Variance and Waiver Requirements for Minnesota Nursing Homes

Minnesota Nursing Home Variance and Waiver Rules
Minnesota Nursing Home Variance and Waiver Rules

Nursing Home Variance and Waiver Rules in Minnesota

According to Minnesota Administrative Rules 4658.0040 VARIANCE AND WAIVER, Subpart 1., request for variance or waiver. A nursing home may request that the department grant a waiver from the provisions of this chapter. A request for a variance or waiver must be submitted to the department in writing. Each request must contain:

A. the specific part or parts for which the variance or waiver is requested;

B. the reasons for the request;

C. the alternative measures that will be taken if a variance or waiver is granted;

D. the length of time for which the variance or waiver is requested; and

E. other relevant information necessary to properly evaluate the request for the variance or waiver.

Subp. 2. Criteria for evaluation. The decision to grant or deny a waiver must be based on the department’s evaluation of the following criteria:

A. whether the variance or waiver adversely affects the health, treatment, comfort, safety, or well-being of a resident;

B. whether the alternative measures to be taken, if any, are equivalent to or superior to those prescribed in this chapter; and

C. whether compliance with the part or parts would impose an undue burden upon the applicant.

Notice of Variance and Waiver Requirements

Subp. 3. Notification of variance. The department must notify the applicant in writing of its decision. If a variance or waiver is granted, the notification must specify the period of time for which the variance or waiver is effective and the alternative measures or conditions, if any, to be met by the applicant.

Subp. 4. Effect of alternative measures or conditions. Alternative measures or conditions attached to a variance or waiver have the force and effect of this chapter and are subject to the issuance of correction orders and penalty assessments in accordance with Minnesota Statutes, section 144A.10. The amount of fines for a violation of this part is that specified for the particular rule for which the variance or waiver was requested.

Subp. 5. Renewal. A request for the renewal of a variance or waiver must be submitted in writing at least 45 days before its expiration date. Renewal requests must contain the information specified in subpart 1. A variance or waiver must be renewed by the department if the applicant continues to satisfy the criteria in subparts 2 and 3, and demonstrates compliance with the alternative measures or conditions imposed at the time the original variance or waiver was granted.

Subp. 6. Denial, revocation, or refusal to renew. The department must deny, revoke, or refuse to renew a variance or waiver if it is determined that the criteria in subparts 2 and 3 are not met. The applicant must be notified in writing of the reasons for the decision and informed of the right to appeal the decision.

Subp. 7. Appeal procedure. An applicant may contest the denial, revocation, or refusal to renew a variance or waiver by requesting a contested case hearing under Minnesota Statutes, chapter 14. The applicant must submit, within 15 days of the receipt of the department’s decision, a written request for a hearing. The request for hearing must set forth in detail the reasons why the applicant contends the decision of the department should be reversed or modified. At the hearing, the applicant has the burden of proving that it satisfied the criteria specified in subparts 2 and 3, except in a proceeding challenging the revocation of a variance or waiver.

According to Minnesota Administrative Rule 4658.0015, COMPLIANCE WITH REGULATIONS AND STANDARDS, a nursing home must operate and provide services in compliance with all applicable federal, state, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in a nursing home.

According to 4658.0020 LICENSING IN GENERAL, Subpart 1., a state license is required for a facility where nursing home care is provided for five or more aged or infirm persons who are not acutely ill.

Subp. 2. License fees. Each application for either an initial or renewal license to operate a nursing home must be accompanied by a fee based upon the formula as provided by Minnesota Statutes, section 144.122. A bed must be licensed if it is available for use by residents. If the number of licensed beds is increased during the term of the license, a full year’s fee for each additional bed must be paid. There is no refund for a decrease in licensed beds.

Subp. 3. License expiration date. Initial and renewal licenses are issued for one year and expire on the anniversary date of issuance. A license renewal must be applied for on an annual basis.

Subp. 4. License to be posted. The license must be posted at the main entrance of a nursing home.

Subp. 5. Separate licenses. Separate licenses are required for institutions maintained on separate, noncontiguous premises even though operated under the same management. A separate license is not required for separate buildings maintained by the same owner on the same premises.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home licensing requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Evaluation Requirements in Minnesota Nursing Homes

Minnesota Nursing Homes Must Undergo Evaluation of Services and Care
Minnesota Nursing Homes Must Undergo Evaluation of Services and Care

Minnesota Nursing Home Evaluation Regulations

According to Minnesota Administrative Rule 4658.0035 EVALUATION, a nursing home is subject to evaluation and approval by the department of the nursing home’s physical plant and its operational aspects before a change in ownership, classification, capacity, or an addition of services which necessitates a change in the nursing home’s physical plant.

