1.1                          A bill for an act 
  1.2             relating to human services; establishing an 
  1.3             alternative quality assurance pilot project in 
  1.4             southeastern Minnesota for persons with developmental 
  1.5             disabilities; establishing a regional quality 
  1.6             assurance commission; prescribing commission duties; 
  1.7             appropriating money; proposing coding for new law in 
  1.8             Minnesota Statutes, chapter 256B. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [256B.095] [THREE-YEAR QUALITY ASSURANCE PILOT 
  1.11  PROJECT ESTABLISHED.] 
  1.12     Effective July 1, 1998, an alternative quality assurance 
  1.13  pilot project for programs for persons with developmental 
  1.14  disabilities is established in Dodge, Fillmore, Freeborn, 
  1.15  Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, and 
  1.16  Winona counties.  A county, at its option, may choose to have 
  1.17  all programs for persons with developmental disabilities located 
  1.18  within the county licensed under the alternative quality 
  1.19  assurance pilot project or may continue regulation of these 
  1.20  programs under the licensing system operated by the 
  1.21  commissioner.  The pilot project expires on June 30, 2001.  
  1.22     Sec. 2.  [256B.0951] [QUALITY ASSURANCE COMMISSION.] 
  1.23     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
  1.24  assurance commission is established.  The commission consists of 
  1.25  at least 13 but not more than 21 members as follows:  at least 
  1.26  three but not more than five members representing advocacy 
  1.27  organizations; at least three but not more than five members 
  2.1   representing consumers, families, and their legal 
  2.2   representatives; at least three but not more than five members 
  2.3   representing service providers; at least three but not more than 
  2.4   five members representing counties; and one member representing 
  2.5   the commissioner of human services.  Initial membership of the 
  2.6   commission shall be recruited and approved by the active 
  2.7   membership of the region 10 stakeholders group.  Prior to 
  2.8   approving the commission's membership, the stakeholders group 
  2.9   shall provide to the commissioner a list of the membership in 
  2.10  the stakeholders group, as of February 1, 1997, a brief summary 
  2.11  of meetings held by the group since July 1, 1996, and copies of 
  2.12  any materials prepared by the group for public distribution.  
  2.13  The first commission shall establish membership guidelines for 
  2.14  the transition and recruitment of membership for the 
  2.15  commission's ongoing existence.  Members of the commission who 
  2.16  do not receive a salary or wages from an employer for time spent 
  2.17  on commission duties may receive a per diem payment when 
  2.18  performing commission duties and functions.  All members may be 
  2.19  reimbursed for expenses related to commission activities.  
  2.20  Notwithstanding the provisions of section 15.059, subdivision 5, 
  2.21  the commission expires on June 30, 2001. 
  2.22     Subd. 2.  [AUTHORITY TO HIRE STAFF.] The commission may 
  2.23  hire staff to perform the duties assigned in this section.  
  2.24  Commission staff are not public employees.  
  2.25     Subd. 3.  [IMMUNITY FROM LIABILITY.] No member of the 
  2.26  commission established under subdivision 1 shall be held civilly 
  2.27  or criminally liable for an act or omission by that person if 
  2.28  the act or omission was in good faith and within the scope of 
  2.29  the member's responsibilities under sections 256B.095 to 
  2.30  256B.0954. 
  2.31     Subd. 4.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
  2.32  commission shall approve an alternative quality assurance 
  2.33  licensing system based on the evaluation of outcomes.  The 
  2.34  commission shall approve measurable outcomes in the areas of 
  2.35  health and safety, consumer evaluation, education and training, 
  2.36  providers, and systems that shall be evaluated during the 
  3.1   alternative licensing process.  The commission shall establish 
  3.2   variable licensure periods not to exceed three years based on 
  3.3   outcomes achieved.  For purposes of this subdivision, "outcome" 
  3.4   means the behavior, action, or status of a person that can be 
  3.5   observed or measured and can be reliably and validly 
  3.6   determined.  The commission shall provide a copy of the quality 
  3.7   assurance licensing system to the commissioner. 
  3.8      (b) By January 15, 1998, the commission shall approve a 
  3.9   training program for members of the quality assurance teams 
  3.10  established under section 3. 
