“Nursing home” means a facility or that part of a facility which provides nursing care to five or more persons. “Nursing home” does not include a facility or that part of a facility which is a hospital, a hospital with approved swing beds as defined in section 144.562, a clinic, doctor’s office, diagnostic or treatment center, or a residential program licensed pursuant to sections 245A.01 to 245A.16 or 252.28 (Minn. Stat § 144A.01, Subd. 5).

Skilled Nursing Facility
Dual Medicare/Medicaid Skilled Nursing and Nursing Facility
Medicaid Nursing Facility

Compliance with Federal Regulations Centers for Medicare and Medicaid Services (CMS)
License Minnesota Department of Health (MDH)
Survey Inspections Minnesota Department of Health (MDH)
Administrator License Minnesota Board of Examiners of Nursing Home
Background Study of Employees Minnesota Department of Human Services (DHS)

Board of Examiners of Nursing Home Administrators
Creation/Organization §§ 144A.19 & 214.01
Duties § 144A.24

Residents of a Nursing Home shall have the right to establish a Resident Advisory and Family Council for the purpose of providing residents and their families with educational and informational services (Minn. Stat. §§ 144A.10; 144A.33; 144.651, Subd. 27).


42 USC § 1395i-3 – Social Security Act, § 1819 (Medicare – Skilled Nursing Facility)
42 USC § 1396r – Social Security Act, § 1919 (Medicaid – Nursing Facility)
42 CFR, Part 483, Subpart B (OBRA Regulations)
42 U.S.C. § 3604(f); 24 C.F.R. 100 (Fair Housing Act)

Minnesota Statutes §§ 144A.01-144A.37 (Nursing Home Main Law)
Minnesota Statute § 144.651 (Health Care Bill of Rights)
Minnesota Statute §§ 144A.10 & 144A.33 (Resident Advisory Council)
Minnesota Rules 4658.0010-4658.5590 (Resident Services)
Minnesota Statute § 504B (Landlord Tenant Law)

• 24 Hour Nursing Care
• Meals; Laundry; Housekeeping; Personal services
• Medicare Skilled Nursing Facility/Medicaid Nursing Facility Services

• No admittance for pregnant women; mentally disturbed; those with infectious disease; or children under the age of 16 (Minn. R. 4655.0400)
o NOTE: This restriction on admittance may violate federal fair housing law. Also, OBRA requires nursing homes to offer many services, including some mental health services. (See In the Matter of the Involuntary Discharge of Transfer of J.S. by Hall, 512 N.W.2d 604 (Minn. App. 1994)).

Nursing Home Definition SAMPLE OF REGULATIONS – Federal OBRA Regulations & State Statutes/ Regulations
To participate in the Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483), otherwise known as the OBRA regulations. The following are examples of federal regulations and corresponding state regulations:
• Resident Rights. 42 CFR § 483.10; Minn. Stat. § 144.651 (Health Care Bill of Rights)
o Admission, transfer and discharge rights. 42 CFR § 483.12
o Quality of life. 42 CFR § 483.15
• Sufficient nursing staff. 42 CFR § 483.30
• Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity in a Resident assessment. 42 CFR § 483.20
• Develop a comprehensive care plan for each resident. 42 CFR § 483.20 (k); Minn. R. 4658.0405, Subpart 1(k) (Comprehensive care plans)
• Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. 42 CFR §483.25(c)
• Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. 42 CFR §483.25 (d)
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. 42 CFR §483.25 (h)
• Maintain acceptable parameters of nutritional status. 42 CFR §483.25 (i)
• Provide each resident with sufficient fluid intake to maintain proper hydration and health. 42 CFR § 483.25 (j)
• Ensure that residents are free of any significant medication errors. 42 CFR §483.25 (m); Minn. R. 4658.1320.
• Assist residents in obtaining routine and 24-hour emergency dental care. 42 CFR § 483.55
• Infection control. 42 CFR § 483.65


