Minnesota nursing home responsiveness requirements

A mandated reporter who has reason to believe a vulnerable adult has been maltreated, or who knows of an unexplained physical injury, must immediately report to the state common entry point (the Minnesota Adult Abuse Reporting Center); certified nursing homes may submit that report electronically, and it may duplicate the report the facility files with the Commissioner of Health under 42 C.F.R. 483.12.

A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained shall immediately report the information to the common entry point.

Every facility must maintain a written internal reporting procedure; a reporter may satisfy the law by reporting internally, but the facility remains responsible for the immediate external report and must tell the reporter in writing within two working days whether it reported to the common entry point.

the facility remains responsible for complying with the immediate reporting requirements of this section. ... The written notice must be provided within two working days and in a manner that protects the confidentiality of the reporter.

The nursing home licensure rules impose per-violation fines on facilities for failures under the Vulnerable Adults Act reporting provisions, including $250 for a violation of the immediate-reporting duty in section 626.557, subdivision 3.

Penalty assessments for violations of Minnesota Statutes, section 626.557, are as follows: A. Minnesota Statutes, section 626.557, subdivision 3, $250;

A nursing home must provide or arrange physician services 24 hours a day for emergencies and advisory care, must keep the emergency physician's name and telephone number readily available at all times, and must have written procedures for obtaining medical intervention when the attending or emergency physician does not respond.

A nursing home must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency, and to act in an advisory capacity. ... The name and telephone number of the emergency physician must be readily available at all times. ... A nursing home must develop and maintain policies and procedures regarding obtaining medical intervention when the resident's attending physician or the emergency physician does not respond to a request for medical care or is not available in a timely manner.

Each resident must have a designated physician supervising their care, and the facility must ensure a back-up physician is available whenever the attending physician is unavailable.

must ensure that another physician is available to supervise the resident's medical care when the attending physician is unavailable

Minnesota's physician visit-frequency rule. A resident must be evaluated by a physician at least once every 30 days for the first 90 days after admission and then whenever medically necessary, and a visit counts as timely if it occurs within ten days after the date it was required. Required visits must be made by the physician personally, except that at the physician's option visits after the initial visit may alternate between personal physician visits and visits by a physician assistant or nurse practitioner. At each visit the physician or the physician's designee must review the resident's comprehensive plan of care including medications, treatments and progress notes, write, sign and date physician progress notes, and sign and date all orders. MDH publicly states that this rule remains more restrictive than CMS (SOM Appendix PP, F712) on who may perform visits, that it plans to amend the rule to align with CMS, and that facilities may request a waiver in the interim.

A resident must be evaluated by a physician at least once every 30 days for the first 90 days after admission, and then whenever medically necessary. A physician visit is considered timely if it occurs within ten days after the date the visit was required. ... At each visit, a physician or physician's designee must: A. review the resident's comprehensive plan of care, including medications and treatments, and progress notes; B. write, sign, and date physician progress notes; and C. sign and date all orders.

A nursing home must have sufficient qualified nursing personnel on duty at all times, must provide on-site nurse coverage eight hours a day seven days a week, and must have a registered nurse on call during every hour an RN is not on duty.

A nurse must be employed so that on-site nursing coverage is provided eight hours per day, seven days per week. ... A registered nurse must be on call during all hours when a registered nurse is not on duty.

A nursing home must provide at least one non-coin-operated telephone accessible to residents at all times for emergencies, plus a conveniently located telephone for residents' personal use.

A nursing home must provide at least one non-coin-operated telephone which is accessible to residents at all times in case of emergency. A resident must have access to a telephone at a convenient location within the building for personal use.

Residents have a statutory right to private association and communication and to telephone access to make and receive calls privately, and a facility without a private area must make reasonable arrangements to accommodate call privacy.

There shall be access to a telephone where patients and residents can make and receive calls as well as speak privately. Facilities which are unable to provide a private area shall make reasonable arrangements to accommodate the privacy of patients' or residents' calls.

A nursing home must maintain a written, facility-specific disaster plan that identifies the persons and local emergency departments to be notified, assigns tasks by shift, and covers evacuation routes and temporary emergency housing.

The plan must include information and procedures about the location of alarm signals and fire extinguishers, frequency of drills, assignments of specific tasks and responsibilities of the personnel on each shift, persons and local emergency departments to be notified, precautions and safety measures during tornado alerts, procedures for evacuation of all persons during fire or floods, planned evacuation routes ... and arrangements for temporary emergency housing in the community in the event of total evacuation.

Basic emergency procedures from the disaster plan must be posted at all nurses' stations, kitchens, laundries and boiler rooms, and complete detailed copies must be available to all supervisory personnel.

Copies of the disaster plan containing the basic emergency procedures must be posted at all nurses' stations, kitchens, laundries, and boiler rooms. Complete copies of the detailed disaster plan must be available to all supervisory personnel.

In existing buildings the nurse call requirement is reduced to a communication system that registers a resident's call at the nursing station and lights a signal by the bedroom door.

A communication system must be provided in a nursing home. It must register a call from the resident at the nursing station and activate a signal light by the bedroom door.

A nursing home must maintain a quality assessment and assurance committee of the administrator, director of nursing, medical director (or designee) and at least three other care-involved staff, which must identify quality issues, implement corrective plans, and at minimum address incident and accident reporting, infection control, and medications and pharmacy services.

The quality assessment and assurance committee must identify issues with respect to which quality assurance activities are necessary and develop and implement appropriate plans of action to correct identified quality deficiencies. The committee must address, at a minimum, incident and accident reporting, infection control, and medications and pharmacy services.

The licensee is legally responsible for management and operation, for the quality of care rendered, and for compliance with the laws and rules relating to resident health, welfare and care — the state hook that carries federal Part 483 obligations into the state license.

The licensee ... must assume legal responsibility for matters under its control, for the quality of care rendered and for compliance with laws and rules relating to the safety and sanitation of nursing homes, or which otherwise relate directly to the health, welfare, and care of residents.