KEY: stricken = removed, old language.underscored = new language to be added
scs-hhs-waiverstandards--art8
A bill for an act
relating to BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:241.3 Section 1. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:
241.4 Subd. 7. Health care facility. "Health care facility" means a hospital or other entity
241.5licensed under sections
241.6section
241.7an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
241.89555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or
241.9a hospice provider licensed under sections
241.10 Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:
241.11 Subd. 4b. Health care facility; notice of status. (a) For the purposes of this
241.12subdivision, "health care facility" means a facility:
241.13(1) licensed by the commissioner of health as a hospital, boarding care home or
241.14supervised living facility under sections
241.15chapter 144A;
241.16(2) registered by the commissioner of health as a housing with services establishment
241.17as defined in section
241.18(3) licensed by the commissioner of human services as a residential facility under
241.19chapter 245A to provide adult foster care, adult mental health treatment, chemical
241.20dependency treatment to adults, or residential services to persons with
241.21 disabilities.
241.22(b) Prior to admission to a health care facility, a person required to register under
241.23this section shall disclose to:
241.24(1) the health care facility employee processing the admission the person's status
241.25as a registered predatory offender under this section; and
241.26(2) the person's corrections agent, or if the person does not have an assigned
241.27corrections agent, the law enforcement authority with whom the person is currently
241.28required to register, that inpatient admission will occur.
241.29(c) A law enforcement authority or corrections agent who receives notice under
241.30paragraph (b) or who knows that a person required to register under this section is
241.31planning to be admitted and receive, or has been admitted and is receiving health care
241.32at a health care facility shall notify the administrator of the facility and deliver a fact
241.33sheet to the administrator containing the following information: (1) name and physical
241.34description of the offender; (2) the offender's conviction history, including the dates of
242.1conviction; (3) the risk level classification assigned to the offender under section
242.2if any; and (4) the profile of likely victims.
242.3(d) Except for a hospital licensed under sections
242.4facility receives a fact sheet under paragraph (c) that includes a risk level classification for
242.5the offender, and if the facility admits the offender, the facility shall distribute the fact
242.6sheet to all residents at the facility. If the facility determines that distribution to a resident
242.7is not appropriate given the resident's medical, emotional, or mental status, the facility
242.8shall distribute the fact sheet to the patient's next of kin or emergency contact.
242.9 Sec. 3. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
242.10MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
242.11 Subdivision 1. Rules. The commissioner of human services shall, within 24 months
242.12of enactment of this section, adopt rules governing the use of positive support strategies,
242.13safety interventions, and emergency use of manual restraint in facilities and services
242.14licensed under chapter 245D.
242.15 Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
242.16develop data collection elements specific to incidents on the use of controlled procedures
242.17with persons receiving services from providers regulated under Minnesota Rules, parts
242.189525.2700 to 9525.2810, and incidents involving persons receiving services from
242.19providers identified to be licensed under chapter 245D effective January 1, 2014. Providers
242.20shall report the data in a format and at a frequency provided by the commissioner of
242.21human services.
242.22(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
242.239525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
242.24in a format and at a frequency provided by the commissioner.
242.25 Sec. 4. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:
242.26 Subd. 10. Nonresidential program. "Nonresidential program" means care,
242.27supervision, rehabilitation, training or habilitation of a person provided outside the
242.28person's own home and provided for fewer than 24 hours a day, including adult day
242.29care programs; and chemical dependency or chemical abuse programs that are located
242.30in a nursing home or hospital and receive public funds for providing chemical abuse or
242.31chemical dependency treatment services under chapter 254B. Nonresidential programs
242.32include home and community-based services
242.33persons with
242.34or outside of a person's own home under chapter 245D.
243.1 Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:
243.2 Subd. 14. Residential program. "Residential program" means a program
243.3that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
243.4education, habilitation, or treatment outside a person's own home, including a program
243.5in an intermediate care facility for four or more persons with developmental disabilities;
243.6and chemical dependency or chemical abuse programs that are located in a hospital
243.7or nursing home and receive public funds for providing chemical abuse or chemical
243.8dependency treatment services under chapter 254B. Residential programs include home
243.9and community-based services for persons with
243.1065 and older that are provided in or outside of a person's own home under chapter 245D.
243.11 Sec. 6. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
243.12 Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial
243.13license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
243.14or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
243.15this chapter for a physical location that will not be the primary residence of the license
243.16holder for the entire period of licensure. If a license is issued during this moratorium, and
243.17the license holder changes the license holder's primary residence away from the physical
243.18location of the foster care license, the commissioner shall revoke the license according
243.19to section
243.20residential setting licensed under chapter 245D. Exceptions to the moratorium include:
243.21(1) foster care settings that are required to be registered under chapter 144D;
243.22(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
243.23community residential setting licenses replacing adult foster care licenses in existence on
243.24December 31, 2013, and determined to be needed by the commissioner under paragraph (b);
243.25(3) new foster care licenses or community residential setting licenses determined to
243.26be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
243.27ICF/MR, or regional treatment center, or restructuring of state-operated services that
243.28limits the capacity of state-operated facilities;
243.29(4) new foster care licenses or community residential setting licenses determined
243.30to be needed by the commissioner under paragraph (b) for persons requiring hospital
243.31level care; or
243.32(5) new foster care licenses or community residential setting licenses determined to
243.33be needed by the commissioner for the transition of people from personal care assistance
243.34to the home and community-based services.
244.1(b) The commissioner shall determine the need for newly licensed foster care
244.2homes or community residential settings as defined under this subdivision. As part of the
244.3determination, the commissioner shall consider the availability of foster care capacity in
244.4the area in which the licensee seeks to operate, and the recommendation of the local
244.5county board. The determination by the commissioner must be final. A determination of
244.6need is not required for a change in ownership at the same address.
244.7(c) The commissioner shall study the effects of the license moratorium under this
244.8subdivision and shall report back to the legislature by January 15, 2011. This study shall
244.9include, but is not limited to the following:
244.10(1) the overall capacity and utilization of foster care beds where the physical location
244.11is not the primary residence of the license holder prior to and after implementation
244.12of the moratorium;
244.13(2) the overall capacity and utilization of foster care beds where the physical
244.14location is the primary residence of the license holder prior to and after implementation
244.15of the moratorium; and
244.16(3) the number of licensed and occupied ICF/MR beds prior to and after
244.17implementation of the moratorium.
244.18(d) When a
244.19foster home that is not the primary residence of the license holder according to section
244.21shall immediately inform the Department of Human Services Licensing Division.
244.22The department shall decrease the statewide licensed capacity for foster care settings
244.23where the physical location is not the primary residence of the license holder, or for
244.24community residential settings, if the voluntary changes described in paragraph (f) are
244.25not sufficient to meet the savings required by reductions in licensed bed capacity under
244.26Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
244.27and maintain statewide long-term care residential services capacity within budgetary
244.28limits. Implementation of the statewide licensed capacity reduction shall begin on July
244.291, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
244.30needs determination process. Under this paragraph, the commissioner has the authority
244.31to reduce unused licensed capacity of a current foster care program, or the community
244.32residential settings, to accomplish the consolidation or closure of settings. A decreased
244.33licensed capacity according to this paragraph is not subject to appeal under this chapter.
244.34(e) Residential settings that would otherwise be subject to the decreased license
244.35capacity established in paragraph (d) shall be exempt under the following circumstances:
245.1(1) until August 1, 2013, the license holder's beds occupied by residents whose
245.2primary diagnosis is mental illness and the license holder is:
245.3(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
245.4health services (ARMHS) as defined in section
245.5(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
245.69520.0870;
245.7(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
245.89520.0870; or
245.9(iv) a provider of intensive residential treatment services (IRTS) licensed under
245.10Minnesota Rules, parts 9520.0500 to 9520.0670; or
245.11(2) the license holder is certified under the requirements in subdivision 6a or section
245.12245D.33.
245.13(f) A resource need determination process, managed at the state level, using the
245.14available reports required by section
245.15be used to determine where the reduced capacity required under paragraph (d) will be
245.16implemented. The commissioner shall consult with the stakeholders described in section
245.18long-term care service needs within budgetary limits, including seeking proposals from
245.19service providers or lead agencies to change service type, capacity, or location to improve
245.20services, increase the independence of residents, and better meet needs identified by the
245.21long-term care services reports and statewide data and information. By February 1 of each
245.22year, the commissioner shall provide information and data on the overall capacity of
245.23licensed long-term care services, actions taken under this subdivision to manage statewide
245.24long-term care services and supports resources, and any recommendations for change to
245.25the legislative committees with jurisdiction over health and human services budget.
245.26 (g) At the time of application and reapplication for licensure, the applicant and the
245.27license holder that are subject to the moratorium or an exclusion established in paragraph
245.28(a) are required to inform the commissioner whether the physical location where the foster
245.29care will be provided is or will be the primary residence of the license holder for the entire
245.30period of licensure. If the primary residence of the applicant or license holder changes, the
245.31applicant or license holder must notify the commissioner immediately. The commissioner
245.32shall print on the foster care license certificate whether or not the physical location is the
245.33primary residence of the license holder.
245.34 (h) License holders of foster care homes identified under paragraph (g) that are not
245.35the primary residence of the license holder and that also provide services in the foster care
245.36home that are covered by a federally approved home and community-based services
246.1waiver, as authorized under section
246.2human services licensing division that the license holder provides or intends to provide
246.3these waiver-funded services.
246.4
246.5
246.6 Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:
246.7 Subd. 8. Excluded providers seeking licensure. Nothing in this section shall
246.8prohibit a program that is excluded from licensure under subdivision 2, paragraph
246.9(a), clause
246.10application received from such an excluded provider is processed in the same manner as
246.11all other applications for child care center licensure.
246.12 Sec. 8. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:
246.13 Subd. 3. Implementation. (a) The commissioner shall implement the
246.14responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
246.15only within the limits of available appropriations or other administrative cost recovery
246.16methodology.
246.17(b) The licensure of home and community-based services according to this section
246.18shall be implemented January 1, 2014. License applications shall be received and
246.19processed on a phased-in schedule as determined by the commissioner beginning July
246.201, 2013. Licenses will be issued thereafter upon the commissioner's determination that
246.21the application is complete according to section
246.22(c) Within the limits of available appropriations or other administrative cost recovery
246.23methodology, implementation of compliance monitoring must be phased in after January
246.241, 2014.
246.25(1) Applicants who do not currently hold a license issued under
246.26 must receive an initial compliance monitoring visit after 12 months of the effective date of
246.27the initial license for the purpose of providing technical assistance on how to achieve and
246.28maintain compliance with the applicable law or rules governing the provision of home and
246.29community-based services under chapter 245D. If during the review the commissioner
246.30finds that the license holder has failed to achieve compliance with an applicable law or
246.31rule and this failure does not imminently endanger the health, safety, or rights of the
246.32persons served by the program, the commissioner may issue a licensing review report with
246.33recommendations for achieving and maintaining compliance.
247.1(2) Applicants who do currently hold a license issued under this chapter must receive
247.2a compliance monitoring visit after 24 months of the effective date of the initial license.
247.3(d) Nothing in this subdivision shall be construed to limit the commissioner's
247.4authority to suspend or revoke a license or issue a fine at any time under section
247.5or
247.6applicable laws or rules under section
247.7of the violation of law or rule and the effect of the violation on the health, safety, or
247.8rights of persons served by the program.
247.9 Sec. 9. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:
247.10 Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license
247.11under section
247.12based on a disqualification for which reconsideration was requested and which was not
247.13set aside under section
247.14disqualification and the licensing sanction or denial of a license, unless otherwise specified
247.15in this subdivision. When the licensing sanction or denial of a license is based on a
247.16determination of maltreatment under section
247.17serious or recurring maltreatment which was not set aside, the scope of the contested case
247.18hearing shall include the maltreatment determination, disqualification, and the licensing
247.19sanction or denial of a license, unless otherwise specified in this subdivision. In such
247.20cases, a fair hearing under section
247.21sections
247.22 (b) Except for family child care and child foster care, reconsideration of a
247.23maltreatment determination under sections
247.24subdivision 9d, and reconsideration of a disqualification under section
247.25not be conducted when:
247.26 (1) a denial of a license under section
247.28or the disqualification of a license holder is based on serious or recurring maltreatment;
247.29 (2) the denial of a license or licensing sanction is issued at the same time as the
247.30maltreatment determination or disqualification; and
247.31 (3) the license holder appeals the maltreatment determination or disqualification,
247.32and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
247.33conducted under sections
247.349d. The scope of the contested case hearing must include the maltreatment determination,
247.35disqualification, and denial of a license or licensing sanction.
248.1 Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
248.2determination or disqualification, but does not appeal the denial of a license or a licensing
248.3sanction, reconsideration of the maltreatment determination shall be conducted under
248.4sections
248.5disqualification shall be conducted under section
248.6shall also be conducted as provided under sections
248.8 (c) In consolidated contested case hearings regarding sanctions issued in family child
248.9care, child foster care, family adult day services,
248.10residential settings, the county attorney shall defend the commissioner's orders in
248.11accordance with section
248.12 (d) The commissioner's final order under subdivision 5 is the final agency action
248.13on the issue of maltreatment and disqualification, including for purposes of subsequent
248.14background studies under chapter 245C and is the only administrative appeal of the final
248.15agency determination, specifically, including a challenge to the accuracy and completeness
248.16of data under section
248.17 (e) When consolidated hearings under this subdivision involve a licensing sanction
248.18based on a previous maltreatment determination for which the commissioner has issued
248.19a final order in an appeal of that determination under section
248.20failed to exercise the right to appeal the previous maltreatment determination under
248.21section
248.22conclusive on the issue of maltreatment. In such cases, the scope of the administrative
248.23law judge's review shall be limited to the disqualification and the licensing sanction or
248.24denial of a license. In the case of a denial of a license or a licensing sanction issued to
248.25a facility based on a maltreatment determination regarding an individual who is not the
248.26license holder or a household member, the scope of the administrative law judge's review
248.27includes the maltreatment determination.
248.28 (f) The hearings of all parties may be consolidated into a single contested case
248.29hearing upon consent of all parties and the administrative law judge, if:
248.30 (1) a maltreatment determination or disqualification, which was not set aside under
248.31section
248.32sanction under section
248.33 (2) the disqualified subject is an individual other than the license holder and upon
248.34whom a background study must be conducted under section
248.35 (3) the individual has a hearing right under section
249.1 (g) When a denial of a license under section
249.2section
249.3and was not set aside under section
249.4right under section
249.5include the denial or sanction and a determination whether the disqualification should
249.6be set aside, unless section
249.7determining whether the disqualification should be set aside, the administrative law judge
249.8shall consider the factors under section
249.9individual poses a risk of harm to any person receiving services from the license holder.
249.10 (h) Notwithstanding section
249.11under section
249.12subdivision 4
249.13and a determination whether the disqualification should be set aside, unless section
249.15disqualification should be set aside, the administrative law judge shall consider the factors
249.16under section
249.17harm to any person receiving services from the license holder.
249.18 Sec. 10. Minnesota Statutes 2012, section 245A.10, is amended to read:
249.19245A.10 FEES.
249.20 Subdivision 1. Application or license fee required, programs exempt from fee.
249.21(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
249.22of applications and inspection of programs which are licensed under this chapter.
249.23(b) Except as provided under subdivision 2, no application or license fee shall be
249.24charged for child foster care, adult foster care,
249.25a community residential setting.
249.26 Subd. 2. County fees for background studies and licensing inspections. (a) For
249.27purposes of family and group family child care licensing under this chapter, a county
249.28agency may charge a fee to an applicant or license holder to recover the actual cost of
249.29background studies, but in any case not to exceed $100 annually. A county agency may
249.30also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
249.31license or $100 for a two-year license.
249.32 (b) A county agency may charge a fee to a legal nonlicensed child care provider or
249.33applicant for authorization to recover the actual cost of background studies completed
249.34under section
249.35 (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
250.1 (1) in cases of financial hardship;
250.2 (2) if the county has a shortage of providers in the county's area;
250.3 (3) for new providers; or
250.4 (4) for providers who have attained at least 16 hours of training before seeking
250.5initial licensure.
250.6 (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
250.7an installment basis for up to one year. If the provider is receiving child care assistance
250.8payments from the state, the provider may have the fees under paragraph (a) or (b)
250.9deducted from the child care assistance payments for up to one year and the state shall
250.10reimburse the county for the county fees collected in this manner.
250.11 (e) For purposes of adult foster care and child foster care licensing, and licensing
250.12the physical plant of a community residential setting, under this chapter, a county agency
250.13may charge a fee to a corporate applicant or corporate license holder to recover the actual
250.14cost of licensing inspections, not to exceed $500 annually.
250.15 (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
250.16following circumstances:
250.17(1) in cases of financial hardship;
250.18(2) if the county has a shortage of providers in the county's area; or
250.19(3) for new providers.
250.20 Subd. 3. Application fee for initial license or certification. (a) For fees required
250.21under subdivision 1, an applicant for an initial license or certification issued by the
250.22commissioner shall submit a $500 application fee with each new application required
250.23under this subdivision. An applicant for an initial day services facility license under
250.24chapter 245D shall submit a $250 application fee with each new application. The
250.25application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
250.26or certification fee that expires on December 31. The commissioner shall not process an
250.27application until the application fee is paid.
250.28(b) Except as provided in clauses (1) to
250.29to provide services at a specific location.
250.30(1)
250.31
250.32
250.33
250.34
250.35
250.36
251.1
251.2
251.3
251.4
251.5
251.6
251.7
251.8
251.9home and community-based services to persons with disabilities or age 65 and older under
251.10chapter 245D, an applicant shall submit an application to provide services statewide.
251.11(2)
251.12
251.13
251.14
251.16
251.17under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
251.18application to provide services statewide.
251.19(c) The initial application fee charged under this subdivision does not include the
251.20temporary license surcharge under section 16E.22.
251.21 Subd. 4. License or certification fee for certain programs. (a) Child care centers
251.22shall pay an annual nonrefundable license fee based on the following schedule:
251.35
251.36
251.37
252.9
252.10
252.11
252.12
252.13
252.14
252.15
252.16
252.17
252.18
252.19
252.20
252.21
252.22
252.23
252.24
252.25
252.26
252.27
252.28
252.29
252.30
252.31
252.32
252.33
252.34
252.35
| 252.36 |
|||
| 252.37 |
|||
| 253.1 |
|||
| 253.2 |
253.4services and supports identified under chapter 245D to persons with disabilities or age
253.565 and older, shall pay an annual nonrefundable license fee that includes a base rate of
253.6$563, plus $46 times the number of persons served on the last day of June of the current
253.7license year for programs serving ten or more persons. The fee is limited to a maximum of
253.8200 persons, regardless of the actual number of persons served. Programs serving nine
253.9or fewer persons pay only the base rate.
253.10(c) A facility licensed under chapter 245D to provide day services shall pay an
253.11annual nonrefundable license fee of $100.
253.12
253.13parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
253.14annual nonrefundable license fee based on the following schedule:
| 253.15 |
Licensed Capacity |
License Fee |
|
| 253.16 |
1 to 24 persons |
$600 |
|
| 253.17 |
25 to 49 persons |
$800 |
|
| 253.18 |
50 to 74 persons |
$1,000 |
|
| 253.19 |
75 to 99 persons |
$1,200 |
|
| 253.20 |
100 or more persons |
$1,400 |
253.229530.6510 to 9530.6590, to provide detoxification services shall pay an annual
253.23nonrefundable license fee based on the following schedule:
| 253.24 |
Licensed Capacity |
License Fee |
|
| 253.25 |
1 to 24 persons |
$760 |
|
| 253.26 |
25 to 49 persons |
$960 |
|
| 253.27 |
50 or more persons |
$1,160 |
253.29Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
253.30based on the following schedule:
| 253.31 |
Licensed Capacity |
License Fee |
|
| 253.32 |
1 to 24 persons |
$1,000 |
|
| 253.33 |
25 to 49 persons |
$1,100 |
|
| 253.34 |
50 to 74 persons |
$1,200 |
|
| 253.35 |
75 to 99 persons |
$1,300 |
|
| 253.36 |
100 or more persons |
$1,400 |
254.29520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
254.3fee based on the following schedule:
| 254.4 |
Licensed Capacity |
License Fee |
|
| 254.5 |
1 to 24 persons |
$2,525 |
|
| 254.6 |
25 or more persons |
$2,725 |
254.89570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
254.9license fee based on the following schedule:
| 254.10 |
Licensed Capacity |
License Fee |
|
| 254.11 |
1 to 24 persons |
$450 |
|
| 254.12 |
25 to 49 persons |
$650 |
|
| 254.13 |
50 to 74 persons |
$850 |
|
| 254.14 |
75 to 99 persons |
$1,050 |
|
| 254.15 |
100 or more persons |
$1,250 |
254.17section
254.18
254.19Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
254.20license fee of $875.
254.21
254.22Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
254.23on the following schedule:
| 254.24 |
Licensed Capacity |
License Fee |
|
| 254.25 |
1 to 24 persons |
$500 |
|
| 254.26 |
25 to 49 persons |
$700 |
|
| 254.27 |
50 to 74 persons |
$900 |
|
| 254.28 |
75 to 99 persons |
$1,100 |
|
| 254.29 |
100 or more persons |
$1,300 |
254.31psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
254.329515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
254.33
254.34purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
254.35parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
254.36mental health center or mental health clinic provides services at a primary location with
255.1satellite facilities, the satellite facilities shall be certified with the primary location without
255.2an additional charge.
