Minnesota Department of Health - Home Care and Assisted Living Teleconference April 29, 2021

Minnesota Department of Health

Home Care and Assisted Living Teleconference │ April 29, 2021
          PROTECTI NG , M AINTAINING AND IM PROVING THE HEALTH OF ALL M IN N ESOT AN S

Assisted Living Licensure │ The “How To’s”

       2020 Minnesota Statutes Chapter 144G   2

Agenda

 Licensed Assisted Living Director (LADL) Application   - Randy Snyder (BELTSS)

 Assisted Living License Application

  • Physical Environment section                         - Bob Dehler (MDH)

  • Resources                                            - Lindsey Krueger (MDH)

 FAQs                                                   - Lindsey Krueger (MDH)

 Provider Enrollment                                    - Sam Acquaah (DHS)

                                                                                   3

Housekeeping

▪ Presenters are unmuted
  – please announce
  yourself and your role
  prior to speaking
▪ Public attendees are
  muted – please submit
  any comments or
  questions in the chat
  feature (bottom right)
                                      4

Licensed Assisted Living Director
         Randy D. Snyder | LNHA, Executive Director
                      April 29, 2021
     PROTECTI NG , M AINTAINING AND IM PROVING THE HEALTH OF ALL M IN N ESOT AN S

Objectives

▪ Update from BELTSS
▪ LALD Discussion
▪ June 30, 2021 = DATE for all changes for BELTSS
▪ Review Online Application materials

                                                       6

New Licensure Minimums effective July 1, 2021

Has successfully :
 Completed a core program
 Completed a MN-based program
 Completed a director in residence field experience (supervised by LALD approved by Board)
 Passed NAB Core and Line of Service (LOS) knowledge exam(s)
 Passed state exam
Is currently licensed as an AL Director in another jurisdiction, is currently licensed as a NHA in MN or
another jurisdiction or has been validated by NAB as a HSE and meets all requirements for
qualification for licensure by endorsement.

                                                                                                       7

Legacy Licensure Pathways

      Must apply for licensure by
              July 1, 2021
and attests that the applicant has read
     the rules and laws governing
 assisted living facilities and satisfies
         one of the following:
                                               8

Legacy Pathways – Options 2-5

   Has training that is reasonably related to the              Has at least three years of supervisory,
domains of practice for assisted living as identified        management, or operational​ experience and
in the NAB job analysis for assisted living directors    higher education training reasonably related to the
   and has a higher education degree in nursing,         domains of practice for assisted living as identified
    social services, or mental health, or another        in the NAB job analysis for assisted living directors.
                 professional degree.

    Has completed at least 1,000 hours of an                    Has managed a housing with services
  executive-in-training program​ provided by an           establishment operating under​ assisted living title
   assisted living director licensed under this                   protection for at least three years.​
    subdivision or on or before July​ 1, 2021.

                                                                                                                  9

MN Requirements

             11

LALD Requirements

Individuals who do not qualify under a legacy pathway must meet the new ALD
requirements (hold off until you need it…one year starts when we issue the ALDIR)
• You can be hired and become an Assisted Living Director in Residence (ALDIR)
• Within 30 days of starting the job, you must get a permit from the Board
• You must have a mentor who is a LALD
• Field Experience must be completed under the direction of a mentor
• A self-assessment will be taken, and, with the mentor, it will determine the number of
  field experience hours that must be completed (min. 320-1000 hours)
• Coursework must be completed....and all requirements in one year to become a ALD.

                                                                                           12

LALD Next Steps

I’m a LALD…What’s next?
 Grandparented LALD’s must obtain 7 continuing education
  hours within first year of licensure
 Licenses will be renewed annually (expiring 10/31)
 Annual renewal fees will be approximately $250
 30 continuing education credits required every 2 years

                                                             13

LALD – Multiple Facilities

The Board may approve a LALD or ALDIR to serve more than one facility if:

 License is in good standing

 Five or fewer settings

 Within a 60-mile radius

 Has common management

       Must maintain a sufficient on-site presence to effectively
          administer, manage, and supervise each facility.
                                                                                       14

BELTSS LALD Webpage

Licensure Requirements
   for Assisted Living
        Directors
(https://mn.gov/boards
        /nursing-
home/applicants/assist
   ed-living-director/)

                          15

Application Reminders

▪ BELTSS (https://mn.gov/boards/nursing-home/)
▪ Review Legacy Pathways 2-5; Videos and steps outlined on the website
▪ Application Live starting April 19, 2021
▪ Apply Online – then submit supporting materials to BELTSS.HLB@state.mn.us
▪ License Portal - Tasks marked Open (bubble with comments) or Completed
▪ Criminal Background Check = 1st Priority (ETA 30-40 days)

                                                                           16

Application Process - Homepage

Go to the application portal Homepage. Click the link that says, “Register to Access Site”.