  3.11     Subd. 5.  [COMMISSION'S AUTHORITY TO WAIVE RULES.] The 
  3.12  commission may waive all or part of any rule referenced in this 
  3.13  subdivision if the commission determines that the alternative 
  3.14  licensing system provides adequate measures to protect the 
  3.15  health, safety, and rights of program enrollees and to provide 
  3.16  quality services.  The waiver takes effect upon notification to 
  3.17  the commissioner of human services or health, as appropriate, by 
  3.18  the commission that the rules have been waived.  This 
  3.19  subdivision only applies to rules applicable to persons with 
  3.20  developmental disabilities governing the following: 
  3.21     (1) case management services to persons with mental 
  3.22  retardation authorized under section 256B.092, excluding 
  3.23  provisions relating to due process rights of the individual or 
  3.24  the individual's legal representative; 
  3.25     (2) licensure of residential programs for persons with 
  3.26  mental retardation or related conditions authorized under 
  3.27  chapter 245A and section 252.28, subdivision 2, paragraph (1); 
  3.28     (3) semi-independent living services authorized under 
  3.29  chapter 245A and section 252.28, subdivision 2, paragraph (1); 
  3.30     (4) developmental achievement centers for mentally retarded 
  3.31  persons authorized under section 252.24, subdivision 2; 
  3.32     (5) grants for providing semi-independent living services 
  3.33  to persons with mental retardation authorized under sections 
  3.34  252.275 and 256B.092; 
  3.35     (6) licensure of training and habilitation services for 
  3.36  adults with mental retardation or related conditions authorized 
  4.1   under sections 245A.09; 252.28, subdivision 2, paragraph (1); 
  4.2   and 256B.092; 
  4.3      (7) administration of home and community-based services 
  4.4   authorized under sections 256B.092, 256B.502, and 256B.503; 
  4.5      (8) licensing of residential-based habilitation services 
  4.6   authorized under sections 245A.09; 252.28, subdivision 2, 
  4.7   paragraph (1); and 256B.092; 
  4.8      (9) licensure of family day care and adult and child foster 
  4.9   care authorized under section 245A.09; 
  4.10     (10) licensure of family foster care and group family 
  4.11  foster care authorized under section 245A.09; 
  4.12     (11) adult foster care services and licensure of adult 
  4.13  foster homes authorized under section 245A.09, except life 
  4.14  safety standards; 
  4.15     (12) foster care for children authorized under section 
  4.16  256.01, subdivision 2; and 
  4.17     (13) licensure of supervised living facilities authorized 
  4.18  under section 144.56. 
  4.19     Subd. 6.  [WAIVER OF CERTAIN RULES AND LAWS 
  4.20  PROHIBITED.] The commission shall not waive the safety 
  4.21  standards, rights, or procedural protections under sections 
  4.22  245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 3b, and 
  4.23  3c; 245A.09, subdivision 2, paragraph (c), clauses (2) and (5); 
  4.24  245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivisions 
  4.25  1b, clause (7), and 10; 626.556; 626.557, or procedures for the 
  4.26  monitoring of psychotropic medications.  The commission may make 
  4.27  recommendations to the commissioner or the legislature regarding 
  4.28  alternatives to or modifications of the rules referenced in this 
  4.29  subdivision. 
  4.30     Sec. 3.  [256B.0952] [COUNTY DUTIES; QUALITY ASSURANCE 
  4.31  TEAMS.] 
  4.32     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
  4.33  affected county shall notify the commission and the commissioner 
  4.34  whether it chooses to implement on July 1, 1998, the alternative 
  4.35  licensing system approved by the commission for the pilot 
  4.36  project.  A county that does not implement the alternative 
  5.1   system on July 1, 1998, may give notice to the commission by 
  5.2   January 15, 1999, or January 15, 2000, that it will implement 
  5.3   the system on the following July 1.  A county that implements 
  5.4   the alternative licensing system must continue to participate in 
  5.5   the alternative licensing system until June 30, 2001.  