Evaluation Including Many Issues Including..

The nursing home must conduct an initial comprehensive and accurate assessment of each resident’s functional capacity. Minnesota Rule 4658.0405, Subpart 1, requires that “a nursing home must develop a comprehensive plan of care for each resident within seven days after the completion of the comprehensive resident assessment as defined in part 4658.0400”. The comprehensive plan of care must be developed by an interdisciplinary team that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, with the participation of the resident, their legal guardian or chosen representative.

It is important that there is an established baseline of the medical condition of the resident upon admission to the facility; this is generally completed in the admission process where the doctor’s orders for the resident as well as the assessments of the relevant risks and needs are compiled into the resident’s care plan. The care plan can then be compared and contrasted with the care and treatment as actually provided and documented in the medical records/chart of the resident.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home evaluation and licensing requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Capacity Regulations for Minnesota Nursing Homes

Nursing Home Bed Capacity in Minnesota
Nursing Home Bed Capacity in Minnesota

Minnesota Nursing Home Capacity Requirements

According to Minnesota Administrative Rule 4658.0030 CAPACITY PRESCRIBED, each license must specify the maximum allowable number of residents to be cared for at any one time. No number of residents in excess of that number may reside in the nursing home. The maximum number of licensed beds is determined by the amount of space that is available in the facility as specified in chapter 4660.

Information on Facilities and Capacity

PATIENT OR RESIDENT AREAS
4660.3400
BEDROOM CAPACITIES, NEW CONSTRUCTION.
4660.3410
LOCATION OF BEDROOMS, EXISTING AND NEW.
4660.3420
USABLE FLOOR AREA.
4660.3430
BED ARRANGEMENT.
4660.3440
WINDOWS, NEW CONSTRUCTION.
4660.3450
BEDROOM DOORS, NEW CONSTRUCTION.
4660.3460
CLOTHES CLOSET.
4660.3470
CUBICLE CURTAINS, EXISTING AND NEW.
4660.3500
CORRIDORS, NEW CONSTRUCTION.
4660.3600
ATTENDANTS’ STATION.
4660.3700
CLEAN LINEN STORAGE, EXISTING AND NEW.
4660.3800
NOURISHMENT AREA, NEW CONSTRUCTION.
4660.3900
SANITARY FIXTURES.
4660.4000
PROVISION OF RESIDENT TOILET ROOMS, NEW CONSTRUCTION.
4660.4100
TOILET ROOM LAYOUT, NEW CONSTRUCTION.
4660.4110
RESIDENT TOILET-BATH COMBINATIONS.
4660.4120
CENTRAL BATHING AREA.
4660.4200
STORAGE ROOM, NEW CONSTRUCTION.
4660.4300
JANITOR’S CLOSET, NEW CONSTRUCTION.
4660.4400
DRINKING FOUNTAINS, NEW CONSTRUCTION.
4660.4500
ROOM NUMBERING, EXISTING AND NEW.
4660.4600
STAFF HOUSING, EXISTING AND NEW.
4660.4700
MECHANICAL AND ELECTRICAL SYSTEMS, EXISTING AND NEW.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about resident capacity and facility requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Minnesota Nursing Home Licensure Application Process

Nursing Home Licensure Application Process Regulations
Nursing Home Licensure Application Process Regulations

Licensure Application Information for Nursing Homes

Pursuant to Minnesota Administrative Rule 4658.0025 PROCEDURES FOR LICENSING NURSING HOMES. Subpart 1. Initial licensure application. For the purpose of this part, initial licensure applies to newly constructed facilities designed to operate as a nursing home and to other facilities not already licensed as a nursing home. Applicants for initial licensure must complete the license application form supplied by the department. An application for initial licensure must be submitted at least 90 days before the requested date for licensure and must be accompanied by a license fee based upon the formula as provided by Minnesota Statutes, section 144.122.

To be issued a license, an applicant must file with the department a current copy of the architectural and engineering plans and specifications of the facility as prepared and certified by an architect or engineer registered to practice in Minnesota.

If the applicant for licensure is a corporation, it must submit with the application a copy of its articles of incorporation and bylaws. A foreign corporation must also submit a copy of its certificate of authority to do business in Minnesota. The department will issue the initial license as of the date the department determines that the nursing home is in compliance with parts 4655.0090 to 4655.9342, 4658.0010 to 4658.1365, 4660.0090 to 4660.9940, and Minnesota Statutes, sections 144A.01 to 144A.16, unless the applicant requests a later date.

