July 2001

Information Bulletin 01-21
SNSA -1

SUPPLEMENTAL NURSING SERVICES AGENCY - SNSA
MINNESOTA STATUTE 2000, Section 144.057; 144A.70 - 144A.74

Please read carefully. This notification requires a response.

I. Purpose:

The purpose of this bulletin is to provide information about the Supplemental Nursing Services Agency (SNSA) registration law passed by the 2001 Minnesota Legislature. It requires registration with the Minnesota Department of Health (MDH) by August 31, 2001 of all SNSAs. Included with this bulletin are materials for registering with MDH and information about the law.

You have received this bulletin because we believe you are engaged in a business that meets the definition of the SNSA law.

The Minnesota SNSA law requires, a person, firm, corporation, partnership, or association engaged for hire in the business of providing or procuring temporary employment in health care facilities for nurses, nursing assistants, nurse aides, and orderlies to register with the Minnesota Department of Health and pay a registration fee. [Minnesota Statute 144A.70 to 144A.74 (PDF)]

The SNSA will be responsible for providing to "health care facilities" proof of this registration prior to the SNSA providing temporary employment of nurses, nursing assistants, nurse aides or orderlies to health care facilities.

The Department will do periodic onsite visits of the SNSA to verify compliance with all requirements.

II. Key Definitions in the SNSA law:

"Supplemental Nursing Services Agency" means a person, firm, corporation, partnership, or association engaged for hire in the business of providing or procuring temporary employment in health care facilities for nurses, nursing assistants, nurse aides, and orderlies. Supplemental nursing services agency does not include an individual who only engages in providing the individual's services on a temporary basis to health care facilities. Supplemental nursing services agency also does not include any nursing service agency that is limited to providing temporary nursing personnel solely to one or more health care facilities owned or operated by the same person, firm, corporation, or partnership.

"Person" includes an individual, firm, corporation, partnership, or association.

"Health care facility" means a hospital, boarding care home, or outpatient surgical center licensed under sections 144.50 to 144.58; a nursing home or home care agency licensed under this chapter; a housing with services establishment registered under chapter 144D; or a board and lodging establishment registered to provide supportive or health supervision services under section 157.17.

III. SNSA Registration:

The law states:

A person who operates a supplemental nursing services agency shall register the agency with the commissioner. Each separate location of business of a supplemental nursing services agency shall register the agency with the commissioner. Each separate location of the business of a supplemental nursing services agency shall have a separate registration. (Emphasis added)

The annual registration for a supplemental nursing services agency which is $891.

When a supplemental nursing services agency is sold or ownership or management is transferred, the registration of the agency must be voided and the new owner or operator may apply for a new registration.

IV. Registration Forms:

Registration forms must be filed by August 15, 2001 with the Minnesota Department of Health MDH to allow for processing of your registration by August 31, 2001, the effective date of the new law. Thereafter, registration forms must be filed prior to providing SNSA Services.

Attached to this informational bulletin are the forms necessary for registration. Your registration must be accompanied by all the items listed in the registration form.

If you believe your business does not require registration, please submit written notification to the MDH at the address below and include the reason your business would be exempt from these requirements.

V. Highlights of the SNSA Registration Law:

A summary of the law is highlighted below. Please see the full law for details.

1. The SNSA must submit criminal background studies on controlling persons (owners, managers) and all employees who will be sent to health care facilities licensed by the Minnesota Department of Health and maintain documentation to show compliance.
   
   (A criminal background study must be completed on all controlling persons as defined in the law and returned with the completed registration form. See background study forms enclosed with the mailing.)
2. Annual criminal background studies are required on all employees providing direct contact.
   
   (Direct contact employees who have a current (annual) criminal background study from Department of Human Services (DHS) that has been initiated by the agency, does not have to resubmit a background study to DHS until the study has expired. The SNSA must pay an $8 fee to the DHS for each background study and DHS will send out periodic invoices to SNSAs for this. Request for Criminal background study forms for employees will be sent out with the issuance of the SNSA registration certificate.)
3. The SNSA must maintain documentation showing that each employee meets the minimum licensing, training and continuing education requirements for their position. The MDH will look for evidence that employees sent to work for all health care facilities have received appropriate training and inservice training.