  5.6      Subd. 2.  [APPOINTMENT OF REVIEW COUNCIL; DUTIES OF 
  5.7   COUNCIL.] A county or group of counties that choose to 
  5.8   participate in the alternative licensing system shall appoint a 
  5.9   quality assurance review council comprised of advocates; 
  5.10  consumers, families, and their legal representatives; providers; 
  5.11  and county staff.  The council shall: 
  5.12     (1) review summary reports from quality assurance team 
  5.13  reviews and make recommendations to counties regarding program 
  5.14  licensure; 
  5.15     (2) make recommendations to the commission regarding the 
  5.16  alternative licensing system and quality assurance process; and 
  5.17     (3) resolve complaints between the quality assurance teams, 
  5.18  counties, providers, and consumers, families, and their legal 
  5.19  representatives. 
  5.20     Subd. 3.  [NOTICE TO COMMISSIONER.] The county, based on 
  5.21  reports from quality assurance managers and recommendations from 
  5.22  the quality assurance review council regarding the findings of 
  5.23  quality assurance teams, shall notify the commissioner regarding 
  5.24  whether facilities, programs, or services have met the outcome 
  5.25  standards for licensure and are eligible for payment. 
  5.26     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
  5.27  county or group of counties that choose to participate in the 
  5.28  alternative licensing system must designate a quality assurance 
  5.29  manager.  The manager shall provide for the recruitment, 
  5.30  training, and assignment of quality assurance team members.  In 
  5.31  assigning team members to conduct the quality assurance process 
  5.32  at a facility, program, or service, the manager shall take into 
  5.33  account the size of the service provider, the number of services 
  5.34  to be reviewed, the skills necessary for team members to 
  5.35  complete the process, and other relevant factors.  The manager 
  5.36  shall ensure that no team member has a financial, personal, or 
  6.1   family relationship with the facility, program, or service being 
  6.2   reviewed or with any clients of the facility, program, or 
  6.3   service. 
  6.4      (b) Quality assurance teams shall report the findings of 
  6.5   their quality assurance reviews to the quality assurance manager.
  6.6   The quality assurance manager shall provide the report from the 
  6.7   quality assurance team to the county and a summary of the report 
  6.8   to the quality assurance review council. 
  6.9      Subd. 5.  [QUALITY ASSURANCE TEAMS.] Quality assurance 
  6.10  teams shall be comprised of county staff; providers; consumers, 
  6.11  families, and their legal representatives; members of advocacy 
  6.12  organizations; and other involved community members.  Team 
  6.13  members must satisfactorily complete the training program 
  6.14  approved by the commission and must demonstrate 
  6.15  performance-based competency.  Team members are not considered 
  6.16  to be county employees for purposes of workers' compensation, 
  6.17  reemployment insurance, or state retirement laws solely on the 
  6.18  basis of participation on a quality assurance team.  The county 
  6.19  may pay a per diem to team members who do not receive a salary 
  6.20  or wages from an employer for time spent on alternative quality 
  6.21  assurance process matters.  All team members may be reimbursed 
  6.22  for expenses related to their participation in the alternative 
  6.23  process. 
  6.24     Sec. 4.  [256B.0953] [QUALITY ASSURANCE PROCESS.] 
  6.25     Subdivision 1.  [PROCESS COMPONENTS.] (a) The quality 
  6.26  assurance licensing process consists of an evaluation by a 
  6.27  quality assurance team of the facility, program, or service 
  6.28  according to the outcome-based measurements approved by the 
  6.29  commission.  The process must include an evaluation of a random 
  6.30  sample of program consumers.  The sample must be representative 
  6.31  of each service provided.  The sample size must be at least five 
  6.32  percent of consumers but not less than three consumers.  
  6.33     (b) All consumers must be given the opportunity to be 
  6.34  included in the evaluation in addition to those chosen for the 
  6.35  random sample.  Public program recipients have an obligation to 
  6.36  participate in the evaluation, but they may choose not to 
  7.1   participate in a specific review if they consider that review to 
  7.2   be untimely or intrusive. 
  7.3      Subd. 2.  [LICENSURE PERIODS.] (a) In order to be licensed 
  7.4   under the alternative quality assurance process, a facility, 
  7.5   program, or service must satisfy the health and safety outcomes 
  7.6   approved by the commission. 
  7.7      (b) Licensure shall be approved for periods from one to 
  7.8   three years for a facility, program, or service that satisfies 
  7.9   the requirements of paragraph (a) and achieves the outcome 
  7.10  measurements in the categories of consumer evaluation, education 
  7.11  and training, providers, and systems. 
