HF 2456

3rd Engrossment - 87th Legislature (2011 - 2012) Posted on 04/02/2012 01:01pm

A bill for an act
relating to human services; amending continuing care policy provisions; making
changes to disability services and licensing provisions; establishing home and
community-based services standards; developing payment methodologies;
amending Minnesota Statutes 2010, sections 245A.03, subdivision 2; 245A.041,
by adding subdivisions; 245A.085; 245B.02, subdivision 10, by adding a
subdivision; 245B.04, subdivisions 1, 2, 3; 245B.05, subdivision 1; 245B.07,
subdivisions 5, 9, 10, by adding a subdivision; 256B.4912; proposing coding for
new law in Minnesota Statutes, chapters 245A; 256B; proposing coding for new
law as Minnesota Statutes, chapter 245D.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2010, section 245A.03, subdivision 2, is amended to
read:

Subd. 2.

Exclusion from licensure.

(a) This chapter does not apply to:

(1) residential or nonresidential programs that are provided to a person by an
individual who is related unless the residential program is a child foster care placement
made by a local social services agency or a licensed child-placing agency, except as
provided in subdivision 2a;

(2) nonresidential programs that are provided by an unrelated individual to persons
from a single related family;

(3) residential or nonresidential programs that are provided to adults who do
not abuse chemicals or who do not have a chemical dependency, a mental illness, a
developmental disability, a functional impairment, or a physical disability;

(4) sheltered workshops or work activity programs that are certified by the
commissioner of employment and economic development;

(5) programs operated by a public school for children 33 months or older;

(6) nonresidential programs primarily for children that provide care or supervision
for periods of less than three hours a day while the child's parent or legal guardian is in
the same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;

(7) nursing homes or hospitals licensed by the commissioner of health except as
specified under section 245A.02;

(8) board and lodge facilities licensed by the commissioner of health that do not
provide children's residential services under Minnesota Rules, chapter 2960, mental health
or chemical dependency treatment;

(9) homes providing programs for persons placed by a county or a licensed agency
for legal adoption, unless the adoption is not completed within two years;

(10) programs licensed by the commissioner of corrections;

(11) recreation programs for children or adults that are operated or approved by a
park and recreation board whose primary purpose is to provide social and recreational
activities;

(12) programs operated by a school as defined in section 120A.22, subdivision 4;
YMCA as defined in section 315.44; YWCA as defined in section 315.44; or JCC as
defined in section 315.51, whose primary purpose is to provide child care or services to
school-age children;

(13) Head Start nonresidential programs which operate for less than 45 days in
each calendar year;

(14) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;

(15) programs for children such as scouting, boys clubs, girls clubs, and sports and
art programs, and nonresidential programs for children provided for a cumulative total of
less than 30 days in any 12-month period;

(16) residential programs for persons with mental illness, that are located in hospitals;

(17) the religious instruction of school-age children; Sabbath or Sunday schools; or
the congregate care of children by a church, congregation, or religious society during the
period used by the church, congregation, or religious society for its regular worship;

(18) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;

(19) mental health outpatient services for adults with mental illness or children
with emotional disturbance;

(20) residential programs serving school-age children whose sole purpose is cultural
or educational exchange, until the commissioner adopts appropriate rules;

deleted text begin (21) unrelated individuals who provide out-of-home respite care services to persons
deleted text end deleted text begin with developmental disabilities from a single related family for no more than 90 days in a
deleted text end deleted text begin 12-month period and the respite care services are for the temporary relief of the person's
deleted text end deleted text begin family or legal representative;
deleted text end

deleted text begin (22) respite care services provided as a home and community-based service to a
deleted text end deleted text begin person with a developmental disability, in the person's primary residence;
deleted text end

deleted text begin (23) deleted text end new text begin (21) new text end community support services programs as defined in section 245.462,
subdivision 6, and family community support services as defined in section 245.4871,
subdivision 17;

deleted text begin (24) deleted text end new text begin (22) new text end the placement of a child by a birth parent or legal guardian in a preadoptive
home for purposes of adoption as authorized by section 259.47;

deleted text begin (25) deleted text end new text begin (23) new text end settings registered under chapter 144D which provide home care services
licensed by the commissioner of health to fewer than seven adults;

deleted text begin (26) deleted text end new text begin (24) new text end chemical dependency or substance abuse treatment activities of licensed
professionals in private practice as defined in Minnesota Rules, part 9530.6405, subpart
15, when the treatment activities are not paid for by the consolidated chemical dependency
treatment fund;

deleted text begin (27) deleted text end new text begin (25) new text end consumer-directed community support service funded under the Medicaid
waiver for persons with developmental disabilities when the individual who provided
the service is:

(i) the same individual who is the direct payee of these specific waiver funds or paid
by a fiscal agent, fiscal intermediary, or employer of record; and

(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service; or

deleted text begin (28) deleted text end new text begin (26) new text end a program serving only children who are age 33 months or older, that is
operated by a nonpublic school, for no more than four hours per day per child, with no
more than 20 children at any one time, and that is accredited by:

(i) an accrediting agency that is formally recognized by the commissioner of
education as a nonpublic school accrediting organization; or

(ii) an accrediting agency that requires background studies and that receives and
investigates complaints about the services provided.

A program that asserts its exemption from licensure under item (ii) shall, upon
request from the commissioner, provide the commissioner with documentation from the
accrediting agency that verifies: that the accreditation is current; that the accrediting
agency investigates complaints about services; and that the accrediting agency's standards
require background studies on all people providing direct contact services.

(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.

(c) new text begin Except for the home and community-based services identified in section
245D.03, subdivision 1, new text end nothing in this chapter shall be construed to require licensure for
any services provided and funded according to an approved federal waiver plan where
licensure is specifically identified as not being a condition for the services and funding.

Sec. 2.

Minnesota Statutes 2010, section 245A.041, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Record retention; license holder requirements. new text end

new text begin (a) A license holder must
maintain and store records in a manner that will allow for review by the commissioner as
identified in section 245A.04, subdivision 5. The following records must be maintained as
specified and in accordance with applicable state or federal law, regulation, or rule:
new text end

new text begin (1) service recipient records, including verification of service delivery, must be
maintained for a minimum of five years following discharge or termination of service;
new text end

new text begin (2) personnel records must be maintained for a minimum of five years following
termination of employment; and
new text end

new text begin (3) program administration and financial records must be maintained for a minimum
of five years from the date the program closes.
new text end

new text begin (b) A license holder who ceases to provide services must maintain all records related
to the licensed program for five years from the date the program closes. The license holder
must notify the commissioner of the location where the licensing records will be stored
and the name of the person responsible for maintaining the stored records.
new text end

new text begin (c) If the ownership of a licensed program or service changes, the transferor, unless
otherwise provided by law or written agreement with the transferee, is responsible for
maintaining, preserving, and making available to the commissioner on demand the license
records generated before the date of the transfer.
new text end

new text begin (d) In the event of a contested case, the license holder must retain records as required
in paragraph (a) or until the final agency decision is issued and the conclusion of any
related appeal, whichever period is longer.
new text end

Sec. 3.

Minnesota Statutes 2010, section 245A.041, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Electronic records; license holder use. new text end

new text begin A license holder's use of
electronic record keeping or electronic signatures must meet the following requirements:
new text end

new text begin (1) use of electronic record keeping or electronic signatures does not alter the license
holder's obligations under state or federal law, regulation, or rule;
new text end

new text begin (2) the license holder must ensure that the use of electronic record keeping does not
limit the commissioner's access to records as specified under section 245A.04, subdivision
5;
new text end

new text begin (3) upon request, the license holder must assist the commissioner in accessing and
copying all records, including encrypted records and electronic signatures; and
new text end

new text begin (4) the license holder must establish a mechanism or procedure to ensure that:
new text end

new text begin (i) the act of creating the electronic record or signature is attributable to the license
holder, according to section 325L.09;
new text end

new text begin (ii) the electronic records and signatures are maintained in a form capable of being
retained and accurately reproduced;
new text end

new text begin (iii) the commissioner has access to information that establishes the date and time
that data and signatures were entered into the electronic record; and
new text end

new text begin (iv) the license holder's use of electronic record keeping or electronic signatures does
not compromise the security of the records.
new text end

Sec. 4.

new text begin [245A.042] HOME AND COMMUNITY-BASED SERVICES;
ADDITIONAL STANDARDS AND PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Standards governing the provision of home and community-based
services. new text end

new text begin Residential and nonresidential programs for persons with disabilities or
age 65 and older must obtain a license according to this chapter to provide home and
community-based services defined in the federal waiver plans governed by United States
Code, title 42, sections 1396 et seq., or the state's alternative care program according to
section 256B.0913, and identified in section 245D.03, subdivision 1. As a condition
of licensure, an applicant or license holder must demonstrate and maintain verification
of compliance with:
new text end

new text begin (1) licensing requirements under this chapter and chapter 245D;
new text end

new text begin (2) applicable health care program requirements under Minnesota Rules, parts
9505.0170 to 9505.0475 and 9505.2160 to 9505.2245; and
new text end

new text begin (3) provider standards and qualifications identified in the federal waiver plans or the
alternative care program.
new text end

new text begin Subd. 2. new text end

new text begin Modified application procedures. new text end

new text begin (a) Applicants seeking chapter 245D
licensure who meet the following criteria are subject to modified application procedures:
new text end

new text begin (1) the applicant holds a chapter 245B license issued on or before December 31,
2012, at the time of application;
new text end

new text begin (2) the applicant's chapter 245B license or licenses are in substantial compliance
according to the licensing standards in this chapter and chapter 245B; and
new text end

new text begin (3) the commissioner has conducted at least one on-site inspection of the chapter
245B license or licenses within the two-year period before submitting the chapter 245D
license application.
new text end

new text begin For purposes of this subdivision, substantial compliance means the commissioner
has not issued a sanction according to section 245A.07 against any chapter 245B license
held by the applicant or made the chapter 245B license or licenses conditional according
to section 245A.06 within the 12-month period before submitting the application for
chapter 245D licensure.
new text end