                                                                                              17

Application Process – Submit an Application

When you successfully login you should see the screen above. To start an application, you would click the
“Online Services” option on the navigation bar and click the link option that says, “Submit an Application for
Licensure”. It will take you to the “Application for Licensure” page.

                                                                                                                 18

License Information – Continuing Education

                                        19

Profile View – Applicants and License Holders

                                           20

Public Website - Licensee Lookup

                              21

Thank you for your work with Minnesotans!

          Randy D. Snyder – beltss.hlb@state.mn.us

                        WWW.H EA L TH. M N. GO V

Minimum Site, Physical Environment,
     and Safety Requirements
          Bob Dehler, P.E. │ Engineering Program Manager
                            April 29, 2021

      PROTECTI NG , M AINTAINING AND IM PROVING THE HEALTH OF ALL M IN N ESOT AN S

Conversion Application – Building Section

                                       24

Conversion Application – Verification Section

  CONVERSION to assisted living licensure -
must attest they are meeting the requirements of
  MN Statute 144G.45 subdivisions 1, 2, and 3
                                                   25

144G.45 Subdivision 1

▪ Connected to approved utilities
▪ Fire Department access
▪ Property not subject to flooding
▪ All-weather walks from exits to
  right-of-way
▪ Space for outdoor activities for
  residents

                                     26

144G.45 Subd. 2

▪ Smoke alarms
▪ Portable fire extinguishers
▪ Fire drills
▪ Physical environment in good condition
▪ Existing construction or elements do not
  constitute a distinct hazard to life

                                                          27

144G.45 Subdivision 3

      All other
state and local laws
       apply

                                 28

144G.81 AL with Dementia Care

 Everything in 144G.45 plus…
  Hazard vulnerability
   assessment on and
   around property
  Fully sprinklered building
   by August 1, 2029

                                29

Provisional Application – Physical Environment
                                                                                                    Did you apply for your building permit before August 1, 2021?

Physical Environment                                                                                  ☐ Yes
                                                                                                      •   Attach the complete permit application as an attachment.

Minn. Stat. sect. 144G.45 (https://www.revisor.mn.gov/statutes/cite/144G.45)                          •   Provide the permit application date: _________________________________________
                                                                                                      ☐ No
All new license applications will require a plan review and on-site inspection of the applicant’s   Provide the requested information below:

proposed building. Attach all signed architectural and engineering plans and specifications           1. Project name: ___________________________________________________________

along with the completed application pursuant to Minn. Rules. 1800.4200                               2. Project narrative: ________________________________________________________
                                                                                                      3. Identify which building(s) in Capacity Section that is part of the construction project:
(https://www.revisor.mn.gov/rules/1800.4200/).                                                             ______________________________________________________________________
                                                                                                      4. Architecture/Engineering firm name: ________________________________________
 New construction means a new building, renovation, modification, reconstruction, physical            5. Firm contact name: ______________________________________________________
 changes altering the use of occupancy, or addition to a building.                                    6. Firm contact mailing address: ______________________________________________
                                                                                                      7. Firm contact email address: ________________________________________________

All new license applications with five or fewer residents must meet Minn. Stat. sect. 144G.45,        8. Firm contact phone number: _______________________________________________
                                                                                                      9. Was there a preliminary plan review with MDH?
subd. 1-3, 6, and Laws 2020, 7th Spec. Sess., chpt. 1, art. 6, sect. 17
                                                                                                          ☐Yes
(https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/); and as applicable                        If yes, please indicate the appropriate MDH engineer or architect:
sections 144G.80, 144G.81, and Laws 2020, 7th Spec. Sess., chpt. 1, art. 6, sect. 22                       ______________________________________________________________________
(https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/).                                          ☐No
                                                                                                     10. Indicate project type:
All new license applications with six or more residents must meet Minn. Stat. sect. 144G,                 ☐Renovation
subd. 1-6, and Laws 2020, 7th Spec. Sess., chpt. 1, art. 6, sect. 18 to 19                                ☐Modification
                                                                                                          ☐Reconstruction
(https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/); and as applicable                        ☐Change of use or change of occupancy
sections 144G.80, 144G.81, and Laws 2020, 7th Spec. Sess., chpt. 1, art. 6, sect. 22                      ☐Addition
                                                                                                      11. Number of floors involved in project: ________________________________________
(https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/).
                                                                                                      12. Project size in square feet: _________________________________________________
                                                                                                      13. Total square feet of existing building and project (if applicable): ___________________