255.3 Subd. 6. License not issued until license or certification fee is paid. The
255.4commissioner shall not issue a license or certification until the license or certification fee
255.5is paid. The commissioner shall send a bill for the license or certification fee to the billing
255.6address identified by the license holder. If the license holder does not submit the license or
255.7certification fee payment by the due date, the commissioner shall send the license holder
255.8a past due notice. If the license holder fails to pay the license or certification fee by the
255.9due date on the past due notice, the commissioner shall send a final notice to the license
255.10holder informing the license holder that the program license will expire on December 31
255.11unless the license fee is paid before December 31. If a license expires, the program is no
255.12longer licensed and, unless exempt from licensure under section
255.13must not operate after the expiration date. After a license expires, if the former license
255.14holder wishes to provide licensed services, the former license holder must submit a new
255.15license application and application fee under subdivision 3.
255.16 Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding
255.17section
255.18a fee, the commissioner must plan to fully recover direct expenditures for licensing
255.19activities under this chapter over a five-year period. The commissioner may have
255.20anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
255.21revenues accumulated in previous bienniums.
255.22 Subd. 8. Deposit of license fees. A human services licensing account is created in
255.23the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
255.24be deposited in the human services licensing account and are annually appropriated to the
255.25commissioner for licensing activities authorized under this chapter.
255.26EFFECTIVE DATE.This section is effective July 1, 2013.
255.27 Sec. 11. Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:
255.28 Subd. 2a. Adult foster care and community residential setting license capacity.
255.29(a) The commissioner shall issue adult foster care and community residential setting
255.30 licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
255.31boarders, except that the commissioner may issue a license with a capacity of five beds,
255.32including roomers and boarders, according to paragraphs (b) to (f).
255.33(b)
255.34of five if all persons in care are age 55 or over and do not have a serious and persistent
255.35mental illness or a developmental disability.
256.1(c) The commissioner may grant variances to paragraph (b) to allow a
256.2
256.3age of 55 if the variance complies with section
256.4the variance is recommended by the county in which the licensed
256.5 facility is located.
256.6(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
256.7bed for emergency crisis services for a person with serious and persistent mental illness
256.8or a developmental disability, regardless of age, if the variance complies with section
256.10which the licensed
256.11(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a
256.12fifth bed for respite services, as defined in section
256.13regardless of age, if the variance complies with sections
256.15which the licensed
256.16provided under the following conditions:
256.17(1) staffing ratios cannot be reduced below the approved level for the individuals
256.18being served in the home on a permanent basis;
256.19(2) no more than two different individuals can be accepted for respite services in
256.20any calendar month and the total respite days may not exceed 120 days per program in
256.21any calendar year;
256.22(3) the person receiving respite services must have his or her own bedroom, which
256.23could be used for alternative purposes when not used as a respite bedroom, and cannot be
256.24the room of another person who lives in the
256.25(4) individuals living in the
256.26variance is approved. The provider must give 60 days' notice in writing to the residents
256.27and their legal representatives prior to accepting the first respite placement. Notice must
256.28be given to residents at least two days prior to service initiation, or as soon as the license
256.29holder is able if they receive notice of the need for respite less than two days prior to
256.30initiation, each time a respite client will be served, unless the requirement for this notice is
256.31waived by the resident or legal guardian.
256.32(f) The commissioner may issue an adult foster care or community residential setting
256.33 license with a capacity of five adults if the fifth bed does not increase the overall statewide
256.34capacity of licensed adult foster care or community residential setting beds in homes that
256.35are not the primary residence of the license holder, as identified in a plan submitted to the
257.1commissioner by the county, when the capacity is recommended by the county licensing
257.2agency of the county in which the facility is located and if the recommendation verifies that:
257.3(1) the facility meets the physical environment requirements in the adult foster
257.4care licensing rule;
257.5(2) the five-bed living arrangement is specified for each resident in the resident's:
257.6(i) individualized plan of care;
257.7(ii) individual service plan under section
257.8(iii) individual resident placement agreement under Minnesota Rules, part
257.99555.5105, subpart 19, if required;
257.10(3) the license holder obtains written and signed informed consent from each
257.11resident or resident's legal representative documenting the resident's informed choice
257.12to remain living in the home and that the resident's refusal to consent would not have
257.13resulted in service termination; and
257.14(4) the facility was licensed for adult foster care before March 1, 2011.
257.15(g) The commissioner shall not issue a new adult foster care license under paragraph
257.16(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care
257.17license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five
257.18adults if the license holder continues to comply with the requirements in paragraph (f).
257.19 Sec. 12. Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:
257.20 Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The
257.21commissioner may grant a variance under section
257.22requiring a caregiver to be present in an adult foster care home during normal sleeping
257.23hours to allow for alternative methods of overnight supervision. The commissioner may
257.24grant the variance if the local county licensing agency recommends the variance and the
257.25county recommendation includes documentation verifying that:
257.26 (1) the county has approved the license holder's plan for alternative methods of
257.27providing overnight supervision and determined the plan protects the residents' health,
257.28safety, and rights;
257.29 (2) the license holder has obtained written and signed informed consent from
257.30each resident or each resident's legal representative documenting the resident's or legal
257.31representative's agreement with the alternative method of overnight supervision; and
257.32 (3) the alternative method of providing overnight supervision, which may include
257.33the use of technology, is specified for each resident in the resident's: (i) individualized
257.34plan of care; (ii) individual service plan under section
258.1required; or (iii) individual resident placement agreement under Minnesota Rules, part
258.29555.5105, subpart 19, if required.
258.3 (b) To be eligible for a variance under paragraph (a), the adult foster care license
258.4holder must not have had a conditional license issued under section
258.5other licensing sanction issued under section
258.6on failure to provide adequate supervision, health care services, or resident safety in
258.7the adult foster care home.
258.8 (c) A license holder requesting a variance under this subdivision to utilize
258.9technology as a component of a plan for alternative overnight supervision may request
258.10the commissioner's review in the absence of a county recommendation. Upon receipt of
258.11such a request from a license holder, the commissioner shall review the variance request
258.12with the county.
258.13(d) A variance granted by the commissioner according to this subdivision before
258.14January 1, 2014, to a license holder for an adult foster care home must transfer with the
258.15license when the license converts to a community residential setting license under chapter
258.16245D. The terms and conditions of the variance remain in effect as approved at the time
258.17the variance was granted.
258.18 Sec. 13. Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:
258.19 Subd. 7a. Alternate overnight supervision technology; adult foster care
258.20 and community residential setting licenses. (a) The commissioner may grant an
258.21applicant or license holder an adult foster care or community residential setting license
258.22for a residence that does not have a caregiver in the residence during normal sleeping
258.23hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, or section
258.24245D.02, subdivision 33b, but uses monitoring technology to alert the license holder
258.25when an incident occurs that may jeopardize the health, safety, or rights of a foster
258.26care recipient. The applicant or license holder must comply with all other requirements
258.27under Minnesota Rules, parts 9555.5105 to 9555.6265, or applicable requirements under
258.28chapter 245D, and the requirements under this subdivision. The license printed by the
258.29commissioner must state in bold and large font:
258.30 (1) that the facility is under electronic monitoring; and
258.31 (2) the telephone number of the county's common entry point for making reports of
258.32suspected maltreatment of vulnerable adults under section
258.33(b) Applications for a license under this section must be submitted directly to
258.34the Department of Human Services licensing division. The licensing division must
258.35immediately notify the
259.1licensing agency. The licensing division must collaborate with the county licensing
259.2agency in the review of the application and the licensing of the program.
259.3 (c) Before a license is issued by the commissioner, and for the duration of the
259.4license, the applicant or license holder must establish, maintain, and document the
259.5implementation of written policies and procedures addressing the requirements in
259.6paragraphs (d) through (f).
259.7 (d) The applicant or license holder must have policies and procedures that:
259.8 (1) establish characteristics of target populations that will be admitted into the home,
259.9and characteristics of populations that will not be accepted into the home;
259.10 (2) explain the discharge process when a
259.11program requires overnight supervision or other services that cannot be provided by the
259.12license holder due to the limited hours that the license holder is on site;
259.13 (3) describe the types of events to which the program will respond with a physical
259.14presence when those events occur in the home during time when staff are not on site, and
259.15how the license holder's response plan meets the requirements in paragraph (e), clause
259.16(1) or (2);
259.17 (4) establish a process for documenting a review of the implementation and
259.18effectiveness of the response protocol for the response required under paragraph (e),
259.19clause (1) or (2). The documentation must include:
259.20 (i) a description of the triggering incident;
259.21 (ii) the date and time of the triggering incident;
259.22 (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
259.23 (iv) whether the response met the resident's needs;
259.24 (v) whether the existing policies and response protocols were followed; and
259.25 (vi) whether the existing policies and protocols are adequate or need modification.
259.26 When no physical presence response is completed for a three-month period, the
259.27license holder's written policies and procedures must require a physical presence response
259.28drill to be conducted for which the effectiveness of the response protocol under paragraph
259.29(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
259.30 (5) establish that emergency and nonemergency phone numbers are posted in a
259.31prominent location in a common area of the home where they can be easily observed by a
259.32person responding to an incident who is not otherwise affiliated with the home.
259.33 (e) The license holder must document and include in the license application which
259.34response alternative under clause (1) or (2) is in place for responding to situations that
259.35present a serious risk to the health, safety, or rights of
259.36
260.1 (1) response alternative (1) requires only the technology to provide an electronic
260.2notification or alert to the license holder that an event is underway that requires a response.
260.3Under this alternative, no more than ten minutes will pass before the license holder will be
260.4physically present on site to respond to the situation; or
260.5 (2) response alternative (2) requires the electronic notification and alert system under
260.6alternative (1), but more than ten minutes may pass before the license holder is present on
260.7site to respond to the situation. Under alternative (2), all of the following conditions are met:
260.8 (i) the license holder has a written description of the interactive technological
260.9applications that will assist the license holder in communicating with and assessing the
260.10needs related to the care, health, and safety of the foster care recipients. This interactive
260.11technology must permit the license holder to remotely assess the well being of the
260.12
260.13foster care recipient. Requiring the foster care recipient to initiate a telephone call does
260.14not meet this requirement;
260.15(ii) the license holder documents how the remote license holder is qualified and
260.16capable of meeting the needs of the foster care recipients and assessing foster care
260.17recipients' needs under item (i) during the absence of the license holder on site;
260.18(iii) the license holder maintains written procedures to dispatch emergency response
260.19personnel to the site in the event of an identified emergency; and
260.20 (iv) each
260.21
260.22subdivision 8; 256B.0915, subdivision 6;
260.23subdivision 15, if required, or individual resident placement agreement under Minnesota
260.24Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time,
260.25which may be greater than ten minutes, for the license holder to be on site for that
260.26
260.27 (f) Each
260.28agreement, and plan must clearly state that the adult foster care or community residential
260.29setting license category is a program without the presence of a caregiver in the residence
260.30during normal sleeping hours; the protocols in place for responding to situations that
260.31present a serious risk to the health, safety, or rights of
260.32served by the program under paragraph (e), clause (1) or (2); and a signed informed
260.33consent from each
260.34legal representative documenting the person's or legal representative's agreement with
260.35placement in the program. If electronic monitoring technology is used in the home, the
260.36informed consent form must also explain the following:
261.1 (1) how any electronic monitoring is incorporated into the alternative supervision
261.2system;
261.3 (2) the backup system for any electronic monitoring in times of electrical outages or
261.4other equipment malfunctions;
261.5 (3) how the caregivers or direct support staff are trained on the use of the technology;
261.6 (4) the event types and license holder response times established under paragraph (e);
261.7 (5) how the license holder protects
261.8related to electronic monitoring and related to any electronically recorded data generated
261.9by the monitoring system. A
261.10not be removed from a program under this subdivision for failure to consent to electronic
261.11monitoring. The consent form must explain where and how the electronically recorded
261.12data is stored, with whom it will be shared, and how long it is retained; and
261.13 (6) the risks and benefits of the alternative overnight supervision system.
261.14 The written explanations under clauses (1) to (6) may be accomplished through
261.15cross-references to other policies and procedures as long as they are explained to the
261.16person giving consent, and the person giving consent is offered a copy.
261.17(g) Nothing in this section requires the applicant or license holder to develop or
261.18maintain separate or duplicative policies, procedures, documentation, consent forms, or
261.19individual plans that may be required for other licensing standards, if the requirements of
261.20this section are incorporated into those documents.
261.21(h) The commissioner may grant variances to the requirements of this section
261.22according to section
261.23(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
261.24under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
261.25contractors affiliated with the license holder.
261.26(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
261.27remotely determine what action the license holder needs to take to protect the well-being
261.28of the foster care recipient.
261.29(k) The commissioner shall evaluate license applications using the requirements
261.30in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
261.31including a checklist of criteria needed for approval.
261.32(l) To be eligible for a license under paragraph (a), the adult foster care or community
261.33residential setting license holder must not have had a conditional license issued under
261.34section
261.35months based on failure to provide adequate supervision, health care services, or resident
261.36safety in the adult foster care home or community residential setting.
262.1(m) The commissioner shall review an application for an alternative overnight
262.2supervision license within 60 days of receipt of the application. When the commissioner
262.3receives an application that is incomplete because the applicant failed to submit required
262.4documents or that is substantially deficient because the documents submitted do not meet
262.5licensing requirements, the commissioner shall provide the applicant written notice
262.6that the application is incomplete or substantially deficient. In the written notice to the
262.7applicant, the commissioner shall identify documents that are missing or deficient and
262.8give the applicant 45 days to resubmit a second application that is substantially complete.
262.9An applicant's failure to submit a substantially complete application after receiving
262.10notice from the commissioner is a basis for license denial under section
262.11commissioner shall complete subsequent review within 30 days.
262.12(n) Once the application is considered complete under paragraph (m), the
262.13commissioner will approve or deny an application for an alternative overnight supervision
262.14license within 60 days.
262.15(o) For the purposes of this subdivision, "supervision" means:
262.16(1) oversight by a caregiver or direct support staff as specified in the individual
262.17resident's place agreement or coordinated service and support plan and awareness of the
262.18resident's needs and activities; and
262.19(2) the presence of a caregiver or direct support staff in a residence during normal
262.20sleeping hours, unless a determination has been made and documented in the individual's
262.21 coordinated service and support plan that the individual does not require the presence of a
262.22caregiver or direct support staff during normal sleeping hours.
262.23 Sec. 14. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:
262.24 Subd. 7b. Adult foster care data privacy and security. (a) An adult foster care
262.25 or community residential setting license holder who creates, collects, records, maintains,
262.26stores, or discloses any individually identifiable recipient data, whether in an electronic
262.27or any other format, must comply with the privacy and security provisions of applicable
262.28privacy laws and regulations, including:
262.29(1) the federal Health Insurance Portability and Accountability Act of 1996
262.30(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
262.31title 45, part 160, and subparts A and E of part 164; and
262.32(2) the Minnesota Government Data Practices Act as codified in chapter 13.
262.33(b) For purposes of licensure, the license holder shall be monitored for compliance
262.34with the following data privacy and security provisions:
263.1(1) the license holder must control access to data on
263.2served by the program according to the definitions of public and private data on individuals
263.3under section
263.5and contracting related to data according to section
263.6assigned the duties of a government entity;
263.7(2) the license holder must provide each
263.8the program with a notice that meets the requirements under section
263.9the license holder is assigned the duties of the government entity, and that meets the
263.10requirements of Code of Federal Regulations, title 45, part
263.11describe the purpose for collection of the data, and to whom and why it may be disclosed
263.12pursuant to law. The notice must inform the
263.13uses electronic monitoring and, if applicable, that recording technology is used;
263.14(3) the license holder must not install monitoring cameras in bathrooms;
263.15(4) electronic monitoring cameras must not be concealed from the
263.16
263.17(5) electronic video and audio recordings of
263.18by the program shall be stored by the license holder for five days unless: (i) a
263.19
263.20be held longer based on a specific report of alleged maltreatment; or (ii) the recording
263.21captures an incident or event of alleged maltreatment under section
263.22a crime under chapter 609. When requested by a
263.23 or when a recording captures an incident or event of alleged maltreatment or a crime, the
263.24license holder must maintain the recording in a secured area for no longer than 30 days
263.25to give the investigating agency an opportunity to make a copy of the recording. The
263.26investigating agency will maintain the electronic video or audio recordings as required in
263.27section
263.28(c) The commissioner shall develop, and make available to license holders and
263.29county licensing workers, a checklist of the data privacy provisions to be monitored
263.30for purposes of licensure.
263.31 Sec. 15. Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:
263.32 Subd. 8. Community residential setting license. (a) The commissioner shall
263.33establish provider standards for residential support services that integrate service standards
263.34and the residential setting under one license. The commissioner shall propose statutory
263.35language and an implementation plan for licensing requirements for residential support
264.1services to the legislature by January 15, 2012, as a component of the quality outcome
264.2standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
264.3(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
264.4for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105
264.5to 9555.6265
264.6and meeting the provisions of
264.7245D.02, subdivision 4a, must be required to obtain a community residential setting license.
264.8 Sec. 16. Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:
264.9 Subdivision 1. Delegation of authority to agencies. (a) County agencies and
264.10private agencies that have been designated or licensed by the commissioner to perform
264.11licensing functions and activities under section
264.12child care under chapter 245C; to recommend denial of applicants under section
264.13to issue correction orders, to issue variances, and recommend a conditional license under
264.14section
264.15section
264.16those functions and with this section. The following variances are excluded from the
264.17delegation of variance authority and may be issued only by the commissioner:
264.18 (1) dual licensure of family child care and child foster care, dual licensure of child
264.19and adult foster care, and adult foster care and family child care;
264.20 (2) adult foster care maximum capacity;
264.21 (3) adult foster care minimum age requirement;
264.22 (4) child foster care maximum age requirement;
264.23 (5) variances regarding disqualified individuals except that county agencies may
264.24issue variances under section
264.25is responsible for conducting a consolidated reconsideration according to sections
264.27and a disqualification based on serious or recurring maltreatment;
264.28 (6) the required presence of a caregiver in the adult foster care residence during
264.29normal sleeping hours; and
264.30 (7) variances for community residential setting licenses under chapter 245D.
264.31Except as provided in section
264.32must not grant a license holder a variance to exceed the maximum allowable family child
264.33care license capacity of 14 children.
264.34 (b) County agencies must report information about disqualification reconsiderations
264.35under sections
265.1granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
265.2prescribed by the commissioner.
265.3 (c) For family day care programs, the commissioner may authorize licensing reviews
265.4every two years after a licensee has had at least one annual review.
265.5 (d) For family adult day services programs, the commissioner may authorize
265.6licensing reviews every two years after a licensee has had at least one annual review.
265.7 (e) A license issued under this section may be issued for up to two years.
265.8 Sec. 17. Minnesota Statutes 2012, section 245D.02, is amended to read:
265.9245D.02 DEFINITIONS.
265.10 Subdivision 1. Scope. The terms used in this chapter have the meanings given
265.11them in this section.
265.12 Subd. 2. Annual and annually. "Annual" and "annually" have the meaning given
265.13in section
265.14 Subd. 2a. Authorized representative. "Authorized representative" means a parent,
265.15family member, advocate, or other adult authorized by the person or the person's legal
265.16representative, to serve as a representative in connection with the provision of services
265.17licensed under this chapter. This authorization must be in writing or by another method
265.18that clearly indicates the person's free choice. The authorized representative must have no
265.19financial interest in the provision of any services included in the person's service delivery
265.20plan and must be capable of providing the support necessary to assist the person in the use
265.21of home and community-based services licensed under this chapter.
265.22 Subd. 3. Case manager. "Case manager" means the individual designated
265.23to provide waiver case management services, care coordination, or long-term care
265.24consultation, as specified in sections
265.25or successor provisions.
265.26 Subd. 3a. Certification. "Certification" means the commissioner's written
265.27authorization for a license holder to provide specialized services based on certification
265.28standards in section 245D.33. The term certification and its derivatives have the same
265.29meaning and may be substituted for the term licensure and its derivatives in this chapter
265.30and chapter 245A.
265.31 Subd. 4. Commissioner. "Commissioner" means the commissioner of the
265.32Department of Human Services or the commissioner's designated representative.
265.33 Subd. 4a. Community residential setting. "Community residential setting" means
265.34a residential program as identified in section 245A.11, subdivision 8, where residential
265.35supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause
266.1(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant
266.2of the facility licensed according to this chapter, and the license holder does not reside
266.3in the facility.
266.4 Subd. 4b. Coordinated service and support plan. "Coordinated service and support
266.5plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision
266.66; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.
266.7 Subd. 4c. Coordinated service and support plan addendum. "Coordinated
266.8service and support plan addendum" means the documentation that this chapter requires
266.9of the license holder for each person receiving services.
266.10 Subd. 4d. Corporate foster care. "Corporate foster care" means a child foster
266.11residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340,
266.12or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to
266.139555.6265, where the license holder does not live in the home.
266.14 Subd. 4e. Cultural competence or culturally competent. "Cultural competence"
266.15or "culturally competent" means the ability and the will to respond to the unique needs of
266.16a person that arise from the person's culture and the ability to use the person's culture as a
266.17resource or tool to assist with the intervention and help meet the person's needs.
266.18 Subd. 4f. Day services facility. "Day services facility" means a facility licensed
266.19according to this chapter at which persons receive day services licensed under this chapter
266.20from the license holder's direct support staff for a cumulative total of more than 30 days
266.21within any 12-month period and the license holder is the owner, lessor, or tenant of the
266.22facility.
