1.1                          A bill for an act
  1.2             relating to human services; expanding adult foster 
  1.3             care; modifying continuing care provisions; amending 
  1.4             Minnesota Statutes 2002, sections 245A.09, subdivision 
  1.5             7; 245A.10; 245A.11, by adding a subdivision; 245B.03, 
  1.6             by adding a subdivision; 245B.06, subdivisions 2, 5; 
  1.7             245B.07, subdivisions 6, 9; 245B.08, subdivision 1; 
  1.8             253B.05, by adding a subdivision; 256B.0623, 
  1.9             subdivisions 2, 4, 6, 8; 256B.0625, subdivision 19c. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11                             ARTICLE 1
  1.12               DEPARTMENT OF HUMAN SERVICES LICENSING
  1.13     Section 1.  Minnesota Statutes 2002, section 245A.09, 
  1.14  subdivision 7, is amended to read: 
  1.15     Subd. 7.  [REGULATORY METHODS.] (a) Where appropriate and 
  1.16  feasible the commissioner shall identify and implement 
  1.17  alternative methods of regulation and enforcement to the extent 
  1.18  authorized in this subdivision.  These methods shall include: 
  1.19     (1) expansion of the types and categories of licenses that 
  1.20  may be granted; 
  1.21     (2) when the standards of another state or federal 
  1.22  governmental agency or an independent accreditation body have 
  1.23  been shown to predict compliance with the rules require the same 
  1.24  standards, methods, or alternative methods to achieve 
  1.25  substantially the same intended outcomes as the licensing 
  1.26  standards, the commissioner shall consider compliance with the 
  1.27  governmental or accreditation standards to be equivalent to 
  2.1   partial compliance with the rules licensing standards; and 
  2.2      (3) use of an abbreviated inspection that employs key 
  2.3   standards that have been shown to predict full compliance with 
  2.4   the rules. 
  2.5      (b) If the commissioner accepts accreditation as 
  2.6   documentation of compliance with a licensing standard under 
  2.7   paragraph (a), the commissioner shall continue to investigate 
  2.8   complaints related to noncompliance with all licensing standards.
  2.9   The commissioner may take a licensing action for noncompliance 
  2.10  under this chapter and shall recognize all existing appeal 
  2.11  rights regarding any licensing actions taken under this chapter. 
  2.12     (c) The commissioner shall work with the commissioners of 
  2.13  health, public safety, administration, and children, families, 
  2.14  and learning in consolidating duplicative licensing and 
  2.15  certification rules and standards if the commissioner determines 
  2.16  that consolidation is administratively feasible, would 
  2.17  significantly reduce the cost of licensing, and would not reduce 
  2.18  the protection given to persons receiving services in licensed 
  2.19  programs.  Where administratively feasible and appropriate, the 
  2.20  commissioner shall work with the commissioners of health, public 
  2.21  safety, administration, and children, families, and learning in 
  2.22  conducting joint agency inspections of programs. 
  2.23     (c) (d) The commissioner shall work with the commissioners 
  2.24  of health, public safety, administration, and children, 
  2.25  families, and learning in establishing a single point of 
  2.26  application for applicants who are required to obtain concurrent 
  2.27  licensure from more than one of the commissioners listed in this 
  2.28  clause. 
  2.29     (d) (e) Unless otherwise specified in statute, the 
  2.30  commissioner may specify in rule periods of licensure up to two 
  2.31  years conduct routine inspections biennially. 
  2.32     Sec. 2.  Minnesota Statutes 2002, section 245A.10, is 
  2.33  amended to read: 
  2.34     245A.10 [FEES.] 
  2.35     The commissioner shall charge a fee for evaluation of 
  2.36  applications and inspection of programs, other than family day 
  3.1   care and foster care, which are licensed under this chapter.  
  3.2   The commissioner may charge a fee for the licensing of school 
  3.3   age child care programs, in an amount sufficient to cover the 
  3.4   cost to the state agency of processing the license. 
  3.5      A county agency may charge a fee to an applicant or license 
  3.6   holder in an amount not to exceed $100 to cover the county 
  3.7   agency's costs for evaluating applications and inspecting family 
  3.8   child care and group family child care programs that are 
  3.9   licensed under this chapter. 