4. The SNSA must assure that individuals receive training before being sent to licensed health care facilities regarding the Minnesota Vulnerable Adult Act, MN Statute § 626.557.

    

5. The SNSA must comply with health requirements for employees, such as TB testing.

6. The SNSA must supply, at the request of the facility, 30 percent of the total personnel hours during the night, on weekends and on holidays.

    

7. The SNSA must carry medical malpractice insurance for incidents related to death or injury as a result of negligence or malpractice caused by supplemental agency staff. Workers' compensation insurance coverage is required.
8. The SNSA is prohibited from having policies that restrict employment opportunities for employees or require the payment of liquidated damages, employment fees or other compensation if the employee is hired as a permanent employee of the health care facility.
9. The SNSA is prohibited from charging or receiving payments from nursing homes more than 150% of the average wage for an employee classification. An average wage is determined by the Commissioner of Human Services. The charge of not more than 150% of the average wage for the classification shall include all charges and an SNSA must not charge any additional fees.

MDH will:

1. Establish a system for investigating complaints against supplemental nursing services agencies.
2. Impose a fine on the SNSA equal to 200 percent of the amount billed or received in excess of the maximum permitted under the provisions of the law and shall subject the SNSA to revocation or nonrenewal of its registration for a "pattern of failure" to comply with the SNSA law.
3. Submit an annual report to the Minnesota legislature on the use of supplemental nursing services, including the number of hours worked by SNSA personnel and payments to the SNSA.
4. Maintain a listing of currently registered Supplemental Nursing Services Agencies at the following website: Health Care Provider Directory
5. Send with each SNSA registration certificate, a technical assistance package to include but not limited to: required state and federal qualifications state health requirements; and DHS employee criminal background study request form.

VI. Included with the mailing of this bulletin:

Copy of the SNSA law.
Registration Form.
Copies of the DHS Background Study Form for Controlling Persons.
Maximum allowable nursing home charges chart.
Evidence of Compliance with Workers' Compensation Coverage Provisions form.
DHS billing form and listing of controlling person who provide direct care.

VII. Questions:

For further information about Supplemental Nursing Services Agencies registration, or if you need additional criminal background study forms for controlling persons, please phone (651) 201-4101 or you may send an email to: tempool@health.state.mn.us

If you have any questions regarding this Information Bulletin, please contact in writing:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, MN 55164-0900
Telephone: (651) 201-4101

Weighted Average¹ Wage Rates in Minnesota Nursing Facilities

[Revised 8-17-01]
Sorted by Rule 50 Geographic Groups
Based on Data from Reporting Year Ending 9/30/00

Weighted Average Wage Rates

Allowable Maximum Supplemental Nursing Service Charge (150%)

Group One is the rural group consisting of Beltrami, Big Stone, Cass, Chippewa, Clearwater, Cottonwood, Crow Wing, Hubbard, Jackson, Kandiyohi, Lac Qui Parle, Lake of the Woods, Lincoln, Lyon, Mahnomen, Meeker, Morrison, Murray, Nobles, Pipestone, Redwood, Renville, Rock, Swift, Todd, Yellow Medicine, and Wadena counties.

Group Two is the semi-rural group consisting of Becker, Benton, Blue Earth, Brown, Chisago, Clay, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Houston, Isanti, Kanabec, Kittson, LeSueur, McLeod, Marshall, Martin, Mille Lacs, Mower, Nicollet, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Pope, Red Lake, Rice, Roseau, Sherburne, Sibley, Stearns, Steele, Stevens, Traverse, Wabasha, Waseca, Watonwan, Wilkin, Winona, and Wright counties.

Group Three is the metro group consisting of Aitkin, Anoka, Carlton, Carver, Cook, Dakota, Hennepin, Itasca, Koochiching, Lake, Ramsey, Saint Louis, Scott, and Washington counties.

¹Weighted by the number of employees in each job classification.