266.23 Subd. 5. Department. "Department" means the Department of Human Services.
266.24 Subd. 6. Direct contact. "Direct contact" has the meaning given in section
266.25subdivision 11
266.26 Subd. 6a. Direct support staff or staff. "Direct support staff" or "staff" means
266.27employees of the license holder who have direct contact with persons served by the
266.28program and includes temporary staff or subcontractors, regardless of employer, providing
266.29program services for hire under the control of the license holder who have direct contact
266.30with persons served by the program.
266.31 Subd. 7. Drug. "Drug" has the meaning given in section
266.32 Subd. 8. Emergency. "Emergency" means any event that affects the ordinary
266.33daily operation of the program including, but not limited to, fires, severe weather, natural
266.34disasters, power failures, or other events that threaten the immediate health and safety of
266.35a person receiving services and that require calling 911, emergency evacuation, moving
267.1to an emergency shelter, or temporary closure or relocation of the program to another
267.2facility or service site for more than 24 hours.
267.3 Subd. 8a. Emergency use of manual restraint. "Emergency use of manual
267.4restraint" means using a manual restraint when a person poses an imminent risk of
267.5physical harm to self or others and is the least restrictive intervention that would achieve
267.6safety. Property damage, verbal aggression, or a person's refusal to receive or participate
267.7in treatment or programming on their own, do not constitute an emergency.
267.8 Subd. 8b. Expanded support team. "Expanded support team" means the members
267.9of the support team defined in subdivision 46, and a licensed health or mental health
267.10professional or other licensed, certified, or qualified professionals or consultants working
267.11with the person and included in the team at the request of the person or the person's legal
267.12representative.
267.13 Subd. 8c. Family foster care. "Family foster care" means a child foster family
267.14setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult
267.15foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265,
267.16where the license holder lives in the home.
267.17 Subd. 9. Health services. "Health services" means any service or treatment
267.18consistent with the physical and mental health needs of the person, such as medication
267.19administration and monitoring, medical, dental, nutritional, health monitoring, wellness
267.20education, and exercise.
267.21 Subd. 10. Home and community-based services. "Home and community-based
267.22services" means the services
267.23245D.03, subdivision 1, and as defined in:
267.24(1) the
267.25title 42, sections 1396 et seq.,
267.26
267.27subdivision 11, including the brain injury (BI) waiver
267.28care (CAC) waiver
267.29waiver
267.30subdivision 5; the elderly waiver (EW)
267.31or successor plans respective to each waiver; or
267.32(2) the alternative care (AC) program under section 256B.0913.
267.33 Subd. 11. Incident. "Incident" means an occurrence
267.34a person and requires the program to make a response that is not a part of the program's
267.35 ordinary provision of services to
267.36(1) serious injury of a person as determined by section
268.1(2) a person's death;
268.2(3) any medical emergency, unexpected serious illness, or significant unexpected
268.3change in an illness or medical condition
268.4requires
268.5physician treatment, or hospitalization;
268.6(4) any mental health crisis that requires the program to call 911 or a mental health
268.7crisis intervention team;
268.8(5) an act or situation involving a person that requires the program to call 911,
268.9law enforcement, or the fire department;
268.10
268.11
268.12person receiving services that
268.13
268.14
268.15(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
268.16a person's opportunities to participate in or receive service or support;
268.17(ii) places the person in actual and reasonable fear of harm;
268.18(iii) places the person in actual and reasonable fear of damage to property of the
268.19person; or
268.20(iv) substantially disrupts the orderly operation of the program;
268.21
268.22coercion as defined under section
268.23(9) any emergency use of manual restraint as identified in section 245D.061; or
268.24
268.25under section
268.26 Subd. 11a. Intermediate care facility for persons with developmental disabilities
268.27or ICF/DD. "Intermediate care facility for persons with developmental disabilities" or
268.28"ICF/DD" means a residential program licensed to serve four or more persons with
268.29developmental disabilities under section 252.28 and chapter 245A and licensed as a
268.30supervised living facility under chapter 144, which together are certified by the Department
268.31of Health as an intermediate care facility for persons with developmental disabilities.
268.32 Subd. 11b. Least restrictive alternative. "Least restrictive alternative" means
268.33the alternative method for providing supports and services that is the least intrusive and
268.34most normalized given the level of supervision and protection required for the person.
268.35This level of supervision and protection allows risk taking to the extent that there is no
268.36reasonable likelihood that serious harm will happen to the person or others.
269.1 Subd. 12. Legal representative. "Legal representative" means the parent of a
269.2person who is under 18 years of age, a court-appointed guardian, or other representative
269.3with legal authority to make decisions about services for a person. Other representatives
269.4with legal authority to make decisions include but are not limited to a health care agent or
269.5an attorney-in-fact authorized through a health care directive or power of attorney.
269.6 Subd. 13. License. "License" has the meaning given in section
269.7subdivision 8
269.8 Subd. 14. Licensed health professional. "Licensed health professional" means a
269.9person licensed in Minnesota to practice those professions described in section
269.10subdivision 2
269.11 Subd. 15. License holder. "License holder" has the meaning given in section
269.13 Subd. 16. Medication. "Medication" means a prescription drug or over-the-counter
269.14drug. For purposes of this chapter, "medication" includes dietary supplements.
269.15
269.16
269.17
269.18
269.19
269.20
269.21
269.22
269.23
269.24
269.25
269.26
269.27
269.28
269.29
269.30
269.31
269.32
269.33
269.34
269.35
270.1
270.2
270.3
270.4
270.5
270.6
270.7
270.8
270.9
270.10
270.11
270.12
270.13
270.14
270.15
270.16 Subd. 20. Mental health crisis intervention team. "Mental health crisis
270.17intervention team" means a mental health crisis response
270.18in section
270.19subdivision 1
270.20 Subd. 20a. Most integrated setting. "Most integrated setting" means a setting that
270.21enables individuals with disabilities to interact with nondisabled persons to the fullest
270.22extent possible.
270.23 Subd. 21. Over-the-counter drug. "Over-the-counter drug" means a drug that
270.24is not required by federal law to bear the statement "Caution: Federal law prohibits
270.25dispensing without prescription."
270.26 Subd. 21a. Outcome. "Outcome" means the behavior, action, or status attained by
270.27the person that can be observed, measured, and determined reliable and valid.
270.28 Subd. 22. Person. "Person" has the meaning given in section
270.2911
270.30 Subd. 23. Person with a disability. "Person with a disability" means a person
270.31determined to have a disability by the commissioner's state medical review team as
270.32identified in section
270.33the person is determined to have a developmental disability as defined in Minnesota
270.34Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
271.1 Subd. 23a. Physician. "Physician" means a person who is licensed under chapter
271.2147.
271.3 Subd. 24. Prescriber. "Prescriber" means a
271.4
271.5151.01, subdivision 23; or
271.6
271.7 Subd. 25. Prescription drug. "Prescription drug" has the meaning given in section
271.9 Subd. 26. Program. "Program" means either the nonresidential or residential
271.10program as defined in section
271.11 Subd. 27. Psychotropic medication. "Psychotropic medication" means any
271.12medication prescribed to treat the symptoms of mental illness that affect thought processes,
271.13mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
271.14(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
271.15stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
271.16Other miscellaneous medications are considered to be a psychotropic medication when
271.17they are specifically prescribed to treat a mental illness or to control or alter behavior.
271.18 Subd. 28. Restraint. "Restraint" means physical or mechanical limiting of the free
271.19and normal movement of body or limbs.
271.20 Subd. 29. Seclusion. "Seclusion" means
271.21
271.22
271.23person or a mechanism such as a lock, a device, or an object positioned to hold the door
271.24closed or otherwise prevent the person from leaving the room.
271.25 Subd. 29a. Self-determination. "Self-determination" means the person makes
271.26decisions independently, plans for the person's own future, determines how money is spent
271.27for the person's supports, and takes responsibility for making these decisions. If a person
271.28has a legal representative, the legal representative's decision-making authority is limited to
271.29the scope of authority granted by the court or allowed in the document authorizing the
271.30legal representative to act.
271.31 Subd. 29b. Semi-independent living services. "Semi-independent living services"
271.32has the meaning given in section 252.275.
271.33 Subd. 30. Service. "Service" means care, training, supervision, counseling,
271.34consultation, or medication assistance assigned to the license holder in the coordinated
271.35service and support plan.
272.1
272.2
272.3
272.4
272.5
272.6
272.7 Subd. 32. Service site. "Service site" means the location where the service is
272.8provided to the person, including, but not limited to, a facility licensed according to
272.9chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's
272.10own home; or a community-based location.
272.11
272.12
272.13 Subd. 33a. Supervised living facility. "Supervised living facility" has the meaning
272.14given in Minnesota Rules, part 4665.0100, subpart 10.
272.15 Subd. 33b. Supervision. (a) "Supervision" means:
272.16(1) oversight by direct support staff as specified in the person's coordinated service
272.17and support plan or coordinated service and support plan addendum and awareness of
272.18the person's needs and activities;
272.19(2) responding to situations that present a serious risk to the health, safety, or rights
272.20of the person while services are being provided; and
272.21(3) the presence of direct support staff at a service site while services are being
272.22provided, unless a determination has been made and documented in the person's coordinated
272.23service and support plan or coordinated service and support plan addendum that the person
272.24does not require the presence of direct support staff while services are being provided.
272.25(b) For the purposes of this definition, "while services are being provided," means
272.26any period of time during which the license holder will seek reimbursement for services.
272.27 Subd. 34. Support team. "Support team" means the service planning team
272.28identified in section
272.29Minnesota Rules, part 9525.0004, subpart 14.
272.30 Subd. 34a. Time out. "Time out" means removing a person involuntarily from an
272.31ongoing activity to a room, either locked or unlocked, or otherwise separating a person
272.32from others in a way that prevents social contact and prevents the person from leaving
272.33the situation if the person chooses. For the purpose of chapter 245D, "time out" does
272.34not mean voluntary removal or self-removal for the purpose of calming, prevention of
272.35escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out"
272.36does not include a person voluntarily moving from an ongoing activity to an unlocked
273.1room or otherwise separating from a situation or social contact with others if the person
273.2chooses. For the purposes of this definition, "voluntarily" means without being forced,
273.3compelled, or coerced.
273.4
273.5
273.6
273.7 Subd. 35a. Treatment. "Treatment" means the provision of care, other than
273.8medications, ordered or prescribed by a licensed health or mental health professional,
273.9provided to a person to cure, rehabilitate, or ease symptoms.
273.10 Subd. 36. Volunteer. "Volunteer" means an individual who, under the direction of the
273.11license holder, provides direct services without pay to a person served by the license holder.
273.12EFFECTIVE DATE.This section is effective January 1, 2014.
273.13 Sec. 18. Minnesota Statutes 2012, section 245D.03, is amended to read:
273.14245D.03 APPLICABILITY AND EFFECT.
273.15 Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
273.16home and community-based services to persons with disabilities and persons age 65 and
273.17older pursuant to this chapter. The licensing standards in this chapter govern the provision
273.18of
273.19
273.20
273.21
273.22
273.23
273.24
273.25
273.26
273.27
273.28
273.29
273.30
273.31
273.32
273.33
273.34
274.1
274.2
274.3
274.4
274.5
274.6
274.7
274.8
274.9
274.10
274.11
274.12
274.13
274.14(b) Basic support services provide the level of assistance, supervision, and care that
274.15is necessary to ensure the health and safety of the person and do not include services that
274.16are specifically directed toward the training, treatment, habilitation, or rehabilitation of
274.17the person. Basic support services include:
274.18(1) in-home and out-of-home respite care services as defined in section 245A.02,
274.19subdivision 15, and under the brain injury, community alternative care, community
274.20alternatives for disabled individuals, developmental disability, and elderly waiver plans;
274.21(2) companion services as defined under the brain injury, community alternatives for
274.22disabled individuals, and elderly waiver plans, excluding companion services provided
274.23under the Corporation for National and Community Services Senior Companion Program
274.24established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
274.25(3) personal support as defined under the developmental disability waiver plan;
274.26(4) 24-hour emergency assistance, personal emergency response as defined under the
274.27community alternatives for disabled individuals and developmental disability waiver plans;
274.28(5) night supervision services as defined under the brain injury waiver plan; and
274.29(6) homemaker services as defined under the community alternatives for disabled
274.30individuals, brain injury, community alternative care, developmental disability, and elderly
274.31waiver plans, excluding providers licensed by the Department of Health under chapter
274.32144A and those providers providing cleaning services only.
274.33(c) Intensive support services provide assistance, supervision, and care that is
274.34necessary to ensure the health and safety of the person and services specifically directed
274.35toward the training, habilitation, or rehabilitation of the person. Intensive support services
274.36include:
275.1(1) intervention services, including:
275.2(i) behavioral support services as defined under the brain injury and community
275.3alternatives for disabled individuals waiver plans;
275.4(ii) in-home or out-of-home crisis respite services as defined under the developmental
275.5disability waiver plan; and
275.6(iii) specialist services as defined under the current developmental disability waiver
275.7plan;
275.8(2) in-home support services, including:
275.9(i) in-home family support and supported living services as defined under the
275.10developmental disability waiver plan;
275.11(ii) independent living services training as defined under the brain injury and
275.12community alternatives for disabled individuals waiver plans; and
275.13(iii) semi-independent living services;
275.14(3) residential supports and services, including:
275.15(i) supported living services as defined under the developmental disability waiver
275.16plan provided in a family or corporate child foster care residence, a family adult foster
275.17care residence, a community residential setting, or a supervised living facility;
275.18(ii) foster care services as defined in the brain injury, community alternative care,
275.19and community alternatives for disabled individuals waiver plans provided in a family or
275.20corporate child foster care residence, a family adult foster care residence, or a community
275.21residential setting; and
275.22(iii) residential services provided in a supervised living facility that is certified by
275.23the Department of Health as an ICF/DD;
275.24(4) day services, including:
275.25(i) structured day services as defined under the brain injury waiver plan;
275.26(ii) day training and habilitation services under sections 252.40 to 252.46, and as
275.27defined under the developmental disability waiver plan; and
275.28(iii) prevocational services as defined under the brain injury and community
275.29alternatives for disabled individuals waiver plans; and
275.30(5) supported employment as defined under the brain injury, developmental
275.31disability, and community alternatives for disabled individuals waiver plans.
275.32 Subd. 2. Relationship to other standards governing home and community-based
275.33services. (a) A license holder governed by this chapter is also subject to the licensure
275.34requirements under chapter 245A.
275.35(b)
275.36
276.1
276.2or family child foster care site controlled by a license holder and providing services
276.3governed by this chapter is exempt from compliance with section 245D.04. This exemption
276.4applies to foster care homes where at least one resident is receiving residential supports
276.5and services licensed according to this chapter. This chapter does not apply to corporate or
276.6family child foster care homes that do not provide services licensed under this chapter.
276.7(c) A family adult foster care site controlled by a license holder and providing
276.8services governed by this chapter is exempt from compliance with Minnesota Rules, parts
276.99555.6185; 9555.6225, subpart 8; 9555.6235, item C; 9555.6245; 9555.6255, subpart
276.102; and 9555.6265. These exemptions apply to family adult foster care homes where at
276.11least one resident is receiving residential supports and services licensed according to this
276.12chapter. This chapter does not apply to family adult foster care homes that do not provide
276.13services licensed under this chapter.
276.14(d) A license holder providing services licensed according to this chapter in a
276.15supervised living facility is exempt from compliance with sections 245D.04; 245D.05,
276.16subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).
276.17(e) A license holder providing residential services to persons in an ICF/DD is exempt
276.18from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
276.192, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
276.20subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
276.21
276.22
276.23
276.24144A is exempt from compliance with section
276.25
276.26
276.27
276.28
276.29
276.30
276.31
276.32
276.33
276.34
276.35
276.36
277.1(g) Nothing in this chapter prohibits a license holder from concurrently serving
277.2persons without disabilities or people who are or are not age 65 and older, provided this
277.3chapter's standards are met as well as other relevant standards.
277.4(h) The documentation required under sections 245D.07 and 245D.071 must meet
277.5the individual program plan requirements identified in section 256B.092 or successor
277.6provisions.
277.7 Subd. 3. Variance. If the conditions in section
277.8the commissioner may grant a variance to any of the requirements in this chapter, except
277.9sections
277.10paragraph (b), and 245D.061, subdivision 3, or provisions governing data practices and
277.11information rights of persons.
277.12
277.13
277.14
277.15
277.16
277.17
277.18
277.19
277.20
277.21 Subd. 4. Program certification. An applicant or a license holder may apply for
277.22program certification as identified in section 245D.33.
277.23EFFECTIVE DATE.This section is effective January 1, 2014.
277.24 Sec. 19. Minnesota Statutes 2012, section 245D.04, is amended to read:
277.25245D.04 SERVICE RECIPIENT RIGHTS.
277.26 Subdivision 1. License holder responsibility for individual rights of persons
277.27served by the program. The license holder must:
277.28(1) provide each person or each person's legal representative with a written notice
277.29that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
277.30those rights within five working days of service initiation and annually thereafter;
277.31(2) make reasonable accommodations to provide this information in other formats
277.32or languages as needed to facilitate understanding of the rights by the person and the
277.33person's legal representative, if any;
278.1(3) maintain documentation of the person's or the person's legal representative's
278.2receipt of a copy and an explanation of the rights; and
278.3(4) ensure the exercise and protection of the person's rights in the services provided
278.4by the license holder and as authorized in the coordinated service and support plan.
278.5 Subd. 2. Service-related rights. A person's service-related rights include the right to:
278.6(1) participate in the development and evaluation of the services provided to the
278.7person;
278.8(2) have services and supports identified in the coordinated service and support plan
278.9and the coordinated service and support plan addendum provided in a manner that respects
278.10and takes into consideration the person's preferences according to the requirements in
278.11sections 245D.07 and 245D.071;
278.12(3) refuse or terminate services and be informed of the consequences of refusing
278.13or terminating services;
278.14(4) know, in advance, limits to the services available from the license holder,
278.15including the license holder's knowledge, skill, and ability to meet the person's service and
278.16support needs based on the information required in section 245D.031, subdivision 2;
278.17(5) know conditions and terms governing the provision of services, including the
278.18license holder's admission criteria and policies and procedures related to temporary
278.19service suspension and service termination;
278.20(6) a coordinated transfer to ensure continuity of care when there will be a change
278.21in the provider;
278.22(7) know what the charges are for services, regardless of who will be paying for the
278.23services, and be notified of changes in those charges;
278.24
278.25funding, or other sources, and be told of any charges the person or other private party
278.26may have to pay; and
278.27
278.28professional certification or licensure, as required, and who meets additional qualifications
278.29identified in the person's coordinated service and support plan
278.30support plan addendum.
278.31 Subd. 3. Protection-related rights. (a) A person's protection-related rights include
278.32the right to:
278.33(1) have personal, financial, service, health, and medical information kept private,
278.34and be advised of disclosure of this information by the license holder;
278.35(2) access records and recorded information about the person in accordance with
278.36applicable state and federal law, regulation, or rule;
279.1(3) be free from maltreatment;
279.2(4) be free from restraint, time out, or seclusion
279.3for emergency use of manual restraint to protect the person from imminent danger to self
279.4or others according to the requirements in section 245D.06;
279.5(5) receive services in a clean and safe environment when the license holder is the
279.6owner, lessor, or tenant of the service site;
279.7(6) be treated with courtesy and respect and receive respectful treatment of the
279.8person's property;
279.9(7) reasonable observance of cultural and ethnic practice and religion;
279.10(8) be free from bias and harassment regarding race, gender, age, disability,
279.11spirituality, and sexual orientation;
279.12(9) be informed of and use the license holder's grievance policy and procedures,
279.13including knowing how to contact persons responsible for addressing problems and to
279.14appeal under section
279.15(10) know the name, telephone number, and the Web site, e-mail, and street
279.16addresses of protection and advocacy services, including the appropriate state-appointed
279.17ombudsman, and a brief description of how to file a complaint with these offices;
279.18(11) assert these rights personally, or have them asserted by the person's family,
279.19authorized representative, or legal representative, without retaliation;
279.20(12) give or withhold written informed consent to participate in any research or
279.21experimental treatment;
279.22(13) associate with other persons of the person's choice;
279.23(14) personal privacy; and
279.24(15) engage in chosen activities.
279.25(b) For a person residing in a residential site licensed according to chapter 245A,
279.26or where the license holder is the owner, lessor, or tenant of the residential service site,
279.27protection-related rights also include the right to:
279.28(1) have daily, private access to and use of a non-coin-operated telephone for local
279.29calls and long-distance calls made collect or paid for by the person;
279.30(2) receive and send, without interference, uncensored, unopened mail or electronic
279.31correspondence or communication;
279.32(3) have use of and free access to common areas in the residence; and
279.33(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
279.34advisor, or others, in accordance with section
279.35privacy in the person's bedroom.
280.1(c) Restriction of a person's rights under subdivision 2, clause (10), or paragraph (a),
280.2clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
280.3the health, safety, and well-being of the person. Any restriction of those rights must be
280.4documented in the person's coordinated service and support plan
280.5coordinated service and support plan addendum. The restriction must be implemented
280.6in the least restrictive alternative manner necessary to protect the person and provide
280.7support to reduce or eliminate the need for the restriction in the most integrated setting
280.8and inclusive manner. The documentation must include the following information:
280.9(1) the justification for the restriction based on an assessment of the person's
280.10vulnerability related to exercising the right without restriction;
280.11(2) the objective measures set as conditions for ending the restriction;
280.12(3) a schedule for reviewing the need for the restriction based on the conditions for
280.13ending the restriction to occur
280.14
280.15 semiannually from the date of initial approval, at a minimum, or more frequently if
280.16requested by the person, the person's legal representative, if any, and case manager; and
280.17(4) signed and dated approval for the restriction from the person, or the person's
280.18legal representative, if any. A restriction may be implemented only when the required
280.19approval has been obtained. Approval may be withdrawn at any time. If approval is
280.20withdrawn, the right must be immediately and fully restored.
