2001 Minnesota Statutes

CHAPTER 245B. Standards governing services to mentally retarded

     245B.01 Rule consolidation. 

    This chapter establishes new methods to ensure the quality 
 of services to persons with mental retardation or related 
 conditions, and streamlines and simplifies regulation of 
 services and supports for persons with mental retardation or 
 related conditions.  Sections 245B.02 to 245B.07 establishes new 
 standards that eliminate duplication and overlap of regulatory 
 requirements by consolidating and replacing rule parts from four 
 program rules.  Section 245B.08 authorizes the commissioner of 
 human services to develop and use new regulatory strategies to 
 maintain compliance with the streamlined requirements.  

    HIST: 1997 c 248 s 35 

     245B.02 Definitions. 

    Subdivision 1.    Scope.  The terms used in this chapter 
 have the meanings given them. 

    Subd. 2.    Applicant.  "Applicant" has the meaning 
 given in section 245A.02, subdivision 3. 

    Subd. 3.    Case manager.  "Case manager" means the 
 individual designated by the county board under rules of the 
 commissioner to provide case management services as delineated 
 in section 256B.092 or successor provisions. 

    Subd. 4.    Consumer.  "Consumer" means a person who has 
 been determined eligible to receive and is receiving services or 
 support for persons with mental retardation or related 
 conditions. 

    Subd. 5.    Commissioner.  "Commissioner" means the 
 commissioner of the department of human services or the 
 commissioner's designated representative. 

    Subd. 6.    Day training and habilitation services for 
 adults with mental retardation or related conditions.  "Day 
 training and habilitation services for adults with mental 
 retardation or related conditions" has the meaning given in 
 sections 252.40 to 252.46. 

    Subd. 7.    Department.  "Department" means the 
 department of human services. 

    Subd. 8.    Direct service.  "Direct service" means, for 
 a consumer receiving residential-based services, day training 
 and habilitation services, or respite care services, one or more 
 of the following:  supervision, assistance, or training. 

    Subd. 9.    Health services.  "Health services" means 
 any service or treatment consistent with the health needs of the 
 consumer, such as medication administration and monitoring, 
 medical, dental, nutritional, health monitoring, wellness 
 education, and exercise. 

    Subd. 10.    Incident.  "Incident" means any serious 
 injury as determined by section 245.91, subdivision 6; accident; 
 reports of a child or vulnerable adult maltreatment; 
 circumstances that involve a law enforcement agency; or a 
 consumer's death. 

    Subd. 11.    Individual service plan.  "Individual 
 service plan" has the meaning given in section 256B.092 or 
 successor provisions. 

    Subd. 12.    Individual who is related.  "Individual who 
 is related" has the meaning given in section 245A.02, 
 subdivision 13. 

    Subd. 13.    Intermediate care facility for persons with 
 mental retardation or related conditions or ICF/MR.  
 "Intermediate care facility" for persons with mental retardation 
 or related conditions or ICF/MR means a residential program 
 licensed to provide services to persons with mental retardation 
 or related conditions under section 252.28 and chapter 245A and 
 a physical facility licensed as a supervised living facility 
 under chapter 144, which together are certified by the 
 department of health as an intermediate care facility for 
 persons with mental retardation or related conditions. 

    Subd. 14.    Least restrictive environment.  "Least 
 restrictive environment" means an environment where services: 

    (1) are delivered with minimum limitation, intrusion, 
 disruption, or departure from typical patterns of living 
 available to persons without disabilities; 

    (2) do not subject the consumer or others to unnecessary 
 risks to health or safety; and 

    (3) maximize the consumer's level of independence, 
 productivity, and inclusion in the community. 

    Subd. 15.    Legal representative.  "Legal 
 representative" means the parent or parents of a consumer who is 
 under 18 years of age or a guardian, conservator, or guardian ad 
 litem authorized by the court, or other legally authorized 
 representative to make decisions about services for a consumer. 

    Subd. 16.    License.  "License" has the meaning given 
 in section 245A.02, subdivision 8. 

    Subd. 17.    License holder.  "License holder" has the 
 meaning given in section 245A.02, subdivision 9. 