new text begin (b) The modified application procedures mean the commissioner must accept
the applicant's attestation of compliance with certain requirements in lieu of providing
information to the commissioner for evaluation that is otherwise required when seeking
chapter 245D licensure.
new text end

new text begin Subd. 3. new text end

new text begin Implementation. new text end

new text begin (a) Licensure of home and community-based services
according to this section will be implemented upon authorization for the commissioner
to collect fees according to section 245A.10, subdivisions 3 and 4, necessary to support
licensing functions. License applications will be received on a phased in schedule as
determined by the commissioner. Licenses will be issued on or after January 1, 2013,
according to section 245A.04.
new text end

new text begin (b) Implementation of compliance monitoring must be phased in after January
1, 2013.
new text end

new text begin (1) Applicants who do not currently hold a license issued under this chapter must
receive an initial compliance monitoring visit within 12 months of the effective date of
the initial license for the purpose of providing technical assistance on how to achieve and
maintain compliance with the applicable law or rules governing the provision of home and
community-based services under chapter 245D. If during the review the commissioner
finds that the license holder has failed to achieve compliance with an applicable law or
rule and this failure does not imminently endanger the health, safety, or rights of the
persons served by the program, the commissioner may issue a licensing review report with
recommendations for achieving and maintaining compliance.
new text end

new text begin (2) Applicants who do currently hold a license issued under this chapter must receive
a compliance monitoring visit after 24 months of the effective date of the initial license.
new text end

new text begin (c) Nothing in this subdivision shall be construed to limit the commissioner's
authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
or make correction orders and make a license conditional for failure to comply with
applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
of the violation of law or rule and the effect of the violation on the health, safety, or
rights of persons served by the program.
new text end

Sec. 5.

Minnesota Statutes 2010, section 245A.085, is amended to read:

245A.085 CONSOLIDATION OF HEARINGS; RECONSIDERATION.

Hearings authorized under this chapter, chapter 245C, and sections 256.045, new text begin
256B.04, new text end 626.556, and 626.557, shall be consolidated if feasible and in accordance with
other applicable statutes and rules. Reconsideration under sections 245C.28; 626.556,
subdivision 10i; and 626.557, subdivision 9d, shall also be consolidated if feasible.

Sec. 6.

Minnesota Statutes 2010, section 245B.02, is amended by adding a subdivision
to read:

new text begin Subd. 8a. new text end

new text begin Emergency. new text end

new text begin "Emergency" means any fires, severe weather, natural
disasters, power failures, or any event that affects the ordinary daily operation of the
program, including, but not limited to, events that threaten the immediate health and
safety of a person receiving services and that require calling 911, emergency evacuation,
moving to an emergency shelter, or temporary closure or relocation of the program
to another facility or service site.
new text end

Sec. 7.

Minnesota Statutes 2010, section 245B.02, subdivision 10, is amended to read:

Subd. 10.

Incident.

"Incident" means new text begin an occurrence that affects the ordinary
provision of services to a person and includes new text end any of the following:

(1) serious injury as determined by section 245.91, subdivision 6;

(2) a consumer's death;

(3) any medical deleted text begin emergencies deleted text end new text begin emergency new text end , unexpected serious deleted text begin illnesses deleted text end new text begin illness new text end , or
deleted text begin accidents deleted text end new text begin significant unexpected changes in an illness or medical condition, or the mental
health status of a person new text end that deleted text begin require deleted text end new text begin requires calling 911 or a mental health mobile crisis
intervention team, new text end physician treatment new text begin , new text end or hospitalization;

(4) a consumer's unauthorized new text begin or unexplained new text end absence;

deleted text begin (5) any fires or other events that require the relocation of services for more than 24
hours, or circumstances involving a law enforcement agency or fire department related to
the health, safety, or supervision of a consumer;
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end physical aggression by a consumer against another consumer that causes
physical pain, injury, or persistent emotional distress, including, but not limited to, hitting,
slapping, kicking, scratching, pinching, biting, pushing, and spitting;

deleted text begin (7) deleted text end new text begin (6) new text end any sexual activity between consumers involving force or coercion as defined
under section 609.341, subdivisions 3 and 14; or

deleted text begin (8) deleted text end new text begin (7) new text end a report of child or vulnerable adult maltreatment under section 626.556 or
626.557.

Sec. 8.

Minnesota Statutes 2010, section 245B.04, subdivision 1, is amended to read:

Subdivision 1.

License holder's responsibility for consumers' rights.

The license
holder must:

(1) provide the consumer or the consumer's legal representative a copy of the
consumer's rights on the day that services are initiated and an explanation of the rights
in subdivisions 2 and 3 within five working days of service initiation new text begin and annually
thereafter new text end . Reasonable accommodations shall be made by the license holder to provide
this information in other formats as needed to facilitate understanding of the rights by the
consumer and the consumer's legal representative, if any;

(2) document the consumer's or the consumer's legal representative's receipt of a
copy of the rights and an explanation of the rights; and

(3) ensure the exercise and protection of the consumer's rights in the services
provided by the license holder and authorized in the individual service plan.

Sec. 9.

Minnesota Statutes 2010, section 245B.04, subdivision 2, is amended to read:

Subd. 2.

Service-related rights.

A consumer's service-related rights include the
right to:

(1) refuse or terminate services and be informed of the consequences of refusing
or terminating services;

(2) know, in advance, limits to the services available from the license holder;

(3) know conditions and terms governing the provision of services, including deleted text begin those deleted text end new text begin
the license holder's policies and procedures new text end related to initiation and termination;

(4) know what the charges are for services, regardless of who will be paying for the
services, and be notified upon request of changes in those charges;

(5) know, in advance, whether services are covered by insurance, government
funding, or other sources, and be told of any charges the consumer or other private party
may have to pay; and

(6) receive licensed services from individuals who are competent and trained,
who have professional certification or licensure, as required, and who meet additional
qualifications identified in the individual service plan.

Sec. 10.

Minnesota Statutes 2010, section 245B.04, subdivision 3, is amended to read:

Subd. 3.

Protection-related rights.

new text begin (a) new text end The consumer's protection-related rights
include the right to:

(1) have personal, financial, services, and medical information kept private, and
be advised of the license holder's policies and procedures regarding disclosure of such
information;

(2) access records and recorded information new text begin about the person in accordance with
applicable state and federal law, regulation, or rule new text end ;

(3) be free from maltreatment;

(4) be treated with courtesy and respect for the consumer's individuality, mode of
communication, and culture, and receive respectful treatment of the consumer's property;

new text begin (5) reasonable observance of cultural and ethnic practice and religion;
new text end

new text begin (6) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;
new text end

new text begin (7) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;
new text end

new text begin (8) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;
new text end

deleted text begin (5) deleted text end new text begin (9) new text end voice grievances, know the contact persons responsible for addressing
problems and how to contact those persons;

deleted text begin (6) deleted text end new text begin (10) new text end any procedures for grievance or complaint resolution and the right to appeal
under section 256.045;

deleted text begin (7) deleted text end new text begin (11) new text end know the name and address of the state, county, or advocacy agency to
contact for additional information or assistance;

deleted text begin (8) deleted text end new text begin (12) new text end assert these rights personally, or have them asserted by the consumer's
family or legal representative, without retaliation;

deleted text begin (9) deleted text end new text begin (13) new text end give or withhold written informed consent to participate in any research or
experimental treatment;

deleted text begin (10) deleted text end new text begin (14) new text end have daily, private access to and use of a non-coin-operated telephone for
local calls and long-distance calls made collect or paid for by the resident;

deleted text begin (11) deleted text end new text begin (15) new text end receive and send new text begin , without interference, new text end uncensored, unopened mail new text begin or
electronic correspondence or communication new text end ;

deleted text begin (12) deleted text end new text begin (16) new text end marital privacy for visits with the consumer's spouse and, if both are
residents of the site, the right to share a bedroom and bed;

deleted text begin (13) deleted text end new text begin (17) new text end associate with other persons of the consumer's choice;

deleted text begin (14) deleted text end new text begin (18) new text end personal privacy; and

deleted text begin (15) deleted text end new text begin (19) new text end engage in chosen activities.

new text begin (b) Restriction of a person's rights under paragraph (a), clauses (13) to (15), or
this paragraph is allowed only if determined necessary to ensure the health, safety, and
well-being of the person. Any restriction of these rights must be documented in the service
plan for the person and must include the following information:
new text end

new text begin (1) the justification for the restriction based on an assessment of the person's
vulnerability related to exercising the right without restriction;
new text end

new text begin (2) the objective measures set as conditions for ending the restriction;
new text end

new text begin (3) a schedule for reviewing the need for the restriction based on the conditions for
ending the restriction to occur, at a minimum, every three months for persons who do not
have a legal representative and annually for persons who do have a legal representative
from the date of initial approval; and
new text end

new text begin (4) signed and dated approval for the restriction from the person, or the person's
legal representative, if any. A restriction may be implemented only when the required
approval has been obtained. Approval may be withdrawn at any time. If approval is
withdrawn, the right must be immediately and fully restored.
new text end

Sec. 11.

Minnesota Statutes 2010, section 245B.05, subdivision 1, is amended to read:

Subdivision 1.

Environment.

The license holder must:

(1) ensure that services are provided in a safe and hazard-free environment when the
license holder is the owner, lessor, or tenant of the service site. All other license holders
shall inform the consumer or the consumer's legal representative and case manager about
any environmental safety concerns in writing;

(2) deleted text begin lock doors deleted text end new text begin ensure that doors are locked or toxic substances or dangerous items
normally accessible to persons served by the program are stored in locked cabinets,
drawers, or containers new text end only to protect the safety of consumers and not as a substitute for
staff supervision or interactions with consumers new text begin . new text end new text begin If doors are locked or toxic substances
or dangerous items normally accessible to persons served by the program are stored in
locked cabinets, drawers, or containers, the license holder must justify and document
how this determination was made in consultation with the person or the person's legal
representative and how access will otherwise be provided to the person and all other
affected persons receiving services new text end ;

(3) follow procedures that minimize the consumer's health risk from communicable
diseases; and

(4) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition.

