Q 3: Who licenses administrators? A: The Board of Examiners for Nursing Home Administrators (BENHA).

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1 2829 University Avenue SE, Suite 440 Minneapolis, MN Phone: (651) Fax: (612) TTY Relay: (800) Hiring and Retaining a Nursing Home Administrator for Your Minnesota Nursing Facility A Guide for Nursing Home Owners and Boards of Directors Updated January, 2011 The purpose of this guide is to assist persons and boards who are responsible for the legal operation of a Minnesota Nursing Home ( controlling parties as they are called in Minnesota Statute) to hire and retain administrators for their nursing facilities in keeping with applicable Minnesota State laws and rules. We hope the Q & A format will help readers answer some common questions about how Minnesota laws and rules apply to real life situations. Where pertinent, applicable laws or rules are referenced, the full text of the cited laws and rules are printed at the end of the questions and answers. Q 1: Is every Minnesota nursing facility required to have a licensed administrator? A: Yes. The statute does provide a few exceptions. (MS 144A.04 subd. 5) Each state was mandated by the Federal Government to create a licensing board to license nursing home administrators. Each facility receiving Medicare and Medicaid funding is required to have a licensed administrator. Individual states vary in their licensing requirements. Minnesota is proud of their long history of high standards and qualifications to become a licensed nursing home administrator. Facilities providing care that depends upon spiritual means through prayer alone, in lieu of medical care for healing, e.g. Clifton House in Minneapolis, are not required to have a licensed administrator. All other licensed nursing homes must have a licensed administrator in charge of the day-today operations of the facility. Q 2: Must the administrator be full time? A: There is no time requirement fulfillment to be the Administrator of Record, but the job typically requires far more than forty hours per week to complete. The fulltime requirement was repealed in 2001 to allow greater flexibility for facilities. The board s intent was to allow smaller facilities the ability to share an administrator. Q 3: Who licenses administrators? A: The Board of Examiners for Nursing Home Administrators (BENHA). Q 4: What are the requirements for MN licensure? (Minn. Rules ) A: A bachelor s or higher degree Completion of college courses in the following areas: Organizational Management Managerial Accounting -1-

2 Gerontology Nursing Facility Services Human Resources Regulatory Management Health Care and Medical Needs of Nursing Facility Residents Information Uses A practicum taken for academic credit performed at a nursing home of hours depending upon experience Passing the NAB (national) exam Passing the State exam Q 5: What if a person is already licensed in another state? Can we assume they will automatically qualify for MN licensure? A: No formal reciprocity or endorsement exists between any states and states range from a high school degree to a requirement of a Masters Degree. Only a person who is licensed and has actively practiced as a nursing home administrator in another state for two out of the last five years may become licensed in Minnesota without showing evidence of the minimum Minnesota requirements, provided they meet the following: (Minn. Rules ) Possess a bachelor s or higher degree (mandatory) Show evidence of having passed the NAB exam Verify that their license is in good standing in the other state(s) in which they are licensed Pass the state exam Persons licensed in other states who have not actively practiced as nursing home administrators for 2 of the last 5 years, must meet the requirements outlined under Q 4. Q 6: How can I be sure the person I want to hire is licensed? A: Verification of the license can also be checked by going to the website at and clicking on Licensees. If questions remain, contact BENHA with the contact information on this brochure. We ll check our records and provide you public information about the status of any licensee on request. Q 7: What if we have an internal candidate that we d like to promote? How long would it take for him/her to qualify for an administrator s license? A: It depends upon how much experience and education the person has already that meets the board s requirements for licensure outlined above. For example, if the person already has a bachelor s degree that included courses to meet most of the board s course requirements and has been serving as Director of Nurses at a nursing home for more than two years (so s/he needs only to complete an 80 hour practicum), the person may be able to qualify in 6 months or less. If the person doesn t have a bachelor s degree, it could take up to four years to achieve the minimum BA/BS requirement. It s best not to provide assurances of promotion or employment until you ve submitted your intended candidate s credentials for review by BENHA. We can provide an advisory assessment on request. Q 8: What s a good way to recruit an administrator? A: Consider one or more of the following: Advertise in the newsletters of either or both trade associations that serve nursing homes in Minnesota Aging Services of Minnesota; Phone: or Care Providers of Minnesota, Inc., Phone:

