Laws of Minnesota 1989 

                        CHAPTER 285-H.F.No. 1423 
           An act relating to nursing home admission agreements; 
          prohibiting use of blanket waivers of liability by 
          continuing care facilities and nursing homes; 
          requiring nursing home admission agreements to be 
          available to the public and clarifying that such 
          agreements are consumer contracts; prohibiting nursing 
          homes from requiring third party guarantors; requiring 
          nursing homes to identify their status as medical 
          assistance providers; prohibiting use of blanket 
          consents for treatment; requiring written 
          acknowledgment that residents have received a copy of 
          the patients' bill of rights; providing requirements 
          for registration of dental assistants; including 
          emotionally abused children among children in need of 
          protection services; changing licensure requirements 
          for dental assistants; providing penalties; amending 
          Minnesota Statutes 1988, sections 80D.04, by adding a 
          subdivision; and 150A.06, subdivision 2a; and 260.015, 
          subdivision 2a, and by adding a subdivision; proposing 
          coding for new law in Minnesota Statutes, chapters 144 
          and 256B; repealing Minnesota Statutes 1988, section 
          150A.06, subdivision 7. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1988, section 80D.04, is 
amended by adding a subdivision to read: 
    Subd. 6.  [WAIVERS OF LIABILITY PROHIBITED.] (a) A contract 
between a facility and resident or resident's representative 
must not include a waiver of facility liability for the health 
and safety or personal property of a resident while the resident 
is under the facility's supervision.  A contract must not 
contain a provision that the facility knows or should know to be 
deceptive, unlawful, or unenforceable under state or federal 
law, nor any provision that requires or implies a lesser 
standard of care or responsibility than is required by law. 
     (b) This subdivision applies to new admissions to 
facilities on and after October 1, 1989.  This subdivision does 
not require the execution of a new admission contract for a 
resident who was residing in a facility before the enactment of 
this subdivision.  However, provisions of the admission contract 
that are inconsistent with or in conflict with this subdivision 
are voidable at the sole option of the resident.  Residents must 
be given notice of the changes in admission contracts according 
to this subdivision and must be given the opportunity to execute 
a new contract that conforms to this subdivision. 
     Sec. 2.  [144.6501] [NURSING HOME ADMISSION CONTRACTS.] 
     Subdivision 1.  [DEFINITIONS.] For purposes of this 
section, the following terms have the meanings given them. 
     (a) "Facility" means a nursing home licensed under chapter 
144A or a boarding care facility licensed under sections 144.50 
to 144.58. 
    (b) "Contract of admission," "admission contract," or 
"admission agreement," includes, but is not limited to, all 
documents that a resident or resident's representative must sign 
at the time of, or as a condition of, admission to the 
facility.  Oral representations and statements between the 
facility and the resident or resident's representative are not 
part of the contract of admission unless expressly contained in 
writing in those documents. 
    (c) "Legal representative" means an attorney-in-fact under 
a valid power of attorney executed by the prospective resident, 
or a conservator or guardian of the person or of the estate, or 
a representative payee appointed for the prospective resident, 
or other agent of limited powers. 
    Subd. 2.  [WAIVERS OF LIABILITY PROHIBITED.] An admission 
contract must not include a waiver of facility liability for the 
health and safety or personal property of a resident while the 
resident is under the facility's supervision.  An admission 
contract must not include a provision that the facility knows or 
should know to be deceptive, unlawful, or unenforceable under 
state or federal law, nor any provision that requires or implies 
a lesser standard of care or responsibility than is required by 
law. 
     Subd. 3.  [CONTRACTS OF ADMISSION.] (a) A facility shall 
make complete unsigned copies of its admission contract 
available to potential applicants and to the state or local 
long-term care ombudsman immediately upon request. 
     (b) A facility shall post conspicuously within the 
facility, in a location accessible to public view, either a 
complete copy of its admission contract or notice of its 
availability from the facility. 
     (c) An admission contract must be printed in black type of 
at least ten-point type size.  The facility shall give a 
complete copy of the admission contract to the resident or the 
resident's legal representative promptly after it has been 
signed by the resident or legal representative. 
     (d) An admission contract is a consumer contract under 
sections 325G.29 to 325G.37. 
    (e) All admission contracts must state in bold capital 
letters the following notice to applicants for admission:  
"NOTICE TO APPLICANTS FOR ADMISSION.  READ YOUR ADMISSION 
CONTRACT.  ORAL STATEMENTS OR COMMENTS MADE BY THE FACILITY OR 
YOU OR YOUR REPRESENTATIVE ARE NOT PART OF YOUR ADMISSION 
CONTRACT UNLESS THEY ARE ALSO IN WRITING.  DO NOT RELY ON ORAL 
STATEMENTS OR COMMENTS THAT ARE NOT INCLUDED IN THE WRITTEN 
ADMISSION CONTRACT." 