Sec. 12.

Minnesota Statutes 2010, section 245B.07, subdivision 5, is amended to read:

Subd. 5.

Staff orientation.

(a) Within 60 days of hiring staff who provide direct
service, the license holder must provide 30 hours of staff orientation. Direct care staff
must complete 15 of the 30 hours orientation before providing any unsupervised direct
service to a consumer. If the staff person has received orientation training from a license
holder licensed under this chapter, or provides semi-independent living services only, the
15-hour requirement may be reduced to eight hours. The total orientation of 30 hours may
be reduced to 15 hours if the staff person has previously received orientation training from
a license holder licensed under this chapter.

(b) The 30 hours of orientation must combine supervised on-the-job training with
deleted text begin coverage deleted text end new text begin review new text end of new text begin and instruction on new text end the following material:

(1) review of the consumer's service plans and risk management plan to achieve an
understanding of the consumer as a unique individual new text begin and staff responsibilities related to
implementation of those plans new text end ;

(2) review and instruction on new text begin implementation of new text end the license holder's policies and
procedures, including their location and access;

(3) new text begin staff responsibilities related to new text end emergency procedures;

(4) explanation of specific job functions, including implementing objectives from
the consumer's individual service plan;

(5) explanation of responsibilities related to section 245A.65; sections 626.556
and 626.557, governing maltreatment reporting and service planning for children and
vulnerable adults; and section 245.825, governing use of aversive and deprivation
procedures;

(6) medication administration as it applies to the individual consumer, from a
training curriculum developed by a health services professional described in section
245B.05, subdivision 5, and when the consumer meets the criteria of having overriding
health care needs, then medication administration taught by a health services professional.
Staff may administer medications only after they demonstrate the ability, as defined in the
license holder's medication administration policy and procedures. Once a consumer with
overriding health care needs is admitted, staff will be provided with remedial training as
deemed necessary by the license holder and the health professional to meet the needs of
that consumer.

For purposes of this section, overriding health care needs means a health care
condition that affects the service options available to the consumer because the condition
requires:

(i) specialized or intensive medical or nursing supervision; and

(ii) nonmedical service providers to adapt their services to accommodate the health
and safety needs of the consumer;

(7) consumer rights new text begin and staff responsibilities related to protecting and ensuring
the exercise of the consumer rights new text end ; and

(8) other topics necessary as determined by the consumer's individual service plan or
other areas identified by the license holder.

(c) The license holder must document each employee's orientation received.

Sec. 13.

Minnesota Statutes 2010, section 245B.07, is amended by adding a
subdivision to read:

new text begin Subd. 7a. new text end

new text begin Subcontractors. new text end

new text begin If the license holder uses a subcontractor to perform
services licensed under this chapter on the license holder's behalf, the license holder must
ensure that the subcontractor meets and maintains compliance with all requirements under
this chapter that apply to the services to be provided.
new text end

Sec. 14.

Minnesota Statutes 2010, section 245B.07, subdivision 9, is amended to read:

Subd. 9.

Availability of current written policies and procedures.

The license
holder shall:

(1) review and update, as needed, the written policies and procedures in this chapter;

(2) inform consumers or the consumer's legal representatives of the written policies
and procedures in this chapter upon service initiation. Copies new text begin of policies and procedures
affecting a consumer's rights under section 245D.04 must be provided upon service
initiation. Copies of all other policies and procedures new text end must be available to consumers
or the consumer's legal representatives, case managers, the county where services are
located, and the commissioner upon request;

(3) provide all consumers or the consumers' legal representatives and case managers
a copy new text begin of the revised policies and procedures new text end and explanation of new text begin the new text end revisions deleted text begin to policies
and procedures deleted text end that affect consumers' service-related or protection-related rights under
section 245B.04 new text begin and maltreatment reporting policies and procedures new text end . Unless there is
reasonable cause, the license holder must provide this notice at least 30 days before
implementing the revised policy and procedure. The license holder must document the
reason for not providing the notice at least 30 days before implementing the revisions;

(4) annually notify all consumers or the consumers' legal representatives and case
managers of any revised policies and procedures under this chapter, other than those in
clause (3). Upon request, the license holder must provide the consumer or consumer's
legal representative and case manager copies of the revised policies and procedures;

(5) before implementing revisions to policies and procedures under this chapter,
inform all employees of the new text begin revisions and provide training on implementation of the new text end
revised policies and procedures; and

(6) document and maintain relevant information related to the policies and
procedures in this chapter.

Sec. 15.

Minnesota Statutes 2010, section 245B.07, subdivision 10, is amended to read:

Subd. 10.

Consumer funds.

(a) The license holder must ensure that consumers
retain the use and availability of personal funds or property unless restrictions are justified
in the consumer's individual service plan.

(b) The license holder must ensure separation of consumer funds from funds of the
license holder, the program, or program staff.

(c) Whenever the license holder assists a consumer with the safekeeping of funds
or other property, the license holder must have written authorization to do so by the
consumer or the consumer's legal representative, and the case manager. In addition, the
license holder must:

(1) document receipt and disbursement of the consumer's funds or the property;

(2) annually survey, document, and implement the preferences of the consumer,
consumer's legal representative, and the case manager for frequency of receiving a
statement that itemizes receipts and disbursements of consumer funds or other property;
and

(3) return to the consumer upon the consumer's request, funds and property in the
license holder's possession subject to restrictions in the consumer's individual service plan,
as soon as possible, but no later than three working days after the date of the request.

(d) License holders and program staff must not:

(1) borrow money from a consumer;

(2) purchase personal items from a consumer;

(3) sell merchandise or personal services to a consumer;

(4) require a consumer to purchase items for which the license holder is eligible for
reimbursement; deleted text begin or
deleted text end

(5) use consumer funds in a manner that would violate section 256B.04, or any
rules promulgated under that section deleted text begin . deleted text end new text begin ; or
new text end

new text begin (6) accept powers-of-attorney from a person receiving services from the license
holder for any purpose, and may not accept an appointment as guardian or conservator of
a person receiving services from the license holder. This does not apply to license holders
that are Minnesota counties or other units of government.
new text end

Sec. 16.

new text begin [245D.01] CITATION.
new text end

new text begin This chapter may be cited as the "Home and Community-Based Services Standards"
or "HCBS Standards."
new text end

Sec. 17.

new text begin [245D.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin The terms used in this chapter have the meanings given
them in this section.
new text end

new text begin Subd. 2. new text end

new text begin Annual and annually. new text end

new text begin "Annual" and "annually" have the meaning given
in section 245A.02, subdivision 2b.
new text end

new text begin Subd. 3. new text end

new text begin Case manager. new text end

new text begin "Case manager" means the individual designated
to provide waiver case management services, care coordination, or long-term care
consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions.
new text end

new text begin Subd. 4. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of the
Department of Human Services or the commissioner's designated representative.
new text end

new text begin Subd. 5. new text end

new text begin Department. new text end

new text begin "Department" means the Department of Human Services.
new text end

new text begin Subd. 6. new text end

new text begin Direct contact. new text end

new text begin "Direct contact" has the meaning given in section 245C.02,
subdivision 11, and is used interchangeably with the term "direct service."
new text end

new text begin Subd. 7. new text end

new text begin Drug. new text end

new text begin "Drug" has the meaning given in section 151.01, subdivision 5.
new text end

new text begin Subd. 8. new text end

new text begin Emergency. new text end

new text begin "Emergency" means any event that affects the ordinary
daily operation of the program including, but not limited to, fires, severe weather, natural
disasters, power failures, or other events that threaten the immediate health and safety of
a person receiving services and that require calling 911, emergency evacuation, moving
to an emergency shelter, or temporary closure or relocation of the program to another
facility or service site.
new text end

new text begin Subd. 9. new text end

new text begin Health services. new text end

new text begin "Health services" means any service or treatment
consistent with the physical and mental health needs of the person, such as medication
administration and monitoring, medical, dental, nutritional, health monitoring, wellness
education, and exercise.
new text end

new text begin Subd. 10. new text end

new text begin Home and community-based services. new text end

new text begin "Home and community-based
services" means the services subject to the provisions of this chapter and defined in the
federal waiver plans governed by United States Code, title 42, sections 1396 et seq., or the
state's alternative care program according to section 256B.0913, including the brain injury
(BI) waiver, the community alternative care (CAC) waiver, the community alternatives
for disabled individuals (CADI) waiver, the developmental disability (DD) waiver, the
elderly waiver (EW), and the alternative care (AC) program.
new text end

new text begin Subd. 11. new text end

new text begin Incident. new text end

new text begin "Incident" means an occurrence that affects the ordinary
provision of services to a person and includes any of the following:
new text end

new text begin (1) serious injury as determined by section 245.91, subdivision 6;
new text end

new text begin (2) a person's death;
new text end

new text begin (3) any medical emergency, unexpected serious illness, or significant unexpected
change in an illness or medical condition, or the mental health status of a person that
requires calling 911 or a mental health crisis intervention team, physician treatment,
or hospitalization;
new text end

new text begin (4) a person's unauthorized or unexplained absence from a program;
new text end

new text begin (5) physical aggression by a person receiving services against another person
receiving services that causes physical pain, injury, or persistent emotional distress,
including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
pushing, and spitting;
new text end

new text begin (6) any sexual activity between persons receiving services involving force or
coercion as defined under section 609.341, subdivisions 3 and 14; or
new text end

new text begin (7) a report of alleged or suspected child or vulnerable adult maltreatment under
section 626.556 or 626.557.
new text end