3 Contact BENHA at to obtain a listing of persons licensed with the Board who have indicated their interest in being considered for administrator vacancies, or to obtain mailing labels for all licensees of the Board (available for a $50 fee) and send a notice directly to each of them informing them of your vacancy. Advertise in one or more regional, local or statewide newspapers or in national trade association magazines. Include in your ad an explanation that qualified applicants must be licensed as a nursing home administrator in Minnesota or be eligible to obtain a Minnesota nursing home administrator s license. Be sure to check with BENHA to determine that the person who thinks s/he may be eligible for licensure with BENHA is indeed eligible or can reasonably expect to complete the requirements for licensure within a short time after their appointment on an acting administrator permit. Q 9: What if it takes some time to recruit a new administrator? What we can do in the meantime? A: Your facility has a number of responsibilities and several options: Within five days of the termination of the former administrator, you must notify the Minnesota Department of Health in writing by mail or fax (MN Dept. of Health, Facility and Provider Compliance Division, 85-E. 7 th Place, Suite 300, PO Box 64900, St. Paul, MN Fax: ) of who is temporarily in charge of the facility. This person must be at least 21 years of age and capable of acting in an emergency. Often facilities appoint the Assistant Administrator, Director of Nurses, the Social Services Director, or another department head to this status. (Minn. Rules subp. 3 C, subp.3) Within 30 days of the termination of the administrator, you must either appoint a fully licensed administrator or an acting administrator. (MS 144A.27, Minn. Rules subp. 3 C) Again, you must notify MDH and BENHA of the name of that person. You may choose to appoint a fully licensed administrator on an interim basis while you continue to search for a permanent replacement or you may choose to obtain an acting administrator permit for a person to serve the facility for up to six months from the termination of the previously licensed administrator. Q 10: How do we obtain an acting administrator permit? A: Both the facility and the prospective acting administrator must file applications with BENHA. (Minn. Rules ) The facility must verify that their previous administrator has terminated and that they are in need of the services of an acting administrator. The person to be appointed as an acting administrator must: be 21 years of age have experience in the management or supervision of a nursing home or similar health care facility (department head level, supervisory experience) or have completed at least half of the requirements for full licensure as a nursing home administrator file an application for an acting administrator permit take and pass the state exam offered by BENHA (note: this must be done within 30 days of the termination of the previously licensed administrator) Forms to apply for an acting administrator permit are available on the website. Q 11: What are the fees for an acting administrator permit? A: The state exam fee is $75 and the fee for an acting permit is $

4 Q 12: What is the state exam like? A: It is a 24 item, multiple-choice test in open book format. It tests the ability to read, interpret and find information in the Minnesota Statutes and Rules of the Minnesota Department of Health which govern nursing home operation. Eighteen correct answers are required to pass. Different forms of the test are available so it may be taken more than once. A new application and fee are required for each test administration. There are 10 beta questions interspersed among the 24 questions to test the validity of new proposed questions for future exams. Q 13: How long can we have an acting administrator? A: If you hire a fully licensed person as an interim administrator, the person may serve for an indefinite time. Since the person is fully licensed, the board regards him/her as they would any person you hire on a permanent basis fully capable of serving the facility for as long as you need his/her services. If you hire someone on an acting administrator permit, the person must complete their service within six (6) months from the termination of your previously licensed administrator. An acting permit cannot be extended for an individual nor can the facility hire another person on another permit back-to-back with a previous acting permit employment situation if the total time to be served exceeds six months. In short, the facility has six (6) months (without extension) from the termination of the previous licensed administrator to obtain the services of a fully licensed administrator. (This is governed by a federal regulation 42CFR ) Q 14: Is all this acting administrator stuff really necessary? Can t we just get a licensed, nonpracticing administrator to permit us to hang his/her license on the wall to cover us while we recruit? A: Yes, technically, it is permissible to hang a license on the wall. However all licensees need to understand that the administrator of record is ultimately responsible for the quality of care provided at the facility which lists them as the licensed nursing home administrator and are held accountable for all of the tasks when they have a license at the facility. The LNHA-AOR (Administrator of Record) listed as responsible for the facility is expected to be actively engaged in the day-to-day management of the facility, to delegate authority when absent from the facility and to be truly responsible for the facility. Board of Directors, owner and licensees need to understand the licensees experience and previous practice ability that should correspond to the size and location of facilities under their direction. Q 15: How can we find someone to be an acting or interim administrator while we conduct our search? A: BENHA can help. BENHA maintains a list of licensed administrators who have indicated a willingness to accept interim assignments. or call us to obtain this list. We also have applicants working to complete their licensure requirements and might be eligible to obtain an acting permit. Q 16: Once we hire a fully licensed administrator, what other actions must we take or ensure that s/he takes to remain in compliance with state law and rules? A: The facility owner is required to notify MDH and the Licensed Nursing Home Administrator is required to notify BENHA. Both notifications can take place simultaneously by going to the BENHA website and updating the Administrator of Record information. The owner should delegate, in writing, appropriate authorities to the administrator to enable him/her to manage the operation of the home within law and established policies. (Minn. Rules subp.3 B) See that the administrator performs his/her responsibilities in accord with Minn. Rules and Chapter (Rules of the Board of Examiners for Nursing Home Administrators.) -4-