Minnesota Nursing Home License: Applicable Statutes & Rules

Licensing Governing Law:
Application § 144A.03
Qualifications § 144A.04
Renewal § 144A.05
Fees § 144.122; R. 4658.0020, Subp. 2
Period of Issuance R. 4658.0020, Subp. 3
Procedures for Licensing R. 4658.0025
Penalties for Licensing Violations R. 4658.0045
Licensee Duties R. 4658.0050 & R. 4655.1200
Quality Services R. 4658.0140
Capacity R. 4658.0030
Twenty four hour care R. 4658.0510
Variance or Waiver from rules R. 4655.1000
New Medicaid Certified Moratorium Exception
§ 144A.071; R. 4655.1070-4655.1098

Application for License:
Applications for License to operate a Nursing Home are available on the MN Dept. of Health (MDH) web site.

License Requirements:
• Provide nursing care to 5 or more persons (Minn. Stat. § 144A.01, Subd. 5; Minn. R. 4658.0020, Subp. 1);
• Operate & provide services in compliance with all applicable federal, state and local laws, regulations and codes (Minn. R. 4658.0015);
• Specify one or more controlling persons who are responsible for dealing with the MDH on all matters under sections Minn. Stat. §§ 144A.01-144A.15 (Minn. Stat. § 144A.03, Subd. 2);
• Meet minimum health, sanitation, safety and comfort standards prescribed by the MDH (Minn. Stat. § 144A.04, Subd. 3);
• Ensure that any “controlling person,” “administrator,” and “managerial employee” is without a certain number of uncorrected or repeated violations or convicted of a felony/gross misdemeanor relevant to nursing home operation and safety in the previous 2-years (Minn. Stat. § 144A.04, Subds. 4&6);
• Employ a Nursing Home Administrator that is licensed by the Board of Examiners for Nursing Home Administrators (Minn. Stat. § 144A.04, Subd. 5);
• Maintain a minimum number of nursing personnel hours at 2 hours per resident in a 24-hour period (Minn. Stat. § 144A.04, Subd. 7);
• Have at all times at least 1 staff member trained in single rescuer adult cardiopulmonary resuscitation in the previous 2 years (Minn. Stat. § 144A.04, Subd. 9);
• Determination by the MDH of compliance with Minnesota Rules 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 (Minn. R. 4658.0025, Subp. 1); and
• Meet a moratorium exception for initial licensure if a new nursing home (Minn. Stat. § 144A.071).

Renewal License Requirements:
• No approval for a nursing home bed in a resident room with more than 4 beds (Minn. Stat. § 144A.05)
• Receipt of the nursing home’s most recent balance sheet and most recent statement of revenues & expenses (Minn. Stat. § 144A.05)
• Continue to comply with Minnesota Rules 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 (Minn. R. 4658.0025, Subp. 2)
Base fee of $183; plus $91 per licensed bed; plus $5 per licensed bed fee for nursing home resident advisory councils.

Period of Issuance:
One year from effective date; renewed on an annual basis.

Nursing Home Administrator License: Applicable Statutes & Rules

License Governing Law:
Qualifications § 144A.20
Licensure Requirements R. 6400.5000-6400.6100
Delegation of Authority R. 4658.0055
Course Requirements R. 6400.6400-6400.6660
Responsibilities R. 6400.6710
Continuing Education R. 6400.6800
Discipline R. 6400.6900
Fees R. 6400.6970

License Requirements:
• Licensure by the Board of Examiners for Nursing Home Administrators (Minn. Stat. § 144A.18)
• Age 21 or older (Minn. Stat. § 144A.20, Subd. 1(a))
• Meet standards designed by the Board of Examiners for Nursing Home Administrators (Minn. Stat. § 144A.20, Subd. 1(b))
o Specified coursework
o Internship
o Bachelor’s degree
• Pass competency exam or otherwise be approved by the Board of Nursing Home Administrators (Minn. Stat. § 144A.20, Subd. 1(c))
o National exam
o State rules test

Application for License:
Application form is available on the BENHA web site

Application fee – $150
National exam fee – $285
Rules exam fee – $75
Initial license fee – $200
Annual renewal fee – $200

Period of Issuance:

Length of Determination Process:
Board meets 4 times a year; National exams by appointment; State exams every other month.

