1.1                          A bill for an act
  1.2             relating to developmental disabilities; establishing 
  1.3             an alternative quality assurance pilot project in 
  1.4             southeastern Minnesota; establishing a regional 
  1.5             quality assurance commission; prescribing commission 
  1.6             duties; appropriating money; proposing coding for new 
  1.7             law in Minnesota Statutes, chapter 256B. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  [256B.095] [THREE-YEAR QUALITY ASSURANCE PILOT 
  1.10  PROJECT ESTABLISHED.] 
  1.11     Effective July 1, 1998, an alternative quality assurance 
  1.12  licensing system pilot project for programs for persons with 
  1.13  developmental disabilities is established in Dodge, Fillmore, 
  1.14  Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
  1.15  Wabasha, and Winona counties for the purpose of improving the 
  1.16  quality of services provided to persons with developmental 
  1.17  disabilities.  A county, at its option, may choose to have all 
  1.18  programs for persons with developmental disabilities located 
  1.19  within the county licensed under chapter 245A using standards 
  1.20  determined under the alternative quality assurance licensing 
  1.21  system pilot project or may continue regulation of these 
  1.22  programs under the licensing system operated by the 
  1.23  commissioner.  The pilot project expires on June 30, 2001. 
  1.24     Sec. 2.  [256B.0951] [QUALITY ASSURANCE COMMISSION.] 
  1.25     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
  1.26  assurance commission is established.  The commission consists of 
  2.1   at least 13 but not more than 20 members as follows:  at least 
  2.2   three but not more than five members representing advocacy 
  2.3   organizations; at least three but not more than five members 
  2.4   representing consumers, families, and their legal 
  2.5   representatives; at least three but not more than five members 
  2.6   representing service providers; and at least three but not more 
  2.7   than five members representing counties.  Initial membership of 
  2.8   the commission shall be recruited and approved by the region 10 
  2.9   stakeholders group.  Prior to approving the commission's 
  2.10  membership, the stakeholders group shall provide to the 
  2.11  commissioner a list of the membership in the stakeholders group, 
  2.12  as of February 1, 1997, a brief summary of meetings held by the 
  2.13  group since July 1, 1996, and copies of any materials prepared 
  2.14  by the group for public distribution.  The first commission 
  2.15  shall establish membership guidelines for the transition and 
  2.16  recruitment of membership for the commission's ongoing 
  2.17  existence.  Members of the commission who do not receive a 
  2.18  salary or wages from an employer for time spent on commission 
  2.19  duties may receive a per diem payment when performing commission 
  2.20  duties and functions.  All members may be reimbursed for 
  2.21  expenses related to commission activities.  Notwithstanding the 
  2.22  provisions of section 15.059, subdivision 5, the commission 
  2.23  expires on June 30, 2001. 
  2.24     Subd. 2.  [AUTHORITY TO HIRE STAFF.] The commission may 
  2.25  hire staff to perform the duties assigned in this section.  
  2.26     Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
  2.27  commission, in cooperation with the commissioners of human 
  2.28  services and health, shall do the following:  (1) approve an 
  2.29  alternative quality assurance licensing system based on the 
  2.30  evaluation of outcomes; (2) approve measurable outcomes in the 
  2.31  areas of health and safety, consumer evaluation, education and 
  2.32  training, providers, and systems that shall be evaluated during 
  2.33  the alternative licensing process; and (3) establish variable 
  2.34  licensure periods not to exceed three years based on outcomes 
  2.35  achieved.  For purposes of this subdivision, "outcome" means the 
  2.36  behavior, action, or status of a person that can be observed or 
  3.1   measured and can be reliably and validly determined. 
  3.2      (b) By January 15, 1998, the commission shall approve, in 
  3.3   cooperation with the commissioner of human services, a training 
  3.4   program for members of the quality assurance teams established 
  3.5   under section 3. 
  3.6      Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
  3.7   LICENSING STANDARDS.] The commission may recommend to the 
  3.8   commissioners of human services and health variances from the 
  3.9   standards governing licensure of programs for persons with 
  3.10  developmental disabilities in order to implement an alternative 
  3.11  developmental disabilities licensing system if the commission 
  3.12  determines that the alternative licensing system does not affect 
  3.13  the health or safety of persons being served by the licensed 
  3.14  program nor compromise the qualifications of staff to provide 
  3.15  services. 
  3.16     Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
  3.17  safety standards, rights, or procedural protections under 
  3.18  sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
  3.19  3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
  3.20  and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
  3.21  subdivisions 1b, clause (7), and 10; 626.556; 626.557, or 
  3.22  procedures for the monitoring of psychotropic medications shall 
  3.23  not be varied under the alternative licensing system pilot 
  3.24  project.  The commission may make recommendations to the 
  3.25  commissioners of human services and health or to the legislature 
  3.26  regarding alternatives to or modifications of the rules 
  3.27  referenced in this subdivision. 
  3.28     Subd. 6.  [PROGRESS REPORT.] The commission shall submit a 
  3.29  progress report to the legislature on pilot project development 
  3.30  by January 15, 1998.  The report shall include recommendations 
  3.31  on any legislative changes necessary to improve cooperation 
  3.32  between the commission and the commissioners of human services 
  3.33  and health. 