                                                                                                                                                                                                    30

New Licenses/New Construction – AL with Dementia Care

▪ Must meet Healthcare (limited care) chapter of the Life Safety
  Code (2018 edition)
▪ Must meet the most current edition of the Facility Guidelines
  Institute “Guidelines for Design and Construction of Residential
  Health, Care and Support Facilities” (6+ residents)
     shall provide the option of a bath, in addition
       to a shower, for all residents

                                                                     31

Questions

 For specific statute questions:
  Bob Dehler          651-201-3710            robert.dehler@state.mn.us
  Michael Mireau      651-201-3712            michael.mireau@state.mn.us

 Email specific questions on how the statute will be enforced to:
  health.healthcareengineers@state.mn.us

 MDH Engineering website where we will post all questions and answers that
  we receive (for consistency and clarity)
  Engineering Services (www.health.state.mn.us/facilities/regulation/engineering/index.html)

                                                                                               32

Thank you

 WWW.H EA L TH. M N. GO V

2 Types of Applications

Conversion license applications
• Current registered Housing with Services (HWS) Registrants (144D) with current
  Comprehensive Homecare Providers (144A)

• Completed via Improved Customer Service Delivery (ICSD) portal

• The HWS Health Facility Identification number (HFID#) will be the driving determinant

Provisional license applications
• Any new business applicants

• Any current providers who miss the deadline of June 1, 2021

                                                                                          34

Conversion Application Notification

          ▪ You will receive this notification via
            ICSD at the email address you
            currently have registered with the
            state.
          ▪ Confirm the correct address is on
            file via the Change of Information
            form.
          ▪ Housing with Services Change of
            Information Form (PDF)
            (www.health.state.mn.us/facilities/
            regulation/hws/docs/hwschange.p
            df)

                                                     35

Application Materials

 Assisted Living Licensure
(www.health.state.mn.us/
   facilities/regulation/
      assistedliving/)

                                                36

ALL Provisional Application Materials

                                   37

Resources and FAQs

                38

Attachment Requirements

All forms required for the application must be
converted to an acceptable format before uploading -
File Types Allowed:
  Via ICSD: pdf, doc, docx, or txt
  Via Portal: pdf, docx, or png

                                                   39

HWS Deadline

 If you are still planning to obtain a
 HWS registration in order to convert to assisted
 living by June 1, 2021, we strongly advise doing so
 no later than May 25, 2021

                                                       40

Total Licensed Resident Capacity

Total Licensed Resident Capacity =
         what is or could be
     the number of residents
     you will be or plan to be
   serving in the license period
        without going over.
                                                41

Outdoor Space – AL with Dementia Care

  Considerations when applying for an assisted living
  with dementia care license:
  ▪ Current Statutory Language 144G.84 (g)
  ▪ If this affects your ability to comply with an
    assisted living with dementia care license, please
    hold off on submitting your application to see if
    legislative correction is passed May 17th
  ▪ MDH will provide more information in the days
    ahead on next steps

                                                    42

Innovation Variance Requirements

 MUST BE A LICENSED       OFFER INNOVATIVE
   ASSISTED LIVING              SERVICES
       FACILITY             LIKELY IMPROVE
                                SERVICES

         NO IMPAIRMENT OF SERVICES
            NO ADVERSE IMPACT
                                                 43

24/7 Awake Staff

 For assisted living license, staff must be awake and
 located in the same building, attached building or
 on a contiguous campus with the facility.
 For an assisted living with dementia care license,
 staff must be awake and physically present in the
 secured dementia care unit.

                                                         44

Customized Living Providers

▪ Q: Can Residential Customized Living Providers continue
  to serve residents
  after August 1, 2021
  even if they don’t have
  “apartment-style,
  self-contained units”?
▪ A: YES

                                                            45

License Fees

 Q: If I choose to hold both a 144A and
  a 144G License, do I pay separately?
 A: Yes, once you send in all the requirements for the
  new ALL application, you will receive an email
  prompting you for payment. You will be holding two
  separate licenses therefore, two separate fees.

                                                          46

Definitions

                                                                 RESIDENT
                                                             (144G.08 Subd. 59)
                                                 A person living in an assisted living facility
                                                    who has executed an assisted living
                                                                  contract.

       ASSISTED LIVING CONTRACT                           ASSISTED LIVING FACILITY
            (144G.08 Subd. 5)                                 (144G.08 Subd. 7)
The legal agreement between a resident            A licensed facility that provides sleeping
and an assisted living facility for housing     accommodations and assisted living services
and, if applicable, assisted living services.
                                                           to one or more adults.