280.21EFFECTIVE DATE.This section is effective January 1, 2014.
280.22 Sec. 20. Minnesota Statutes 2012, section 245D.05, is amended to read:
280.23245D.05 HEALTH SERVICES.
280.24 Subdivision 1. Health needs. (a) The license holder is responsible for
280.25 meeting health
280.26
280.27health needs. The license holder is responsible for promptly notifying
280.28 the person's legal representative, if any, and the case manager of changes in a person's
280.29physical and mental health needs affecting
280.30to the license holder in the coordinated service and support plan or the coordinated service
280.31and support plan addendum, when discovered by the license holder, unless the license
280.32holder has reason to know the change has already been reported. The license holder
280.33must document when the notice is provided.
281.1(b)
281.2health service needs has been assigned to the license holder in the coordinated service and
281.3support plan or the coordinated service and support plan addendum, the license holder
281.4
281.5including a description of the procedures the license holder will follow in order to:
281.6(1) provide medication
281.7
281.8(2) monitor health conditions according to written instructions from
281.9
281.10(3) assist with or coordinate medical, dental, and other health service appointments; or
281.11(4) use medical equipment, devices, or adaptive aides or technology safely and
281.12correctly according to written instructions from
281.13health professional.
281.14 Subd. 1a. Medication setup. For the purposes of this subdivision, "medication
281.15setup" means the arranging of medications according to instructions from the pharmacy,
281.16the prescriber, or a licensed nurse, for later administration when the license holder
281.17is assigned responsibility for medication assistance or medication administration in
281.18the coordinated service and support plan or the coordinated service and support plan
281.19addendum. A prescription label or the prescriber's written or electronically recorded order
281.20for the prescription is sufficient to constitute written instructions from the prescriber. The
281.21license holder must document in the person's medication administration record: dates
281.22of setup, name of medication, quantity of dose, times to be administered, and route of
281.23administration at time of setup; and, when the person will be away from home, to whom
281.24the medications were given.
281.25 Subd. 1b. Medication assistance. If responsibility for medication assistance
281.26is assigned to the license holder in the coordinated service and support plan or the
281.27coordinated service and support plan addendum, the license holder must ensure that
281.28the requirements of subdivision 2, paragraph (b), have been met when staff provides
281.29medication assistance to enable a person to self-administer medication or treatment when
281.30the person is capable of directing the person's own care, or when the person's legal
281.31representative is present and able to direct care for the person. For the purposes of this
281.32subdivision, "medication assistance" means any of the following:
281.33(1) bringing to the person and opening a container of previously set up medications,
281.34emptying the container into the person's hand, or opening and giving the medications in
281.35the original container to the person;
281.36(2) bringing to the person liquids or food to accompany the medication; or
282.1(3) providing reminders to take regularly scheduled medication or perform regularly
282.2scheduled treatments and exercises.
282.3 Subd. 2. Medication administration. (a) If responsibility for medication
282.4administration is assigned to the license holder in the coordinated service and support plan
282.5or the coordinated service and support plan addendum, the license holder must implement
282.6the following medication administration procedures to ensure a person takes medications
282.7and treatments as prescribed:
282.8(1) checking the person's medication record;
282.9(2) preparing the medication as necessary;
282.10(3) administering the medication or treatment to the person;
282.11(4) documenting the administration of the medication or treatment or the reason for
282.12not administering the medication or treatment; and
282.13(5) reporting to the prescriber or a nurse any concerns about the medication or
282.14treatment, including side effects, effectiveness, or a pattern of the person refusing to
282.15take the medication or treatment as prescribed. Adverse reactions must be immediately
282.16reported to the prescriber or a nurse.
282.17(b)(1) The license holder must ensure that the
282.18clauses (2) to (4) have been met before
282.19
282.20
282.21the person or the person's legal representative to administer medication or treatment
282.22
282.23legal representative refuses to authorize the license holder to administer medication, the
282.24medication must not be administered. The refusal to authorize medication administration
282.25must be reported to the prescriber as expediently as possible.
282.26
282.27or treatment must complete medication administration training according to section
282.29to the person, paragraph (d).
282.30
282.31
282.32
282.33
282.34
282.35
283.1(4) For a license holder providing intensive support services, the medication or
283.2treatment must be administered according to the license holder's medication administration
283.3policy and procedures as required under section 245D.11, subdivision 2, clause (3).
283.4
283.5the person's medication administration record:
283.6(1) the information on the current prescription label or the prescriber's current written
283.7or electronically recorded order or prescription that includes
283.8name, description of the medication or treatment to be provided, and the frequency and
283.9other information needed to safely and correctly
283.10or treatment to ensure effectiveness;
283.11(2) information on any
283.12expect, and any contraindications to its use. This information must be readily available
283.13to all staff administering the medication;
283.14(3) the possible consequences if the medication or treatment is not taken or
283.15administered as directed;
283.16(4) instruction
283.17(i) if
283.18performed as prescribed, whether by error by the staff or the person or by refusal by
283.19the person; and
283.20(ii) the occurrence of possible adverse reactions to the medication or treatment;
283.21(5) notation of any occurrence of a dose of medication not being administered or
283.22treatment not performed as prescribed, whether by error by the staff or the person or by
283.23refusal by the person, or of adverse reactions, and when and to whom the report was
283.24made; and
283.25(6) notation of when a medication or treatment is started, administered, changed, or
283.26discontinued.
283.27
283.28
283.29
283.30
283.31
283.32
283.33
283.34
283.35
283.36
284.1
284.2
284.3
284.4 Subd. 4. Reviewing and reporting medication and treatment issues.
284.5
284.6
284.7
284.8
284.9administration, the license holder must ensure that the information maintained in
284.10the medication administration record is current and is regularly reviewed to identify
284.11medication administration errors. At a minimum, the review must be conducted every
284.12three months, or more frequently as directed in the coordinated service and support plan
284.13or coordinated service and support plan addendum or as requested by the person or the
284.14person's legal representative. Based on the review, the license holder must develop and
284.15implement a plan to correct patterns of medication administration errors when identified.
284.16(b) If assigned responsibility for medication assistance or medication administration,
284.17the license holder must report the following to the person's legal representative and case
284.18manager as they occur or as otherwise directed in the coordinated service and support plan
284.19or the coordinated service and support plan addendum:
284.20(1) any reports made to the person's physician or prescriber required under
284.21subdivision 2, paragraph
284.22(2) a person's refusal or failure to take or receive medication or treatment as
284.23prescribed; or
284.24(3) concerns about a person's self-administration of medication or treatment.
284.25 Subd. 5. Injectable medications. Injectable medications may be administered
284.26according to a prescriber's order and written instructions when one of the following
284.27conditions has been met:
284.28(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
284.29intramuscular injection;
284.30(2) a supervising registered nurse with a physician's order has delegated the
284.31administration of subcutaneous injectable medication to an unlicensed staff member
284.32and has provided the necessary training; or
284.33(3) there is an agreement signed by the license holder, the prescriber, and the
284.34person or the person's legal representative specifying what subcutaneous injections may
284.35be given, when, how, and that the prescriber must retain responsibility for the license
285.1holder's giving the injections. A copy of the agreement must be placed in the person's
285.2service recipient record.
285.3Only licensed health professionals are allowed to administer psychotropic
285.4medications by injection.
285.5EFFECTIVE DATE.This section is effective January 1, 2014.
285.6 Sec. 21. [245D.051] PSYCHOTROPIC MEDICATION USE AND
285.7MONITORING.
285.8 Subdivision 1. Conditions for psychotropic medication administration. (a)
285.9When a person is prescribed a psychotropic medication and the license holder is assigned
285.10responsibility for administration of the medication in the person's coordinated service
285.11and support plan or the coordinated service and support plan addendum, the license
285.12holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
285.13subdivision 2, are met.
285.14(b) Use of the medication must be included in the person's coordinated service and
285.15support plan or in the coordinated service and support plan addendum and based on a
285.16prescriber's current written or electronically recorded prescription.
285.17(c) The license holder must develop, implement, and maintain the following
285.18documentation in the person's coordinated service and support plan addendum according
285.19to the requirements in sections 245D.07 and 245D.071:
285.20(1) a description of the target symptoms that the psychotropic medication is to
285.21alleviate; and
285.22(2) documentation methods the license holder will use to monitor and measure
285.23changes in the target symptoms that are to be alleviated by the psychotropic medication if
285.24required by the prescriber. The license holder must collect and report on medication and
285.25symptom-related data as instructed by the prescriber. The license holder must provide
285.26the monitoring data to the expanded support team for review every three months, or as
285.27otherwise requested by the person or the person's legal representative.
285.28For the purposes of this section, "target symptom" refers to any perceptible
285.29diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
285.30and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
285.31successive editions that has been identified for alleviation.
285.32(d) If a person is prescribed a psychotropic medication, monitoring the use of the
285.33psychotropic medication must be assigned to the license holder in the coordinated service
285.34and support plan or the coordinated service and support plan addendum. The assigned
285.35license holder must monitor the psychotropic medication as required by this section.
286.1 Subd. 2. Refusal to authorize psychotropic medication. If the person or the
286.2person's legal representative refuses to authorize the administration of a psychotropic
286.3medication as ordered by the prescriber, the license holder must follow the requirement
286.4in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
286.5to the prescriber, the license holder must follow any directives or orders given by the
286.6prescriber. A court order must be obtained to override the refusal. Refusal to authorize
286.7administration of a specific psychotropic medication is not grounds for service termination
286.8and does not constitute an emergency. A decision to terminate services must be reached in
286.9compliance with section 245D.10, subdivision 3.
286.10EFFECTIVE DATE.This section is effective January 1, 2014.
286.11 Sec. 22. Minnesota Statutes 2012, section 245D.06, is amended to read:
286.12245D.06 PROTECTION STANDARDS.
286.13 Subdivision 1. Incident response and reporting. (a) The license holder must
286.14respond to
286.15services to protect the health and safety of and minimize risk of harm to the person.
286.16(b) The license holder must maintain information about and report incidents to the
286.17person's legal representative or designated emergency contact and case manager within 24
286.18hours of an incident occurring while services are being provided,
286.19discovery or receipt of information that an incident occurred, unless the license holder
286.20has reason to know that the incident has already been reported, or as otherwise directed
286.21in a person's coordinated service and support plan or coordinated service and support
286.22plan addendum. An incident of suspected or alleged maltreatment must be reported as
286.23required under paragraph (d), and an incident of serious injury or death must be reported
286.24as required under paragraph (e).
286.25(c) When the incident involves more than one person, the license holder must not
286.26disclose personally identifiable information about any other person when making the report
286.27to each person and case manager unless the license holder has the consent of the person.
286.28(d) Within 24 hours of reporting maltreatment as required under section
286.29or
286.30reason to believe that the case manager is involved in the suspected maltreatment. The
286.31license holder must disclose the nature of the activity or occurrence reported and the
286.32agency that received the report.
286.33(e) The license holder must report the death or serious injury of the person
286.34
287.1of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
287.2and Developmental Disabilities as required under section
287.324 hours of the death, or receipt of information that the death occurred, unless the license
287.4holder has reason to know that the death has already been reported.
287.5(f) When a death or serious injury occurs in a facility certified as an intermediate
287.6care facility for persons with developmental disabilities, the death or serious injury must
287.7be reported to the Department of Health, Office of Health Facility Complaints, and the
287.8Office of Ombudsman for Mental Health and Developmental Disabilities, as required
287.9under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
287.10know that the death has already been reported.
287.11
287.12deaths and serious injuries that occurred while services were being provided and that
287.13were not reported by the program as alleged or suspected maltreatment, for identification
287.14of incident patterns, and implementation of corrective action as necessary to reduce
287.15occurrences. The review must include an evaluation of whether related policies and
287.16procedures were followed, whether the policies and procedures were adequate, whether
287.17there is a need for additional staff training, whether the reported event is similar to past
287.18events with the persons or the services involved, and whether there is a need for corrective
287.19action by the license holder to protect the health and safety of persons receiving services.
287.20Based on the results of this review, the license holder must develop, document, and
287.21implement a corrective action plan designed to correct current lapses and prevent future
287.22lapses in performance by staff or the license holder, if any.
287.23(h) The license holder must verbally report the emergency use of manual restraint of
287.24a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
287.25must ensure the written report and internal review of all incident reports of the emergency
287.26use of manual restraints are completed according to the requirements in section 245D.061.
287.27 Subd. 2. Environment and safety. The license holder must:
287.28(1) ensure the following when the license holder is the owner, lessor, or tenant
287.29of
287.30(i) the service site is a safe and hazard-free environment;
287.31(ii)
287.32inaccessible to persons served by the program
287.33
287.34for staff supervision or interactions with a person who is receiving services. If
287.35
287.36
288.1license holder must
288.2
288.3
288.4of the physical plant, its environment, and its population identifying the risk factors which
288.5require toxic substances or dangerous items to be inaccessible and a statement of specific
288.6measures to be taken to minimize the safety risk to persons receiving services;
288.7(iii) doors are locked from the inside to prevent a person from exiting only when
288.8necessary to protect the safety of a person receiving services and not as a substitute for
288.9staff supervision or interactions with the person. If doors are locked from the inside, the
288.10license holder must document an assessment of the physical plant, the environment and
288.11the population served, identifying the risk factors which require the use of locked doors,
288.12and a statement of specific measures to be taken to minimize the safety risk to persons
288.13receiving services at the service site; and
288.14
288.15required in a person's coordinated service and support plan or coordinated service and
288.16support plan addendum, cardiopulmonary resuscitation, whenever persons are present and
288.17staff are required to be at the site to provide direct service. The training must include
288.18in-person instruction, hands-on practice, and an observed skills assessment under the
288.19direct supervision of a first aid instructor;
288.20(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
288.21license holder in good condition when used to provide services;
288.22(3) follow procedures to ensure safe transportation, handling, and transfers of the
288.23person and any equipment used by the person, when the license holder is responsible for
288.24transportation of a person or a person's equipment;
288.25(4) be prepared for emergencies and follow emergency response procedures to
288.26ensure the person's safety in an emergency; and
288.27(5) follow universal precautions and sanitary practices, including hand washing, for
288.28infection prevention and control, and to prevent communicable diseases.
288.29
288.30
288.31
288.32
288.33
288.34 Subd. 4. Funds and property. (a) Whenever the license holder assists a person
288.35with the safekeeping of funds or other property according to section
288.3613
289.1the person's legal representative and the case manager. Authorization must be obtained
289.2within five working days of service initiation and renewed annually thereafter. At the time
289.3initial authorization is obtained, the license holder must survey, document, and implement
289.4the preferences of the person or the person's legal representative and the case manager
289.5for frequency of receiving a statement that itemizes receipts and disbursements of funds
289.6or other property. The license holder must document changes to these preferences when
289.7they are requested.
289.8(b) A license holder or staff person may not accept powers-of-attorney from a
289.9person receiving services from the license holder for any purpose
289.10
289.11
289.12units of government or to staff persons employed by license holders who were acting
289.13as
289.14prior to
289.15documentation of the power-of-attorney
289.16recipient record.
289.17(c) Upon the transfer or death of a person, any funds or other property of the person
289.18must be surrendered to the person or the person's legal representative, or given to the
289.19executor or administrator of the estate in exchange for an itemized receipt.
289.20 Subd. 5. Prohibitions. (a) The license holder is prohibited from using
289.21
289.22or seclusion as a substitute for adequate staffing, for a behavioral or therapeutic program
289.23to reduce or eliminate behavior, as punishment, or for staff convenience
289.24
289.25
289.26
289.27
289.28
289.29
289.30
289.31
289.32
289.33
289.34
289.35
289.36
290.1(b) For the purposes of this subdivision, "chemical restraint" means the
290.2administration of a drug or medication to control the person's behavior or restrict the
290.3person's freedom of movement and is not a standard treatment of dosage for the person's
290.4medical or psychological condition.
290.5(c) For the purposes of this subdivision, "mechanical restraint practice" means the
290.6use of any adaptive equipment or safety device to control the person's behavior or restrict
290.7the person's freedom of movement and not as ordered by a licensed health professional.
290.8Mechanical restraint practices include, but are not limited to, the use of bed rails or similar
290.9devices on a bed to prevent the person from getting out of bed, chairs that prevent a person
290.10from rising, or placing a person in a wheelchair so close to a wall that the wall prevents
290.11the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to
290.12warn staff that a person is leaving a room or area do not, in and of themselves, restrict
290.13freedom of movement and should not be considered restraints.
290.14(d) A license holder must not use manual restraints, time out, or seclusion under any
290.15circumstance, except for emergency use of manual restraints according to the requirements
290.16in section 245D.061 or the use of controlled procedures with a person with a developmental
290.17disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor
290.18provisions. License holders implementing nonemergency use of manual restraint, or any
290.19other programmatic use of mechanical restraint, time out, or seclusion with persons who
290.20do not have a developmental disability that is not subject to the requirements of Minnesota
290.21Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner
290.22for continued use of the procedure within three months of implementation of this chapter.
290.23EFFECTIVE DATE.This section is effective January 1, 2014.
290.24 Sec. 23. [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.
290.25 Subdivision 1. Standards for emergency use of manual restraints. Except
290.26for the emergency use of controlled procedures with a person with a developmental
290.27disability as governed by Minnesota Rules, part 9525.2770, or its successor provisions,
290.28the license holder must ensure that emergency use of manual restraints complies with the
290.29requirements of this chapter and the license holder's policy and procedures as required
290.30under subdivision 10.
290.31 Subd. 2. Definitions. (a) The terms used in this section have the meaning given
290.32them in this subdivision.
290.33(b) "Manual restraint" means physical intervention intended to hold a person
290.34immobile or limit a person's voluntary movement by using body contact as the only source
290.35of physical restraint.
291.1(c) "Mechanical restraint" means the use of devices, materials, or equipment attached
291.2or adjacent to the person's body, or the use of practices which restrict freedom of movement
291.3or normal access to one's body or body parts, or limits a person's voluntary movement
291.4or holds a person immobile as an intervention precipitated by a person's behavior. The
291.5term does apply to mechanical restraint used to prevent injury with persons who engage in
291.6self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue
291.7damage that have caused or could cause medical problems resulting from the self-injury.
291.8 Subd. 3. Conditions for emergency use of manual restraint. Emergency use of
291.9manual restraint must meet the following conditions:
291.10(1) immediate intervention must be needed to protect the person or others from
291.11imminent risk of physical harm; and
291.12(2) the type of manual restraint used must be the least restrictive intervention to
291.13eliminate the immediate risk of harm and effectively achieve safety. The manual restraint
291.14must end when the threat of harm ends.
291.15 Subd. 4. Permitted instructional techniques and therapeutic conduct. (a) Use of
291.16physical contact as therapeutic conduct or as an instructional technique as identified in
291.17paragraphs (b) and (c), is permitted and is not subject to the requirements of this section
291.18when such use is addressed in a person's coordinated service and support plan addendum
291.19and the required conditions have been met. For the purposes of this subdivision,
291.20"therapeutic conduct" has the meaning given in section 626.5572, subdivision 20.
291.21(b) Physical contact or instructional techniques must use the least restrictive
291.22alternative possible to meet the needs of the person and may be used:
291.23(1) to calm or comfort a person by holding that person with no resistance from
291.24that person;
291.25(2) to protect a person known to be at risk of injury due to frequent falls as a result of
291.26a medical condition; or
291.27(3) to position a person with physical disabilities in a manner specified in the
291.28person's coordinated service and support plan addendum.
291.29(c) Restraint may be used as therapeutic conduct:
291.30(1) to allow a licensed health care professional to safely conduct a medical
291.31examination or to provide medical treatment ordered by a licensed health care professional
291.32to a person necessary to promote healing or recovery from an acute, meaning short-term,
291.33medical condition;
291.34(2) to facilitate the person's completion of a task or response when the person does
291.35not resist or the person's resistance is minimal in intensity and duration;
292.1(3) to briefly block or redirect a person's limbs or body without holding the person
292.2or limiting the person's movement to interrupt the person's behavior that may result in
292.3injury to self or others; or
292.4(4) to assist in the safe evacuation of a person in the event of an emergency or to
292.5redirect a person who is at imminent risk of harm in a dangerous situation.
292.6(d) A plan for using restraint as therapeutic conduct must be developed according to
292.7the requirements in sections 245D.07 and 245D.071, and must include methods to reduce
292.8or eliminate the use of and need for restraint.
292.9 Subd. 5. Restrictions when implementing emergency use of manual restraint.
292.10(a) Emergency use of manual restraint procedures must not:
292.11(1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
292.12physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
292.13(2) be implemented with an adult in a manner that constitutes abuse or neglect as
292.14defined in section 626.5572, subdivisions 2 and 17;
292.15(3) be implemented in a manner that violates a person's rights and protections
292.16identified in section 245D.04;
292.17(4) restrict a person's normal access to a nutritious diet, drinking water, adequate
292.18ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
292.19conditions, or necessary clothing, or to any protection required by state licensing standards
292.20and federal regulations governing the program;
292.21(5) deny the person visitation or ordinary contact with legal counsel, a legal
292.22representative, or next of kin;
292.23(6) be used as a substitute for adequate staffing, for the convenience of staff, as
292.24punishment, or as a consequence if the person refuses to participate in the treatment
292.25or services provided by the program; or
292.26(7) use prone restraint. For the purposes of this section, "prone restraint" means use
292.27of manual restraint that places a person in a face-down position. This does not include
292.28brief physical holding of a person who, during an emergency use of manual restraint, rolls
292.29into a prone position, and the person is restored to a standing, sitting, or side-lying position
292.30as quickly as possible. Applying back or chest pressure while a person is in the prone or
292.31supine position or face-up is prohibited.