  3.34     Sec. 3.  [256B.0952] [COUNTY DUTIES; QUALITY ASSURANCE 
  3.35  TEAMS.] 
  3.36     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
  4.1   affected county shall notify the commission and the 
  4.2   commissioners of human services and health as to whether it 
  4.3   chooses to implement on July 1, 1998, the alternative licensing 
  4.4   system for the pilot project.  A county that does not implement 
  4.5   the alternative licensing system on July 1, 1998, may give 
  4.6   notice to the commission and the commissioners by January 15, 
  4.7   1999, or January 15, 2000, that it will implement the 
  4.8   alternative licensing system on the following July 1.  A county 
  4.9   that implements the alternative licensing system commits to 
  4.10  participate until June 30, 2001.  
  4.11     Subd. 2.  [APPOINTMENT OF REVIEW COUNCIL; DUTIES OF 
  4.12  COUNCIL.] A county or group of counties that choose to 
  4.13  participate in the alternative licensing system shall appoint a 
  4.14  quality assurance review council comprised of advocates; 
  4.15  consumers, families, and their legal representatives; providers; 
  4.16  and county staff.  The council shall: 
  4.17     (1) review summary reports from quality assurance team 
  4.18  reviews and make recommendations to counties regarding program 
  4.19  licensure; 
  4.20     (2) make recommendations to the commission regarding the 
  4.21  alternative licensing system and quality assurance process; and 
  4.22     (3) resolve complaints between the quality assurance teams, 
  4.23  counties, providers, and consumers, families, and their legal 
  4.24  representatives. 
  4.25     Subd. 3.  [NOTICE TO COMMISSIONERS.] The county, based on 
  4.26  reports from quality assurance managers and recommendations from 
  4.27  the quality assurance review council regarding the findings of 
  4.28  quality assurance teams, shall notify the commissioners of human 
  4.29  services and health regarding whether facilities, programs, or 
  4.30  services have met the outcome standards for licensure and are 
  4.31  eligible for payment. 
  4.32     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
  4.33  county or group of counties that choose to participate in the 
  4.34  alternative licensing system shall designate a quality assurance 
  4.35  manager and shall establish quality assurance teams in 
  4.36  accordance with subdivision 5.  The manager shall recruit, 
  5.1   train, and assign duties to the quality assurance team members.  
  5.2   In assigning team members to conduct the quality assurance 
  5.3   process at a facility, program, or service, the manager shall 
  5.4   take into account the size of the service provider, the number 
  5.5   of services to be reviewed, the skills necessary for team 
  5.6   members to complete the process, and other relevant factors.  
  5.7   The manager shall ensure that no team member has a financial, 
  5.8   personal, or family relationship with the facility, program, or 
  5.9   service being reviewed or with any clients of the facility, 
  5.10  program, or service. 
  5.11     (b) Quality assurance teams shall report the findings of 
  5.12  their quality assurance reviews to the quality assurance manager.
  5.13  The quality assurance manager shall provide the report from the 
  5.14  quality assurance team to the county and commissioners of human 
  5.15  services and health and a summary of the report to the quality 
  5.16  assurance review council.  
  5.17     Subd. 5.  [QUALITY ASSURANCE TEAMS.] Quality assurance 
  5.18  teams shall be comprised of county staff; providers; consumers, 
  5.19  families, and their legal representatives; members of advocacy 
  5.20  organizations; and other involved community members.  Team 
  5.21  members must satisfactorily complete the training program 
  5.22  approved by the commission and must demonstrate 
  5.23  performance-based competency.  Team members are not considered 
  5.24  to be county employees for purposes of workers' compensation, 
  5.25  unemployment compensation, or state retirement laws solely on 
  5.26  the basis of participation on a quality assurance team.  The 
  5.27  county may pay a per diem to team members who do not receive a 
  5.28  salary or wages from an employer for time spent on alternative 
  5.29  quality assurance process matters.  All team members may be 
  5.30  reimbursed for expenses related to their participation in the 
  5.31  alternative process. 
  5.32     Subd. 6.  [LICENSING FUNCTIONS.] Participating counties 
  5.33  shall perform licensing functions and activities as delegated by 
  5.34  the commissioner of human services in accordance with section 
  5.35  245A.16. 
  5.36     Sec. 4.  [256B.0953] [QUALITY ASSURANCE PROCESS.] 
  6.1      Subdivision 1.  [PROCESS COMPONENTS.] (a) The quality 
  6.2   assurance licensing process consists of an evaluation by a 
  6.3   quality assurance team of the facility, program, or service 
  6.4   according to outcome-based measurements.  The process must 
  6.5   include an evaluation of a random sample of program consumers.  
  6.6   The sample must be representative of each service provided.  The 
  6.7   sample size must be at least five percent of consumers but not 
  6.8   less than three consumers.  
  6.9      (b) All consumers must be given the opportunity to be 
  6.10  included in the quality assurance process in addition to those 
  6.11  chosen for the random sample. 