    Subd. 18.    Person with mental retardation or a related 
 condition.  "Person with mental retardation or a related 
 condition" means a person who has been diagnosed under section 
 256B.092 as having substantial limitations in present 
 functioning, manifested as significantly subaverage intellectual 
 functioning, existing concurrently with demonstrated deficits in 
 adaptive behavior, and who manifests these conditions before the 
 person's 22nd birthday.  A person with a related condition means 
 a person who meets the diagnostic definition under section 
 252.27, subdivision 1a. 

    Subd. 19.    Psychotropic medication use checklist.  
 "Psychotropic medication use checklist" means the psychotropic 
 medication monitoring checklist and manual used to govern the 
 administration of psychotropic medications.  The commissioner 
 may revise or update the psychotropic medication use checklist 
 to comply with legal requirements or to meet professional 
 standards or guidelines in the area of developmental 
 disabilities.  For purposes of this chapter, psychotropic 
 medication means any medication prescribed to treat mental 
 illness and associated behaviors or to control or alter 
 behavior.  The major classes of psychotropic medication are 
 antipsychotic (neuroleptic), antidepressant, antianxiety, 
 antimania, stimulant, and sedative or hypnotic.  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. 

    Subd. 20.    Residential-based habilitation.  
 "Residential-based habilitation" means care, supervision, and 
 training provided primarily in the consumer's own home or place 
 of residence but also including community-integrated activities 
 following the individual service plan.  Residential habilitation 
 services are provided in coordination with the provision of day 
 training and habilitation services for those persons receiving 
 day training and habilitation services under sections 252.40 to 
 252.46. 

    Subd. 21.    Respite care.  "Respite care" has the 
 meaning given in section 245A.02, subdivision 15. 

    Subd. 22.    Service.  "Service" means care, 
 supervision, activities, or training designed to achieve the 
 outcomes assigned to the license holder. 

    Subd. 23.    Semi-independent living services or SILS  
 "Semi-independent living services" or "SILS" has the meaning 
 given in section 252.275. 

    Subd. 23a.    Supported employment.  "Supported 
 employment" services include individualized counseling, 
 individualized job development and placement that produce an 
 appropriate job match for the individual and the employer, 
 on-the-job training in work and related work skills required for 
 job performance, ongoing supervision and monitoring of the 
 person's performance, long-term support services to assure job 
 retention, training in related skills essential to obtaining and 
 retaining employment such as the effective use of community 
 resources, use of break and lunch areas, transportation and 
 mobility training, and transportation between the individual's 
 place of residence and the work place when other forms of 
 transportation are unavailable or inaccessible. 

    Subd. 24.    Volunteer.  "Volunteer" means an individual 
 who, under the direction of the license holder, provides direct 
 services without pay to consumers served by the license holder. 

    HIST: 1997 c 248 s 36; 2001 c 203 s 1 

     245B.03 Applicability and effect. 

    Subdivision 1.    Applicability.  The standards in this 
 chapter govern services to persons with mental retardation or 
 related conditions receiving services from license holders 
 providing residential-based habilitation; day training and 
 habilitation services for adults; supported employment; 
 semi-independent living services; residential programs that 
 serve more than four consumers, including intermediate care 
 facilities for persons with mental retardation; and respite care 
 provided outside the consumer's home for more than four 
 consumers at the same time at a single site. 

    Subd. 2.    Relationship to other standards governing 
 services for persons with mental retardation or related 
 conditions.  (a) ICFs/MR are exempt from: 

    (1) section 245B.04; 

    (2) section 245B.06, subdivisions 4 and 6; and 

    (3) section 245B.07, subdivisions 4, paragraphs (b) and 
 (c); 7; and 8, paragraphs (1), clause (iv), and (2). 

    (b) License holders also licensed under chapter 144 as a 
 supervised living facility are exempt from section 245B.04. 