  3.10     Sec. 3.  Minnesota Statutes 2002, section 245A.11, is 
  3.11  amended by adding a subdivision to read: 
  3.12     Subd. 7.  [ADULT FOSTER CARE; VARIANCE FOR ALTERNATE 
  3.13  OVERNIGHT SUPERVISION.] (a) The commissioner may grant a 
  3.14  variance under section 245A.04, subdivision 9, to rule parts 
  3.15  requiring a caregiver to be present in an adult foster care home 
  3.16  during normal sleeping hours to allow for alternative methods of 
  3.17  overnight supervision.  The commissioner may grant the variance 
  3.18  if the local county licensing agency recommends the variance and 
  3.19  the county recommendation includes documentation verifying that: 
  3.20     (1) the county has approved the license holder's plan for 
  3.21  alternative methods of providing overnight supervision and 
  3.22  determined the plan protects the residents' health, safety, and 
  3.23  rights; 
  3.24     (2) the license holder has obtained written and signed 
  3.25  informed consent from each resident or each resident's legal 
  3.26  representative documenting the resident's or legal 
  3.27  representative's agreement with the alternative method of 
  3.28  overnight supervision; and 
  3.29     (3) the alternative method of providing overnight 
  3.30  supervision is specified for each resident in the resident's: 
  3.31  (i) individualized plan of care; (ii) individual service plan 
  3.32  under section 256B.092, subdivision 1b, if required; or (iii) 
  3.33  individual resident placement agreement under Minnesota Rules, 
  3.34  part 9555.5105, subpart 19, if required. 
  3.35     (b) To be eligible for a variance under paragraph (a), the 
  3.36  adult foster care license holder must not have had a licensing 
  4.1   action under section 245A.06 or 245A.07 during the prior 24 
  4.2   months based on failure to provide adequate supervision, health 
  4.3   care services, or resident safety in the adult foster care home. 
  4.4      Sec. 4.  Minnesota Statutes 2002, section 245B.03, is 
  4.5   amended by adding a subdivision to read: 
  4.6      Subd. 3.  [CONTINUITY OF CARE.] (a) When a consumer changes 
  4.7   service to the same type of service provided under a different 
  4.8   license held by the same license holder and the policies and 
  4.9   procedures under section 245B.07, subdivision 8, are 
  4.10  substantially similar, the license holder is exempt from the 
  4.11  requirements in sections 245B.06, subdivisions 2, paragraphs (e) 
  4.12  and (f), and 4; and 245B.07, subdivision 9, clause (2). 
  4.13     (b) When a direct service staff person begins providing 
  4.14  direct service under one or more licenses other than the license 
  4.15  for which the staff person initially received the staff 
  4.16  orientation requirements under section 245B.07, subdivision 5, 
  4.17  the license holder is exempt from all staff orientation 
  4.18  requirements under section 245B.07, subdivision 5, except that: 
  4.19     (1) if the service provision location changes, the staff 
  4.20  person must receive orientation regarding any policies or 
  4.21  procedures under section 245B.07, subdivision 8, that are 
  4.22  specific to the service provision location; and 
  4.23     (2) if the staff person provides direct service to one or 
  4.24  more consumers to whom the staff person has not previously 
  4.25  provided direct service, the staff person must review each 
  4.26  consumer's:  (i) service plans and risk management plan in 
  4.27  accordance with section 245B.07, subdivision 5, paragraph (b), 
  4.28  clause (1); and (ii) medication administration in accordance 
  4.29  with section 245B.07, subdivision 5, paragraph (b), clause (6). 
  4.30     Sec. 5.  Minnesota Statutes 2002, section 245B.06, 
  4.31  subdivision 2, is amended to read: 
  4.32     Subd. 2.  [RISK MANAGEMENT PLAN.] (a) The license holder 
  4.33  must develop and, document in writing, and implement a risk 
  4.34  management plan that incorporates the individual abuse 
  4.35  prevention plan as required in section 245A.65 meets the 
  4.36  requirements of this subdivision.  License holders licensed 
  5.1   under this chapter are exempt from sections 245A.65, subdivision 
  5.2   2, and 626.557, subdivision 14, if the requirements of this 
  5.3   subdivision are met.  