  6.12     Subd. 2.  [LICENSURE PERIODS.] (a) In order to be licensed 
  6.13  under the alternative quality assurance process, a facility, 
  6.14  program, or service must satisfy the health and safety outcomes 
  6.15  approved for the pilot project. 
  6.16     (b) Licensure shall be approved for periods of one to three 
  6.17  years for a facility, program, or service that satisfies the 
  6.18  requirements of paragraph (a) and achieves the outcome 
  6.19  measurements in the categories of consumer evaluation, education 
  6.20  and training, providers, and systems. 
  6.21     Subd. 3.  [APPEALS PROCESS.] A facility, program, or 
  6.22  service may contest a licensing decision of the quality 
  6.23  assurance team as permitted under chapter 245A. 
  6.24     Sec. 5.  [256B.0954] [CERTAIN PERSONS DEFINED AS MANDATED 
  6.25  REPORTERS.] 
  6.26     Members of the quality assurance commission established 
  6.27  under section 2, members of quality assurance review councils 
  6.28  established under section 3, quality assurance managers 
  6.29  appointed under section 3, and members of quality assurance 
  6.30  teams established under section 3 are mandated reporters as that 
  6.31  term is defined in sections 626.556, subdivision 3, and 
  6.32  626.5572, subdivision 16. 
  6.33     Sec. 6.  [256B.0955] [DUTIES OF THE COMMISSIONER OF HUMAN 
  6.34  SERVICES.] 
  6.35     (a) Effective July 1, 1998, the commissioner of human 
  6.36  services shall delegate authority to perform licensing functions 
  7.1   and activities, in accordance with section 245A.16, to counties 
  7.2   participating in the alternative licensing system.  The 
  7.3   commissioner shall not license or reimburse a facility, program, 
  7.4   or service for persons with developmental disabilities in a 
  7.5   county that participates in the alternative licensing system if 
  7.6   the commissioner has received from the appropriate county 
  7.7   notification that the facility, program, or service has been 
  7.8   reviewed by a quality assurance team and has failed to qualify 
  7.9   for licensure. 
  7.10     (b) The commissioner may conduct random licensing 
  7.11  inspections based on outcomes adopted under section 2 at 
  7.12  facilities, programs, and services governed by the alternative 
  7.13  licensing system.  The role of such random inspections shall be 
  7.14  to verify that the alternative licensing system protects the 
  7.15  safety and well-being of consumers and maintains the 
  7.16  availability of high-quality services for persons with 
  7.17  developmental disabilities.  
  7.18     (c) The commissioner shall provide technical assistance and 
  7.19  support or training to the alternative licensing system pilot 
  7.20  project. 
  7.21     (d) The commissioner and the commission shall establish an 
  7.22  ongoing evaluation process for the alternative licensing system. 
  7.23     (e) The commissioner shall contract with an independent 
  7.24  entity to conduct a financial review of the alternative 
  7.25  licensing system, including an evaluation of possible budgetary 
  7.26  savings within the department of human services and the 
  7.27  department of health as a result of implementation of the 
  7.28  alternative quality assurance licensing system.  This review 
  7.29  must be completed by December 15, 2000.  
  7.30     (f) The commissioner and the commission shall submit a 
  7.31  report to the legislature by January 15, 2001, on the results of 
  7.32  the evaluation process of the alternative licensing system, a 
  7.33  summary of the results of the independent financial review, and 
  7.34  a recommendation on whether the pilot project should be extended 
  7.35  beyond June 30, 2001. 
  7.36     Sec. 7.  [REQUEST FOR WAIVER.] 
  8.1      By January 1, 1998, the commissioner of human services or 
  8.2   health shall request a waiver from the federal Department of 
  8.3   Health and Human Services to permit the use of the alternative 
  8.4   quality assurance system to license and certify intermediate 
  8.5   care facilities for persons with mental retardation. 
  8.6      Sec. 8.  [APPROPRIATIONS.] 
  8.7      Subdivision 1.  [QUALITY ASSURANCE REVIEW 
  8.8   COMMISSION.] $....... is appropriated to the quality assurance 
  8.9   review commission for the biennium beginning July 1, 1997, for 
  8.10  the costs associated with section 2. 
  8.11     Subd. 2.  [COMMISSIONER OF HUMAN SERVICES.] (a) $....... is 
  8.12  appropriated to the commissioner of human services for the 
  8.13  fiscal year beginning July 1, 1998, for grants to counties that 
  8.14  participate in the alternative quality assurance licensing 
  8.15  system.  This appropriation shall be transferred to the counties 
  8.16  that choose by January 15, 1998, to participate in the 
  8.17  alternative licensing system for the year beginning July 1, 
  8.18  1998.  Each participating county shall receive a pro rata share 
  8.19  of the appropriation based on each county's case management 
  8.20  caseload for persons with developmental disabilities for 
  8.21  calendar year 1997. 
  8.22     (b) $....... is appropriated to the commissioner of human 
  8.23  services to contract with an independent entity to conduct a 
  8.24  financial review as specified in section 6, paragraph (e). 
  8.25     (c) $....... is appropriated to the commissioner of human 
  8.26  services for the ongoing evaluation process for the alternative 
  8.27  licensing system.