    (c) Residential service sites controlled by license holders 
 licensed under chapter 245B for home and community-based 
 waivered services for four or fewer adults are exempt from 
 compliance with Minnesota Rules, parts 9543.0040, subpart 2, 
 item C; 9555.5505; 9555.5515, items B and G; 9555.5605; 
 9555.5705; 9555.6125, subparts 3, item C, subitem (2), and 4 to 
 6; 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 
 9555.6265.  The commissioner may approve alternative methods of 
 providing overnight supervision using the process and criteria 
 for granting a variance in section 245A.04, subdivision 9.  This 
 chapter does not apply to foster care homes that do not provide 
 residential habilitation services funded under the home and 
 community-based waiver programs defined in section 256B.092. 

    (d) The commissioner may exempt license holders from 
 applicable standards of this chapter when the license holder 
 meets the standards under section 245A.09, subdivision 7.  
 License holders that are accredited by an independent 
 accreditation body shall continue to be licensed under this 
 chapter. 

    (e) License holders governed by sections 245B.02 to 245B.07 
 must also meet the licensure requirements in chapter 245A.  

    (f) Nothing in this chapter prohibits license holders from 
 concurrently serving consumers with and without mental 
 retardation or related conditions provided this chapter's 
 standards are met as well as other relevant standards. 

    (g) The documentation that sections 245B.02 to 245B.07 
 require of the license holder meets the individual program plan 
 required in section 256B.092 or successor provisions.  

    HIST: 1997 c 248 s 37; 2001 c 203 s 2 

     245B.04 Consumer rights. 

    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.  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. 

    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 those 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 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. 

    Subd. 3.    Protection-related rights.  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; 

    (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; 

    (5) voice grievances, know the contact persons responsible 
 for addressing problems and how to contact those persons; 

    (6) any procedures for grievance or complaint resolution 
 and the right to appeal under section 256.045; 

    (7) know the name and address of the state, county, or 
 advocacy agency to contact for additional information or 
 assistance; 

    (8) assert these rights personally, or have them asserted 
 by the consumer's family or legal representative, without 
 retaliation; 

    (9) give or withhold written informed consent to 
 participate in any research or experimental treatment; 

    (10) 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; 

    (11) receive and send uncensored, unopened mail; 

    (12) 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; 

    (13) associate with other persons of the consumer's choice; 

    (14) personal privacy; and 

    (15) engage in chosen activities. 

    HIST: 1997 c 248 s 38 

     245B.05 Consumer protection standards. 

    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) lock doors only to protect the safety of consumers and 
 not as a substitute for staff supervision or interactions with 
 consumers; 

    (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. 

    Subd. 2.    Licensed capacity for facility-based day 
 training and habilitation services.  Licensed capacity of day 
 training and habilitation service sites must be determined by 
 the amount of primary space available, the scheduling of 
 activities at other service sites, and the space requirements of 
 consumers receiving services.  Primary space does not include 
 hallways, stairways, closets, utility areas, bathrooms, 
 kitchens, and floor areas beneath stationary equipment.  A 
 minimum of 40 square feet of primary space must be available for 
 each consumer who is engaged in a day training and habilitation 
 activity at the site for which the licensed capacity must be 
 determined. 

    Subd. 3.    Residential service sites for more than four 
 consumers; four-bed ICFs/MR.  Residential service sites 
 licensed to serve more than four consumers and four-bed ICFs/MR 
 must meet the fire protection provisions of either the 
 Residential Board and Care Occupancies Chapter or the Health 
 Care Occupancies Chapter of the Life Safety Code (LSC), National 
 Fire Protection Association, 1985 edition, or its successors.  
 Sites meeting the definition of a residential board and care 
 occupancy for 16 or less beds must have the emergency evacuation 
 capability of residents evaluated in accordance with Appendix F 
 of the LSC or its successors, except for those sites that meet 
 the LSC Health Care Occupancies Chapter or its successors. 

    Subd. 4.    Meeting fire and safety codes.  An applicant 
 or license holder under sections 245A.01 to 245A.16 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. 

    Subd. 5.    Consumer health.  The license holder is 
 responsible for meeting the health service needs assigned to the 
 license holder in the individual service plan and for bringing 
 health needs as discovered by the license holder promptly to the 
 attention of the consumer, the consumer's legal representative, 
 and the case manager.  The license holder is required to 
 maintain documentation on how the consumer's health needs will 
 be met, including a description of procedures the license holder 
 will follow for the consumer regarding medication monitoring and 
 administration and seizure monitoring, if needed.  The 
 medication administration procedures are those procedures 
 necessary to implement medication and treatment orders issued by 
 appropriately licensed professionals, and must be established in 
 consultation with a registered nurse, nurse practitioner, 
 physician's assistant, or medical doctor. 