     Subd. 4.  [RESIDENTS' SIGNATURES.] (a) Before or at the 
time of admission, the facility shall make reasonable efforts to 
communicate the content of the admission contract to, and obtain 
on the admission contract the signature of, the person who is to 
be admitted to the facility.  The admission contract must be 
signed by the prospective resident unless the resident is 
legally incompetent or cannot understand or sign the admission 
contract because of the resident's medical condition.  
     (b) If the resident cannot sign the admission contract, the 
reason must be documented in the resident's medical record by 
the admitting physician. 
    (c) If the determination under paragraph (b) has been made, 
the facility may request the signature of another person on 
behalf of the applicant, subject to the provisions of paragraph 
(d).  The facility must not require the person to disclose any 
information regarding the person's personal financial assets, 
liabilities, or income, unless the person voluntarily chooses to 
become financially responsible for the resident's care.  
    (d) A person other than the resident or a spouse who is 
financially responsible for the resident who signs an admission 
contract must not be required by the facility to assume 
financial responsibility for the resident's care.  A person who 
desires to assume financial responsibility for the resident's 
care may contract with the facility to do so. 
    (e) The admission contract must include written notice, in 
bold capital letters, that a person other than the resident or 
financially responsible spouse may not be required by the 
facility to assume financial responsibility for the resident's 
care.  
     (f) This subdivision does not preclude the facility from 
obtaining the signature of a legal representative, if applicable.
     Subd. 5.  [PUBLIC BENEFITS ELIGIBILITY.] An admission 
contract must clearly and explicitly state whether the facility 
participates in the Medicare, medical assistance, or Veterans 
Administration programs.  If the facility's participation in any 
of those programs is limited for any reason, the admission 
contract must clearly state the limitation and whether the 
facility is eligible to receive payment from the program for the 
person who is considering admission or who has been admitted to 
the facility. 
    Subd. 6.  [MEDICAL ASSISTANCE PAYMENT.] (a) An admission 
contract for a facility that is certified for participation in 
the medical assistance program must state that neither the 
prospective resident, nor anyone on the resident's behalf, is 
required to pay privately any amount for which the resident's 
care at the facility has been approved for payment by medical 
assistance or to make any kind of donation, voluntary or 
otherwise.  An admission contract must state that the facility 
does not require as a condition of admission, either in its 
admission contract or by oral promise before signing the 
admission contract, that residents remain in private pay status 
for any period of time. 
    (b) The admission contract must state that upon 
presentation of proof of eligibility, the facility will submit a 
medical assistance claim for reimbursement and will return any 
and all payments made by the resident, or by any person on the 
resident's behalf, for services covered by medical assistance, 
upon receipt of medical assistance payment.  
    (c) A facility that participates in the medical assistance 
program shall not charge for the day of the resident's discharge 
from the facility or subsequent days.  
    (d) If a facility's charges incurred by the resident are 
delinquent for 30 days, and no person has agreed to apply for 
medical assistance for the resident, the facility may petition 
the court under chapter 525 to appoint a representative for the 
resident in order to apply for medical assistance for the 
resident. 
    (e) The remedy provided in this subdivision does not 
preclude a facility from seeking any other remedy available 
under other laws of this state. 
    Subd. 7.  [CONSENT TO TREATMENT.] An admission contract 
must not include a clause requiring a resident to sign a consent 
to all treatment ordered by any physician.  An admission 
contract may require consent only for routine nursing care or 
emergency care.  An admission contract must contain a clause 
that informs the resident of the right to refuse treatment.  
    Subd. 8.  [WRITTEN ACKNOWLEDGMENT.] An admission contract 
must contain a written acknowledgment that the resident has been 
informed of the patient's bill of rights, as required in section 
144.652.  
    Subd. 9.  [VIOLATIONS; PENALTIES.] (a) Violation of this 
section is grounds for issuance of a correction order, and if 
uncorrected, a penalty assessment issued by the commissioner of 
health, under section 144A.10.  The civil fine for noncompliance 
with a correction order issued under this section is $250 per 
day.  
    (b) Unless otherwise expressly provided, the remedies or 
penalties provided by this subdivision do not preclude a 
resident from seeking any other remedy and penalty available 
under other laws of this state.  
    Subd. 10.  [APPLICABILITY.] This section applies to new 
admissions to facilities on and after October 1, 1989.  This 
section does not require the execution of a new admission 
contract for a resident who was residing in a facility before 
the enactment of this section.  However, provisions of the 
admission contract that are inconsistent with or in conflict 
with this section are voidable at the sole option of the 
resident.  Residents must be given notice of the changes in 
admission contracts according to this section and must be given 
the opportunity to execute a new admission contract that 
conforms to this section. 