An annual statistical report is required to be submitted by the nursing home online by December 31st of each year.

• MDH shall inspect each nursing home to ensure compliance with §§ 144A.01-144A.155 (Minn. Stat. § 144A.10, Subd. 2)
• Annual surveys conducted – MDH, Compliance Monitoring Division, under a cooperative agreement with the Centers for Medicare and Medicaid (CMS), is responsible for ensuring that facilities accepting Medicare and Medicaid payment for services provided to program beneficiaries meet federal regulations and certification rules; Results of surveys at:

• Correction orders shall be issued by the MDH to the facility to correct a discovered violation (Minn. Stat. § 144A.10, Subd. 4)
• MDH shall assess a civil fine when a correction order is issued (Minn. Stat. § 144A.10, Subds. 6-8a)
• Placement of Monitor (42 C.F.R. 488.422)

o Appeals of survey violations may be brought before Office of Administrative Hearings; Decisions can be found at
Locating Survey Information on a Provider
Office of Health Facility Complaints, MDH;

Minimum Staffing – Minn. Stat. § 144A.04, Subd. 7; Minn. Rs. 4655.5100, 4658.0500
o Director of Nursing –
 1 full-time Director of Nursing (at least 35 hours per week)
 Director must designate a nurse to be responsible in Director’s absence
o RN or LPN
 1 RN or LPN 8 hours/day for 7 days/week
 RN must be on call during all hours when no RN is on duty
o Nursing Personnel (RN, LPN, Director of Nursing, and Nursing Assistant)
 1 “responsible person” on duty at all times
 Under 60 licensed beds – 2 hours of nursing personnel per resident daily, including Director of Nursing
 60 or more licensed beds – 2 hours of nursing personnel per resident daily, excluding Director of Nursing hours

o 42 U.S.C. § 1396r(c)(2)(D) and 42 C.F.R. § 483.12(b); Minn. R. 9050.0150 (VA)
o A resident shall be readmitted to the nursing home after hospitalization, if he or she requires nursing home services and is eligible for Medical Assistance, upon the first availability of a bed in a semi-private room


• Federal Legislation (42 U.S.C. § 1396r9(c)(2); 42 U.S.C. § 1395i-3(c)(2))
o Requirements for Transfer or Discharge
 Resident must not be transferred or discharged unless necessary to meet the resident’s welfare; the resident’s health has improved; the safety or health of individuals at the facility is endangered; the residents has failed to pay (after reasonable notice); or the facility closes (§ 1396r(c)(2)(A)
 The list of acceptable reasons for discharge is exclusive
 Notice must be given prior to discharge or transfer(§ 1396r(c)(2)(B))
 Nursing home must provide an orientation to ensure safe transfer or discharge (§ 1396r(c)(2)(C))
o Appeals
 State must provide an appeals of transfer or discharge decisions (§ 1396r(e)(3))
• State Legislation
o Requirements for Transfer or Discharge (§ 144.651, Subd. 29 – Minnesota Health Care Bill of Rights)
 Transfer of discharge of residents must not be arbitrary
 Written notice is required at least 30 days before discharge and 7 days before transfer to another room
• Notice shall include the resident’s right to contest the proposed action
 Involuntary discharge requires a preponderance of the evidence standard (In the Matter of the Involuntary Discharge of Transfer of J.S. by Hall, 512 N.W.2d 604 (Minn. App. 1994).
o Appeals (§ 144A.135)
 Appeals of transfer or discharge decisions are first brought before Office of Administrative Hearings (decisions can be found at

This website is not to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation. In addition to providing related information this blog may also be considered an advertisement for legal services.

If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota , please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact attorney Kenneth LaBore, directly please send an email to, or call Ken at 612-743-9048.

Nursing Home Definition in Minnesota?

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