    Subd. 6.    First aid.  When the license holder is 
 providing direct service and supervision to a consumer who 
 requires a 24-hour plan of care and receives services at a site 
 licensed under this chapter, the license holder must have 
 available a staff person trained in first aid, and, if needed 
 under section 245B.07, subdivision 6, paragraph (d), 
 cardiopulmonary resuscitation from a qualified source, as 
 determined by the commissioner. 

    Subd. 7.    Reporting incidents and emergencies.  The 
 license holder must report the following incidents to the 
 consumer's legal representative, caregiver, and case manager 
 within 24 hours of the occurrence, or within 24 hours of receipt 
 of the information: 

    (1) the death of a consumer; 

    (2) any medical emergencies, unexpected serious illnesses, 
 or accidents that require physician treatment or 
 hospitalization; 

    (3) a consumer's unauthorized absence; or 

    (4) any fires and incidents involving a law enforcement 
 agency. 

    Death or serious injury of the consumer must also be 
 reported to the department of human services licensing division 
 and the ombudsman, as required under sections 245.91 and 245.94, 
 subdivision 2a. 

    HIST: 1997 c 248 s 39; 1999 c 245 art 4 s 11 

     245B.06 Service standards. 

    Subdivision 1.    Outcome-based services.  (a) The 
 license holder must provide outcome-based services in response 
 to the consumer's identified needs as specified in the 
 individual service plan.  

    (b) Services must be based on the needs and preferences of 
 the consumer and the consumer's personal goals and be consistent 
 with the principles of least restrictive environment, 
 self-determination, and consistent with: 

    (1) the recognition of each consumer's history, dignity, 
 and cultural background; 

    (2) the affirmation and protection of each consumer's civil 
 and legal rights; 

    (3) the provision of services and supports for each 
 consumer which: 

    (i) promote community inclusion and self-sufficiency; 

    (ii) provide services in the least restrictive environment; 

    (iii) promote social relationships, natural supports, and 
 participation in community life; 

    (iv) allow for a balance between safety and opportunities; 
 and 

    (v) provide opportunities for the development and exercise 
 of age-appropriate skills, decision making and choice, personal 
 advocacy, and communication; and 

    (4) the provision of services and supports for families 
 which address the needs of the consumer in the context of the 
 family and support family self-sufficiency. 

    (c) The license holder must make available to the consumer 
 opportunities to participate in the community, functional skill 
 development, reduced dependency on care providers, and 
 opportunities for development of decision-making skills.  
 "Outcome" means the behavior, action, or status attained by the 
 consumer that can be observed, measured, and can be determined 
 reliable and valid.  Outcomes are the equivalent of the 
 long-range goals and short-term goals referenced in section 
 256B.092, and any rules promulgated under that section.  

    Subd. 2.    Risk management plan.  The license holder 
 must develop and document in writing a risk management plan that 
 incorporates the individual abuse prevention plan as required in 
 section 245A.65.  License holders jointly providing services to 
 a consumer shall coordinate and use the resulting assessment of 
 risk areas for the development of this plan.  Upon initiation of 
 services, the license holder will have in place an initial risk 
 management plan that identifies areas in which the consumer is 
 vulnerable, including health, safety, and environmental issues 
 and the supports the provider will have in place to protect the 
 consumer and to minimize these risks.  The plan must be changed 
 based on the needs of the individual consumer and reviewed at 
 least annually. 

    Subd. 3.    Assessments.  (a) The license holder shall 
 assess and reassess the consumer within stated time lines and 
 assessment areas specified in the individual service plan or as 
 requested in writing by the case manager. 

    (b) For each area of assessment requested, the license 
 holder must provide a written summary, analysis, and 
 recommendations for use in the development of the individual 
 service plan. 