5 See that the administrator retains his/her license to practice through annual renewal and completion of required continuing education. (Minn. Rules and ) Q 17: Can the licensed administrator from a neighboring community serve as our administrator while we conduct a search for a permanent administrator to lead our facility? A: Yes. Each facility must employ a licensed administrator or permitted acting administrator. The LNHA from a neighboring community may assist you if they can maintain sufficient on-site presence and complete the tasks listed in Minn. Rules The LNHA needs to understand that they are ultimately responsible for the care provided at that facility and they need to establish procedures and delegate authority for on-site operations in their absence. Each facility must post the name of the licensed administrator and the name of the person in charge on the premises in the absence of the licensed administrator. The LNHA must notify BENHA and MDH of the assignment and receive a duplicate license from BENHA ($10 fee) to post at the facility. Q 18: Can the facility enter into a contractual relationship instead of making the temporary licensed administrator an employee? A: Yes. The statutes intent is to assure that each facility had a formal relationship with a licensed administrator per BENHA s interpretation of federal regulation. Q 19: How do I notify the public that I m a licensed administrator at another facility? A: Minn. Rules requires the Licensed Nursing Home Administrator to post their license in a conspicuous place in the facility which the licensee administers, visible to residents and visitors. A duplicate license prepared by BENHA must be requested to be posted at each facility. Both BENHA and MDH are required to be notified of administrator of record changes. A $10.00 fee is required. EXCERPTS FROM MINNESOTA STATUTES AND RULES RE: NURSING HOME ADMINISTRATOR LICENSURE MS 144A.04 QUALIFICATIONS FOR LICENSE. Subdivision 5. Administrators. Each nursing home must employ an administrator who must be licensed or permitted as a nursing home administrator by the board of examiners for nursing home administrators. The nursing home may share the services of a licensed administrator. The administrator must maintain a sufficient on-site presence in the facility to effectively manage the facility in compliance with applicable rules and regulations. The administrator must establish procedures and delegate authority for on-site operations in the administrator's absence, but is ultimately responsible for the management of the facility. Each nursing home must have posted at all times the name of the administrator and the name of the person in charge on the premises in the absence of the licensed administrator. (b) Notwithstanding sections 144A.18 to 144A.27, a nursing home with a director of nursing serving as an unlicensed nursing home administrator as of March 1, 2001, may continue to have a director of nursing serve in that capacity, provided the director of nursing has passed the state law and rules examination administered by the board of examiners for nursing home administrators and maintains evidence of completion of 20 hours of continuing education each year on topics pertinent to nursing home administration ADMINISTRATOR. Subpart 1. Designation. A nursing home must designate a licensed nursing home administrator to be in immediate charge of the operation and administration of the nursing home, whether that individual is the licensee or a person designated by the licensee. The individual must have authority to carry out the provisions of this chapter and must be charged with the responsibility of doing so. -5-