new text begin Subd. 12. new text end

new text begin Legal representative. new text end

new text begin "Legal representative" means the parent of a
person who is under 18 years of age, a court-appointed guardian, or other representative
with legal authority to make decisions about services for a person.
new text end

new text begin Subd. 13. new text end

new text begin License. new text end

new text begin "License" has the meaning given in section 245A.02,
subdivision 8.
new text end

new text begin Subd. 14. new text end

new text begin Licensed health professional. new text end

new text begin "Licensed health professional" means a
person licensed in Minnesota to practice those professions described in section 214.01,
subdivision 2.
new text end

new text begin Subd. 15. new text end

new text begin License holder. new text end

new text begin "License holder" has the meaning given in section
245A.02, subdivision 9.
new text end

new text begin Subd. 16. new text end

new text begin Medication. new text end

new text begin "Medication" means a prescription drug or over-the-counter
drug. For purposes of this chapter, "medication" includes dietary supplements.
new text end

new text begin Subd. 17. new text end

new text begin Medication administration. new text end

new text begin "Medication administration" means
performing the following set of tasks to ensure a person takes both prescription and
over-the-counter medications and treatments according to orders issued by appropriately
licensed professionals, and includes the following:
new text end

new text begin (1) checking the person's medication record;
new text end

new text begin (2) preparing the medication for administration;
new text end

new text begin (3) administering the medication to the person;
new text end

new text begin (4) documenting the administration of the medication or the reason for not
administering the medication; and
new text end

new text begin (5) reporting to the prescriber or a nurse any concerns about the medication,
including side effects, adverse reactions, effectiveness, or the person's refusal to take the
medication or the person's self-administration of the medication.
new text end

new text begin Subd. 18. new text end

new text begin Medication assistance. new text end

new text begin "Medication assistance" means providing verbal
or visual reminders to take regularly scheduled medication, which includes either of
the following:
new text end

new text begin (1) bringing to the person and opening a container of previously set up medications
and emptying the container into the person's hand or opening and giving the medications
in the original container to the person, or bringing to the person liquids or food to
accompany the medication; or
new text end

new text begin (2) providing verbal or visual reminders to perform regularly scheduled treatments
and exercises.
new text end

new text begin Subd. 19. new text end

new text begin Medication management. new text end

new text begin "Medication management" means the
provision of any of the following:
new text end

new text begin (1) medication-related services to a person;
new text end

new text begin (2) medication setup;
new text end

new text begin (3) medication administration;
new text end

new text begin (4) medication storage and security;
new text end

new text begin (5) medication documentation and charting;
new text end

new text begin (6) verification and monitoring of effectiveness of systems to ensure safe medication
handling and administration;
new text end

new text begin (7) coordination of medication refills;
new text end

new text begin (8) handling changes to prescriptions and implementation of those changes;
new text end

new text begin (9) communicating with the pharmacy; or
new text end

new text begin (10) coordination and communication with prescriber.
new text end

new text begin For the purposes of this chapter, medication management does not mean "medication
therapy management services" as identified in section 256B.0625, subdivision 13h.
new text end

new text begin Subd. 20. new text end

new text begin Mental health crisis intervention team. new text end

new text begin "Mental health crisis
intervention team" means mental health crisis response providers as identified in section
256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision
1, paragraph (d), for children.
new text end

new text begin Subd. 21. new text end

new text begin Over-the-counter drug. new text end

new text begin "Over-the-counter drug" means a drug that
is not required by federal law to bear the statement "Caution: Federal law prohibits
dispensing without prescription."
new text end

new text begin Subd. 22. new text end

new text begin Person. new text end

new text begin "Person" has the meaning given in section 245A.02, subdivision
11.
new text end

new text begin Subd. 23. new text end

new text begin Person with a disability. new text end

new text begin "Person with a disability" means a person
determined to have a disability by the commissioner's state medical review team as
identified in section 256B.055, subdivision 7, the Social Security Administration, or
the person is determined to have a developmental disability as defined in Minnesota
Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
252.27, subdivision 1a.
new text end

new text begin Subd. 24. new text end

new text begin Prescriber. new text end

new text begin "Prescriber" means a licensed practitioner as defined in
section 151.01, subdivision 23, who is authorized under section 151.37 to prescribe
drugs. For the purposes of this chapter, the term "prescriber" is used interchangeably
with "physician."
new text end

new text begin Subd. 25. new text end

new text begin Prescription drug. new text end

new text begin "Prescription drug" has the meaning given in section
151.01, subdivision 17.
new text end

new text begin Subd. 26. new text end

new text begin Program. new text end

new text begin "Program" means either the nonresidential or residential
program as defined in section 245A.02, subdivisions 10 and 14.
new text end

new text begin Subd. 27. new text end

new text begin Psychotropic medication. new text end

new text begin "Psychotropic medication" means any
medication prescribed to treat the symptoms of mental illness that affect thought processes,
mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
Other miscellaneous medications are considered to be a psychotropic medication when
they are specifically prescribed to treat a mental illness or to control or alter behavior.
new text end

new text begin Subd. 28. new text end

new text begin Restraint. new text end

new text begin "Restraint" means physical or mechanical limiting of the free
and normal movement of body or limbs.
new text end

new text begin Subd. 29. new text end

new text begin Seclusion. new text end

new text begin "Seclusion" means separating a person from others in a way
that prevents social contact and prevents the person from leaving the situation if he or she
chooses.
new text end

new text begin Subd. 30. new text end

new text begin Service. new text end

new text begin "Service" means care, training, supervision, counseling,
consultation, or medication assistance assigned to the license holder in the service plan.
new text end

new text begin Subd. 31. new text end

new text begin Service plan. new text end

new text begin "Service plan" means the individual service plan or
individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions, and includes any support plans or service needs identified as
a result of long-term care consultation, or a support team meeting that includes the
participation of the person, the person's legal representative, and case manager, or assigned
to a license holder through an authorized service agreement.
new text end

new text begin Subd. 32. new text end

new text begin Service site. new text end

new text begin "Service site" means the location where the service is
provided to the person, including but not limited to, a facility licensed according to chapter
245A; a location where the license holder is the owner, lessor, or tenant; a person's own
home; or a community-based location.
new text end

new text begin Subd. 33. new text end

new text begin Staff. new text end

new text begin "Staff" means an employee who will have direct contact with a
person served by the facility, agency, or program.
new text end

new text begin Subd. 34. new text end

new text begin Support team. new text end

new text begin "Support team" means the service planning team
identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
Minnesota Rules, part 9525.0004, subpart 14.
new text end

new text begin Subd. 35. new text end

new text begin Unit of government. new text end

new text begin "Unit of government" means every city, county,
town, school district, other political subdivisions of the state, and any agency of the state
or the United States, and includes any instrumentality of a unit of government.
new text end

new text begin Subd. 36. new text end

new text begin Volunteer. new text end

new text begin "Volunteer" means an individual who, under the direction of
the license holder, provides direct services without pay to a person served by the license
holder.
new text end

Sec. 18.

new text begin [245D.03] APPLICABILITY AND EFFECT.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of the following services:
new text end

new text begin (1) housing access coordination as defined under the current BI, CADI, and DD
waiver plans or successor plans;
new text end

new text begin (2) respite services as defined under the current CADI, BI, CAC, DD, and EW
waiver plans or successor plans when the provider is an individual who is not an employee
of a residential or nonresidential program licensed by the Department of Human Services
or the Department of Health that is otherwise providing the respite service;
new text end

new text begin (3) behavioral programming as defined under the current BI and CADI waiver
plans or successor plans;
new text end

new text begin (4) specialist services as defined under the current DD waiver plan or successor
plans;
new text end

new text begin (5) companion services as defined under the current BI, CADI, and EW waiver
plans or successor plans, excluding companion services provided under the Corporation
for National and Community Services Senior Companion Program established under the
Domestic Volunteer Service Act of 1973, Public Law 98-288;
new text end

new text begin (6) personal support as defined under the current DD waiver plan or successor plans;
new text end

new text begin (7) 24-hour emergency assistance, on-call and personal emergency response as
defined under the current CADI and DD waiver plans or successor plans;
new text end

new text begin (8) night supervision services as defined under the current BI waiver plan or
successor plans;
new text end

new text begin (9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW
waiver plans or successor plans, excluding providers licensed by the Department of Health
under chapter 144A and those providers providing cleaning services only;
new text end

new text begin (10) independent living skills training as defined under the current BI and CADI
waiver plans or successor plans;
new text end

new text begin (11) prevocational services as defined under the current BI and CADI waiver plans
or successor plans;
new text end

new text begin (12) structured day services as defined under the current BI waiver plan or successor
plans; or
new text end

new text begin (13) supported employment as defined under the current BI and CADI waiver plans
or successor plans.
new text end

new text begin Subd. 2. new text end

new text begin Relationship to other standards governing home and community-based
services. new text end

new text begin (a) A license holder governed by this chapter is also subject to the licensure
requirements under chapter 245A.
new text end

new text begin (b) A license holder concurrently providing child foster care services licensed
according to Minnesota Rules, chapter 2960, to the same person receiving a service
licensed under this chapter is exempt from section 245D.04, as it applies to the person.
new text end

new text begin (c) A license holder concurrently providing home care services registered according
to sections 144A.43 to 144A.49 to the same person receiving home management services
licensed under this chapter is exempt from section 245D.04, as it applies to the person.
new text end

new text begin (d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt
from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557,
subdivision 14, paragraph (b).
new text end

new text begin (e) Notwithstanding section 245D.06, subdivision 5, a license holder providing
structured day, prevocational, or supported employment services under this chapter and
day training and habilitation or supported employment services licensed under chapter
245B within the same program is exempt from compliance with this chapter, when
the license holder notifies the commissioner in writing that the requirements under
chapter 245B will be met for all persons receiving these services from the program. For
the purposes of this paragraph, if the license holder has obtained approval from the
commissioner for an alternative inspection status according to section 245B.031, that
approval will apply to all persons receiving services in the program.
new text end

new text begin Subd. 3. new text end

new text begin Variance. new text end

new text begin If the conditions in section 245A.04, subdivision 9, are met,
the commissioner may grant a variance to any of the requirements in this chapter, except
sections 245D.04, and 245D.10, subdivision 4, paragraph (b), or provisions governing
data practices and information rights of persons.
new text end

new text begin Subd. 4. new text end

new text begin License holders with multiple 245D licenses. new text end

new text begin (a) When a person changes
service from one license to a different license held by the same license holder, the license
holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
new text end

new text begin (b) When a staff person begins providing direct service under one or more licenses
held by the same license holder, other than the license for which staff orientation was
initially provided according to section 245D.09, subdivision 4, the license holder is
exempt from those staff orientation requirements; except the staff person must review each
person's service plan and medication administration procedures in accordance with section
245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
new text end