292.32 Subd. 6. Monitoring emergency use of manual restraint. The license holder shall
292.33monitor a person's health and safety during an emergency use of a manual restraint. Staff
292.34monitoring the procedure must not be the staff implementing the procedure when possible.
292.35The license holder shall complete a monitoring form, approved by the commissioner, for
292.36each incident involving the emergency use of a manual restraint.
293.1 Subd. 7. Reporting emergency use of manual restraint incident. (a) Within
293.2three calendar days after an emergency use of a manual restraint, the staff person who
293.3implemented the emergency use must report in writing to the designated coordinator the
293.4following information about the emergency use:
293.5(1) the staff and persons receiving services who were involved in the incident
293.6leading up to the emergency use of manual restraint;
293.7(2) a description of the physical and social environment, including who was present
293.8before and during the incident leading up to the emergency use of manual restraint;
293.9(3) a description of what less restrictive alternative measures were attempted to
293.10de-escalate the incident and maintain safety before the manual restraint was implemented
293.11that identifies when, how, and how long the alternative measures were attempted before
293.12manual restraint was implemented;
293.13(4) a description of the mental, physical, and emotional condition of the person who
293.14was restrained, and other persons involved in the incident leading up to, during, and
293.15following the manual restraint;
293.16(5) whether there was any injury to the person who was restrained or other persons
293.17involved in the incident, including staff, before or as a result of the use of manual
293.18restraint; and
293.19(6) whether there was an attempt to debrief with the staff, and, if not contraindicated,
293.20with the person who was restrained and other persons who were involved in or who
293.21witnessed the restraint, following the incident and the outcome of the debriefing. If the
293.22debriefing was not conducted at the time the incident report was made, the report should
293.23identify whether a debriefing is planned.
293.24(b) Each single incident of emergency use of manual restraint must be reported
293.25separately. For the purposes of this subdivision, an incident of emergency use of manual
293.26restraint is a single incident when the following conditions have been met:
293.27(1) after implementing the manual restraint, staff attempt to release the person at the
293.28moment staff believe the person's conduct no longer poses an imminent risk of physical
293.29harm to self or others and less restrictive strategies can be implemented to maintain safety;
293.30(2) upon the attempt to release the restraint, the person's behavior immediately
293.31re-escalates; and
293.32(3) staff must immediately reimplement the restraint in order to maintain safety.
293.33 Subd. 8. Internal review of emergency use of manual restraint. (a) Within five
293.34working days of the emergency use of manual restraint, the license holder must complete
293.35an internal review of each report of emergency use of manual restraint. The review must
293.36include an evaluation of whether:
294.1(1) the person's service and support strategies developed according to sections
294.2245D.07 and 245D.071 need to be revised;
294.3(2) related policies and procedures were followed;
294.4(3) the policies and procedures were adequate;
294.5(4) there is a need for additional staff training;
294.6(5) the reported event is similar to past events with the persons, staff, or the services
294.7involved; and
294.8(6) there is a need for corrective action by the license holder to protect the health
294.9and safety of persons.
294.10(b) Based on the results of the internal review, the license holder must develop,
294.11document, and implement a corrective action plan for the program designed to correct
294.12current lapses and prevent future lapses in performance by individuals or the license
294.13holder, if any. The corrective action plan, if any, must be implemented within 30 days of
294.14the internal review being completed.
294.15 Subd. 9. Expanded support team review. (a) Within five working days after the
294.16completion of the internal review required in subdivision 8, the license holder must consult
294.17with the expanded support team following the emergency use of manual restraint to:
294.18(1) discuss the incident reported in subdivision 7, to define the antecedent or event
294.19that gave rise to the behavior resulting in the manual restraint and identify the perceived
294.20function the behavior served; and
294.21(2) determine whether the person's coordinated service and support plan addendum
294.22needs to be revised according to sections 245D.07 and 245D.071 to positively and
294.23effectively help the person maintain stability and to reduce or eliminate future occurrences
294.24requiring emergency use of manual restraint.
294.25 Subd. 10. Emergency use of manual restraints policy and procedures. The
294.26license holder must develop, document, and implement a policy and procedures that
294.27promote service recipient rights and protect health and safety during the emergency use of
294.28manual restraints. The policy and procedures must comply with the requirements of this
294.29section and must specify the following:
294.30(1) a description of the positive support strategies and techniques staff must use to
294.31attempt to de-escalate a person's behavior before it poses an imminent risk of physical
294.32harm to self or others;
294.33(2) a description of the types of manual restraints the license holder allows staff to
294.34use on an emergency basis, if any. If the license holder will not allow the emergency use
294.35of manual restraint, the policy and procedure must identify the alternative measures the
295.1license holder will require staff to use when a person's conduct poses an imminent risk of
295.2physical harm to self or others and less restrictive strategies would not achieve safety;
295.3(3) instructions for safe and correct implementation of the allowed manual restraint
295.4procedures;
295.5(4) the training that staff must complete and the timelines for completion, before they
295.6may implement an emergency use of manual restraint. In addition to the training on this
295.7policy and procedure and the orientation and annual training required in section 245D.09,
295.8subdivision 4, the training for emergency use of manual restraint must incorporate the
295.9following subjects:
295.10(i) alternatives to manual restraint procedures, including techniques to identify
295.11events and environmental factors that may escalate conduct that poses an imminent risk of
295.12physical harm to self or others;
295.13(ii) de-escalation methods, positive support strategies, and how to avoid power
295.14struggles;
295.15(iii) simulated experiences of administering and receiving manual restraint
295.16procedures allowed by the license holder on an emergency basis;
295.17(iv) how to properly identify thresholds for implementing and ceasing restrictive
295.18procedures;
295.19(v) how to recognize, monitor, and respond to the person's physical signs of distress,
295.20including positional asphyxia;
295.21(vi) the physiological and psychological impact on the person and the staff when
295.22restrictive procedures are used;
295.23(vii) the communicative intent of behaviors; and
295.24(viii) relationship building;
295.25(5) the procedures and forms to be used to monitor the emergency use of manual
295.26restraints, including what must be monitored and the frequency of monitoring per
295.27each incident of emergency use of manual restraint, and the person or position who is
295.28responsible for monitoring the use;
295.29(6) the instructions, forms, and timelines required for completing and submitting an
295.30incident report by the person or persons who implemented the manual restraint; and
295.31(7) the procedures and timelines for conducting the internal review and the expanded
295.32support team review, and the person or position responsible for completing the reviews and
295.33who is responsible for ensuring that corrective action is taken or the person's coordinated
295.34service and support plan addendum is revised, when determined necessary.
295.35EFFECTIVE DATE.This section is effective January 1, 2014.
296.1 Sec. 24. Minnesota Statutes 2012, section 245D.07, is amended to read:
296.2245D.07 SERVICE
296.3 Subdivision 1. Provision of services. The license holder must provide services as
296.4
296.5
296.6the federal waiver plans.
296.7 Subd. 1a. Person-centered planning and service delivery. (a) The license holder
296.8must provide services in response to the person's identified needs, interests, preferences,
296.9and desired outcomes as specified in the coordinated service and support plan, the
296.10coordinated service and support plan addendum, and in compliance with the requirements
296.11of this chapter. License holders providing intensive support services must also provide
296.12outcome-based services according to the requirements in section 245D.071.
296.13(b) Services must be provided in a manner that supports the person's preferences,
296.14daily needs, and activities and accomplishment of the person's personal goals and service
296.15outcomes, consistent with the principles of:
296.16(1) person-centered service planning and delivery that:
296.17(i) identifies and supports what is important to the person as well as what is
296.18important for the person, including preferences for when, how, and by whom direct
296.19support service is provided;
296.20(ii) uses that information to identify outcomes the person desires; and
296.21(iii) respects each person's history, dignity, and cultural background;
296.22(2) self-determination that supports and provides:
296.23(i) opportunities for the development and exercise of functional and age-appropriate
296.24skills, decision making and choice, personal advocacy, and communication; and
296.25(ii) the affirmation and protection of each person's civil and legal rights;
296.26(3) providing the most integrated setting and inclusive service delivery that supports,
296.27promotes, and allows:
296.28(i) inclusion and participation in the person's community as desired by the person
296.29in a manner that enables the person to interact with nondisabled persons to the fullest
296.30extent possible and supports the person in developing and maintaining a role as a valued
296.31community member;
296.32(ii) opportunities for self-sufficiency as well as developing and maintaining social
296.33relationships and natural supports; and
296.34(iii) a balance between risk and opportunity, meaning the least restrictive supports or
296.35interventions necessary are provided in the most integrated settings in the most inclusive
297.1manner possible to support the person to engage in activities of the person's own choosing
297.2that may otherwise present a risk to the person's health, safety, or rights.
297.3 Subd. 2. Service planning requirements for basic support services. (a) License
297.4holders providing basic support services must meet the requirements of this subdivision.
297.5(b) Within 15 days of service initiation the license holder must complete a
297.6preliminary coordinated service and support plan addendum based on the coordinated
297.7service and support plan.
297.8(c) Within 60 days of service initiation the license holder must review and revise as
297.9needed the preliminary coordinated service and support plan addendum to document the
297.10services that will be provided including how, when, and by whom services will be provided,
297.11and the person responsible for overseeing the delivery and coordination of services.
297.12(d) The license holder must participate in service planning and support team
297.13meetings
297.14 coordinated service and support plan or as requested by
297.15the person's legal representative, the support team or the expanded support team.
297.16 Subd. 3. Reports. The license holder must provide written reports regarding the
297.17person's progress or status as requested by the person, the person's legal representative, the
297.18case manager, or the team.
297.19EFFECTIVE DATE.This section is effective January 1, 2014.
297.20 Sec. 25. [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE
297.21SUPPORT SERVICES.
297.22 Subdivision 1. Requirements for intensive support services. A license holder
297.23providing intensive support services identified in section 245D.03, subdivision 1,
297.24paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1
297.25and 3, and this section.
297.26 Subd. 2. Abuse prevention. Prior to or upon initiating services, the license holder
297.27must develop, document, and implement an abuse prevention plan according to section
297.28245A.65, subdivision 2.
297.29 Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
297.30initiation the license holder must complete a preliminary coordinated service and support
297.31plan addendum based on the coordinated service and support plan.
297.32(b) Within 45 days of service initiation the license holder must meet with the person,
297.33the person's legal representative, the case manager, and other members of the support team
297.34or expanded support team to assess and determine the following based on the person's
298.1coordinated service and support plan and the requirements in subdivision 4 and section
298.2245D.07, subdivision 1a:
298.3(1) the scope of the services to be provided to support the person's daily needs
298.4and activities;
298.5(2) the person's desired outcomes and the supports necessary to accomplish the
298.6person's desired outcomes;
298.7(3) the person's preferences for how services and supports are provided;
298.8(4) whether the current service setting is the most integrated setting available and
298.9appropriate for the person; and
298.10(5) how services must be coordinated across other providers licensed under this
298.11chapter serving the same person to ensure continuity of care for the person.
298.12(c) Within the scope of services, the license holder must, at a minimum, assess
298.13the following areas:
298.14(1) the person's ability to self-manage health and medical needs to maintain or
298.15improve physical, mental, and emotional well-being, including, when applicable, allergies,
298.16seizures, choking, special dietary needs, chronic medical conditions, self-administration
298.17of medication or treatment orders, preventative screening, and medical and dental
298.18appointments;
298.19(2) the person's ability to self-manage personal safety to avoid injury or accident in
298.20the service setting, including, when applicable, risk of falling, mobility, regulating water
298.21temperature, community survival skills, water safety skills, and sensory disabilities; and
298.22(3) the person's ability to self-manage symptoms or behavior that may otherwise
298.23result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
298.24(7), suspension or termination of services by the license holder, or other symptoms
298.25or behaviors that may jeopardize the health and safety of the person or others. The
298.26assessments must produce information about the person that is descriptive of the person's
298.27overall strengths, functional skills and abilities, and behaviors or symptoms.
298.28 Subd. 4. Service outcomes and supports. (a) Within ten working days of the
298.2945-day meeting, the license holder must develop and document the service outcomes and
298.30supports based on the assessments completed under subdivision 3 and the requirements
298.31in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
298.32coordinated service and support plan addendum.
298.33(b) The license holder must document the supports and methods to be implemented
298.34to support the accomplishment of outcomes related to acquiring, retaining, or improving
298.35skills. The documentation must include:
299.1(1) the methods or actions that will be used to support the person and to accomplish
299.2the service outcomes, including information about:
299.3(i) any changes or modifications to the physical and social environments necessary
299.4when the service supports are provided;
299.5(ii) any equipment and materials required; and
299.6(iii) techniques that are consistent with the person's communication mode and
299.7learning style;
299.8(2) the measurable and observable criteria for identifying when the desired outcome
299.9has been achieved and how data will be collected;
299.10(3) the projected starting date for implementing the supports and methods and
299.11the date by which progress towards accomplishing the outcomes will be reviewed and
299.12evaluated; and
299.13(4) the names of the staff or position responsible for implementing the supports
299.14and methods.
299.15(c) Within 20 working days of the 45-day meeting, the license holder must obtain
299.16dated signatures from the person or the person's legal representative and case manager
299.17to document completion and approval of the assessment and coordinated service and
299.18support plan addendum.
299.19 Subd. 5. Progress reviews. (a) The license holder must give the person or the
299.20person's legal representative and case manager an opportunity to participate in the ongoing
299.21review and development of the methods used to support the person and accomplish
299.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
299.23the person's support team or expanded support team, must meet with the person, the
299.24person's legal representative, and the case manager, and participate in progress review
299.25meetings following stated timelines established in the person's coordinated service and
299.26support plan or coordinated service and support plan addendum or within 30 days of a
299.27written request by the person, the person's legal representative, or the case manager,
299.28at a minimum of once per year.
299.29(b) The license holder must summarize the person's progress toward achieving the
299.30identified outcomes and make recommendations and identify the rationale for changing,
299.31continuing, or discontinuing implementation of supports and methods identified in
299.32subdivision 4 in a written report sent to the person or the person's legal representative
299.33and case manager five working days prior to the review meeting, unless the person, the
299.34person's legal representative, or the case manager request to receive the report at the
299.35time of the meeting.
300.1(c) Within ten working days of the progress review meeting, the license holder
300.2must obtain dated signatures from the person or the person's legal representative and
300.3the case manager to document approval of any changes to the coordinated service and
300.4support plan addendum.
300.5EFFECTIVE DATE.This section is effective January 1, 2014.
300.6 Sec. 26. [245D.081] PROGRAM COORDINATION, EVALUATION, AND
300.7OVERSIGHT.
300.8 Subdivision 1. Program coordination and evaluation. (a) The license holder
300.9is responsible for:
300.10(1) coordination of service delivery and evaluation for each person served by the
300.11program as identified in subdivision 2; and
300.12(2) program management and oversight that includes evaluation of the program
300.13quality and program improvement for services provided by the license holder as identified
300.14in subdivision 3.
300.15(b) The same person may perform the functions in paragraph (a) if the work and
300.16education qualifications are met in subdivisions 2 and 3.
300.17 Subd. 2. Coordination and evaluation of individual service delivery. (a) Delivery
300.18and evaluation of services provided by the license holder must be coordinated by a
300.19designated staff person. The designated coordinator must provide supervision, support,
300.20and evaluation of activities that include:
300.21(1) oversight of the license holder's responsibilities assigned in the person's
300.22coordinated service and support plan and the coordinated service and support plan
300.23addendum;
300.24(2) taking the action necessary to facilitate the accomplishment of the outcomes
300.25according to the requirements in section 245D.07;
300.26(3) instruction and assistance to direct support staff implementing the coordinated
300.27service and support plan and the service outcomes, including direct observation of service
300.28delivery sufficient to assess staff competency; and
300.29(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
300.30the person's outcomes based on the measurable and observable criteria for identifying when
300.31the desired outcome has been achieved according to the requirements in section 245D.07.
300.32(b) The license holder must ensure that the designated coordinator is competent to
300.33perform the required duties identified in paragraph (a) through education and training in
300.34human services and disability-related fields, and work experience in providing direct care
300.35services and supports to persons with disabilities. The designated coordinator must have
301.1the skills and ability necessary to develop effective plans and to design and use data
301.2systems to measure effectiveness of services and supports. The license holder must verify
301.3and document competence according to the requirements in section 245D.09, subdivision
301.43. The designated coordinator must minimally have:
301.5(1) a baccalaureate degree in a field related to human services, and one year of
301.6full-time work experience providing direct care services to persons with disabilities or
301.7persons age 65 and older;
301.8(2) an associate degree in a field related to human services, and two years of
301.9full-time work experience providing direct care services to persons with disabilities or
301.10persons age 65 and older;
301.11(3) a diploma in a field related to human services from an accredited postsecondary
301.12institution and three years of full-time work experience providing direct care services to
301.13persons with disabilities or persons age 65 and older; or
301.14(4) a minimum of 50 hours of education and training related to human services
301.15and disabilities, and
301.16four years of full-time work experience providing direct care services to persons
301.17with disabilities or persons age 65 and older under the supervision of a staff person who
301.18meets the qualifications identified in clauses (1) to (3).
301.19 Subd. 3. Program management and oversight. (a) The license holder must
301.20designate a managerial staff person or persons to provide program management and
301.21oversight of the services provided by the license holder. The designated manager is
301.22responsible for the following:
301.23(1) maintaining a current understanding of the licensing requirements sufficient to
301.24ensure compliance throughout the program as identified in section 245A.04, subdivision
301.251, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21,
301.26paragraph (b);
301.27(2) ensuring the duties of the designated coordinator are fulfilled according to the
301.28requirements in subdivision 2;
301.29(3) ensuring the program implements corrective action identified as necessary
301.30by the program following review of incident and emergency reports according to the
301.31requirements in section 245D.11, subdivision 2, clause (7). An internal review of
301.32incident reports of alleged or suspected maltreatment must be conducted according to the
301.33requirements in section 245A.65, subdivision 1, paragraph (b);
301.34(4) evaluation of satisfaction of persons served by the program, the person's legal
301.35representative, if any, and the case manager, with the service delivery and progress
302.1towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and
302.2ensuring and protecting each person's rights as identified in section 245D.04;
302.3(5) ensuring staff competency requirements are met according to the requirements in
302.4section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
302.5according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
302.6(6) ensuring corrective action is taken when ordered by the commissioner and that
302.7the terms and condition of the license and any variances are met; and
302.8(7) evaluating the information identified in clauses (1) to (6) to develop, document,
302.9and implement ongoing program improvements.
302.10(b) The designated manager must be competent to perform the duties as required and
302.11must minimally meet the education and training requirements identified in subdivision
302.122, paragraph (b), and have a minimum of three years of supervisory level experience in
302.13a program providing direct support services to persons with disabilities or persons age
302.1465 and older.
302.15EFFECTIVE DATE.This section is effective January 1, 2014.
302.16 Sec. 27. Minnesota Statutes 2012, section 245D.09, is amended to read:
302.17245D.09 STAFFING STANDARDS.
302.18 Subdivision 1. Staffing requirements. The license holder must provide the level of
302.19 direct service support staff
302.20(1) to ensure the health, safety, and protection of rights of each person; and
302.21(2) to be able to implement the responsibilities assigned to the license holder in each
302.22person's coordinated service and support plan or identified in the coordinated service and
302.23support plan addendum, according to the requirements of this chapter.
302.24 Subd. 2. Supervision of staff having direct contact. Except for a license holder
302.25who is the sole direct
302.26supervision of staff providing direct
302.27protection of rights of each person and implementation of the responsibilities assigned to
302.28the license holder in each person's
302.29coordinated service and support plan addendum.
302.30 Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
302.31direct support, or staff who have responsibilities related to supervising or managing the
302.32provision of direct support service, is competent as demonstrated through skills and
302.33knowledge training, experience, and education to meet the person's needs and additional
302.34requirements as written in the coordinated service and support plan or coordinated
303.1service and support plan addendum, or when otherwise required by the case manager or
303.2the federal waiver plan. The license holder must verify and maintain evidence of staff
303.3competency, including documentation of:
303.4(1) education and experience qualifications relevant to the job responsibilities
303.5assigned to the staff and the needs of the general population of persons served by the
303.6program, including a valid degree and transcript, or a current license, registration, or
303.7certification, when a degree or licensure, registration, or certification is required by this
303.8chapter or in the coordinated service and support plan or coordinated service and support
303.9plan addendum;
303.10(2)
303.11 areas required under this chapter,
303.12education required to maintain professional licensure, registration, or certification
303.13requirements. Competency in these areas is determined by the license holder through
303.14knowledge testing and observed skill assessment conducted by the trainer or instructor; and
303.15(3) except for a license holder who is the sole direct
303.16 performance evaluations completed by the license holder of the direct
303.17person's ability to perform the job functions based on direct observation.
303.18(b) Staff under 18 years of age may not perform overnight duties or administer
303.19medication.