Renewal of Nursing Homes Licensure Application

Subp. 2. Renewed licenses. An applicant for license renewal must complete the license application form supplied by the department. An application must be submitted at least 60 days before the expiration of the current license and must be accompanied by a license fee based upon the formula as provided by Minnesota Statutes, section 144.122.

The department will issue a renewed license if a nursing home continues to satisfy the requirements of parts 4655.0090 to 4655.9342, 4658.0010 to 4658.1365, 4660.0100 to 4660.9940, and Minnesota Statutes, sections 144A.01 to 144A.16.

If the licensee is a corporation, it must submit any amendments to its articles of incorporation or bylaws with the renewal application.

If the renewal application specifies a different licensed capacity from that provided on the current license, the licensee must comply with subpart 6. If the changes are not approved before the current license expires, the renewed license will be issued without reflecting the requested changes.

Subp. 3. Transfer of interest; notice. A controlling person, as defined in Minnesota Statutes, section 144A.01, subdivision 4, who transfers a beneficial interest in the nursing home must notify the department, in writing, at least 14 days before the date of the transfer. The written notice must contain the name and address of the transferor, the name and address of the transferee, the nature and amount of the transferred interests, and the date of the transfer.

Subp. 4. Transfer of interest; expiration of license. A transfer of a beneficial interest will result in the expiration of the nursing home’s license:

A. if the transferred beneficial interest exceeds ten percent of the total beneficial interest in the licensee, in the structure in which the nursing home is located, or in the land upon which the nursing home is located, and if, as the result of the transfer, the transferee then possesses a beneficial interest in excess of 50 percent of the total beneficial interest in the licensee, in the structure in which the nursing home is located, or in the land upon which the nursing home is located; or

B. if the transferred beneficial interest exceeds 50 percent of the total beneficial interest in the licensee, the structure in which the nursing home is located, or in the land upon which the nursing home is located.
Under either of these conditions, the nursing home license expires at the time of relicensure, 90 days after the date of the transfer, or 90 days after the date when notice of transfer is received, whichever date is later. If the current license expires before the end of the 90-day period, the licensee must apply for a renewed license in accordance with subpart 2. The department must notify the licensee by certified mail at least 60 days before the license expires.

Subp. 5. Transfer of interest; relicensure. A controlling person may apply for relicensure by submitting the license application form at least 60 days before the license expiration date. Application for relicensure must be accompanied by a license fee based upon the formula as provided by Minnesota Statutes, section 144.122. Payment of any outstanding penalty assessments must be submitted before the application for relicensure may be acted upon by the department. If the applicant for relicensure is a corporation, it must submit a copy of its current articles of incorporation and bylaws with the license application. A foreign corporation must also submit a copy of its certificate of authority to do business in Minnesota. The department will relicense the nursing home as of the date the commissioner determines that the prospective licensee complies with parts 4655.0090 to 4655.9342, 4658.0010 to 4658.1365, 4660.0100 to 4660.9940, and Minnesota Statutes, sections 144A.01 to 144A.16, unless the applicant requests a later date. The former licensee remains responsible for the operation of the nursing home until the nursing home is relicensed.

Subp. 6. Amendment to the license. If the nursing home requests a change in its licensed capacity or in its license classification, it must submit the request on the application for amendments to the license. This application must be submitted at least 30 days before the requested date of change and if an increase in the number of licensed beds is requested, accompanied by a fee based upon the formula as provided by Minnesota Statutes, section 144.122. The department will amend the license as of the date the department determines that the nursing home is in compliance with parts 4655.0090 to 4655.9342, 4658.0010 to 4658.1365, 4660.0100 to 4660.9940, and Minnesota Statutes, sections 144A.01 to 144A.16, unless a later date is requested by the licensee. The amendment to a license is effective for the remainder of the nursing home’s licensure year.

Subp. 7. Issuing conditions or limitations on the license. The department must attach to the license any conditions or limitations necessary according to subpart 8 to assure compliance with the laws and rules governing the operation of the nursing home or to protect the health, treatment, safety, comfort, and well-being of the nursing home residents. A condition or limitation may be attached to a license at any time.

Subp. 8. Reasons for conditions or limitations. In deciding to condition or limit a license the department must consider:

A. the nature and number of correction orders or penalty assessments issued to the nursing home or to other nursing homes having some or all of the same controlling persons;

B. the permitting, aiding, or abetting of the commission of any illegal act in the nursing home by any of the controlling persons or employees of the nursing home;

C. the performance of any acts contrary to the welfare of the residents in a nursing home by a controlling person or employee;

D. the condition of the physical plant or physical environment;

E. the existence of any outstanding variances or waivers; or

F. the number or types of residents the nursing home is able to provide for.

Subp. 9. Types of conditions or limitations. The department must impose one or more of the following conditions or limitations for reasons determined under subpart 8:

A. restrictions on the number or types of residents to be admitted or permitted to remain in the nursing home;

B. restrictions on the inclusion of specified individuals as controlling persons or managerial employees; or

C. imposition of schedules for the completion of specified activities.
Subp. 10. Statement of conditions or limitations. The department must notify the applicant or licensee, in writing, of its decision to issue a conditional or limited license. The department must inform the applicant or licensee of the reasons for the condition or limitation and of the right to appeal.