    (c) All assessments must include information about the 
 consumer that is descriptive of: 

    (1) the consumer's strengths and functional skills; and 

    (2) the level of support and supervision the consumer needs 
 to achieve the outcomes in subdivision 1. 

    Subd. 4.    Supports and methods.  The license holder, 
 in coordination with other service providers, shall meet with 
 the consumer, the consumer's legal representative, case manager, 
 and other members of the interdisciplinary team within 45 days 
 of service initiation.  Within ten working days after the 
 meeting, the license holder shall develop and document in 
 writing: 

    (1) the methods that will be used to support the individual 
 or accomplish the outcomes in subdivision 1, including 
 information about physical and social environments, the 
 equipment and materials required, and techniques that are 
 consistent with the consumer's communication mode and learning 
 style specified as the license holder's responsibility in the 
 individual service plan; 

    (2) the projected starting date for service supports and 
 the criteria for identifying when the desired outcome has been 
 achieved and when the service supports need to be reviewed; and 

    (3) the names of the staff, staff position, or contractors 
 responsible for implementing each outcome. 

    Subd. 5.    Progress reviews.  The license holder must 
 participate in progress review meetings following stated time 
 lines established in the consumer's individual service plan or 
 as requested in writing by the consumer, the consumer's legal 
 representative, or the case manager, at a minimum of once a 
 year.  The license holder must summarize the progress toward 
 achieving the desired outcomes and make recommendations in a 
 written report sent to the consumer or the consumer's legal 
 representative and case manager prior to the review meeting.  
 For consumers under public guardianship, the license holder is 
 required to provide quarterly written progress review reports to 
 the consumer, designated family member, and case manager.  

    Subd. 6.    Reports.  The license holder shall provide 
 written reports regarding the consumer's status as requested by 
 the consumer, or the consumer's legal representative and case 
 manager. 

    Subd. 7.    Staffing requirements.  The license holder 
 must provide supervision to ensure the health, safety, and 
 protection of rights of each consumer and to be able to 
 implement each consumer's individual service plan.  Day training 
 and habilitation programs must meet the minimum staffing 
 requirements as specified in sections 252.40 to 252.46 and rules 
 promulgated under those sections. 

    Subd. 8.    Leaving the residence.  As specified in each 
 consumer's individual service plan, each consumer requiring a 
 24-hour plan of care must leave the residence to participate in 
 regular education, employment, or community activities.  License 
 holders, providing services to consumers living in a licensed 
 site, shall ensure that they are prepared to care for consumers 
 whenever they are at the residence during the day because of 
 illness, work schedules, or other reasons. 

    Subd. 9.    Day training and habilitation service days.  
 Day training and habilitation services must meet a minimum of 
 195 available service days. 

    Subd. 10.    Prohibition.  Psychotropic medication and 
 the use of aversive and deprivation procedures, as referenced in 
 section 245.825 and rules promulgated under that section, cannot 
 be used as a substitute for adequate staffing, as punishment, or 
 for staff convenience. 

    HIST: 1997 c 248 s 40; 1998 c 407 art 6 s 6 

     245B.07 Management standards. 

    Subdivision 1.    Consumer data file.  The license 
 holder must maintain the following information for each consumer:

    (1) identifying information that includes date of birth, 
 medications, legal representative, history, medical, and other 
 individual-specific information, and names and telephone numbers 
 of contacts; 

    (2) consumer health information, including individual 
 medication administration and monitoring information; 

    (3) the consumer's individual service plan.  When a 
 consumer's case manager does not provide a current individual 
 service plan, the license holder shall make a written request to 
 the case manager to provide a copy of the individual service 
 plan and inform the consumer or the consumer's legal 
 representative of the right to an individual service plan and 
 the right to appeal under section 256.045; 

    (4) copies of assessments, analyses, summaries, and 
 recommendations; 

    (5) progress review reports; 

    (6) incident and emergency reports involving the consumer; 

    (7) discharge summary, when applicable; 

    (8) record of other license holders serving the consumer 
 that includes a contact person and telephone numbers, services 
 being provided, services that require coordination between two 
 license holders, and name of staff responsible for coordination; 
 and 

    (9) incidents involving verbal and physical aggression 
 between consumers and self-abuse affecting the consumer. 