  5.4      (b) The risk management plan must identify areas in which 
  5.5   the consumer is vulnerable, based on an assessment, at a 
  5.6   minimum, of the following areas: 
  5.7      (1) an adult consumer's susceptibility to physical, 
  5.8   emotional, and sexual abuse as defined in section 626.5572, 
  5.9   subdivision 2, and financial exploitation as defined in section 
  5.10  626.5572, subdivision 9; a minor consumer's susceptibility to 
  5.11  sexual and physical abuse as defined in section 626.556, 
  5.12  subdivision 2; and a consumer's susceptibility to self-abuse, 
  5.13  regardless of age; 
  5.14     (2) the consumer's health needs, considering the consumer's 
  5.15  physical disabilities; allergies; sensory impairments; seizures; 
  5.16  diet; need for medications; and ability to obtain medical 
  5.17  treatment; 
  5.18     (3) the consumer's safety needs, considering the consumer's 
  5.19  ability to take reasonable safety precautions; community 
  5.20  survival skills; water survival skills; ability to seek 
  5.21  assistance or provide medical care; and access to toxic 
  5.22  substances or dangerous items; 
  5.23     (4) environmental issues, considering the program's 
  5.24  location in a particular neighborhood or community; the type of 
  5.25  grounds and terrain surrounding the building; and the consumer's 
  5.26  ability to respond to weather-related conditions, open locked 
  5.27  doors, and remain alone in any environment; and 
  5.28     (5) the consumer's behavior, including behaviors that may 
  5.29  increase the likelihood of physical aggression between consumers 
  5.30  or sexual activity between consumers involving force or 
  5.31  coercion, as defined under section 245B.02, subdivision 10, 
  5.32  clauses (6) and (7). 
  5.33     (c) When assessing a consumer's vulnerability, the license 
  5.34  holder must consider only the consumer's skills and abilities, 
  5.35  independent of staffing patterns, supervision plans, the 
  5.36  environment, or other situational elements.  
  6.1      (d) License holders jointly providing services to a 
  6.2   consumer shall coordinate and use the resulting assessment of 
  6.3   risk areas for the development of this each license holder's 
  6.4   risk management or the shared risk management plan.  Upon 
  6.5   initiation of services, the license holder will have in place an 
  6.6   initial risk management plan that identifies areas in which the 
  6.7   consumer is vulnerable, including health, safety, and 
  6.8   environmental issues and the supports the provider will have in 
  6.9   place to protect the consumer and to minimize these risks.  The 
  6.10  plan must be changed based on the needs of the individual 
  6.11  consumer and reviewed at least annually.  The license holder's 
  6.12  plan must include the specific actions a staff person will take 
  6.13  to protect the consumer and minimize risks for the identified 
  6.14  vulnerability areas.  The specific actions must include the 
  6.15  proactive measures being taken, training being provided, or a 
  6.16  detailed description of actions a staff person will take when 
  6.17  intervention is needed. 
  6.18     (e) Prior to or upon initiating services, a license holder 
  6.19  must develop an initial risk management plan that is, at a 
  6.20  minimum, verbally approved by the consumer or consumer's legal 
  6.21  representative and case manager.  The license holder must 
  6.22  document the date the license holder receives the consumer's or 
  6.23  consumer's legal representative's and case manager's verbal 
  6.24  approval of the initial plan. 
  6.25     (f) As part of the meeting held within 45 days of 
  6.26  initiating service, as required under section 245B.06, 
  6.27  subdivision 4, the license holder must review the initial risk 
  6.28  management plan for accuracy and revise the plan if necessary.  
  6.29  The license holder must give the consumer or consumer's legal 
  6.30  representative and case manager an opportunity to participate in 
  6.31  this plan review.  If the license holder revises the plan, or if 
  6.32  the consumer or consumer's legal representative and case manager 
  6.33  have not previously signed and dated the plan, the license 
  6.34  holder must obtain dated signatures to document the plan's 
  6.35  approval. 
  6.36     (g) After plan approval, the license holder must review the 
  7.1   plan at least annually and update the plan based on the 
  7.2   individual consumer's needs and changes to the environment.  The 
  7.3   license holder must give the consumer or consumer's legal 
  7.4   representative and case manager an opportunity to participate in 
  7.5   the ongoing plan development.  The license holder shall obtain 
  7.6   dated signatures from the consumer or consumer's legal 
  7.7   representative and case manager to document completion of the 
  7.8   annual review and approval of plan changes. 
