or immediate needs related to supporting the health, welfare, or safety of people. In responding, DHS may make expenditures on the following: • Services, supplies, and equipment to support the health, welfare, or safety of people.

• Training and coordination with service providers, Tribal Nations, and local government entities.

• Communication with and outreach to impacted people.

• Informational technology.

• Staffing.

Bill language Chapter 127, Article 52, Section 1: https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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Evaluation of statewide healthcare needs and capacity

2024 Regular Session HF 5247/SF 5234 Chapter 127, Article 66, Section 23 Tax Bill Effective: By November 1, 2024, the commissioner of health must publish a request for information; By February 1, 2025, the commissioner must submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over health care Short Description Minnesota is looking to evaluate the State’s health care system. The commissioner of health must put out an RFP asking for information on how to define healthcare capacity, what future needs might be, and how best to study this topic. This information will be used to design a larger study.

Summary Minnesota is requiring an evaluation of the current state of healthcare in the state. This includes what healthcare services are needed, what resources are available, and how those needs might change in the future. To prepare for this evaluation, the department will be issuing a request for information by November 1st, 2024. This request will ask for input on how to define and measure healthcare needs and capacity, how to consider different types of healthcare providers, and how to account for future trends like technology and workforce shortages. By February 1st, 2025, the department will use the gathered info to recommend how to proceed with the full evaluation.

Implications Information in the report may shape future legislation.

Bill language Chapter 127, Article 66, Section 23:

https://www.revisor.mn.gov/laws/2024/0/Session+Law/Chapter/127/

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