Sec. 19.

new text begin [245D.04] SERVICE RECIPIENT RIGHTS.
new text end

new text begin Subdivision 1. new text end

new text begin License holder responsibility for individual rights of persons
served by the program. new text end

new text begin The license holder must:
new text end

new text begin (1) provide each person or each person's legal representative with a written notice
that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
those rights within five working days of service initiation and annually thereafter;
new text end

new text begin (2) make reasonable accommodations to provide this information in other formats
or languages as needed to facilitate understanding of the rights by the person and the
person's legal representative, if any;
new text end

new text begin (3) maintain documentation of the person's or the person's legal representative's
receipt of a copy and an explanation of the rights; and
new text end

new text begin (4) ensure the exercise and protection of the person's rights in the services provided
by the license holder and as authorized in the service plan.
new text end

new text begin Subd. 2. new text end

new text begin Service-related rights. new text end

new text begin A person's service-related rights include the right
to:
new text end

new text begin (1) participate in the development and evaluation of the services provided to the
person;
new text end

new text begin (2) have services identified in the service plan provided in a manner that respects
and takes into consideration the person's preferences;
new text end

new text begin (3) refuse or terminate services and be informed of the consequences of refusing
or terminating services;
new text end

new text begin (4) know, in advance, limits to the services available from the license holder;
new text end

new text begin (5) know conditions and terms governing the provision of services, including the
license holder's policies and procedures related to temporary service suspension and
service termination;
new text end

new text begin (6) know what the charges are for services, regardless of who will be paying for the
services, and be notified of changes in those charges;
new text end

new text begin (7) know, in advance, whether services are covered by insurance, government
funding, or other sources, and be told of any charges the person or other private party
may have to pay; and
new text end

new text begin (8) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the person's service plan.
new text end

new text begin Subd. 3. new text end

new text begin Protection-related rights. new text end

new text begin (a) A person's protection-related rights include
the right to:
new text end

new text begin (1) have personal, financial, service, health, and medical information kept private,
and be advised of disclosure of this information by the license holder;
new text end

new text begin (2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;
new text end

new text begin (3) be free from maltreatment;
new text end

new text begin (4) be free from restraint or seclusion used for a purpose other than to protect the
person from imminent danger to self or others;
new text end

new text begin (5) receive services in a clean and safe environment when the license holder is the
owner, lessor, or tenant of the service site;
new text end

new text begin (6) be treated with courtesy and respect and receive respectful treatment of the
person's property;
new text end

new text begin (7) reasonable observance of cultural and ethnic practice and religion;
new text end

new text begin (8) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;
new text end

new text begin (9) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;
new text end

new text begin (10) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;
new text end

new text begin (11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;
new text end

new text begin (12) give or withhold written informed consent to participate in any research or
experimental treatment;
new text end

new text begin (13) associate with other persons of the person's choice;
new text end

new text begin (14) personal privacy; and
new text end

new text begin (15) engage in chosen activities.
new text end

new text begin (b) For a person residing in a residential site licensed according to chapter 245A,
or where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:
new text end

new text begin (1) have daily, private access to and use of a non-coin-operated telephone for local
calls and long-distance calls made collect or paid for by the person;
new text end

new text begin (2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication; and
new text end

new text begin (3) privacy for visits with the person's spouse, next of kin, legal counsel, religious
advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
privacy in the person's bedroom.
new text end

new text begin (c) Restriction of a person's rights under paragraph (a), clauses (13) to (15), or
paragraph (b) is allowed only if determined necessary to ensure the health, safety, and
well-being of the person. Any restriction of those rights must be documented in the service
plan for the person and must include the following information:
new text end

new text begin (1) the justification for the restriction based on an assessment of the person's
vulnerability related to exercising the right without restriction;
new text end

new text begin (2) the objective measures set as conditions for ending the restriction;
new text end

new text begin (3) a schedule for reviewing the need for the restriction based on the conditions for
ending the restriction to occur, at a minimum, every three months for persons who do not
have a legal representative and annually for persons who do have a legal representative
from the date of initial approval; and
new text end

new text begin (4) signed and dated approval for the restriction from the person, or the person's
legal representative, if any. A restriction may be implemented only when the required
approval has been obtained. Approval may be withdrawn at any time. If approval is
withdrawn, the right must be immediately and fully restored.
new text end

Sec. 20.

new text begin [245D.05] HEALTH SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Health needs. new text end

new text begin (a) The license holder is responsible for providing
health services assigned in the service plan and consistent with the person's health needs.
The license holder is responsible for promptly notifying the person or the person's legal
representative and the case manager of changes in a person's physical and mental health
needs affecting assigned health services, when discovered by the license holder, unless
the license holder has reason to know the change has already been reported. The license
holder must document when the notice is provided.
new text end

new text begin (b) When assigned in the service plan, the license holder is required to maintain
documentation on how the person's health needs will be met, including a description of
the procedures the license holder will follow in order to:
new text end

new text begin (1) provide medication administration, medication assistance, or medication
management according to this chapter;
new text end

new text begin (2) monitor health conditions according to written instructions from the person's
physician or a licensed health professional;
new text end

new text begin (3) assist with or coordinate medical, dental, and other health service appointments;
or
new text end

new text begin (4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from the person's physician or a licensed
health professional.
new text end

new text begin Subd. 2. new text end

new text begin Medication administration. new text end

new text begin (a) The license holder must ensure that the
following criteria have been met before staff that is not a licensed health professional
administers medication or treatment:
new text end

new text begin (1) new text end new text begin written authorization has been obtained from the person or the person's legal
representative to administer medication or treatment orders;
new text end

new text begin (2) the staff person has completed medication administration training according to
section 245D.09, subdivision 4, paragraph (c), clause (2); and
new text end

new text begin (3) the medication or treatment will be administered under administration procedures
established for the person in consultation with a licensed health professional. Written
instruction from the person's physician may constitute the medication administration
procedures. A prescription label or the prescriber's order for the prescription is sufficient
to constitute written instructions from the prescriber. A licensed health professional may
delegate medication administration procedures.
new text end

new text begin (b) The license holder must ensure the following information is documented in the
person's medication administration record:
new text end

new text begin (1) the information on the prescription label or the prescriber's order that includes
directions for safely and correctly administering the medication to ensure effectiveness;
new text end

new text begin (2) information on any discomforts, risks, or other side effects that are reasonable to
expect, and any contraindications to its use;
new text end

new text begin (3) the possible consequences if the medication or treatment is not taken or
administered as directed;
new text end

new text begin (4) instruction from the prescriber on when and to whom to report the following:
new text end

new text begin (i) if the medication or treatment is not administered as prescribed, whether by error
by the staff or the person or by refusal by the person; and
new text end

new text begin (ii) the occurrence of possible adverse reactions to the medication or treatment;
new text end

new text begin (5) notation of any occurrence of medication not being administered as prescribed or
of adverse reactions, and when and to whom the report was made; and
new text end

new text begin (6) notation of when a medication or treatment is started, changed, or discontinued.
new text end

new text begin (c) The license holder must ensure that the information maintained in the medication
administration record is current and is regularly reviewed with the person or the person's
legal representative and the staff administering the medication to identify medication
administration issues or errors. At a minimum, the review must be conducted every three
months or more often if requested by the person or the person's legal representative.
Based on the review, the license holder must develop and implement a plan to correct
medication administration issues or errors. If issues or concerns are identified related to
the medication itself, the license holder must report those as required under subdivision 4.
new text end

new text begin Subd. 3. new text end

new text begin Medication assistance. new text end

new text begin The license holder must ensure that the
requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
to enable a person to self-administer medication when the person is capable of directing
the person's own care, or when the person's legal representative is present and able to
direct care for the person.
new text end

new text begin Subd. 4. new text end

new text begin Reporting medication and treatment issues. new text end

new text begin The following medication
administration issues must be reported to the person or the person's legal representative
and case manager as they occur or following timelines established in the person's service
plan or as requested in writing by the person or the person's legal representative, or the
case manager:
new text end

new text begin (1) any reports made to the person's physician or prescriber required under
subdivision 2, paragraph (b), clause (4);
new text end

new text begin (2) a person's refusal or failure to take medication or treatment as prescribed; or
new text end

new text begin (3) concerns about a person's self-administration of medication.
new text end

new text begin Subd. 5. new text end

new text begin Injectable medications. new text end

new text begin Injectable medications may be administered
according to a prescriber's order and written instructions when one of the following
conditions has been met:
new text end

new text begin (1) a registered nurse or licensed practical nurse will administer the subcutaneous or
intramuscular injection;
new text end

new text begin (2) a supervising registered nurse with a physician's order has delegated the
administration of subcutaneous injectable medication to an unlicensed staff member
and has provided the necessary training; or
new text end

new text begin (3) there is an agreement signed by the license holder, the prescriber, and the person
or the person's legal representative, specifying what subcutaneous injections may be
given, when, how, and that the prescriber must retain responsibility for the license
holder's giving the injections. A copy of the agreement must be placed in the person's
service recipient record.
new text end

new text begin Only licensed health professionals are allowed to administer psychotropic
medications by injection.
new text end

Sec. 21.

