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“Quality Staffing, Quality Care” Bill – 2005
An initiative of the Seniors and Workers for Quality Coalition
House File 744 / Senate File 811

“Quality Staffing, Quality Care” is based on the principle that attaining quality long-term care begins with attracting, supporting, and maintaining the long-term care workforce, particularly those who deliver “hands on” care.  To that end, the bill proposes cost of living adjustments for the near term as well as staffing levels to ease the pressure of “working short.” Building for the future, the bill proposes an insurance pooling approach to providing health care coverage for nursing facility workers and supports the continued development of a data-driven nursing home reimbursement system that rewards quality.  With an eye to overall long-term care system reform, Seniors and Workers approach the strategic reduction of nursing facility buildings with the perspective that a decentralized, consumer-driven long-term care system will require the growth and development of an expanded workforce for care.  Therefore, the savings should be used to support the development of the workforce for increasingly specialized facility care and increasingly diverse community care.

Summary of Bill Provisions:

Section 1.  Nursing Facility Rate Increase, COLA for Direct Care Staff.  This update of our 2004 bill (HF2582/SF2438) proposes a 3.0% COLA for each of the next 2 years, directly passed through to “hands-on” workers in facilities for the elderly and disabled.  The section describes how new monies must be spent, the process for facilities’ applying for the new monies, employees’ information and rights relative to the distribution plan for new monies, and the effect on private pay rates.

Sections 2-3.  Direct Care Worker Health Insurance Pooling.  This section adapts language from HF3764, introduced in the 2000 MN legislative session.  Its provisions establish a monthly assessment of 10 cents per staff hour worked each month, paid to the commissioner (with some exemptions) to establish a health insurance purchasing pool in the general fund.  The section describes how rates are increased, assessments made, and payments deposited into the account.  A nursing facility health insurance board is established to design the insurance purchasing pool, develop a timeline and plan for implementation of the purchasing pool, and upon legislative approval, implement and administer the purchasing pool.

Section 4.  Community Services Provider Rate Increases, COLA for Direct Care Staff.  This update of our 2004 bill (HF2582/SF2438) proposes a 3.0% COLA for each of the next 2 years, directly passed through to “hands-on” workers in community services for the elderly and disabled.  This section enumerates the services whose workers are included, describes how new monies must be spent, and describes employees’ information and rights relative to the distribution plan.

Section 5.  Reporting Nursing Facility Statistical and Cost Information.  This adaptation of 2004 legislation (HF1754/SF1604) requires facilities to file annual statistical and cost reports in detail at least equal to Ch. 194, Laws of Minnesota, 2004, Section 3, Subdivision 3, a law that was enacted for the specific purpose of developing a new reimbursement system.  This section further details how the commissioner of human services may respond if cost reports are incomplete, inaccurate, or not submitted.  The commissioner may also work in consultation with stakeholders to add additional items to the cost report.

Section 6. Nursing Hours and Rates.  This adaptation of our 2004 bill (HF2866/SF2717) raises the minimum nursing hours in licensed nursing facilites to 4.1 per resident per day, beginning July 1, 2005.  The section further details the relative proportion of certified nursing assistant and licensed nursing hours, requires an upward adjustment of hours to meets the needs of residents with higher acuity, and requires the state’s nursing facility payment rates to be reasonable and adequate to meet the costs incurred by efficiently and economically operated facilities.

Section 7.  Nursing Assistant, Home Health Aide Curriculum.  This is an update of our 2001 amendment to the House Health and Human Services budget bill, a provision that was neither accepted by the Senate nor the Conference Committee.  The section directs the commissioner of health, in consultation with stakeholders, to review the content of the training curriculum for nursing assistants and home health aides.  That review is to identify changes in the current training to improve workers’ skills, job satisfaction, and motivation to work in long-term care settings.  The commissioner is directed to submit recommendations for curriculum updates to the chairs of legislative committees dealing with health care policy by January 1, 2006, with time lines and cost estimates for curriculum development and implementation.

Section 8.  Long-Term Care System Planning and Redesign.  This section plans a strategic reduction in nursing facility bed capacity that would involve (a) explicit policy decisions about the future uses of nursing homes for short-term and chronic care, (b) specific steps to protect consumers from access problems, including extended hospitalizations, and (c) utilization of savings to fund facility and community care workforce development.  The point is to move toward a smaller but well-supported nursing home system and a larger, varied layout of community services.  A fundamental assumption is that the move toward a decentralized long-term care system will require growth and development of the workforce for care.

Section 9.  Appropriations.  This section is written as a general fund appropriation for 2006 and 2007.

For further information, contact Iris C. Freeman, 612-834-4747.

January 19, 2005