    Subd. 2.    Access to records.  The license holder must 
 ensure that the following people have access to the information 
 in subdivision 1: 

    (1) the consumer, the consumer's legal representative, and 
 anyone properly authorized by the consumer or legal 
 representative; 

    (2) the consumer's case manager; 

    (3) staff providing direct services to the consumer unless 
 the information is not relevant to carrying out the individual 
 service plan; and 

    (4) the county adult foster care licensor, when services 
 are also licensed as an adult foster home.  Adult foster home 
 means a licensed residence operated by an operator who, for 
 financial gain or otherwise, provides 24-hour foster care to no 
 more than four functionally impaired residents. 

    Subd. 3.    Retention of consumer's records.  The 
 license holder must retain the records required for consumers 
 for at least three years following termination of services. 

    Subd. 4.    Staff qualifications.  (a) The license 
 holder must ensure that staff is competent through training, 
 experience, and education to meet the consumer's needs and 
 additional requirements as written in the individual service 
 plan.  Staff qualifications must be documented.  Staff under 18 
 years of age may not perform overnight duties or administer 
 medication. 

    (b) Delivery and evaluation of services provided by the 
 license holder to a consumer must be coordinated by a designated 
 person.  The designated person or coordinator must minimally 
 have a four-year degree in a field related to service provision, 
 and one year work experience with consumers with mental 
 retardation or related conditions, a two-year degree in a field 
 related to service provision, and two years of work experience 
 with consumers with mental retardation or related conditions, or 
 a diploma in community-based developmental disability services 
 from an accredited post-secondary institution and two years of 
 work experience with consumers with mental retardation or 
 related conditions.  The coordinator must provide supervision, 
 support, and evaluation of activities that include: 

    (1) oversight of the license holder's responsibilities 
 designated in the individual service plan; 

    (2) instruction and assistance to staff implementing the 
 individual service plan areas; 

    (3) evaluation of the effectiveness of service delivery, 
 methodologies, and progress on consumer outcomes based on the 
 condition set for objective change; and 

    (4) review of incident and emergency reports, 
 identification of incident patterns, and implementation of 
 corrective action as necessary to reduce occurrences. 

    (c) The coordinator is responsible for taking the action 
 necessary to facilitate the accomplishment of the outcomes for 
 each consumer as specified in the consumer's individual service 
 plan. 

    (d) The license holder must provide for adequate 
 supervision of direct care staff to ensure implementation of the 
 individual service plan. 

    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 coverage of 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; 

    (2) review and instruction on the license holder's policies 
 and procedures, including their location and access; 

    (3) 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; 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. 

    Subd. 6.    Staff training.  (a) The license holder 
 shall ensure that direct service staff annually complete hours 
 of training equal to two percent of the number of hours the 
 staff person worked or one percent for license holders providing 
 semi-independent living services.  If direct service staff has 
 received training from a license holder licensed under a program 
 rule identified in this chapter or completed course work 
 regarding disability-related issues from a post-secondary 
 educational institute, that training may also count toward 
 training requirements for other services and for other license 
 holders. 

    (b) The license holder must document the training completed 
 by each employee. 

    (c) Training shall address staff competencies necessary to 
 address the consumer needs as identified in the consumer's 
 individual service plan and ensure consumer health, safety, and 
 protection of rights.  Training may also include other areas 
 identified by the license holder. 

    (d) For consumers requiring a 24-hour plan of care, the 
 license holder shall provide training in cardiopulmonary 
 resuscitation, from a qualified source determined by the 
 commissioner, if the consumer's health needs as determined by 
 the consumer's physician indicate trained staff would be 
 necessary to the consumer. 

    Subd. 7.    Volunteers.  The license holder must ensure 
 that volunteers who provide direct services to consumers receive 
 the training and orientation necessary to fulfill their 
 responsibilities. 

    Subd. 8.    Policies and procedures.  The license holder 
 must develop and implement the policies and procedures in 
 paragraphs (1) to (3). 