new text begin [245D.06] PROTECTION STANDARDS.
new text end

new text begin Subdivision 1. new text end

new text begin Incident response and reporting. new text end

new text begin (a) The license holder must
respond to all incidents under section 245D.02, subdivision 11, that occur while providing
services to protect the health and safety of and minimize risk of harm to the person.
new text end

new text begin (b) The license holder must maintain information about and report incidents to the
person's legal representative or designated emergency contact and case manager within 24
hours of an incident occurring while services are being provided, or within 24 hours of
discovery or receipt of information that an incident occurred, unless the license holder has
reason to know that the incident has already been reported. An incident of suspected or
alleged maltreatment must be reported as required under paragraph (d), and an incident of
serious injury or death must be reported as required under paragraph (e).
new text end

new text begin (c) When the incident involves more than one person, the license holder must not
disclose personally identifiable information about any other person when making the report
to each person and case manager unless the license holder has the consent of the person.
new text end

new text begin (d) Within 24 hours of reporting maltreatment as required under section 626.556
or 626.557, the license holder must inform the case manager of the report unless there is
reason to believe that the case manager is involved in the suspected maltreatment. The
license holder must disclose the nature of the activity or occurrence reported and the
agency that received the report.
new text end

new text begin (e) Within 24 hours of the occurrence, or within 24 hours of receipt of the
information, the license holder must report the death or serious injury of the person to
the legal representative, if any, and case manager, the Department of Human Services
Licensing Division, and the Office of Ombudsman for Mental Health and Developmental
Disabilities as required under section 245.94, subdivision 2a, within 24 hours of the death,
discovery of the death, or receipt of information that the death occurred unless the license
holder has reason to know that the death has already been reported.
new text end

new text begin (f) The license holder must conduct a review of incident reports, for identification
of incident patterns, and implementation of corrective action as necessary to reduce
occurrences.
new text end

new text begin Subd. 2. new text end

new text begin Environment and safety. new text end

new text begin The license holder must:
new text end

new text begin (1) ensure the following when the license holder is the owner, lessor, or tenant
of the service site:
new text end

new text begin (i) the service site is a safe and hazard-free environment;
new text end

new text begin (ii) doors are locked or toxic substances or dangerous items normally accessible
to persons served by the program are stored in locked cabinets, drawers, or containers
only to protect the safety of a person receiving services and not as a substitute for staff
supervision or interactions with a person who is receiving services. If doors are locked or
toxic substances or dangerous items normally accessible to persons served by the program
are stored in locked cabinets, drawers, or containers, the license holder must justify and
document how this determination was made in consultation with the person or person's
legal representative, and how access will otherwise be provided to the person and all other
affected persons receiving services; and
new text end

new text begin (iii) a staff person is available on site who is trained in basic first aid whenever
persons are present and staff are required to be at the site to provide direct service;
new text end

new text begin (2) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition when used to provide services;
new text end

new text begin (3) follow procedures to ensure safe transportation, handling, and transfers of the
person and any equipment used by the person, when the license holder is responsible for
transportation of a person or a person's equipment;
new text end

new text begin (4) be prepared for emergencies and follow emergency response procedures to
ensure the person's safety in an emergency; and
new text end

new text begin (5) follow sanitary practices for infection control and to prevent communicable
diseases.
new text end

new text begin Subd. 3. new text end

new text begin Compliance with fire and safety codes. new text end

new text begin When services are provided at a
service site licensed according to chapter 245A or where the license holder is the owner,
lessor, or tenant of the service site, the license holder must document compliance with
applicable building codes, fire and safety codes, health rules, and zoning ordinances, or
document that an appropriate waiver has been granted.
new text end

new text begin Subd. 4. new text end

new text begin Funds and property. new text end

new text begin (a) Whenever the license holder assists a person
with the safekeeping of funds or other property according to section 245A.04, subdivision
13, the license holder must have written authorization to do so from the person and the
case manager.
new text end

new text begin (b) A license holder or staff person may not accept powers-of-attorney from a
person receiving services from the license holder for any purpose, and may not accept an
appointment as guardian or conservator of a person receiving services from the license
holder. This does not apply to license holders that are Minnesota counties or other units
of government or to staff persons employed by license holders who were acting as
power-of-attorney, guardian, or conservator for specific individuals prior to enactment of
this section. The license holder must maintain documentation of the power-of-attorney,
guardianship, or conservatorship in the service recipient record.
new text end

new text begin Subd. 5. new text end

new text begin Prohibitions. new text end

new text begin The license holder is prohibited from using psychotropic
medication as a substitute for adequate staffing, as punishment, for staff convenience,
or for any reason other than as prescribed. The license holder is prohibited from using
restraints or seclusion under any circumstance, unless the commissioner has approved a
variance request from the license holder that allows for the emergency use of restraints
and seclusion according to terms and conditions approved in the variance.
new text end

Sec. 22.

new text begin [245D.07] SERVICE NEEDS.
new text end

new text begin Subdivision 1. new text end

new text begin Provision of services. new text end

new text begin The license holder must provide services as
specified in the service plan and assigned to the license holder. The provision of services
must comply with the requirements of this chapter and the federal waiver plans.
new text end

new text begin Subd. 2. new text end

new text begin Service planning. new text end

new text begin The license holder must participate in support team
meetings related to the person following stated timelines established in the person's service
plan or as requested by the support team, the person, or the person's legal representative.
new text end

new text begin Subd. 3. new text end

new text begin Reports. new text end

new text begin The license holder must provide written reports regarding the
person's progress or status as requested by the person, the person's legal representative, the
case manager, or the team.
new text end

Sec. 23.

new text begin [245D.08] RECORD REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Record-keeping systems. new text end

new text begin The license holder must ensure that the
content and format of service recipient, personnel, and program records are uniform,
legible, and in compliance with the requirements of this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Service recipient record. new text end

new text begin (a) The license holder must:
new text end

new text begin (1) maintain a record of current services provided to each person on the premises
where the services are provided or coordinated; and
new text end

new text begin (2) protect service recipient records against loss, tampering, or unauthorized
disclosure in compliance with sections 13.01 to 13.10 and 13.46.
new text end

new text begin (b) The license holder must maintain the following information for each person:
new text end

new text begin (1) identifying information, including the person's name, date of birth, address, and
telephone number;
new text end

new text begin (2) the name, address, and telephone number of the person's legal representative, if
any, an emergency contact, the case manager, and family members or others as identified
by the person or case manager;
new text end

new text begin (3) service information, including service initiation information, verification of the
person's eligibility for services, and documentation verifying that services have been
provided as identified in the service plan according to paragraph (a);
new text end

new text begin (4) health information, including medical history and allergies; and when the license
holder is assigned responsibility for meeting the person's health needs according to section
245D.05:
new text end

new text begin (i) current orders for medication, treatments, or medical equipment;
new text end

new text begin (ii) medication administration procedures;
new text end

new text begin (iii) a medication administration record documenting the implementation of the
medication administration procedures, including any agreements for administration of
injectable medications by the license holder; and
new text end

new text begin (iv) a medical appointment schedule;
new text end

new text begin (5) the person's current service plan or that portion of the plan assigned to the
license holder. When a person's case manager does not provide a current service plan,
the license holder must make a written request to the case manager to provide a copy of
the service plan and inform the person of the right to a current service plan and the right
to appeal under section 256.045;
new text end

new text begin (6) a record of other service providers serving the person when the person's service
plan identifies the need for coordination between the service providers, that includes
a contact person and telephone numbers, services being provided, and names of staff
responsible for coordination;
new text end

new text begin (7) documentation of orientation to the service recipient rights according to section
245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
section 245A.65, subdivision 1, paragraph (c);
new text end

new text begin (8) copies of authorizations to handle a person's funds, according to section 245D.06,
subdivision 4, paragraph (a);
new text end

new text begin (9) documentation of complaints received and grievance resolution;
new text end

new text begin (10) incident reports required under section 245D.06, subdivision 1;
new text end

new text begin (11) copies of written reports regarding the person's status when requested according
to section 245D.07, subdivision 3; and
new text end

new text begin (12) discharge summary, including service termination notice and related
documentation, when applicable.
new text end

new text begin Subd. 3. new text end

new text begin Access to service recipient records. new text end

new text begin The license holder must ensure that
the following people have access to the information in subdivision 1 in accordance with
applicable state and federal law, regulation, or rule:
new text end

new text begin (1) the person, the person's legal representative, and anyone properly authorized
by the person;
new text end

new text begin (2) the person's case manager;
new text end

new text begin (3) staff providing services to the person unless the information is not relevant to
carrying out the service plan; and
new text end

new text begin (4) the county adult foster care licensor, when services are also licensed as adult
foster care.
new text end

new text begin Subd. 4. new text end

new text begin Personnel records. new text end

new text begin The license holder must maintain a personnel record
of each employee, direct service volunteer, and subcontractor to document and verify staff
qualifications, orientation, and training. For the purposes of this subdivision, the terms
"staff" or "staff person" mean paid employee, direct service volunteer, or subcontractor.
The personnel record must include:
new text end

new text begin (1) the staff person's date of hire, completed application, a position description
signed by the staff person, documentation that the staff person meets the position
requirements as determined by the license holder, the date of first supervised direct contact
with a person served by the program, and the date of first unsupervised direct contact with
a person served by the program;
new text end

new text begin (2) documentation of staff qualifications, orientation, training, and performance
evaluations as required under section 245D.09, subdivisions 3, 4, and 5, including the
date the training was completed, the number of hours per subject area, and the name and
qualifications of the trainer or instructor; and
new text end

new text begin (3) a completed background study as required under chapter 245C.
new text end

Sec. 24.