303.20 Subd. 4. Orientation to program requirements.
303.21who does not supervise any direct
303.22
303.23and ensure completion of orientation for direct support staff that combines supervised
303.24on-the-job training with review of and instruction
303.25(1) the job description and how to complete specific job functions, including:
303.26(i) responding to and reporting incidents as required under section
303.27subdivision 1; and
303.28(ii) following safety practices established by the license holder and as required in
303.29section
303.30(2) the license holder's current policies and procedures required under this chapter,
303.31including their location and access, and staff responsibilities related to implementation
303.32of those policies and procedures;
303.33(3) data privacy requirements according to sections
303.34federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
303.35responsibilities related to complying with data privacy practices;
304.1(4) the service recipient rights
304.2related to ensuring the exercise and protection of those rights according to the requirements
304.3in section 245D.04;
304.4(5) sections
304.5reporting and service planning for children and vulnerable adults, and staff responsibilities
304.6related to protecting persons from maltreatment and reporting maltreatment. This
304.7orientation must be provided within 72 hours of first providing direct contact services and
304.8annually thereafter according to section 245A.65, subdivision 3;
304.9(6)
304.10
304.11person-centered service planning and delivery as identified in section 245D.07, subdivision
304.121a, and how they apply to direct support service provided by the staff person; and
304.13(7) other topics as determined necessary in the person's coordinated service and
304.14support plan by the case manager or other areas identified by the license holder.
304.15
304.16
304.17 Subd. 4a. Orientation to individual service recipient needs.
304.18
304.19program, or for whom the staff person has not previously provided direct
304.20or any time the plans or procedures identified in
304.21(f) are revised, the staff person must review and receive instruction on the
304.22
304.23functions for that person
304.24(b) Orientation training and competency evaluation of direct care staff in a program
304.25providing 24-hour care for a client with corporate supervision must be provided under
304.26the direction of a registered nurse. Training and competency evaluations must include
304.27the following:
304.28(1) documentation requirements for all services provided;
304.29(2) reports of changes in the client's condition to the supervisor designated by the
304.30home care provider;
304.31(3) basic infection control, including blood-borne pathogens;
304.32(4) maintenance of a clean and safe environment;
304.33(5) appropriate and safe techniques in personal hygiene and grooming, including
304.34hair care, bathing, care of teeth, gums, oral prosthetic devices, and other activities of
304.35daily living (ADLs);
305.1(6) an understanding of what constitutes a healthy diet according to data from the
305.2Centers for Disease Control and Prevention and the skills necessary to prepare that diet;
305.3(7) skills necessary to provide appropriate support in instrumental activities of
305.4daily living (IADLs); and
305.5(8) demonstrated competence in providing first aid.
305.6
305.7 coordinated service and support plan or coordinated service and support plan addendum as
305.8it relates to the responsibilities assigned to the license holder, and when applicable, the
305.9person's individual abuse prevention plan
305.10demonstrate an understanding of the person as a unique individual, and how to implement
305.11those plans
305.12
305.13administration procedures established for the person when medication administration is
305.14 assigned to the license holder according to section
305.15(b). Unlicensed staff may administer medications only after successful completion of a
305.16medication administration training, from a training curriculum developed by a registered
305.17nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
305.18practitioner, physician's assistant, or physician
305.19must incorporate an observed skill assessment conducted by the trainer to ensure staff
305.20demonstrate the ability to safely and correctly follow medication procedures.
305.21Medication administration must be taught by a registered nurse, clinical nurse
305.22specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
305.23service initiation or any time thereafter, the person has or develops a health care condition
305.24that affects the service options available to the person because the condition requires:
305.25
305.26
305.27health and safety needs of the person
305.28
305.29
305.30(e) The staff person must review and receive instruction on the safe and correct
305.31operation of medical equipment used by the person to sustain life, including but not
305.32limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
305.33by a licensed health care professional or a manufacturer's representative and incorporate
305.34an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
305.35operate the equipment according to the treatment orders and the manufacturer's instructions.
306.1(f) The staff person must review and receive instruction on what constitutes use of
306.2restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
306.3related to the prohibitions of their use according to the requirements in section 245D.06,
306.4subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
306.5or undesired behavior and why they are not safe, and the safe and correct use of manual
306.6restraint on an emergency basis according to the requirements in section 245D.061.
306.7(g) In the event of an emergency service initiation, the license holder must ensure
306.8the training required in this subdivision occurs within 72 hours of the direct support staff
306.9person first having unsupervised contact with the person receiving services. The license
306.10holder must document the reason for the unplanned or emergency service initiation and
306.11maintain the documentation in the person's service recipient record.
306.12(h) License holders who provide direct support services themselves must complete
306.13the orientation required in subdivision 4, clauses (3) to (7).
306.14 Subd. 5. Annual training.
306.15to direct
306.16 clauses (3) to
306.17corporate supervision must provide a minimum of 24 hours of annual training to direct
306.18service staff in topics described in subdivision 4, and subdivision 4a, paragraphs (a) to
306.19(h). Training on relevant topics received from sources other than the license holder may
306.20count toward training requirements.
306.21
306.22
306.23
306.24
306.25
306.26
306.27
306.28
306.29
306.30
306.31
306.32
306.33
306.34 Subd. 5a. Alternative sources of training. Orientation or training received by the
306.35staff person from sources other than the license holder in the same subjects as identified
306.36in subdivision 4 may count toward the orientation and annual training requirements if
307.1received in the 12-month period before the staff person's date of hire. The license holder
307.2must maintain documentation of the training received from other sources and of each staff
307.3person's competency in the required area according to the requirements in subdivision 3.
307.4 Subd. 6. Subcontractors and temporary staff. If the license holder uses a
307.5subcontractor or temporary staff to perform services licensed under this chapter on the
307.6license holder's behalf, the license holder must ensure that the subcontractor or temporary
307.7staff meets and maintains compliance with all requirements under this chapter that apply
307.8to the services to be provided, including training, orientation, and supervision necessary
307.9to fulfill their responsibilities. The license holder must ensure that a background study
307.10has been completed according to the requirements in sections 245C.03, subdivision 1,
307.11and 245C.04. Subcontractors and temporary staff hired by the license holder must meet
307.12the Minnesota licensing requirements applicable to the disciplines in which they are
307.13providing services. The license holder must maintain documentation that the applicable
307.14requirements have been met.
307.15 Subd. 7. Volunteers. The license holder must ensure that volunteers who provide
307.16direct support services to persons served by the program receive the training, orientation,
307.17and supervision necessary to fulfill their responsibilities. The license holder must ensure
307.18that a background study has been completed according to the requirements in sections
307.19245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation
307.20that the applicable requirements have been met.
307.21 Subd. 8. Staff orientation and training plan. The license holder must develop
307.22a staff orientation and training plan documenting when and how compliance with
307.23subdivisions 4, 4a, and 5 will be met.
307.24EFFECTIVE DATE.This section is effective January 1, 2014.
307.25 Sec. 28. [245D.091] INTERVENTION SERVICES.
307.26 Subdivision 1. Licensure requirements. An individual meeting the staff
307.27qualification requirements of this section who is an employee of a program licensed
307.28according to this chapter and providing behavioral support services, specialist services,
307.29or crisis respite services is not required to hold a separate license under this chapter.
307.30An individual meeting the staff qualifications of this section who is not providing these
307.31services as an employee of a program licensed according to this chapter must obtain a
307.32license according to this chapter.
307.33 Subd. 2. Behavior professional qualifications. A behavior professional, as defined
307.34in the brain injury and community alternatives for disabled individuals waiver plans or
307.35successor plans, must have competencies in areas related to:
308.1(1) ethical considerations;
308.2(2) functional assessment;
308.3(3) functional analysis;
308.4(4) measurement of behavior and interpretation of data;
308.5(5) selecting intervention outcomes and strategies;
308.6(6) behavior reduction and elimination strategies that promote least restrictive
308.7approved alternatives;
308.8(7) data collection;
308.9(8) staff and caregiver training;
308.10(9) support plan monitoring;
308.11(10) co-occurring mental disorders or neuro-cognitive disorder;
308.12(11) demonstrated expertise with populations being served; and
308.13(12) must be a:
308.14(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
308.15Board of Psychology competencies in the above identified areas;
308.16(ii) clinical social worker licensed as an independent clinical social worker under
308.17chapter 148D, or a person with a master's degree in social work from an accredited college
308.18or university, with at least 4,000 hours of post-master's supervised experience in the
308.19delivery of clinical services in the areas identified in clauses (1) to (11);
308.20(iii) physician licensed under chapter 147 and certified by the American Board
308.21of Psychiatry and Neurology or eligible for board certification in psychiatry with
308.22competencies in the areas identified in clauses (1) to (11);
308.23(iv) licensed professional clinical counselor licensed under sections 148B.29 to
308.24148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
308.25of clinical services who has demonstrated competencies in the areas identified in clauses
308.26(1) to (11);
308.27(v) person with a master's degree from an accredited college or university in one
308.28of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
308.29supervised experience in the delivery of clinical services with demonstrated competencies
308.30in the areas identified in clauses (1) to (11); or
308.31(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
308.32certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
308.33mental health nursing by a national nurse certification organization, or who has a master's
308.34degree in nursing or one of the behavioral sciences or related fields from an accredited
308.35college or university or its equivalent, with at least 4,000 hours of post-master's supervised
308.36experience in the delivery of clinical services.
309.1 Subd. 3. Behavior analyst qualifications. (a) A behavior analyst, as defined in
309.2the brain injury and community alternatives for disabled individuals waiver plans or
309.3successor plans, must:
309.4(1) have obtained a baccalaureate degree, master's degree, or a PhD in a social
309.5services discipline; or
309.6(2) meet the qualifications of a mental health practitioner as defined in section
309.7245.462, subdivision 17.
309.8(b) In addition, a behavior analyst must:
309.9(1) have four years of supervised experience working with individuals who exhibit
309.10challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;
309.11(2) have received ten hours of instruction in functional assessment and functional
309.12analysis;
309.13(3) have received 20 hours of instruction in the understanding of the function of
309.14behavior;
309.15(4) have received ten hours of instruction on design of positive practices behavior
309.16support strategies;
309.17(5) have received 20 hours of instruction on the use of behavior reduction approved
309.18strategies used only in combination with behavior positive practices strategies;
309.19(6) be determined by a behavior professional to have the training and prerequisite
309.20skills required to provide positive practice strategies as well as behavior reduction
309.21approved and permitted intervention to the person who receives behavioral support; and
309.22(7) be under the direct supervision of a behavior professional.
309.23 Subd. 4. Behavior specialist qualifications. (a) A behavior specialist, as defined
309.24in the brain injury and community alternatives for disabled individuals waiver plans or
309.25successor plans, must meet the following qualifications:
309.26(1) have an associate's degree in a social services discipline; or
309.27(2) have two years of supervised experience working with individuals who exhibit
309.28challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.
309.29(b) In addition, a behavior specialist must:
309.30(1) have received a minimum of four hours of training in functional assessment;
309.31(2) have received 20 hours of instruction in the understanding of the function of
309.32behavior;
309.33(3) have received ten hours of instruction on design of positive practices behavioral
309.34support strategies;
310.1(4) be determined by a behavior professional to have the training and prerequisite
310.2skills required to provide positive practices strategies as well as behavior reduction
310.3approved intervention to the person who receives behavioral support; and
310.4(5) be under the direct supervision of a behavior professional.
310.5 Subd. 5. Specialist services qualifications. An individual providing specialist
310.6services, as defined in the developmental disabilities waiver plan or successor plan, must
310.7have:
310.8(1) the specific experience and skills required of the specialist to meet the needs of
310.9the person identified by the person's service planning team; and
310.10(2) the qualifications of the specialist identified in the person's coordinated service
310.11and support plan.
310.12EFFECTIVE DATE.This section is effective January 1, 2014.
310.13 Sec. 29. [245D.095] RECORD REQUIREMENTS.
310.14 Subdivision 1. Record-keeping systems. The license holder must ensure that the
310.15content and format of service recipient, personnel, and program records are uniform and
310.16legible according to the requirements of this chapter.
310.17 Subd. 2. Admission and discharge register. The license holder must keep a written
310.18or electronic register, listing in chronological order the dates and names of all persons
310.19served by the program who have been admitted, discharged, or transferred, including
310.20service terminations initiated by the license holder and deaths.
310.21 Subd. 3. Service recipient record. (a) The license holder must maintain a record of
310.22current services provided to each person on the premises where the services are provided
310.23or coordinated. When the services are provided in a licensed facility, the records must
310.24be maintained at the facility, otherwise the records must be maintained at the license
310.25holder's program office. The license holder must protect service recipient records against
310.26loss, tampering, or unauthorized disclosure according to the requirements in sections
310.2713.01 to 13.10 and 13.46.
310.28(b) The license holder must maintain the following information for each person:
310.29(1) an admission form signed by the person or the person's legal representative
310.30that includes:
310.31(i) identifying information, including the person's name, date of birth, address,
310.32and telephone number; and
310.33(ii) the name, address, and telephone number of the person's legal representative, if
310.34any, and a primary emergency contact, the case manager, and family members or others as
310.35identified by the person or case manager;
311.1(2) service information, including service initiation information, verification of the
311.2person's eligibility for services, documentation verifying that services have been provided
311.3as identified in the coordinated service and support plan or coordinated service and support
311.4plan addendum according to paragraph (a), and date of admission or readmission;
311.5(3) health information, including medical history, special dietary needs, and
311.6allergies, and when the license holder is assigned responsibility for meeting the person's
311.7health service needs according to section 245D.05:
311.8(i) current orders for medication, treatments, or medical equipment and a signed
311.9authorization from the person or the person's legal representative to administer or assist in
311.10administering the medication or treatments, if applicable;
311.11(ii) a signed statement authorizing the license holder to act in a medical emergency
311.12when the person's legal representative, if any, cannot be reached or is delayed in arriving;
311.13(iii) medication administration procedures;
311.14(iv) a medication administration record documenting the implementation of the
311.15medication administration procedures, the medication administration record reviews, and
311.16including any agreements for administration of injectable medications by the license
311.17holder according to the requirements in section 245D.05; and
311.18(v) a medical appointment schedule when the license holder is assigned
311.19responsibility for assisting with medical appointments;
311.20(4) the person's current coordinated service and support plan or that portion of the
311.21plan assigned to the license holder;
311.22(5) copies of the individual abuse prevention plan and assessments as required under
311.23section 245D.071, subdivisions 2 and 3;
311.24(6) a record of other service providers serving the person when the person's
311.25coordinated service and support plan or coordinated service and support plan addendum
311.26identifies the need for coordination between the service providers, that includes a contact
311.27person and telephone numbers, services being provided, and names of staff responsible for
311.28coordination;
311.29(7) documentation of orientation to service recipient rights according to section
311.30245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
311.31section 245A.65, subdivision 1, paragraph (c);
311.32(8) copies of authorizations to handle a person's funds, according to section 245D.06,
311.33subdivision 4, paragraph (a);
311.34(9) documentation of complaints received and grievance resolution;
311.35(10) incident reports involving the person, required under section 245D.06,
311.36subdivision 1;
312.1(11) copies of written reports regarding the person's status when requested according
312.2to section 245D.07, subdivision 3, progress review reports as required under section
312.3245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
312.4and reports received from other agencies involved in providing services or care to the
312.5person; and
312.6(12) discharge summary, including service termination notice and related
312.7documentation, when applicable.
312.8 Subd. 4. Access to service recipient records. The license holder must ensure that
312.9the following people have access to the information in subdivision 1 in accordance with
312.10applicable state and federal law, regulation, or rule:
312.11(1) the person, the person's legal representative, and anyone properly authorized
312.12by the person;
312.13(2) the person's case manager;
312.14(3) staff providing services to the person unless the information is not relevant to
312.15carrying out the coordinated service and support plan or coordinated service and support
312.16plan addendum; and
312.17(4) the county child or adult foster care licensor, when services are also licensed as
312.18child or adult foster care.
312.19 Subd. 5. Personnel records. (a) The license holder must maintain a personnel
312.20record of each employee to document and verify staff qualifications, orientation, and
312.21training. The personnel record must include:
312.22(1) the employee's date of hire, completed application, an acknowledgement signed
312.23by the employee that job duties were reviewed with the employee and the employee
312.24understands those duties, and documentation that the employee meets the position
312.25requirements as determined by the license holder;
312.26 (2) documentation of staff qualifications, orientation, training, and performance
312.27evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
312.28the training was completed, the number of hours per subject area, and the name of the
312.29trainer or instructor; and
312.30(3) a completed background study as required under chapter 245C.
312.31(b) For employees hired after January 1, 2014, the license holder must maintain
312.32documentation in the personnel record or elsewhere, sufficient to determine the date of the
312.33employee's first supervised direct contact with a person served by the program, and the
312.34date of first unsupervised direct contact with a person served by the program.
312.35EFFECTIVE DATE.This section is effective January 1, 2014.
313.1 Sec. 30. Minnesota Statutes 2012, section 245D.10, is amended to read:
313.2245D.10 POLICIES AND PROCEDURES.
313.3 Subdivision 1. Policy and procedure requirements.
313.4 providing either basic or intensive supports and services must establish, enforce, and
313.5maintain policies and procedures as required in this chapter, chapter 245A, and other
313.6applicable state and federal laws and regulations governing the provision of home and
313.7community-based services licensed according to this chapter.
313.8 Subd. 2. Grievances. The license holder must establish policies and procedures
313.9that
313.10persons served by the program and their authorized representatives to bring a grievance that:
313.11(1) provides staff assistance with the complaint process when requested, and the
313.12addresses and telephone numbers of outside agencies to assist the person;
313.13(2) allows the person to bring the complaint to the highest level of authority in the
313.14program if the grievance cannot be resolved by other staff members, and that provides
313.15the name, address, and telephone number of that person;
313.16(3) requires the license holder to promptly respond to all complaints affecting a
313.17person's health and safety. For all other complaints, the license holder must provide an
313.18initial response within 14 calendar days of receipt of the complaint. All complaints must
313.19be resolved within 30 calendar days of receipt or the license holder must document the
313.20reason for the delay and a plan for resolution;
313.21(4) requires a complaint review that includes an evaluation of whether:
313.22(i) related policies and procedures were followed and adequate;
313.23(ii) there is a need for additional staff training;
313.24(iii) the complaint is similar to past complaints with the persons, staff, or services
313.25involved; and
313.26(iv) there is a need for corrective action by the license holder to protect the health
313.27and safety of persons receiving services;
313.28(5) based on the review in clause (4), requires the license holder to develop,
313.29document, and implement a corrective action plan designed to correct current lapses and
313.30prevent future lapses in performance by staff or the license holder, if any;
313.31(6) provides a written summary of the complaint and a notice of the complaint
313.32resolution to the person and case manager that:
313.33(i) identifies the nature of the complaint and the date it was received;
313.34(ii) includes the results of the complaint review;
313.35(iii) identifies the complaint resolution, including any corrective action; and
314.1(7) requires that the complaint summary and resolution notice be maintained in the
314.2service recipient record.
314.3 Subd. 3. Service suspension and service termination. (a) The license holder must
314.4establish policies and procedures for temporary service suspension and service termination
314.5that promote continuity of care and service coordination with the person and the case
314.6manager and with other licensed caregivers, if any, who also provide support to the person.
314.7(b) The policy must include the following requirements:
314.8(1) the license holder must notify the person or the person's legal representative and
314.9case manager in writing of the intended termination or temporary service suspension, and
314.10the person's right to seek a temporary order staying the termination of service according to
314.11the procedures in section
314.12(2) notice of the proposed termination of services, including those situations
314.13that began with a temporary service suspension, must be given at least 60 days before
314.14the proposed termination is to become effective when a license holder is providing
314.15
314.16
314.17subdivision 1, paragraph (c), and 30 days prior to termination for all other services
314.18licensed under this chapter;
314.19(3) the license holder must provide information requested by the person or case
314.20manager when services are temporarily suspended or upon notice of termination;
314.21(4) prior to giving notice of service termination or temporary service suspension,
314.22the license holder must document actions taken to minimize or eliminate the need for
314.23service suspension or termination;
314.24(5) during the temporary service suspension or service termination notice period,
314.25the license holder will work with the appropriate county agency to develop reasonable
314.26alternatives to protect the person and others;
314.27(6) the license holder must maintain information about the service suspension or
314.28termination, including the written termination notice, in the service recipient record; and
314.29(7) the license holder must restrict temporary service suspension to situations in
314.30which the person's
314.31
314.32and less restrictive or positive support strategies would not achieve safety.
314.33 Subd. 4. Availability of current written policies and procedures. (a) The license
314.34holder must review and update, as needed, the written policies and procedures required
314.35under this chapter.
315.1(b)(1) The license holder must inform the person and case manager of the policies
315.2and procedures affecting a person's rights under section
315.3those policies and procedures, within five working days of service initiation.
315.4(2) If a license holder only provides basic services and supports, this includes the:
315.5(i) grievance policy and procedure required under subdivision 2; and
315.6(ii) service suspension and termination policy and procedure required under
315.7subdivision 3.
315.8(3) For all other license holders this includes the:
315.9(i) policies and procedures in clause (2);
315.10(ii) emergency use of manual restraints policy and procedure required under
315.11subdivision 3a; and
315.12(iii) data privacy requirements under section 245D.11, subdivision 3.
315.13(c) The license holder must provide a written notice at least 30 days before
315.14implementing any
315.15 affecting a person's service-related or protection-related rights under section
315.16maltreatment reporting policies and procedures. The notice must explain the revision that
315.17was made and include a copy of the revised policy and procedure. The license holder
315.18must document the
315.19before implementing the revisions.