     Sec. 3.  Minnesota Statutes 1988, section 150A.06, 
subdivision 2a, is amended to read: 
    Subd. 2a.  [REGISTERED DENTAL ASSISTANT.] A person of good 
moral character, who has submitted an application and fee as 
prescribed by the board and the diploma or equivalent awarded to 
the person by a training school for dental assistants or its 
equivalent approved by the board, may be examined by the board 
or by an agency pursuant to section 150A.03, subdivision 1, in a 
manner to test the applicant's fitness to perform as a 
registered dental assistant.  The diploma or its equivalent must 
evidence compliance with the time limit requirement of 
subdivision 7.  In the case of examinations conducted pursuant 
to section 150A.03, subdivision 1, applicants may take the 
examination before applying to the board for registration.  The 
examination shall include an examination of the applicant's 
knowledge of the laws of Minnesota relating to dentistry and the 
rules of the board.  An applicant is ineligible to retake the 
clinical examination required by the board after failing it 
twice until further education and training are obtained as 
specified by the board by rule.  A separate, nonrefundable fee 
may be charged for each time a person applies.  An applicant who 
passes the examination in compliance with subdivision 2b and 
meets all the other requirements of the board shall be 
registered as a dental assistant.  The examination fee set by 
the board in rule is the application fee until the board amends, 
repeals, or otherwise changes the rules pursuant to chapter 14. 
    Sec. 4.  [256B.32] [FACILITY FEE FOR OUTPATIENT HOSPITAL 
EMERGENCY ROOM AND CLINIC VISITS.] 
    The commissioner shall establish a facility fee payment 
mechanism that will pay a facility fee to all enrolled 
outpatient hospitals for each emergency room or outpatient 
clinic visit provided on or after July 1, 1989.  This payment 
mechanism may not result in an overall increase in outpatient 
payment rates.  This section does not apply to federally 
mandated maximum payment limits, department approved program 
packages, or services billed using a non-outpatient hospital 
provider number. 
    Sec. 5.  Minnesota Statutes 1988, section 260.015, 
subdivision 2a, is amended to read: 
    Subd. 2a.  [CHILD IN NEED OF PROTECTION OR SERVICES.] 
"Child in need of protection or services" means a child who is 
in need of protection or services because the child: 
    (1) is abandoned or without parent, guardian, or custodian; 
    (2) has been a victim of physical or sexual abuse or 
resides with a victim of domestic child abuse as defined in 
subdivision 24, or is a victim of emotional maltreatment as 
defined in section 260.015, subdivision 5a; 
    (3) is without necessary food, clothing, shelter, 
education, or other required care for the child's physical or 
mental health or morals because the child's parent, guardian, or 
custodian is unable or unwilling to provide that care; 
    (4) is without the special care made necessary by a 
physical, mental, or emotional condition because the child's 
parent, guardian, or custodian is unable or unwilling to provide 
that care; 
    (5) is medically neglected, which includes, but is not 
limited to, the withholding of medically indicated treatment 
from a disabled infant with a life-threatening condition.  The 
term "withholding of medically indicated treatment" means the 
failure to respond to the infant's life-threatening conditions 
by providing treatment, including appropriate nutrition, 
hydration, and medication which, in the treating physician's or 
physicians' reasonable medical judgment, will be most likely to 
be effective in ameliorating or correcting all conditions, 
except that the term does not include the failure to provide 
treatment other than appropriate nutrition, hydration, or 
medication to an infant when, in the treating physician's or 
physicians' reasonable medical judgment: 
     (i) the infant is chronically and irreversibly comatose; 
     (ii) the provision of the treatment would merely prolong 
dying, not be effective in ameliorating or correcting all of the 
infant's life-threatening conditions, or otherwise be futile in 
terms of the survival of the infant; or 
     (iii) the provision of the treatment would be virtually 
futile in terms of the survival of the infant and the treatment 
itself under the circumstances would be inhumane; 
     (6) is one whose parent, guardian, or other custodian for 
good cause desires to be relieved of the child's care and 
custody; 
     (7) has been placed for adoption or care in violation of 
law; 
     (8) is without proper parental care because of the 
emotional, mental, or physical disability, or state of 
immaturity of the child's parent, guardian, or other custodian; 
     (9) is one whose occupation, behavior, condition, 
environment, or associations are such as to be injurious or 
dangerous to the child or others; 
    (10) has committed a delinquent act before becoming ten 
years old; 
    (11) is a runaway; or 
    (12) is an habitual truant. 
    Sec. 6.  Minnesota Statutes 1988, section 260.015, is 
amended by adding a subdivision to read: 
    Subd. 5a.  [EMOTIONAL MALTREATMENT.] "Emotional 
maltreatment" means the consistent, deliberate infliction of 
mental harm on a child by a person responsible for the child's 
care, that has an observable, sustained, and adverse effect on 
the child's physical, mental, or emotional development. 
"Emotional maltreatment" does not include reasonable training or 
discipline administered by the person responsible for the 
child's care or the reasonable exercise of authority by that 
person. 
    Sec. 7.  [REPEALER.] 
    Minnesota Statutes 1988, section 150A.06, subdivision 7, is 
repealed. 
    Sec. 8.  [EFFECTIVE DATE.] 
    Section 4 is effective July 1, 1989. 
    Presented to the governor May 30, 1989 
    Signed by the governor June 1, 1989, 11:27 p.m.