new text begin [245D.09] STAFFING STANDARDS.
new text end

new text begin Subdivision 1. new text end

new text begin Staffing requirements. new text end

new text begin The license holder must provide direct
service staff sufficient to ensure the health, safety, and protection of rights of each person
and to be able to implement the responsibilities assigned to the license holder in each
person's service plan.
new text end

new text begin Subd. 2. new text end

new text begin Supervision of staff having direct contact. new text end

new text begin Except for a license holder
who are the sole direct service staff, the license holder must provide adequate supervision
of staff providing direct service to ensure the health, safety, and protection of rights of
each person and implementation of the responsibilities assigned to the license holder in
each person's service plan.
new text end

new text begin Subd. 3. new text end

new text begin Staff qualifications. new text end

new text begin (a) The license holder must ensure that staff is
competent through training, experience, and education to meet the person's needs and
additional requirements as written in the service plan, or when otherwise required by the
case manager or the federal waiver plan. The license holder must verify and maintain
evidence of staff competency, including documentation of:
new text end

new text begin (1) education and experience qualifications, including a valid degree and transcript,
or a current license, registration, or certification, when a degree or licensure, registration,
or certification is required;
new text end

new text begin (2) completion of required orientation and training, including completion of
continuing education required to maintain professional licensure, registration, or
certification requirements; and
new text end

new text begin (3) except for a license holder who is the sole direct service staff, performance
evaluations completed by the license holder of the direct service staff person's ability to
perform the job functions based on direct observation.
new text end

new text begin (b) Staff under 18 years of age may not perform overnight duties or administer
medication.
new text end

new text begin Subd. 4. new text end

new text begin Orientation. new text end

new text begin (a) Except for a license holder who does not supervise any
direct service staff, within 90 days of hiring direct service staff, the license holder must
provide and ensure completion of orientation that combines supervised on-the-job training
with review of and instruction on the following:
new text end

new text begin (1) the job description and how to complete specific job functions, including:
new text end

new text begin (i) responding to and reporting incidents as required under section 245D.06,
subdivision 1; and
new text end

new text begin (ii) following safety practices established by the license holder and as required in
section 245D.06, subdivision 2;
new text end

new text begin (2) the license holder's current policies and procedures required under this chapter,
including their location and access, and staff responsibilities related to implementation
of those policies and procedures;
new text end

new text begin (3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
responsibilities related to complying with data privacy practices;
new text end

new text begin (4) the service recipient rights under section 245D.04, and staff responsibilities
related to ensuring the exercise and protection of those rights;
new text end

new text begin (5) sections 245A.65; 245A.66, 626.556, and 626.557, governing maltreatment
reporting and service planning for children and vulnerable adults, and staff responsibilities
related to protecting persons from maltreatment and reporting maltreatment;
new text end

new text begin (6) what constitutes use of restraints, seclusion, and psychotropic medications, and
staff responsibilities related to the prohibitions of their use; and
new text end

new text begin (7) other topics as determined necessary in the person's service plan by the case
manager or other areas identified by the license holder.
new text end

new text begin (b) License holders who provide direct service themselves must complete the
orientation required in paragraph (a), clauses (3) to (7).
new text end

new text begin (c) Before providing unsupervised direct service to a person served by the program,
or for whom the staff person has not previously provided direct service, or any time the
plans or procedures identified in clauses (1) and (2) are revised, the staff person must
review and receive instruction on the following as it relates to the staff person's job
functions for that person:
new text end

new text begin (1) the person's service plan as it relates to the responsibilities assigned to the license
holder, and when applicable, the person's individual abuse prevention plan according to
section 245A.65, to achieve an understanding of the person as a unique individual, and
how to implement those plans; and
new text end

new text begin (2) medication administration procedures established for the person when assigned
to the license holder according to section 245D.05, subdivision 1, paragraph (b).
Unlicensed staff may administer medications only after successful completion of a
medication administration training, from a training curriculum developed by a registered
nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
practitioner, physician's assistant, or physician incorporating an observed skill assessment
conducted by the trainer to ensure staff demonstrate the ability to safely and correctly
follow medication procedures. Medication administration must be taught by a registered
nurse, clinical nurse specialist, certified nurse practitioner, physician's assistant, or
physician, if at the time of service initiation or any time thereafter, the person has or
develops a health care condition that affects the service options available to the person
because the condition requires:
new text end

new text begin (i) specialized or intensive medical or nursing supervision;
new text end

new text begin (ii) nonmedical service providers to adapt their services to accommodate the health
and safety needs of the person; and
new text end

new text begin (iii) necessary training in order to meet the health service needs of the person as
determined by the person's physician.
new text end

new text begin Subd. 5. new text end

new text begin Training. new text end

new text begin (a) A license holder must provide annual training to direct
service staff on the topics identified in subdivision 4, paragraph (a), clauses (3) to (6).
new text end

new text begin (b) A license holder providing behavioral programming, specialist services, personal
support, 24-hour emergency assistance, night supervision, independent living skills,
structured day, prevocational, or supported employment services must provide a minimum
of eight hours of annual training to direct service staff that addresses:
new text end

new text begin (1) topics related to the general health, safety, and service needs of the population
served by the license holder; and
new text end

new text begin (2) other areas identified by the license holder or in the person's current service plan.
new text end

new text begin Training on relevant topics received from sources other than the license holder
may count toward training requirements.
new text end

new text begin (c) When the license holder is the owner, lessor, or tenant of the service site and
whenever a person receiving services is present at the site, the license holder must have
a staff person available on site who is trained in basic first aid and, when required in a
person's service plan, cardiopulmonary resuscitation.
new text end

new text begin Subd. 6. new text end

new text begin Subcontractors. new text end

new text begin If the license holder uses a subcontractor to perform
services licensed under this chapter on their behalf, the license holder must ensure that the
subcontractor meets and maintains compliance with all requirements under this chapter
that apply to the services to be provided.
new text end

new text begin Subd. 7. new text end

new text begin Volunteers. new text end

new text begin The license holder must ensure that volunteers who provide
direct services to persons served by the program receive the training, orientation, and
supervision necessary to fulfill their responsibilities.
new text end

Sec. 25.

new text begin [245D.10] POLICIES AND PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Policy and procedure requirements. new text end

new text begin The license holder must
establish, enforce, and maintain policies and procedures as required in this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Grievances. new text end

new text begin The license holder must establish policies and procedures that
provide a simple complaint process for persons served by the program and their authorized
representatives to bring a grievance that:
new text end

new text begin (1) provides staff assistance with the complaint process when requested, and the
addresses and telephone numbers of outside agencies to assist the person;
new text end

new text begin (2) allows the person to bring the complaint to the highest level of authority in the
program if the grievance cannot be resolved by other staff members, and that provides
the name, address, and telephone number of that person;
new text end

new text begin (3) requires the license holder to promptly respond to all complaints affecting a
person's health and safety. For all other complaints the license holder must provide an
initial response within 14 calendar days of receipt of the complaint. All complaints must
be resolved within 30 calendar days of receipt or the license holder must document the
reason for the delay and a plan for resolution;
new text end

new text begin (4) requires a complaint review that includes an evaluation of whether:
new text end

new text begin (i) related policies and procedures were followed and adequate;
new text end

new text begin (ii) there is a need for additional staff training;
new text end

new text begin (iii) the complaint is similar to past complaints with the persons, staff, or services
involved; and
new text end

new text begin (iv) there is a need for corrective action by the license holder to protect the health
and safety of persons receiving services;
new text end

new text begin (5) based on the review in clause (4), requires the license holder to develop,
document, and implement a corrective action plan, designed to correct current lapses and
prevent future lapses in performance by staff or the license holder, if any;
new text end

new text begin (6) provides a written summary of the complaint and a notice of the complaint
resolution to the person and case manager, that:
new text end

new text begin (i) identifies the nature of the complaint and the date it was received;
new text end

new text begin (ii) includes the results of the complaint review;
new text end

new text begin (iii) identifies the complaint resolution, including any corrective action; and
new text end

new text begin (7) requires that the complaint summary and resolution notice be maintained in the
service recipient record.
new text end

new text begin Subd. 3. new text end

new text begin Service suspension and service termination. new text end

new text begin (a) The license holder must
establish policies and procedures for temporary service suspension and service termination
that promote continuity of care and service coordination with the person and the case
manager, and with other licensed caregivers, if any, who also provide support to the person.
new text end

new text begin (b) The policy must include the following requirements:
new text end

new text begin (1) the license holder must notify the person and case manager in writing of the
intended termination or temporary service suspension, and the person's right to seek a
temporary order staying the termination of service according to the procedures in section
256.045, subdivision 4a, or 6, paragraph (c);
new text end

new text begin (2) notice of the proposed termination of services, including those situations
that began with a temporary service suspension, must be given at least 60 days before
the proposed termination is to become effective when a license holder is providing
independent living skills training, structured day, prevocational or supported employment
services to the person, and 30 days prior to termination for all other services licensed
under this chapter;
new text end

new text begin (3) the license holder must provide information requested by the person or case
manager when services are temporarily suspended or upon notice of termination;
new text end

new text begin (4) prior to giving notice of service termination or temporary service suspension,
the license holder must document actions taken to minimize or eliminate the need for
service suspension or termination;
new text end

new text begin (5) during the temporary service suspension or service termination notice period,
the license holder will work with the appropriate county agency to develop reasonable
alternatives to protect the person and others;
new text end

new text begin (6) the license holder must maintain information about the service suspension or
termination, including the written termination notice, in the service recipient record; and
new text end

new text begin (7) the license holder must restrict temporary service suspension to situations in
which the person's behavior causes immediate and serious danger to the health and safety
of the person or others.
new text end

new text begin Subd. 4. new text end

new text begin Availability of current written policies and procedures. new text end

new text begin (a) The license
holder must review and update, as needed, the written policies and procedures required
under this chapter.
new text end

new text begin (b) The license holder must inform the person and case manager of the policies and
procedures affecting a person's rights under section 245D.04, and provide copies of those
policies and procedures, within five working days of service initiation.
new text end

new text begin (c) The license holder must provide a written notice at least 30 days before
implementing any revised policies and procedures affecting a person's rights under section
245D.04. The notice must explain the revision that was made and include a copy of
the revised policy and procedure. The license holder must document the reason for not
providing the notice at least 30 days before implementing the revisions.
new text end

new text begin (d) Before implementing revisions to required policies and procedures the license
holder must inform all employees of the revisions and provide training on implementation
of the revised policies and procedures.
new text end

Sec. 26.

