Last week the Minnesota Department of Health (MDH) announced its plan to introduce the replacement language of the home care licensing requirements during the 2011 legislative session. As previously communicated, MDH has involved stakeholders in this complete overhaul of the home care requirements for several years. Care Providers of Minnesota staff, associate members, and volunteers have been represented on the re-writing process. In the end, however, MDH put the concepts to paper and has now posted the most recent version of the overhaul . . . the version it intends to send to the Office of the Revisor of Statutes and introduce this session. MDH claims that comments received since their November 2010 posted version were reviewed, considered, and taken into account with this most recent re-write. Read the “final” MDH version.

Care Providers of Minnesota, along with many of our home care members and other stakeholders, submitted numerous comments based on the November 2010 draft provided by MDH. Until last week, we were uncertain if MDH would get the “go-ahead” from their new Commissioner of Health, Dr. Ed Ehlinger or from the Governor's Office to pursue these changes this session. MDH now says they have the “go-ahead” and have sent the “final” version to the Office of the Revisor of Statutes to prepare it for introduction this session.

It is important to understand what parts of the proposal are “new” and what parts are carried over from current statutes and rules. As you look through the “final” draft, understand that all current language from the home care statute or rule that has not changed is not underlined. Retained rule language is italicized and retained statutory language is not italicized. Statutory language that will be deleted is shown with strikethrough. All new language is underlined. Rule and statutory citations are referenced wherever applicable.

MDH says the following are the major changes to the home care requirements:

• Streamlining the current four license types into two license types (Basic and Comprehensive); no longer requiring some providers to obtain two licenses in order to practice in different care settings;

• Moving the rules into statute so that all the requirements are in one place and better organized for easier access and understanding;

• Simplifying terminology that was confusing and inconsistently used throughout;

• Clarifying requirements for medication management and medication administration;

• Updating the tuberculosis (TB) infection control standards;

• Focusing on staff competency in the training requirements, continuing to allow providers to train their own staff, but adding key client safety topics to the training list;

• Adding a temporary one-year license for new providers during which time MDH will conduct an onsite survey to assure compliance before issuing the license;

• Adding to the initial license application, requirements to verify that new providers have the right systems in place to provide home care safely to clients;

• Adding an Advisory Council with client and provider membership to address complex novel issues and community standards questions;

• Retaining Home Management Registration;

• Establishing a transition period during which MDH will educate folks about the new requirements that are coming, get their internal systems in place and also host a workgroup process to look at how to structure fees for the new licensing requirements. In the meantime, fees will remain the same for providers until a new fee structure is enacted legislatively.

• The fines will stay the same for the near term, and internally MDH staff will develop “crosswalks” for providers and publish those so that everyone can see how fines are assessed. The fines will continue to apply to same provisions they apply to now if those provisions were retained. For new provisions and requirements, until a new fine amount is enacted, there would be no fine for that conduct. The transition period workgroup that will be discussing the fee structure will also talk about the correction fines.

Care Providers of Minnesota staff met with staff from Aging Services of Minnesota and the Minnesota Home Care Association on Tuesday, March 8, 2011 to discuss the “final” MDH language. All three association staff identified language that could rise to the level of a “deal breaker”, meaning that significant comments or concepts provided by the associations had not been incorporated into the “final” version. The three associations have since met with MDH and requested a timeline when the revisor’s version will be completed, so that our objections, concerns, amendments, etc. will be based on the revisor’s version of the document. When possible, the three associations intend to submit objections or recommended changes as a unified group, rather than as separate organizations. If introduced, we hope to coordinate our legislative efforts through the Long-Term Care Imperative whenever possible.

Some initial concerns included in MDH’s “final” document identified by staff at Care Providers of Minnesota include:

• Continued use of the term Home Care Aide (also used by DHS for payment)
• Unclear language regarding training and competency testing
• Defining “nutritional supplements” as medications (the FDA defines them as a category of food)
• Requirements that are repeated in 2-3 different area of the document
• Unreasonable documentation required by a new license applicant
• Uncertain minimum frequency of surveys for currently licensed providers
• Overreaching requirements for personnel file documentation
• Unreasonable additional requirements to the service plan
• Overreaching responsibilities included in medication management reviews
• Unreasonable staff training requirements based on individual client instructions
• Unreasonable documentation requirements for the client record
• Continued confusion regarding qualifications for home care aides

Note that there are many, many positive changes included in the draft and conceptually, two levels of licensure that are not location-dependent would provide increased business opportunities for many providers.

Our challenge is to determine what changes must be made to make it acceptable to providers, and if those changes can or will be made during the 2011 legislative session, or if the entire project can be given another year for continued concept development and wordsmithing to be brought forward in the 2012 session.

Home care providers are encouraged to take a look at the “final” MDH language, and send their specific concerns and/or comments by March 18th to Doug Beardsley (dbeardsley@careproviders.org).

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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