                                                                                                  47

Assisted Living Licensure and
            Customized Living Providers
Department of Human Services (DHS) I Provider Eligibility and Compliance
                                                                           48

Effective August 1, 2021

   ▪   Minn. Stat. Chapter 144G will change the license requirement for Customized Living Service
       providers effective Aug. 1, 2021

   ▪   Housing with Services registration no longer valid to provide customized living services

   ▪   Home and Community-Based Services (HCBS) waiver service for customized living providers
       need to do the following to continue to delivering customized living services
       on and after August 1, 2021:
       •   Obtain an assisted living facility license
       •   Delivering services in an exempt setting

   ▪   This requirement applies to these waiver programs: Elderly Waiver (EW), Brain Injury (BI),
       Community Access for Disability Inclusion (CADI)

                                                                                                    49

Action You Need To Take
To Continue Providing These Services – Step 1

  You must apply for an assisted living facility license
  no later than June 1, 2021, if you:
   Are registered as a housing with services establishment under
    chapter 144D; and
   Are providing home care services or have contracted with a
    comprehensive home care provider providing services to at least one
    resident; and
   Intend to provide customized living services on or after August 1,
    2021

                                                                          50

Action You Need to Take
To Continue Providing These Services – Step 2

You must update your Provider Enrollment Record with Minnesota Health Care Programs (MHCP) Provider
Eligibility and Compliance (PEC)

    Providers Requiring an Assisted Living Facility License - Upload a copy of the Assisted Living Facility
     License for each setting providing customized living services at Minnesota Provider Screening and
     Enrollment (MPSE) Portal (https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-
     health-care-programs/provider/mpse/) as soon as you receive you license

    Providers delivering services in an Exempt Setting - A Provider Assurance Statement will need to be
     completed and submitted with a Comprehensive Home Care License to PEC

           ▪   Being developed now by DHS

           ▪   See Home and Community Based Services (HCBS) Programs Provider Enrollment
               (https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&Revision
               SelectionMethod=LatestReleased&dDocName=id_017530) in the MHCP Provider Manual in
               May 2021 for more details

                                                                                                               51

Action You Need to Take
If You Will Not provide Customized Living Services after 8/1/2021

▪ Notify current residents no later than May 31, 2021
▪ Work with residents and their case managers or care coordinators to transition them to an
  eligible provider
▪ Notify Provider Eligibility and Compliance to end service or terminate your enrollment record
▪ Upload proper form to MPSE Portal (https://mn.gov/dhs/partners-and-providers/policies-
  procedures/minnesota-health-care-programs/provider/mpse/) or fax to 651-431-7493
   • To stop providing customized living services: HCBS Programs Service Request Form DHS-6638
     (PDF) (https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6638-ENG)
   • To terminate provider enrollment for all services: Organization MHCP Provider Profile Change
     Form DHS 3535A (PDF) (https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3535A-ENG)

                                                                                              52

Payment for Services

August 1, 2021 - Provider Eligibility and Compliance will suspend reimbursement for Customized Living Services
until providers have submitted proof of:
▪ Assisted Living Licensure (under 144G) OR
▪ Comprehensive Home Care License and the Assurance Statement form verifying Exempt Setting
   (144G.08 Subd. 7 (11-13) (www.revisor.mn.gov/statutes/cite/144G.08))
If there is a lapse in a provider's license (with an effective date after August 1, 2021), DHS will NOT pay for
services during the lapse.
 Services delivered after August 1, 2021 will ONLY be covered with proof of license with an effective date of
     August 1, 2021. If proof of license is provided after August 1, 2021, services will be covered retroactively to
     August 1, 2021, if proof of license has an effective date of August 1, 2021.
See HCBS Programs Provider Enrollment
(https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod
=LatestReleased&dDocName=id_017530) section of MHCP Provider Manual for more information on enrolling as
a customized living services provider with MHCP.

                                                                                                                53

Questions?

Questions about new provider standards for customized living
providers?
 Contact DHS Aging and Adult Services Division at
  dhs.aasd.hcbs@state.mn.us
Questions about enrollment for customized living service
providers?
 Contact the MHCP Provider Call Center at
  651-431-2700 or 800-366-5411
                                                               54

Thank You!

             55

Upcoming Presentations

 Thursday, May 13, 2021       Thursday, May 20, 2021
 10:00 a.m. to 11:30a.m.      10:00 a.m. to 11:30 a.m.
  Application Issues and     Relocation Responsibilities
   Updates on Progress
                             Provider Enrollment by DHS
Topic of your Choice Based
    Provider Feedback          Review of Top 10 FAQs

                                                           56

Any Questions?
                 57

Thank you.
Lindsey Krueger - health.assistedliving@state.mn.us

                   WWW.H EA L TH. M N. GO V