Minnesota Statutes 2010, section 256B.4912, is amended to read:

256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS
AND PAYMENT.

Subdivision 1.

Provider qualifications.

For the home and community-based
waivers providing services to seniors and individuals with disabilities, the commissioner
shall establish:

(1) agreements with enrolled waiver service providers to ensure providers meet
deleted text begin qualifications defined in the waiver plans deleted text end new text begin Minnesota health care program requirements new text end ;

(2) regular reviews of provider qualifications new text begin , and including requests of proof of
documentation new text end ; and

(3) processes to gather the necessary information to determine provider
qualifications.

deleted text begin By July 2010, deleted text end new text begin Beginning July 1, 2012, new text end staff that provide direct contact, as defined
in section 245C.02, subdivision 11, deleted text begin that are employees of waiver service providers deleted text end new text begin for
services specified in the federally approved waiver plans new text end must meet the requirements
of chapter 245C prior to providing waiver services and as part of ongoing enrollment.
Upon federal approval, this requirement must also apply to consumer-directed community
supports.

Subd. 2.

deleted text begin Rate-setting deleted text end new text begin Payment new text end methodologies.

new text begin (a) new text end The commissioner shall
establish statewide deleted text begin rate-setting deleted text end new text begin payment new text end methodologies that meet federal waiver
requirements for home and community-based waiver services for individuals with
disabilities. The deleted text begin rate-setting deleted text end new text begin payment new text end methodologies must abide by the principles of
transparency and equitability across the state. The methodologies must involve a uniform
process of structuring rates for each service and must promote quality and participant
choice.

new text begin (b) As of January 1, 2012, counties shall not implement changes to established
processes for rate-setting methodologies for individuals using components of or data
from research rates.
new text end

new text begin Subd. 3. new text end

new text begin Payment requirements. new text end

new text begin The payment methodologies established under
this section shall accommodate:
new text end

new text begin (1) supervision costs;
new text end

new text begin (2) staffing patterns;
new text end

new text begin (3) program-related expenses;
new text end

new text begin (4) general and administrative expenses; and
new text end

new text begin (5) consideration of recipient intensity.
new text end

new text begin Subd. 4. new text end

new text begin Payment rate criteria. new text end

new text begin (a) The payment methodologies under this section
shall reflect the payment rate criteria in paragraphs (b), (c), and (d).
new text end

new text begin (b) Payment rates shall reflect the reasonable, ordinary, and necessary costs of
service delivery.
new text end

new text begin (c) Payment rates shall be sufficient to enlist enough providers so that care and
services are available at least to the extent that such care and services are available to
the general population in the geographic area as required by section 1902(a)(30)(A) of
the Social Security Act.
new text end

new text begin (d) The commissioner must not reimburse:
new text end

new text begin (1) unauthorized service delivery;
new text end

new text begin (2) services provided under a receipt of a special grant;
new text end

new text begin (3) services provided under contract to a local school district;
new text end

new text begin (4) extended employment services under Minnesota Rules, parts 3300.2005 to
3300.3100, or vocational rehabilitation services provided under the federal Rehabilitation
Act, as amended, Title I, section 110, or Title VI-C, and not through use of medical
assistance or county social service funds; or
new text end

new text begin (5) services provided to a client by a licensed medical, therapeutic, or rehabilitation
practitioner or any other vendor of medical care which are billed separately on a
fee-for-service basis.
new text end

new text begin Subd. 5. new text end

new text begin County and tribal provider contract elimination. new text end

new text begin County and tribal
contracts with providers of home and community-based waiver services provided under
sections 256B.0913, 256B.0915, 256B.092, and 256B.49 are eliminated effective January
1, 2014.
new text end

new text begin Subd. 6. new text end

new text begin Program standards. new text end

new text begin The commissioner of human services must establish
uniform program standards for services identified in chapter 245D for persons with
disabilities and people age 65 and older. The commissioner must grant licenses according
to the provisions of chapter 245A.
new text end

new text begin Subd. 7. new text end

new text begin Applicant and license holder training. new text end

new text begin An applicant or license holder
that is not enrolled as a Minnesota health care program home and community-based
services waiver provider at the time of application must ensure that at least one controlling
individual completes a onetime training on the requirements for providing home and
community-based services from a qualified source as determined by the commissioner,
before a provider is enrolled or license is issued.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 27.

new text begin [256B.4913] PAYMENT METHODOLOGY DEVELOPMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Research period and rates. new text end

new text begin (a) For the purposes of this
section, "research rate" means a proposed payment rate for the provision of home
and community-based waivered services to meet federal requirements and assess
the implications of changing resources on the provision of services and "research
period" means the time period during which the research rate is being assessed by the
commissioner.
new text end

new text begin (b) The commissioner shall determine and publish initial frameworks and values to
generate research rates for individuals receiving home and community-based services.
new text end

new text begin (c) The initial values issued by the commissioner shall ensure projected spending
for home and community-based services for each service area is equivalent to projected
spending under current law in the most recent expenditure forecast.
new text end

new text begin (d) The initial values issued shall be based on the most updated information and cost
data available on supervision, employee-related costs, client programming and supports,
programming planning supports, transportation, administrative overhead, and utilization
costs. These service areas are:
new text end

new text begin (1) residential services, defined as corporate foster care, family foster care, residential
care, supported living services, customized living, and 24-hour customized living;
new text end

new text begin (2) day program services, defined as adult day care, day training and habilitation,
prevocational services, structured day services, and transportation;
new text end

new text begin (3) unit-based services with programming, defined as in-home family support,
independent living services, supported living services, supported employment, behavior
programming, and housing access coordination; and
new text end

new text begin (4) unit-based services without programming, defined as respite, personal support,
and night supervision.
new text end

new text begin (e) The commissioner shall make available the underlying assessment information,
without any identifying information, and the statistical modeling used to generate the
initial research rate and calculate budget neutrality.
new text end

new text begin Subd. 2. new text end

new text begin Framework values. new text end

new text begin (a) The commissioner shall propose legislation with
the specific payment methodology frameworks, process for calculation, and specific
values to populate the frameworks by February 15, 2013.
new text end

new text begin (b) The commissioner shall provide underlying data and information used to
formulate the final frameworks and values to the existing stakeholder workgroup by
January 15, 2013.
new text end

new text begin (c) The commissioner shall provide recommendations for the final frameworks
and values, and the basis for the recommendations to the legislative committees with
jurisdiction over health and human services finance by February 15, 2013.
new text end

new text begin (d) The commissioner shall review the following topics during the research period
and propose, as necessary, recommendations to address the following research questions:
new text end

new text begin (1) underlying differences in the cost to provide services throughout the state;
new text end

new text begin (2) a data-driven process for determining labor costs and customizations for staffing
classifications included in each rate framework based on the services performed;
new text end

new text begin (3) the allocation of resources previously established under section 256B.501,
subdivision 4b;
new text end

new text begin (4) further definition and development of unit-based services;
new text end

new text begin (5) the impact of splitting the allocation of resources for unit-based services for those
with programming aspects and those without;
new text end

new text begin (6) linking assessment criteria to future assessment processes for determination
of customizations;
new text end

new text begin (7) recognition of cost differences in the use of monitoring technology where it is
appropriate to substitute for supervision;
new text end

new text begin (8) implications for day services of reimbursement based on a unit rate and a daily
rate;
new text end

new text begin (9) a definition of shared and individual staffing for unit-based services;
new text end

new text begin (10) the underlying costs of providing transportation associated with day services;
and
new text end

new text begin (11) an exception process for individuals with exceptional needs that cannot be met
under the initial research rate, and an alternative payment structure for those individuals.
new text end

new text begin (e) The commissioner shall develop a comprehensive plan based on information
gathered during the research period that uses statistically reliable and valid assessment
data to refine payment methodologies.
new text end

new text begin (f) The commissioner shall make recommendations and provide underlying data and
information used to formulate these research recommendations to the existing stakeholder
workgroup by January 15, 2013.
new text end

new text begin Subd. 3. new text end

new text begin Data collection. new text end

new text begin (a) The commissioner shall conduct any necessary
research and gather additional data for the further development and refinement of payment
methodology components. These include but are not limited to:
new text end

new text begin (1) levels of service utilization and patterns of use;
new text end

new text begin (2) staffing patterns for each service;
new text end

new text begin (3) profile of individual service needs; and
new text end

new text begin (4) cost factors involved in providing transportation services.
new text end

new text begin (b) The commissioner shall provide this information to the existing stakeholder
workgroup by January 15, 2013.
new text end

new text begin Subd. 4. new text end

new text begin Rate stabilization adjustment. new text end

new text begin Beginning January 1, 2014, the
commissioner shall adjust individual rates determined by the new payment methodology
so that the new rate varies no more than one percent per year from the rate effective
on December 31 of the prior calendar year. This adjustment is made annually and is
effective for three calendar years from the date of implementation. This subdivision
expires January 1, 2017.
new text end

new text begin Subd. 5. new text end

new text begin Stakeholder consultation. new text end

new text begin The commissioner shall continue consultation
on regular intervals with the existing stakeholder group established as part of the
rate-setting methodology process to gather input, concerns, data, and exchange ideas for
the legislative proposals for the new rate payment system and make pertinent information
available to the public through the department's Web site.
new text end

new text begin Subd. 6. new text end

new text begin Implementation. new text end

new text begin The commissioner may implement changes no
sooner than January 1, 2014, to payment rates for individuals receiving home and
community-based waivered services after the enactment of legislation that establishes
specific payment methodology frameworks, processes for rate calculations, and specific
values to populate the payment methodology frameworks.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end