    (1) policies and procedures that promote consumer health 
 and safety by ensuring: 

    (i) consumer safety in emergency situations as identified 
 in section 245B.05, subdivision 7; 

    (ii) consumer health through sanitary practices; 

    (iii) safe transportation, when the license holder is 
 responsible for transportation of consumers, with provisions for 
 handling emergency situations; 

    (iv) a system of recordkeeping for both individuals and the 
 organization, for review of incidents and emergencies, and 
 corrective action if needed; 

    (v) a plan for responding to and reporting all emergencies, 
 including deaths, medical emergencies, illnesses, accidents, 
 missing consumers, fires, severe weather and natural disasters, 
 bomb threats, and other threats; 

    (vi) safe medication administration as identified in 
 section 245B.05, subdivision 5, incorporating an observed skill 
 assessment to ensure that staff demonstrate the ability to 
 administer medications consistent with the license holder's 
 policy and procedures; 

    (vii) psychotropic medication monitoring when the consumer 
 is prescribed a psychotropic medication, including the use of 
 the psychotropic medication use checklist.  If the 
 responsibility for implementing the psychotropic medication use 
 checklist has not been assigned in the individual service plan 
 and the consumer lives in a licensed site, the residential 
 license holder shall be designated; and 

    (viii) criteria for admission or service initiation 
 developed by the license holder; 

    (2) policies and procedures that protect consumer rights 
 and privacy by ensuring: 

    (i) consumer data privacy, in compliance with the Minnesota 
 Data Practices Act, chapter 13; and 

    (ii) that complaint procedures provide consumers with a 
 simple process to bring grievances and consumers receive a 
 response to the grievance within a reasonable time period.  The 
 license holder must provide a copy of the program's grievance 
 procedure and time lines for addressing grievances.  The 
 program's grievance procedure must permit consumers served by 
 the program and the authorized representatives to bring a 
 grievance to the highest level of authority in the program; and 

    (3) policies and procedures that promote continuity and 
 quality of consumer supports by ensuring: 

    (i) continuity of care and service coordination, including 
 provisions for service termination, temporary service 
 suspension, and efforts made by the license holder to coordinate 
 services with other vendors who also provide support to the 
 consumer.  The policy must include the following requirements: 

    (A) the license holder must notify the consumer or 
 consumer's legal representative and the consumer's case manager 
 in writing of the intended termination or temporary service 
 suspension and the consumer's right to seek a temporary order 
 staying the termination or suspension of service according to 
 the procedures in section 256.045, subdivision 4a or subdivision 
 6, paragraph (c); 

    (B) 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; 

    (C) the license holder must provide information requested 
 by the consumer or consumer's legal representative or case 
 manager when services are temporarily suspended or upon notice 
 of termination; 

    (D) use of temporary service suspension procedures are 
 restricted to situations in which the consumer's behavior causes 
 immediate and serious danger to the health and safety of the 
 individual or others; 

    (E) 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 
 termination or temporary service suspension; and 

    (F) during the period of temporary service suspension, the 
 license holder will work with the appropriate county agency to 
 develop reasonable alternatives to protect the individual and 
 others; and 

    (ii) quality services measured through a program evaluation 
 process including regular evaluations of consumer satisfaction 
 and sharing the results of the evaluations with the consumers 
 and legal representatives. 

    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 and inform all consumers or the 
 consumer's legal representatives, case managers, and employees 
 of the revised policies and procedures when they affect the 
 service provision; 

    (2) inform consumers or the consumer's legal 
 representatives of the written policies and procedures in this 
 chapter upon service initiation.  Copies must be available to 
 consumers or the consumer's legal representatives, case 
 managers, the county where services are located, and the 
 commissioner upon request; and 

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

    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; or 

    (5) use consumer funds in a manner that would violate 
 section 256B.04, or any rules promulgated under that section. 

    Subd. 11.    Travel time to and from a day training and 
 habilitation site.  Except in unusual circumstances, the 
 license holder must not transport a consumer receiving services 
 for longer than one hour per one-way trip. 

    Subd. 12.    Separate license required for separate sites. 
  The license holder shall apply for separate licenses for each 
 day training and habilitation service site owned or leased by 
 the license holder at which persons receiving services and the 
 provider's employees who provide training and habilitation 
 services are present for a cumulative total of more than 30 days 
 within any 12-month period, and for each residential service 
 site.  