Unless otherwise specified, a condition or limitation remains valid as long as the licensee of the nursing home remains unchanged or as long as the reason for the condition or limitation exists. The licensee must notify the department when the reasons for the condition or limitation no longer exist. If the department determines that the condition or limitation is no longer required, it will be removed from the license.

The existence of a condition or limitation must be noted on the face of the license. If the condition or limitation is not fully stated on the license, the department’s licensure letter containing the full text of the condition or limitation must be posted alongside the license in an accessible and visible location.

Subp. 11. Effect of a condition or limitation. A condition or limitation has the force of law. If a licensee fails to comply with a condition or limitation, the department may issue a correction order or assess a fine or it may suspend, revoke, or refuse to renew the license in accordance with Minnesota Statutes, section 144A.11.
If the department assesses a fine, the fine is $250. The fine accrues on a daily basis according to Minnesota Statutes, section 144A.10.

Subp. 12. Appeal procedure. The applicant or licensee may contest the issuance of a conditional or limited license by requesting a contested case proceeding under the Administrative Procedure Act, Minnesota Statutes, sections 14.57 to 14.69, within 15 days after receiving the notification described in subpart 10. The request for a hearing must set out in detail the reasons why the applicant contends that a conditional or limited license should not be issued.

Subp. 13. License application forms. The department will furnish the applicant or the licensee with the necessary forms to obtain initial or renewed licensure or to request relicensure of the nursing home after a transfer of interest. The license forms must require that the information described in subparts 14 to 16 be provided.

Subp. 14. General information. General information means:

A. the name, address, and telephone number of the nursing home;

B. the name of the county in which the nursing home is located;

C. the legal property description of the land upon which the nursing home is located;

D. the licensed bed capacity;

E. the designation of the classification of ownership, for example, state, county, city, city and county, hospital district, federal, corporation, nonprofit corporation, partnership, sole proprietorship, or other entity;

F. the name and address of the controlling person or managerial employee who will be responsible for communicating with the commissioner of health on all matters relating to the nursing home license and on whom personal service of all notices and orders will be served; and

G. the location and square footage of the floor space constituting the facility.

Subp. 15. Disclosure of controlling persons. According to Minnesota Statutes, section 144A.03, the nursing home license application must identify the name and address of all controlling persons of the nursing home, as defined in Minnesota Statutes, section 144A.01, subdivision 4.

Subp. 16. Disclosure of managerial employees. A nursing home license application must identify the name and address of all administrators, assistant administrators, directors of nursing, medical directors, and all other managerial employees, as defined in Minnesota Statutes, section 144A.01, subdivision 8, and indicate their previous work experience in nursing homes during the past two years.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home licensing requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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License of Nursing Home Required by State and Federal Law

Nursing Homes Must Have License According to State and Federal Law

Minnesota Nursing Homes Must Have a License From the State

Pursuant to Minnesota Administrative Rule, 4658.0020 LICENSING IN GENERAL. Subpart 1., required, for the purpose of this chapter, a state license is required for a facility where nursing home care is provided for five or more aged or infirm persons who are not acutely ill.

Subp. 2. License fees. Each application for either an initial or renewal license to operate a nursing home must be accompanied by a fee based upon the formula as provided by Minnesota Statutes, section 144.122. A bed must be licensed if it is available for use by residents. If the number of licensed beds is increased during the term of the license, a full year’s fee for each additional bed must be paid. There is no refund for a decrease in licensed beds.

Subp. 3. License expiration date. Initial and renewal licenses are issued for one year and expire on the anniversary date of issuance. A license renewal must be applied for on an annual basis.

Subp. 4. License to be posted. The license must be posted at the main entrance of a nursing home.

Subp. 5. Separate licenses. Separate licenses are required for institutions maintained on separate, noncontiguous premises even though operated under the same management. A separate license is not required for separate buildings maintained by the same owner on the same premises.

Federal Regulations Also Require Licensure of Nursing Homes

Federal regulations contained in 42 CFR § 483.70, administration, a facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

(a) Licensure. A facility must be licensed under applicable State and local law.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home license requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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