6 Subp. 3. Administrator s absence; requirements. The administrator must not leave the premises without delegating authority to a person who is at least 21 years of age and capable of acting in an emergency and without giving information as to where the administrator can be reached. At no time may a nursing home be left without competent supervision. The person left in charge must have the authority to act in an emergency. Subp. 4. Notice of person in charge. The name of the person in charge at the time must be posted at the main entrance of the nursing home LICENSURE REQUIREMENTS. The board shall issue an individual a license to practice as a nursing home facility administrator in Minnesota upon determining that the individual: A. has filed a completed application for licensure under part ; B. meets the requirements specified in Minnesota Statutes, section 144A.20; C. has obtained a bachelor's degree from an accredited post-secondary institution; D. has passed the national examination for nursing home administrator developed by NAB to test knowledge of subjects pertinent to the domains of practice of nursing home administration as identified in the NAB job analysis for nursing home administrator; E. has passed the state examination given by the board to test knowledge of Minnesota laws and rules governing nursing facility operations in Minnesota; F. has presented evidence, as specified in part , that the applicant has satisfactorily completed courses in each of the areas specified in part , or qualifies for waivers under part ; G. has not had an application rejected by the board under part , subpart 5; and H. has paid the fees required under part WAIVER PROVISIONS. Subpart 1. Waiver of all course requirements. The board shall waive part if the applicant meets all other licensure requirements and submits satisfactory evidence of having actively and effectively served full time for a minimum of two continuous years within the immediate past five years as the licensed nursing home administrator and chief executive officer of one or more nursing facilities in a single jurisdiction regulated by the licensing board of that jurisdiction. Time working as an acting administrator under an acting license or permit or as an administrator-in-training does not count to meet this requirement. To determine the effectiveness of the applicant's service, the board shall review the results of the two most recent regulatory inspections of the nursing facilities administered by the applicant LICENSEE. (This refers to the individual or group holding the license from the MN Dept. of Health for the nursing home not to the administrator licensed by BENHA.) Subpart 1. General duties. The licensee (the person or governing body to whom the license to operate a nursing home is issued) of a nursing home is responsible for its management, control, and operation. A nursing home must be managed, controlled and operated in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Subp. 2. Specific duties. The licensee must develop written bylaws or policies for the management and operation of the nursing home and for the provision of resident care, which must be available to all members of the governing body, and 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. Subp. 3. Responsibilities. A licensee is responsible for: A. Full disclosure of each person having an interest of ten percent or more of the ownership of the home to the department with any change reported in writing within 14 days after the licensee knew of or should have known of the transfer, whichever occurs first. In case of -6-

7 corporate ownership, the name and address of each officer and director must be specified. If the home is organized as a partnership, the name and address of each partner must be furnished. In the case of a home operated by a lessee, the persons or business entities having an interest in the lessee organization must be reported and an executed copy of the lease agreement furnished. If the home is operated by the holder of a franchise, disclosure must be made as to the franchise holder who must also furnish an executed copy of the franchise agreement. B. Appointment of a licensed nursing home administrator who is responsible for the operation of the home in accordance with law and established policies and whose authority to serve as administrator is delegated in writing. C. Notification of the termination of service of the administrator and the appointment of a replacement within five working days in writing to the department. If a licensed nursing home administrator is not available to assume the position immediately, notification to the department must include the name of the person temporarily in charge of the home. The governing body of a nursing home must not employ an individual as the permanent administrator until it is determined that the individual qualifies for licensure as a nursing home administrator in Minnesota under Minnesota Statutes, section 144A.04. The governing body of the nursing home must not employ an individual as an acting administrator or person temporarily in charge for more than 30 days unless that individual has secured an acting administrator license, as required by Minnesota Statutes, section 144A.27. D. Provision of an adequate and competent staff and maintenance of professional standards in the care of residents and operation of the nursing home. E. Provision of facilities, equipment, and supplies for care consistent with the needs of the residents. F. Provision of evidence of adequate financing, proper administration of funds, and the maintenance of required statistics. A nursing home must have financial resources at the time of initial licensure to permit full service operation of the nursing home for six months without regard to income from resident fees. 144A.27 ACTING ADMINISTRATORS. If a licensed nursing home administrator is removed from the position by death or other unexpected cause, the controlling persons of the nursing home suffering the removal may designate an acting nursing home administrator who shall secure an acting administrator s license within 30 days of appointment as the acting administrator ACTING ADMINISTRATOR PERMITS. Subpart 1. Board to issue permits. When the controlling persons of a nursing home designate an acting nursing home administrator under Minnesota Statutes, section 144A.27, the designee must secure an acting administrator's permit within 30 days of the termination of the previous licensed administrator. The board shall issue a permit to serve a facility as an acting administrator for up to six months from the termination of the facility's previous licensed administrator to an individual who meets the qualifications specified in subpart 2. A permit to serve a facility as an acting administrator is valid only for the holder's work with that facility and shall not be transferable to another facility. A permit to serve as acting administrator is not renewable beyond the six months for which it was issued. Subp. 2. Qualifications. An applicant for a permit to serve a facility as an acting nursing home administrator must furnish satisfactory evidence that the applicant: A. has graduated from high school or holds a general education development (GED) certificate of equivalent competency or has completed an associate or higher degree from an accredited postsecondary institution; B. is at least 21 years of age; C. has experience in the management of a nursing home or related facility or program or has completed a majority of the courses required for licensure under part ; D. has passed within the last two years the state examination under parts , item E and -7-