315.20(d) Before implementing revisions to required policies and procedures, the license
315.21holder must inform all employees of the revisions and provide training on implementation
315.22of the revised policies and procedures.
315.23(e) The license holder must annually notify all persons, or their legal representatives,
315.24and case managers of any procedural revisions to policies required under this chapter,
315.25other than those in paragraph (c). Upon request, the license holder must provide the
315.26person, or the person's legal representative, and case manager with copies of the revised
315.27policies and procedures.
315.28EFFECTIVE DATE.This section is effective January 1, 2014.
315.29 Sec. 31. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
315.30SERVICES.
315.31 Subdivision 1. Policy and procedure requirements. A license holder providing
315.32intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
315.33must establish, enforce, and maintain policies and procedures as required in this section.
315.34 Subd. 2. Health and safety. The license holder must establish policies and
315.35procedures that promote health and safety by ensuring:
316.1(1) use of universal precautions and sanitary practices in compliance with section
316.2245D.06, subdivision 2, clause (5);
316.3(2) if the license holder operates a residential program, health service coordination
316.4and care according to the requirements in section 245D.05, subdivision 1;
316.5(3) safe medication assistance and administration according to the requirements
316.6in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
316.7consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
316.8doctor and require completion of medication administration training according to the
316.9requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance
316.10and administration includes, but is not limited to:
316.11(i) providing medication-related services for a person;
316.12(ii) medication setup;
316.13(iii) medication administration;
316.14(iv) medication storage and security;
316.15(v) medication documentation and charting;
316.16(vi) verification and monitoring of effectiveness of systems to ensure safe medication
316.17handling and administration;
316.18(vii) coordination of medication refills;
316.19(viii) handling changes to prescriptions and implementation of those changes;
316.20(ix) communicating with the pharmacy; and
316.21(x) coordination and communication with prescriber;
316.22(4) safe transportation, when the license holder is responsible for transportation of
316.23persons, with provisions for handling emergency situations according to the requirements
316.24in section 245D.06, subdivision 2, clauses (2) to (4);
316.25(5) a plan for ensuring the safety of persons served by the program in emergencies as
316.26defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
316.27to the license holder. A license holder with a community residential setting or a day service
316.28facility license must ensure the policy and procedures comply with the requirements in
316.29section 245D.22, subdivision 4;
316.30(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
316.3111; and reporting all incidents required to be reported according to section 245D.06,
316.32subdivision 1. The plan must:
316.33(i) provide the contact information of a source of emergency medical care and
316.34transportation; and
317.1(ii) require staff to first call 911 when the staff believes a medical emergency may be
317.2life threatening, or to call the mental health crisis intervention team when the person is
317.3experiencing a mental health crisis; and
317.4(7) a procedure for the review of incidents and emergencies to identify trends or
317.5patterns, and corrective action if needed. The license holder must establish and maintain
317.6a record-keeping system for the incident and emergency reports. Each incident and
317.7emergency report file must contain a written summary of the incident. The license holder
317.8must conduct a review of incident reports for identification of incident patterns, and
317.9implementation of corrective action as necessary to reduce occurrences. Each incident
317.10report must include:
317.11(i) the name of the person or persons involved in the incident. It is not necessary
317.12to identify all persons affected by or involved in an emergency unless the emergency
317.13resulted in an incident;
317.14(ii) the date, time, and location of the incident or emergency;
317.15(iii) a description of the incident or emergency;
317.16(iv) a description of the response to the incident or emergency and whether a person's
317.17coordinated service and support plan addendum or program policies and procedures were
317.18implemented as applicable;
317.19(v) the name of the staff person or persons who responded to the incident or
317.20emergency; and
317.21(vi) the determination of whether corrective action is necessary based on the results
317.22of the review.
317.23 Subd. 3. Data privacy. The license holder must establish policies and procedures that
317.24promote service recipient rights by ensuring data privacy according to the requirements in:
317.25(1) the Minnesota Government Data Practices Act, section 13.46, and all other
317.26applicable Minnesota laws and rules in handling all data related to the services provided;
317.27and
317.28(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
317.29extent that the license holder performs a function or activity involving the use of protected
317.30health information as defined under Code of Federal Regulations, title 45, section 164.501,
317.31including, but not limited to, providing health care services; health care claims processing
317.32or administration; data analysis, processing, or administration; utilization review; quality
317.33assurance; billing; benefit management; practice management; repricing; or as otherwise
317.34provided by Code of Federal Regulations, title 45, section 160.103. The license holder
317.35must comply with the Health Insurance Portability and Accountability Act of 1996 and
318.1its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
318.2and all applicable requirements.
318.3 Subd. 4. Admission criteria. The license holder must establish policies and
318.4procedures that promote continuity of care by ensuring that admission or service initiation
318.5criteria:
318.6(1) is consistent with the license holder's registration information identified in the
318.7requirements in section 245D.031, subdivision 2, and with the service-related rights
318.8identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
318.9(2) identifies the criteria to be applied in determining whether the license holder
318.10can develop services to meet the needs specified in the person's coordinated service and
318.11support plan;
318.12(3) requires a license holder providing services in a health care facility to comply
318.13with the requirements in section 243.166, subdivision 4b, to provide notification to
318.14residents when a registered predatory offender is admitted into the program or to a
318.15potential admission when the facility was already serving a registered predatory offender.
318.16For purposes of this clause, "health care facility" means a facility licensed by the
318.17commissioner as a residential facility under chapter 245A to provide adult foster care or
318.18residential services to persons with disabilities; and
318.19(4) requires that when a person or the person's legal representative requests services
318.20from the license holder, a refusal to admit the person must be based on an evaluation of
318.21the person's assessed needs and the license holder's lack of capacity to meet the needs of
318.22the person. The license holder must not refuse to admit a person based solely on the
318.23type of residential services the person is receiving, or solely on the person's severity of
318.24disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
318.25communication skills, physical disabilities, toilet habits, behavioral disorders, or past
318.26failure to make progress. Documentation of the basis for refusal must be provided to the
318.27person or the person's legal representative and case manager upon request.
318.28EFFECTIVE DATE.This section is effective January 1, 2014.
318.29 Sec. 32. [245D.21] FACILITY LICENSURE REQUIREMENTS AND
318.30APPLICATION PROCESS.
318.31 Subdivision 1. Community residential settings and day service facilities. For
318.32purposes of this section, "facility" means both a community residential setting and day
318.33service facility and the physical plant.
318.34 Subd. 2. Inspections and code compliance. (a) Physical plants must comply with
318.35applicable state and local fire, health, building, and zoning codes.
319.1(b)(1) The facility must be inspected by a fire marshal or their delegate within
319.212 months before initial licensure to verify that it meets the applicable occupancy
319.3requirements as defined in the State Fire Code and that the facility complies with the fire
319.4safety standards for that occupancy code contained in the State Fire Code.
319.5(2) The fire marshal inspection of a community residential setting must verify the
319.6residence is a dwelling unit within a residential occupancy as defined in section 9.117 of
319.7the State Fire Code. A home safety checklist, approved by the commissioner, must be
319.8completed for a community residential setting by the license holder and the commissioner
319.9before the satellite license is reissued.
319.10(3) The facility shall be inspected according to the facility capacity specified on the
319.11initial application form.
319.12(4) If the commissioner has reasonable cause to believe that a potentially hazardous
319.13condition may be present or the licensed capacity is increased, the commissioner shall
319.14request a subsequent inspection and written report by a fire marshal to verify the absence
319.15of hazard.
319.16(5) Any condition cited by a fire marshal, building official, or health authority as
319.17hazardous or creating an immediate danger of fire or threat to health and safety must be
319.18corrected before a license is issued by the department, and for community residential
319.19settings, before a license is reissued.
319.20(c) The facility must maintain in a permanent file the reports of health, fire, and
319.21other safety inspections.
319.22(d) The facility's plumbing, ventilation, heating, cooling, lighting, and other
319.23fixtures and equipment, including elevators or food service, if provided, must conform to
319.24applicable health, sanitation, and safety codes and regulations.
319.25EFFECTIVE DATE.This section is effective January 1, 2014.
319.26 Sec. 33. [245D.22] FACILITY SANITATION AND HEALTH.
319.27 Subdivision 1. General maintenance. The license holder must maintain the interior
319.28and exterior of buildings, structures, or enclosures used by the facility, including walls,
319.29floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a
319.30sanitary and safe condition. The facility must be clean and free from accumulations of
319.31dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must
319.32correct building and equipment deterioration, safety hazards, and unsanitary conditions.
319.33 Subd. 2. Hazards and toxic substances. The license holder must ensure that
319.34service sites owned or leased by the license holder are free from hazards that would
320.1threaten the health or safety of a person receiving services by ensuring the requirements
320.2in paragraphs (a) to (g) are met.
320.3(a) Chemicals, detergents, and other hazardous or toxic substances must not be
320.4stored with food products or in any way that poses a hazard to persons receiving services.
320.5(b) The license holder must install handrails and nonslip surfaces on interior and
320.6exterior runways, stairways, and ramps according to the applicable building code.
320.7(c) If there are elevators in the facility, the license holder must have elevators
320.8inspected each year. The date of the inspection, any repairs needed, and the date the
320.9necessary repairs were made must be documented.
320.10(d) The license holder must keep stairways, ramps, and corridors free of obstructions.
320.11(e) Outside property must be free from debris and safety hazards. Exterior stairs and
320.12walkways must be kept free of ice and snow.
320.13(f) Heating, ventilation, air conditioning units, and other hot surfaces and moving
320.14parts of machinery must be shielded or enclosed.
320.15(g) Use of dangerous items or equipment by persons served by the program must be
320.16allowed in accordance with the person's coordinated service and support plan addendum
320.17or the program abuse prevention plan, if not addressed in the coordinated service and
320.18support plan addendum.
320.19 Subd. 3. Storage and disposal of medication. Schedule II controlled substances in
320.20the facility that are named in section 152.02, subdivision 3, must be stored in a locked
320.21storage area permitting access only by persons and staff authorized to administer the
320.22medication. This must be incorporated into the license holder's medication administration
320.23policy and procedures required under section 245D.11, subdivision 2, clause (3).
320.24Medications must be disposed of according to the Environmental Protection Agency
320.25recommendations.
320.26 Subd. 4. First aid must be available on site. (a) A staff person trained in first aid
320.27must be available on site and, when required in a person's coordinated service and support
320.28plan or coordinated service and support plan addendum, cardiopulmonary resuscitation,
320.29whenever persons are present and staff are required to be at the site to provide direct
320.30service. The training must include in-person instruction, hands-on practice, and an
320.31observed skills assessment under the direct supervision of a first aid instructor.
320.32(b) A facility must have first aid kits readily available for use by, and that meets
320.33the needs of, persons receiving services and staff. At a minimum, the first aid kit must
320.34be equipped with accessible first aid supplies including bandages, sterile compresses,
320.35scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
320.36adhesive tape, and first aid manual.
321.1 Subd. 5. Emergencies. (a) The license holder must have a written plan for
321.2responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the
321.3safety of persons served in the facility. The plan must include:
321.4(1) procedures for emergency evacuation and emergency sheltering, including:
321.5(i) how to report a fire or other emergency;
321.6(ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive
321.7procedures or equipment to assist with the safe evacuation of persons with physical or
321.8sensory disabilities; and
321.9(iii) instructions on closing off the fire area, using fire extinguishers, and activating
321.10and responding to alarm systems;
321.11(2) a floor plan that identifies:
321.12(i) the location of fire extinguishers;
321.13(ii) the location of audible or visual alarm systems, including but not limited to
321.14manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and
321.15sprinkler systems;
321.16(iii) the location of exits, primary and secondary evacuation routes, and accessible
321.17egress routes, if any; and
321.18(iv) the location of emergency shelter within the facility;
321.19(3) a site plan that identifies:
321.20(i) designated assembly points outside the facility;
321.21(ii) the locations of fire hydrants; and
321.22(iii) the routes of fire department access;
321.23(4) the responsibilities each staff person must assume in case of emergency;
321.24(5) procedures for conducting quarterly drills each year and recording the date of
321.25each drill in the file of emergency plans;
321.26(6) procedures for relocation or service suspension when services are interrupted
321.27for more than 24 hours;
321.28(7) for a community residential setting with three or more dwelling units, a floor
321.29plan that identifies the location of enclosed exit stairs; and
321.30(8) an emergency escape plan for each resident.
321.31(b) The license holder must:
321.32(1) maintain a log of quarterly fire drills on file in the facility;
321.33(2) provide an emergency response plan that is readily available to staff and persons
321.34receiving services;
322.1(3) inform each person of a designated area within the facility where the person
322.2should go to for emergency shelter during severe weather and the designated assembly
322.3points outside the facility; and
322.4(4) maintain emergency contact information for persons served at the facility that
322.5can be readily accessed in an emergency.
322.6 Subd. 6. Emergency equipment. The facility must have a flashlight and a portable
322.7radio or television set that do not require electricity and can be used if a power failure
322.8occurs.
322.9 Subd. 7. Telephone and posted numbers. A facility must have a non-coin operated
322.10telephone that is readily accessible. A list of emergency numbers must be posted in a
322.11prominent location. When an area has a 911 number or a mental health crisis intervention
322.12team number, both numbers must be posted and the emergency number listed must be
322.13911. In areas of the state without a 911 number, the numbers listed must be those of the
322.14local fire department, police department, emergency transportation, and poison control
322.15center. The names and telephone numbers of each person's representative, physician, and
322.16dentist must be readily available.
322.17EFFECTIVE DATE.This section is effective January 1, 2014.
322.18 Sec. 34. [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE
322.19LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
322.20 Subdivision 1. Separate satellite license required for separate sites. (a) A license
322.21holder providing residential support services must obtain a separate satellite license for
322.22each community residential setting located at separate addresses when the community
322.23residential settings are to be operated by the same license holder. For purposes of this
322.24chapter, a community residential setting is a satellite of the home and community-based
322.25services license.
322.26(b) Community residential settings are permitted single-family use homes. After a
322.27license has been issued, the commissioner shall notify the local municipality where the
322.28residence is located of the approved license.
322.29 Subd. 2. Notification to local agency. The license holder must notify the local
322.30agency within 24 hours of the onset of changes in a residence resulting from construction,
322.31remodeling, or damages requiring repairs that require a building permit or may affect a
322.32licensing requirement in this chapter.
322.33 Subd. 3. Alternate overnight supervision. A license holder granted an alternate
322.34overnight supervision technology adult foster care license according to section 245A.11,
323.1subdivision 7a, that converts to a community residential setting satellite license according
323.2to this chapter must retain that designation.
323.3EFFECTIVE DATE.This section is effective January 1, 2014.
323.4 Sec. 35. [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL
323.5PLANT AND ENVIRONMENT.
323.6 Subdivision 1. Occupancy. The residence must meet the definition of a dwelling
323.7unit in a residential occupancy.
323.8 Subd. 2. Common area requirements. The living area must be provided with an
323.9adequate number of furnishings for the usual functions of daily living and social activities.
323.10The dining area must be furnished to accommodate meals shared by all persons living in
323.11the residence. These furnishings must be in good repair and functional to meet the daily
323.12needs of the persons living in the residence.
323.13 Subd. 3. Bedrooms. (a) People receiving services must mutually consent, in
323.14writing, to sharing a bedroom with one another. No more than two people receiving
323.15services may share one bedroom.
323.16(b) A single occupancy bedroom must have at least 80 square feet of floor space with
323.17a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
323.18space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and
323.19other habitable rooms by floor to ceiling walls containing no openings except doorways
323.20and must not serve as a corridor to another room used in daily living.
323.21(c) A person's personal possessions and items for the person's own use are the only
323.22items permitted to be stored in a person's bedroom.
323.23(d) Unless otherwise documented through assessment as a safety concern for the
323.24person, each person must be provided with the following furnishings:
323.25(1) a separate bed of proper size and height for the convenience and comfort of the
323.26person, with a clean mattress in good repair;
323.27(2) clean bedding appropriate for the season for each person;
323.28(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
323.29possessions and clothing; and
323.30(4) a mirror for grooming.
323.31(e) When possible, a person must be allowed to have items of furniture that the
323.32person personally owns in the bedroom, unless doing so would interfere with safety
323.33precautions, violate a building or fire code, or interfere with another person's use of the
323.34bedroom. A person may choose to not have a cabinet, dresser, shelves, or a mirror in the
323.35bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may
324.1choose to use a mattress other than an innerspring mattress and may choose to not have
324.2the mattress on a mattress frame or support. If a person chooses not to have a piece of
324.3required furniture, the license holder must document this choice and is not required to
324.4provide the item. If a person chooses to use a mattress other than an innerspring mattress
324.5or chooses to not have a mattress frame or support, the license holder must document this
324.6choice and allow the alternative desired by the person.
324.7(f) A person must be allowed to bring personal possessions into the bedroom
324.8and other designated storage space, if such space is available, in the residence. The
324.9person must be allowed to accumulate possessions to the extent the residence is able to
324.10accommodate them, unless doing so is contraindicated for the person's physical or mental
324.11health, would interfere with safety precautions or another person's use of the bedroom, or
324.12would violate a building or fire code. The license holder must allow for locked storage
324.13of personal items. Any restriction on the possession or locked storage of personal items,
324.14including requiring a person to use a lock provided by the license holder, must comply
324.15with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if
324.16and when the license holder opens the lock.
324.17EFFECTIVE DATE.This section is effective January 1, 2014.
324.18 Sec. 36. [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND
324.19WATER.
324.20 Subdivision 1. Water. Potable water from privately owned wells must be tested
324.21annually by a Department of Health-certified laboratory for coliform bacteria and nitrate
324.22nitrogens to verify safety. The health authority may require retesting and corrective
324.23measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in
324.24the event of a flooding or incident which may put the well at risk of contamination. To
324.25prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
324.26 Subd. 2. Food. Food served must meet any special dietary needs of a person as
324.27prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day
324.28must be served or made available to persons, and nutritious snacks must be available
324.29between meals.
324.30 Subd. 3. Food safety. Food must be obtained, handled, and properly stored to
324.31prevent contamination, spoilage, or a threat to the health of a person.
324.32EFFECTIVE DATE.This section is effective January 1, 2014.
325.1 Sec. 37. [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION
325.2AND HEALTH.
325.3 Subdivision 1. Goods provided by the license holder. Individual clean bed linens
325.4appropriate for the season and the person's comfort, including towels and wash cloths,
325.5must be available for each person. Usual or customary goods for the operation of a
325.6residence which are communally used by all persons receiving services living in the
325.7residence must be provided by the license holder, including household items for meal
325.8preparation, cleaning supplies to maintain the cleanliness of the residence, window
325.9coverings on windows for privacy, toilet paper, and hand soap.
325.10 Subd. 2. Personal items. Personal health and hygiene items must be stored in a
325.11safe and sanitary manner.
325.12 Subd. 3. Pets and service animals. Pets and service animals housed within
325.13the residence must be immunized and maintained in good health as required by local
325.14ordinances and state law. The license holder must ensure that the person and the person's
325.15representative is notified before admission of the presence of pets in the residence.
325.16 Subd. 4. Smoking in the residence. License holders must comply with the
325.17requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when
325.18smoking is permitted in the residence.
325.19 Subd. 5. Weapons. Weapons and ammunition must be stored separately in locked
325.20areas that are inaccessible to a person receiving services. For purposes of this subdivision,
325.21"weapons" means firearms and other instruments or devices designed for and capable of
325.22producing bodily harm.
325.23EFFECTIVE DATE.This section is effective January 1, 2014.
325.24 Sec. 38. [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE
325.25REQUIREMENTS AND APPLICATION PROCESS.
325.26Except for day service facilities on the same or adjoining lot, the license holder
325.27providing day services must apply for a separate license for each facility-based service
325.28site when the license holder is the owner, lessor, or tenant of the service site at which
325.29persons receive day services and the license holder's employees who provide day services
325.30are present for a cumulative total of more than 30 days within any 12-month period. For
325.31purposes of this chapter, a day services facility license is a satellite license of the day
325.32services program. A day services program may operate multiple licensed day service
325.33facilities in one or more counties in the state. For the purposes of this section, "adjoining
325.34lot" means day services facilities that are next door to or across the street from one another.
326.1EFFECTIVE DATE.This section is effective January 1, 2014.
326.2 Sec. 39. [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND
326.3SPACE REQUIREMENTS.
326.4 Subdivision 1. Facility capacity and useable space requirements. (a) The facility
326.5capacity of each day service facility must be determined by the amount of primary space
326.6available, the scheduling of activities at other service sites, and the space requirements of
326.7all persons receiving services at the facility, not just the licensed services. The facility
326.8capacity must specify the maximum number of persons that may receive services on
326.9site at any one time.
326.10(b) When a facility is located in a multifunctional organization, the facility may
326.11share common space with the multifunctional organization if the required available
326.12primary space for use by persons receiving day services is maintained while the facility is
326.13operating. The license holder must comply at all times with all applicable fire and safety
326.14codes under section 245A.04, subdivision 2a, and adequate supervision requirements
326.15under section 245D.31 for all persons receiving day services.
326.16(c) A day services facility must have a minimum of 40 square feet of primary space
326.17available for each person who is present at the site at any one time. Primary space does
326.18not include:
326.19(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms,
326.20and kitchens;
326.21(2) floor areas beneath stationary equipment; or
326.22(3) any space occupied by persons associated with the multifunctional organization
326.23while persons receiving day services are using common space.
326.24 Subd. 2. Individual personal articles. Each person must be provided space in a
326.25closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own
326.26use while receiving services at the facility, unless doing so would interfere with safety
326.27precautions, another person's work space, or violate a building or fire code.