    Subd. 13.    Variance.  The commissioner may grant a 
 variance to any of the requirements in sections 245B.02 to 
 245B.07 except section 245B.07, subdivision 8(1)(vii), or 
 provisions governing data practices and information rights of 
 consumers if the conditions in section 245A.04, subdivision 9 
 are met.  Upon the request of the license holder, the 
 commissioner shall continue variances from the standards in this 
 chapter previously granted under Minnesota Rules that are 
 repealed as a result of this chapter.  The commissioner may 
 approve variances for a license holder on a program, geographic, 
 or organizational basis. 

    HIST: 1997 c 248 s 41; 3Sp1997 c 3 s 7,8; 1999 c 245 art 4 s 
 12-14 

     245B.08 Compliance strategies. 

    Subdivision 1.    Alternative methods of determining 
 compliance.  (a) In addition to methods specified in chapter 
 245A, the commissioner may use alternative methods and new 
 regulatory strategies to determine compliance with this 
 section.  The commissioner may use sampling techniques to ensure 
 compliance with this section.  Notwithstanding section 245A.09, 
 subdivision 7, paragraph (d), the commissioner may also extend 
 periods of licensure, not to exceed five years, for license 
 holders who have demonstrated substantial and consistent 
 compliance with sections 245B.02 to 245B.07 and have 
 consistently maintained the health and safety of consumers and 
 have demonstrated by alternative methods in paragraph (b) that 
 they meet or exceed the requirements of this section.  For 
 purposes of this section, "substantial and consistent 
 compliance" means that during the current licensing period: 

    (1) the license holder's license has not been made 
 conditional, suspended, or revoked; 

    (2) there have been no substantiated allegations of 
 maltreatment against the license holder; 

    (3) there have been no program deficiencies that have been 
 identified that would jeopardize the health or safety of 
 consumers being served; and 

    (4) the license holder is in substantial compliance with 
 the other requirements of chapter 245A and other applicable laws 
 and rules. 

    (b) To determine the length of a license, the commissioner 
 shall consider: 

    (1) information from affected consumers, and the license 
 holder's responsiveness to consumers' concerns and 
 recommendations; 

    (2) self assessments and peer reviews of the standards of 
 this section, corrective actions taken by the license holder, 
 and sharing the results of the inspections with consumers, the 
 consumers' families, and others, as requested; 

    (3) length of accreditation by an independent accreditation 
 body, if applicable; 

    (4) information from the county where the license holder is 
 located; and 

    (5) information from the license holder demonstrating 
 performance that meets or exceeds the minimum standards of this 
 chapter. 

    (c) The commissioner may reduce the length of the license 
 if the license holder fails to meet the criteria in paragraph 
 (a) and the conditions specified in paragraph (b). 

    Subd. 2.    Additional measures.  The commissioner may 
 require the license holder to implement additional measures on a 
 time-limited basis to ensure the health and safety of consumers 
 when the health and safety of consumers has been determined to 
 be at risk as determined by substantiated incidents of 
 maltreatment under sections 626.556 and 626.557.  The license 
 holder may request reconsideration of the actions taken by the 
 commissioner under this subdivision according to section 245A.06.

    Subd. 3.    Sanctions available.  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; make correction orders and make a 
 license conditional for failure to comply with applicable laws 
 or rules under section 245A.06; or deny an application for 
 license under section 245A.05. 

    Subd. 4.    Efficient application.  The commissioner 
 shall establish application procedures for license holders 
 licensed under this chapter to reduce the need to submit 
 duplicative material. 

    Subd. 5.    Information.  The commissioner shall make 
 information available to consumers and interested others 
 regarding the licensing status of a license holder. 

    Subd. 6.    Implementation.  The commissioner shall seek 
 advice from parties affected by the implementation of this 
 chapter. 

    Subd. 7.    Deem status.  The commissioner may exempt a 
 license holder from duplicative standards if the license holder 
 is already licensed under chapter 245A. 

    HIST: 1997 c 248 s 42; 1Sp2001 c 9 art 14 s 25