8 , subpart 4; and E. is in good standing in each jurisdiction from which the applicant has ever received a nursing facility administrator license. Federal Regulations 42 CFR PROVISIONAL LICENSES. To fill a position of nursing home administrator that unexpectedly becomes vacant, the agency or board may issue one provisional license, for a single period not to exceed 6 months. The license may be issued to a person who does not meet all of the licensing requirements established under but who (a) Is of good character and otherwise suitable; and (b) Meets any other standards established for provisional licensure by the agency or board RESPONSIBILITIES OF ADMINISTRATOR. The administrator is responsible for the: A. maintenance, completion, and submission of reports and records as required by the department; B. formulation of written policies, procedures, and programs for operation, management, and maintenance of the nursing home; C. current personnel records for each employee according to part ; D. written job descriptions for all positions which define responsibilities, duties, and qualifications that are readily available for all employees; E. work assignments consistent with qualifications and the work load; F. maintenance of a weekly time schedule which shows each employees name, job title, hours of work, and days off for each day of the week. The schedule must be dated and communicated to employees. The schedules and time cards, payroll records, or other written documentation of actual time worked and paid for must be kept on file in the home for three years; G. orientation for new employees and volunteers and provision of a continuing in-service education program for all employees and volunteers to give assurance that they understand the proper method of carrying out all procedures; H. establishment of a recognized accounting system; and I. the development and maintenance of channels of communications with employees, including: (1) distribution of written personnel policies to employees; (2) regularly scheduled meetings of supervisory personnel; (3) an employee suggestion system; and (4) employee evaluation RENEWING LICENSES. Subpart 1. Forms, time for renewal. Every individual who holds a valid license as a nursing home administrator issued by the board shall annually apply to the board on or before June 1 for renewal of the individual's license and shall report any information pertinent to continued licensure requested by the board on forms provided for that purpose. The applicant shall submit evidence satisfactory to the board and subject to audit under part , subpart 3, that during the annual period immediately preceding the renewal application the licensee has complied with the rules of the board and completed continuing education requirements for license renewal CONTINUING EDUCATION REQUIREMENTS. Subpart 1. Renewal requirements. At the time of license renewal, each licensee shall provide evidence satisfactory to the board that the licensee has completed in the preceding year 20 CE credits of acceptable continuing education activities as specified in this part and part Licensees in their first year of licensure shall have the number of CE credits required for license renewal prorated for the number of months they were licensed during the preceding year. For purposes of obtaining and presenting CE credits, a year shall run from May 1 to April

9 CHECKLIST Hiring a Nursing Home Administrator As soon as you learn that your current administrator is leaving: Begin recruiting a permanent replacement who is (or will be within 6 months) licensed in Minnesota Within 5 days of the termination of the previous administrator, notify MDH of who you are placing temporarily in charge Within 30 days of the termination of the previous administrator, either appoint a fully licensed administrator (on a permanent or interim basis) or obtain a permit for an appropriate person to serve as acting administrator (appointee must apply, be tested and obtain the permit within 30 days from previous administrator s termination) If you decide to hire an acting administrator, here are the requirements to obtain an acting permit: File with BENHA an application for acting permit and a verification form with $250 fee Appointee must be at least 21 years old Appointee must have experience in management or supervision within a nursing home or related health care operation or have completed at least half of the requirements for full licensure as a nursing home administrator Appointee must apply, pay the $75 fee for and pass the State exam on nursing home laws and rules Remember, an acting administrator permit is limited to 6 months and cannot be renewed. Within 6 months from the termination of your previous licensed administrator, you must have another fully licensed administrator hired and working at your facility. When hiring a permanent administrator: Check your intended appointee s qualifications with BENHA to be sure that s/he is eligible to become fully licensed as an administrator in Minnesota within the time your facility has available to make an appointment of a fully licensed administrator. Do not assume that any person holding an administrators license in another state or taking courses to meet BENHA requirements will automatically qualify for licensure. -9-