326.28EFFECTIVE DATE.This section is effective January 1, 2014.
326.29 Sec. 40. [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY
326.30REQUIREMENTS.
326.31 Subdivision 1. Refrigeration. If the license holder provides refrigeration at service
326.32sites owned or leased by the license holder for storing perishable foods and perishable
326.33portions of bag lunches, whether the foods are supplied by the license holder or the
327.1persons receiving services, the refrigeration must have a temperature of 40 degrees
327.2Fahrenheit or less.
327.3 Subd. 2. Drinking water. Drinking water must be available to all persons
327.4receiving services. If a person is unable to request or obtain drinking water, it must be
327.5provided according to that person's individual needs. Drinking water must be provided in
327.6single-service containers or from drinking fountains accessible to all persons.
327.7 Subd. 3. Individuals who become ill during the day. There must be an area in
327.8which a person receiving services can rest if:
327.9(1) the person becomes ill during the day;
327.10(2) the person does not live in a licensed residential site;
327.11(3) the person requires supervision; and
327.12(4) there is not a caretaker immediately available. Supervision must be provided
327.13until the caretaker arrives to bring the person home.
327.14 Subd. 4. Safety procedures. The license holder must establish general written
327.15safety procedures that include criteria for selecting, training, and supervising persons who
327.16work with hazardous machinery, tools, or substances. Safety procedures specific to each
327.17person's activities must be explained and be available in writing to all staff members
327.18and persons receiving services.
327.19EFFECTIVE DATE.This section is effective January 1, 2014.
327.20 Sec. 41. [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND
327.21FACILITY COVERAGE.
327.22 Subdivision 1. Scope. This section applies only to facility-based day services.
327.23 Subd. 2. Factors. (a) The number of direct support service staff members that a
327.24license holder must have on duty at the facility at a given time to meet the minimum
327.25staffing requirements established in this section varies according to:
327.26(1) the number of persons who are enrolled and receiving direct support services
327.27at that given time;
327.28(2) the staff ratio requirement established under subdivision 3 for each person who
327.29is present; and
327.30(3) whether the conditions described in subdivision 8 exist and warrant additional
327.31staffing beyond the number determined to be needed under subdivision 7.
327.32(b) The commissioner must consider the factors in paragraph (a) in determining a
327.33license holder's compliance with the staffing requirements and must further consider
327.34whether the staff ratio requirement established under subdivision 3 for each person
327.35receiving services accurately reflects the person's need for staff time.
328.1 Subd. 3. Staff ratio requirement for each person receiving services. The case
328.2manager, in consultation with the interdisciplinary team, must determine at least once each
328.3year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
328.4services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
328.5assigned each person and the documentation of how the ratio was arrived at must be kept
328.6in each person's individual service plan. Documentation must include an assessment of the
328.7person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
328.8assessment form required by the commissioner.
328.9 Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
328.10staff ratio requirement of one to four if:
328.11(1) on a daily basis the person requires total care and monitoring or constant
328.12hand-over-hand physical guidance to successfully complete at least three of the following
328.13activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
328.14taking appropriate action for self-preservation under emergency conditions; or
328.15(2) the person engages in conduct that poses an imminent risk of physical harm to
328.16self or others at a documented level of frequency, intensity, or duration requiring frequent
328.17daily ongoing intervention and monitoring as established in the person's coordinated
328.18service and support plan or coordinated service and support plan addendum.
328.19 Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
328.20staff ratio requirement of one to eight if:
328.21(1) the person does not meet the requirements in subdivision 4; and
328.22(2) on a daily basis the person requires verbal prompts or spot checks and minimal
328.23or no physical assistance to successfully complete at least four of the following activities:
328.24toileting, communicating basic needs, eating, ambulating, or taking appropriate action for
328.25self-preservation under emergency conditions.
328.26 Subd. 6. Person requiring staff ratio of one to six. A person who does not have
328.27any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio
328.28requirement of one to six.
328.29 Subd. 7. Determining number of direct support service staff required. The
328.30minimum number of direct support service staff members required at any one time to
328.31meet the combined staff ratio requirements of the persons present at that time can be
328.32determined by the following steps:
328.33(1) assign each person in attendance the three-digit decimal below that corresponds
328.34to the staff ratio requirement assigned to that person. A staff ratio requirement of one to
328.35four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio
328.36requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
329.1(2) add all of the three-digit decimals (one three-digit decimal for every person in
329.2attendance) assigned in clause (1);
329.3(3) when the sum in clause (2) falls between two whole numbers, round off the sum
329.4to the larger of the two whole numbers; and
329.5(4) the larger of the two whole numbers in clause (3) equals the number of direct
329.6support service staff members needed to meet the staff ratio requirements of the persons
329.7in attendance.
329.8 Subd. 8. Staff to be included in calculating minimum staffing requirement. Only
329.9direct support staff must be counted as staff members in calculating the staff to participant
329.10ratio. A volunteer may be counted as a direct support staff in calculating the staff to
329.11participant ratio if the volunteer meets the same standards and requirements as paid staff.
329.12No person receiving services must be counted as or be substituted for a staff member in
329.13calculating the staff to participant ratio.
329.14 Subd. 9. Conditions requiring additional direct support staff. The license holder
329.15must increase the number of direct support staff members present at any one time beyond
329.16the number arrived at in subdivision 4 if necessary when any one or combination of the
329.17following circumstances can be documented by the commissioner as existing:
329.18(1) the health and safety needs of the persons receiving services cannot be met by
329.19the number of staff members available under the staffing pattern in effect even though the
329.20number has been accurately calculated under subdivision 7; or
329.21(2) the person's conduct frequently presents an imminent risk of physical harm to
329.22self or others.
329.23 Subd. 10. Supervision requirements. (a) At no time must one direct support
329.24staff member be assigned responsibility for supervision and training of more than ten
329.25persons receiving supervision and training, except as otherwise stated in each person's risk
329.26management plan.
329.27(b) In the temporary absence of the director or a supervisor, a direct support staff
329.28member must be designated to supervise the center.
329.29 Subd. 11. Multifunctional programs. A multifunctional program may count other
329.30employees of the organization besides direct support staff of the day service facility in
329.31calculating the staff to participant ratio if the employee is assigned to the day services
329.32facility for a specified amount of time, during which the employee is not assigned to
329.33another organization or program.
329.34EFFECTIVE DATE.This section is effective January 1, 2014.
329.35 Sec. 42. [245D.32] ALTERNATIVE LICENSING INSPECTIONS.
330.1 Subdivision 1. Eligibility for an alternative licensing inspection. (a) A license
330.2holder providing services licensed under this chapter, with a qualifying accreditation and
330.3meeting the eligibility criteria in paragraphs (b) and (c) may request approval for an
330.4alternative licensing inspection when all services provided under the license holder's
330.5license are accredited. A license holder with a qualifying accreditation and meeting
330.6the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative
330.7licensing inspection for individual community residential settings or day services facilities
330.8licensed under this chapter.
330.9(b) In order to be eligible for an alternative licensing inspection, the program must
330.10have had at least one inspection by the commissioner following issuance of the initial
330.11license. For programs operating a day services facility, each facility must have had at least
330.12one on-site inspection by the commissioner following issuance of the initial license.
330.13(c) In order to be eligible for an alternative licensing inspection, the program must
330.14have been in "substantial and consistent compliance" at the time of the last licensing
330.15inspection and during the current licensing period. For purposes of this section, substantial
330.16and consistent compliance means:
330.17(1) the license holder's license was not made conditional, suspended, or revoked;
330.18(2) there have been no substantiated allegations of maltreatment against the license
330.19holder;
330.20(3) there were no program deficiencies identified that would jeopardize the health,
330.21safety, or rights of persons being served; and
330.22(4) the license holder maintained substantial compliance with the other requirements
330.23of chapters 245A and 245C and other applicable laws and rules.
330.24(d) For the purposes of this section, the license holder's license includes services
330.25licensed under this chapter that were previously licensed under chapter 245B until
330.26December 31, 2013.
330.27 Subd. 2. Qualifying accreditation. The commissioner must accept a three-year
330.28accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF)
330.29as a qualifying accreditation.
330.30 Subd. 3. Request for approval of an alternative inspection status. (a) A request
330.31for an alternative inspection must be made on the forms and in the manner prescribed
330.32by the commissioner. When submitting the request, the license holder must submit all
330.33documentation issued by the accrediting body verifying that the license holder has obtained
330.34and maintained the qualifying accreditation and has complied with recommendations
330.35or requirements from the accrediting body during the period of accreditation. Based
331.1on the request and the additional required materials, the commissioner may approve
331.2an alternative inspection status.
331.3(b) The commissioner must notify the license holder in writing that the request for
331.4an alternative inspection status has been approved. Approval must be granted until the
331.5end of the qualifying accreditation period.
331.6(c) The license holder must submit a written request for approval to be renewed
331.7one month before the end of the current approval period according to the requirements
331.8in paragraph (a). If the license holder does not submit a request to renew approval as
331.9required, the commissioner must conduct a licensing inspection.
331.10 Subd. 4. Programs approved for alternative licensing inspection; deemed
331.11compliance licensing requirements. (a) A license holder approved for alternative
331.12licensing inspection under this section is required to maintain compliance with all
331.13licensing standards according to this chapter.
331.14(b) A license holder approved for alternative licensing inspection under this section
331.15must be deemed to be in compliance with all the requirements of this chapter, and the
331.16commissioner must not perform routine licensing inspections.
331.17(c) Upon receipt of a complaint regarding the services of a license holder approved
331.18for alternative licensing inspection under this section, the commissioner must investigate
331.19the complaint and may take any action as provided under section 245A.06 or 245A.07.
331.20 Subd. 5. Investigations of alleged or suspected maltreatment. Nothing in this
331.21section changes the commissioner's responsibilities to investigate alleged or suspected
331.22maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
331.23 Subd. 6. Termination or denial of subsequent approval. Following approval of
331.24an alternative licensing inspection, the commissioner may terminate or deny subsequent
331.25approval of an alternative licensing inspection if the commissioner determines that:
331.26(1) the license holder has not maintained the qualifying accreditation;
331.27(2) the commissioner has substantiated maltreatment for which the license holder or
331.28facility is determined to be responsible during the qualifying accreditation period; or
331.29(3) during the qualifying accreditation period, the license holder has been issued
331.30an order for conditional license, fine, suspension, or license revocation that has not been
331.31reversed upon appeal.
331.32 Subd. 7. Appeals. The commissioner's decision that the conditions for approval for
331.33an alternative licensing inspection have not been met is final and not subject to appeal
331.34under the provisions of chapter 14.
332.1 Subd. 8. Commissioner's programs. Home and community-based services licensed
332.2under this chapter for which the commissioner is the license holder with a qualifying
332.3accreditation are excluded from being approved for an alternative licensing inspection.
332.4EFFECTIVE DATE.This section is effective January 1, 2014.
332.5 Sec. 43. [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
332.6(a) The commissioner of human services shall issue a mental health certification
332.7for services licensed under this chapter, when a license holder is determined to have met
332.8the requirements under paragraph (b). This certification is voluntary for license holders.
332.9The certification shall be printed on the license and identified on the commissioner's
332.10public Web site.
332.11(b) The requirements for certification are:
332.12(1) all staff have received at least seven hours of annual training covering all of
332.13the following topics:
332.14(i) mental health diagnoses;
332.15(ii) mental health crisis response and de-escalation techniques;
332.16(iii) recovery from mental illness;
332.17(iv) treatment options, including evidence-based practices;
332.18(v) medications and their side effects;
332.19(vi) co-occurring substance abuse and health conditions; and
332.20(vii) community resources;
332.21(2) a mental health professional, as defined in section 245.462, subdivision 18, or a
332.22mental health practitioner as defined in section 245.462, subdivision 17, is available
332.23for consultation and assistance;
332.24(3) there is a plan and protocol in place to address a mental health crisis; and
332.25(4) each person's individual service and support plan identifies who is providing
332.26clinical services and their contact information, and includes an individual crisis prevention
332.27and management plan developed with the person.
332.28(c) License holders seeking certification under this section must request this
332.29certification on forms and in the manner prescribed by the commissioner.
332.30(d) If the commissioner finds that the license holder has failed to comply with the
332.31certification requirements under paragraph (b), the commissioner may issue a correction
332.32order and an order of conditional license in accordance with section 245A.06 or may
332.33issue a sanction in accordance with section 245A.07, including and up to removal of
332.34the certification.
333.1(e) A denial of the certification or the removal of the certification based on a
333.2determination that the requirements under paragraph (b) have not been met is not subject to
333.3appeal. A license holder that has been denied a certification or that has had a certification
333.4removed may again request certification when the license holder is in compliance with the
333.5requirements of paragraph (b).
333.6EFFECTIVE DATE.This section is effective January 1, 2014.
333.7 Sec. 44. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
333.8 Subd. 11. Residential support services. (a) Upon federal approval, there is
333.9established a new service called residential support that is available on the community
333.10alternative care, community alternatives for disabled individuals, developmental
333.11disabilities, and brain injury waivers. Existing waiver service descriptions must be
333.12modified to the extent necessary to ensure there is no duplication between other services.
333.13Residential support services must be provided by vendors licensed as a community
333.14residential setting as defined in section
333.15licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care
333.16setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265.
333.17 (b) Residential support services must meet the following criteria:
333.18
333.19
333.20
333.21 responsible for program management, oversight, development, and implementation of
333.22policies and procedures;
333.23
333.24and assistance as described in the person's coordinated service and support plan; and
333.25
333.26licensure and additional requirements of the person's coordinated service and support plan.
333.27 (c) Providers of residential support services that meet the definition in paragraph (a)
333.28
333.29 must be licensed according to chapter 245D. Providers licensed to provide child foster care
333.30under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
333.31Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section
333.33 Sec. 45. Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:
334.1 Subdivision 1. Provider qualifications. (a) For the home and community-based
334.2waivers providing services to seniors and individuals with disabilities under sections
334.3256B.0913, 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
334.4(1) agreements with enrolled waiver service providers to ensure providers meet
334.5Minnesota health care program requirements;
334.6(2) regular reviews of provider qualifications, and including requests of proof of
334.7documentation; and
334.8(3) processes to gather the necessary information to determine provider qualifications.
334.9 (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
334.11must meet the requirements of chapter 245C prior to providing waiver services and as
334.12part of ongoing enrollment. Upon federal approval, this requirement must also apply to
334.13consumer-directed community supports.
334.14 (c) Beginning January 1, 2014, service owners and managerial officials overseeing
334.15the management or policies of services that provide direct contact as specified in the
334.16federally approved waiver plans must meet the requirements of chapter 245C prior to
334.17reenrollment or, for new providers, prior to initial enrollment if they have not already done
334.18so as a part of service licensure requirements.
334.19 Sec. 46. Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:
334.20 Subd. 7. Applicant and license holder training. An applicant or license holder
334.21for the home and community-based waivers providing services to seniors and individuals
334.22with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 that is
334.23not enrolled as a Minnesota health care program home and community-based services
334.24waiver provider at the time of application must ensure that at least one controlling
334.25individual completes a onetime training on the requirements for providing home and
334.26community-based services
334.27before a provider is enrolled or license is issued. Within six months of enrollment, a newly
334.28enrolled home and community-based waiver service provider must ensure that at least one
334.29controlling individual has completed training on waiver and related program billing.
334.30 Sec. 47. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
334.31subdivision to read:
334.32 Subd. 8. Data on use of emergency use of manual restraint. Beginning July 1,
334.332013, facilities and services to be licensed under chapter 245D shall submit data regarding
335.1the use of emergency use of manual restraint as identified in section 245D.061 in a format
335.2and at a frequency identified by the commissioner.
335.3 Sec. 48. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
335.4subdivision to read:
335.5 Subd. 9. Definitions. (a) For the purposes of this section the following terms have
335.6the meanings given them.
335.7(b) "Controlling individual" means a public body, governmental agency, business
335.8entity, officer, owner, or managerial official whose responsibilities include the direction of
335.9the management or policies of a program.
335.10(c) "Managerial official" means an individual who has decision-making authority
335.11related to the operation of the program and responsibility for the ongoing management of
335.12or direction of the policies, services, or employees of the program.
335.13(d) "Owner" means an individual who has direct or indirect ownership interest in
335.14a corporation or partnership, or business association enrolling with the Department of
335.15Human Services as a provider of waiver services.
335.16 Sec. 49. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
335.17subdivision to read:
335.18 Subd. 10. Enrollment requirements. All home and community-based waiver
335.19providers must provide, at the time of enrollment and within 30 days of a request, in a
335.20format determined by the commissioner, information and documentation that includes, but
335.21is not limited to, the following:
335.22(1) proof of surety bond coverage in the amount of $50,000 or ten percent of the
335.23provider's payments from Medicaid in the previous calendar year, whichever is greater;
335.24(2) proof of fidelity bond coverage in the amount of $20,000; and
335.25(3) proof of liability insurance.
335.26 Sec. 50. Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:
335.27 Subd. 9a. Evaluation and referral of reports made to common entry point unit.
335.28 The common entry point must screen the reports of alleged or suspected maltreatment for
335.29immediate risk and make all necessary referrals as follows:
335.30 (1) if the common entry point determines that there is an immediate need for
335.31adult protective services, the common entry point agency shall immediately notify the
335.32appropriate county agency;
336.1 (2) if the report contains suspected criminal activity against a vulnerable adult, the
336.2common entry point shall immediately notify the appropriate law enforcement agency;
336.3 (3) the common entry point shall refer all reports of alleged or suspected
336.4maltreatment to the appropriate lead investigative agency as soon as possible, but in any
336.5event no longer than two working days; and
336.6
336.7
336.8
336.9
336.10
336.11entry point shall immediately notify the appropriate law enforcement agencies, the local
336.12medical examiner, and the ombudsman for mental health and developmental disabilities
336.13established under section
336.14local medical examiner and the ombudsman as provided by law.
336.15 Sec. 51. Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:
336.16 Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary
336.17administrative agency responsible for investigating reports made under section
336.18(a) The Department of Health is the lead investigative agency for facilities or
336.19services licensed or required to be licensed as hospitals, home care providers, nursing
336.20homes, boarding care homes, hospice providers, residential facilities that are also federally
336.21certified as intermediate care facilities that serve people with developmental disabilities,
336.22or any other facility or service not listed in this subdivision that is licensed or required to
336.23be licensed by the Department of Health for the care of vulnerable adults. "Home care
336.24provider" has the meaning provided in section
336.25care or services are delivered in the vulnerable adult's home, whether a private home or a
336.26housing with services establishment registered under chapter 144D, including those that
336.27offer assisted living services under chapter 144G.
336.28(b)
336.29
336.30facilities or services licensed or required to be licensed as adult day care, adult foster care,
336.31programs for people with developmental disabilities, family adult day services, mental
336.32health programs, mental health clinics, chemical dependency programs, the Minnesota
336.33sex offender program, or any other facility or service not listed in this subdivision that is
336.34licensed or required to be licensed by the Department of Human Services.
337.1(c) The county social service agency or its designee is the lead investigative agency
337.2for all other reports, including, but not limited to, reports involving vulnerable adults
337.3receiving services from a personal care provider organization under section
337.4
337.5
337.6 Sec. 52. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
337.7AND COMMUNITY-BASED SERVICES.
337.8(a) The Department of Health Compliance Monitoring Division and the Department
337.9of Human Services Licensing Division shall jointly develop an integrated licensing system
337.10for providers of both home care services subject to licensure under Minnesota Statutes,
337.11chapter 144A, and for home and community-based services subject to licensure under
337.12Minnesota Statutes, chapter 245D. The integrated licensing system shall:
337.13(1) require only one license of any provider of services under Minnesota Statutes,
337.14sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
337.15(2) promote quality services that recognize a person's individual needs and protect
337.16the person's health, safety, rights, and well-being;
337.17(3) promote provider accountability through application requirements, compliance
337.18inspections, investigations, and enforcement actions;
337.19(4) reference other applicable requirements in existing state and federal laws,
337.20including the federal Affordable Care Act;
337.21(5) establish internal procedures to facilitate ongoing communications between the
337.22agencies, and with providers and services recipients about the regulatory activities;
337.23(6) create a link between the agency Web sites so that providers and the public can
337.24access the same information regardless of which Web site is accessed initially; and
337.25(7) collect data on identified outcome measures as necessary for the agencies to
337.26report to the Centers for Medicare and Medicaid Services.
337.27(b) The joint recommendations for legislative changes to implement the integrated
337.28licensing system are due to the legislature by February 15, 2014.
337.29(c) Before implementation of the integrated licensing system, providers licensed as
337.30home care providers under Minnesota Statutes, chapter 144A, may also provide home
337.31and community-based services subject to licensure under Minnesota Statutes, chapter
337.32245D, without obtaining a home and community-based services license under Minnesota
337.33Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
337.34apply to these providers:
338.1(1) the provider must comply with all requirements under Minnesota Statutes, chapter
338.2245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
338.3(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
338.4enforced by the Department of Health under the enforcement authority set forth in
338.5Minnesota Statutes, section 144A.475; and
338.6(3) the Department of Health will provide information to the Department of Human
338.7Services about each provider licensed under this section, including the provider's license
338.8application, licensing documents, inspections, information about complaints received, and
338.9investigations conducted for possible violations of Minnesota Statutes, chapter 245D.
338.10 Sec. 53. REPEALER.
338.11(a) Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031;
338.12245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and
338.13245B.08, are repealed effective January 1, 2014.
338.14(b) Minnesota Statutes 2012, section 245D.08, is repealed.