  7.12     (c) If a facility, program, or service fails to 
  7.13  satisfactorily achieve the outcome measurements approved by the 
  7.14  commission, licensure may be granted on a provisional basis as 
  7.15  established by the commission.  Provisional licensure shall only 
  7.16  be granted after approval by the county of a plan of correction 
  7.17  designed: 
  7.18     (1) to increase achievement of outcome measures; and 
  7.19     (2) to address any critical deficiencies demanding 
  7.20  immediate attention in order to allow continued program 
  7.21  operation. 
  7.22     Subd. 3.  [APPEALS PROCESS.] A facility, program, or 
  7.23  service may contest a licensing decision of the quality 
  7.24  assurance team through the administrative appeals process in 
  7.25  section 256.045. 
  7.26     Sec. 5.  [256B.0954] [COMMISSIONER'S DUTIES.] 
  7.27     (a) Effective July 1, 1998, the commissioner shall not 
  7.28  license or reimburse a facility, program, or service for persons 
  7.29  with developmental disabilities in a county that participates in 
  7.30  the alternative licensing system if the commissioner has 
  7.31  received from the appropriate county notification that the 
  7.32  facility, program, or service has been reviewed by a quality 
  7.33  assurance team and has failed to qualify for licensure. 
  7.34     (b) The commissioner may conduct random licensing 
  7.35  inspections based on outcomes established by the commission at 
  7.36  facilities, programs, and services governed by the alternative 
  8.1   licensing system.  The role of such random inspections shall be 
  8.2   to verify that the alternative licensing system protects the 
  8.3   safety and well-being of consumers and maintains the 
  8.4   availability of high-quality services for persons with 
  8.5   developmental disabilities.  
  8.6      (c) The commissioner and the commission shall establish an 
  8.7   ongoing evaluation process for the alternative system. 
  8.8      (d) The commissioner shall contract with an independent 
  8.9   entity to conduct a financial review of the alternative quality 
  8.10  assurance system, including an evaluation of possible budgetary 
  8.11  savings within the department of human services as a result of 
  8.12  implementation of the alternative quality assurance licensing 
  8.13  system.  This review must be completed by December 15, 2000.  
  8.14     (e) The commissioner and the commission shall submit a 
  8.15  report to the legislature by January 15, 2001, on the results of 
  8.16  the evaluation process of the alternative licensing system, a 
  8.17  summary of the results of the independent financial review, and 
  8.18  a recommendation on whether the pilot project should be extended 
  8.19  beyond June 30, 2001. 
  8.20     Sec. 6.  [REQUEST FOR WAIVER.] 
  8.21     By January 1, 1998, the commissioner of human services 
  8.22  shall request a waiver from the federal Department of Health and 
  8.23  Human Services to permit the use of the alternative quality 
  8.24  assurance system to license intermediate care facilities for 
  8.25  persons with mental retardation. 
  8.26     Sec. 7.  [APPROPRIATIONS.] 
  8.27     Subdivision 1.  [QUALITY ASSURANCE REVIEW 
  8.28  COMMISSION.] $....... is appropriated to the quality assurance 
  8.29  review commission for the biennium beginning July 1, 1997, for 
  8.30  the costs associated with section 2. 
  8.31     Subd. 2.  [COMMISSIONER OF HUMAN SERVICES.] (a) $....... is 
  8.32  appropriated to the commissioner of human services for the 
  8.33  fiscal year beginning July 1, 1998, for grants to counties that 
  8.34  participate in the alternative quality assurance licensing 
  8.35  system.  This appropriation shall be transferred to the counties 
  8.36  that choose by January 15, 1998, to participate in the 
  9.1   alternative licensing system for the year beginning July 1, 
  9.2   1998.  Each participating county shall receive a pro rata share 
  9.3   of the appropriation based on each county's case management 
  9.4   caseload for persons with developmental disabilities for 
  9.5   calendar year 1997. 
  9.6      (b) $....... is appropriated to the commissioner of human 
  9.7   services to contract with an independent entity to conduct a 
  9.8   financial review as specified in section 5, paragraph (d).