  7.9      Sec. 6.  Minnesota Statutes 2002, section 245B.06, 
  7.10  subdivision 5, is amended to read: 
  7.11     Subd. 5.  [PROGRESS REVIEWS.] The license holder must 
  7.12  participate in progress review meetings following stated time 
  7.13  lines established in the consumer's individual service plan or 
  7.14  as requested in writing by the consumer, the consumer's legal 
  7.15  representative, or the case manager, at a minimum of once a 
  7.16  year.  The license holder must summarize the progress toward 
  7.17  achieving the desired outcomes and make recommendations in a 
  7.18  written report sent to the consumer or the consumer's legal 
  7.19  representative and case manager prior to the review meeting.  
  7.20  For consumers under public guardianship, the license holder is 
  7.21  required to provide quarterly written progress review reports to 
  7.22  the consumer, designated family member, and case manager.  
  7.23     Sec. 7.  Minnesota Statutes 2002, section 245B.07, 
  7.24  subdivision 6, is amended to read: 
  7.25     Subd. 6.  [STAFF TRAINING.] (a) The license holder shall 
  7.26  ensure that direct service staff annually complete hours of 
  7.27  training equal to two percent of the number of hours the staff 
  7.28  person worked or one percent for license holders providing 
  7.29  semi-independent living services.  Direct service staff who have 
  7.30  worked for the license holder for an average of at least 30 
  7.31  hours per week for 24 or more months must annually complete 
  7.32  hours of training equal to one percent of the number of hours 
  7.33  the staff person worked.  If direct service staff has received 
  7.34  training from a license holder licensed under a program rule 
  7.35  identified in this chapter or completed course work regarding 
  7.36  disability-related issues from a post-secondary educational 
  8.1   institute, that training may also count toward training 
  8.2   requirements for other services and for other license holders. 
  8.3      (b) The license holder must document the training completed 
  8.4   by each employee. 
  8.5      (c) Training shall address staff competencies necessary to 
  8.6   address the consumer needs as identified in the consumer's 
  8.7   individual service plan and ensure consumer health, safety, and 
  8.8   protection of rights.  Training may also include other areas 
  8.9   identified by the license holder. 
  8.10     (d) For consumers requiring a 24-hour plan of care, the 
  8.11  license holder shall provide training in cardiopulmonary 
  8.12  resuscitation, from a qualified source determined by the 
  8.13  commissioner, if the consumer's health needs as determined by 
  8.14  the consumer's physician indicate trained staff would be 
  8.15  necessary to the consumer. 
  8.16     Sec. 8.  Minnesota Statutes 2002, section 245B.07, 
  8.17  subdivision 9, is amended to read: 
  8.18     Subd. 9.  [AVAILABILITY OF CURRENT WRITTEN POLICIES AND 
  8.19  PROCEDURES.] The license holder shall: 
  8.20     (1) review and update, as needed, the written policies and 
  8.21  procedures in this chapter and inform all consumers or the 
  8.22  consumer's legal representatives, case managers, and employees 
  8.23  of the revised policies and procedures when they affect the 
  8.24  service provision; 
  8.25     (2) inform consumers or the consumer's legal 
  8.26  representatives of the written policies and procedures in this 
  8.27  chapter upon service initiation.  Copies must be available to 
  8.28  consumers or the consumer's legal representatives, case 
  8.29  managers, the county where services are located, and the 
  8.30  commissioner upon request; and 
  8.31     (3) provide all consumers or the consumers' legal 
  8.32  representatives and case managers a copy and explanation of 
  8.33  revisions to policies and procedures that affect consumers' 
  8.34  service-related or protection-related rights under section 
  8.35  245B.04.  Unless there is reasonable cause, the license holder 
  8.36  must provide this notice at least 30 days before implementing 
  9.1   the revised policy and procedure.  The license holder must 
  9.2   document the reason for not providing the notice at least 30 
  9.3   days before implementing the revisions; 
  9.4      (4) annually notify all consumers or the consumers' legal 
  9.5   representatives and case managers of any revised policies and 
  9.6   procedures under this chapter, other than those in clause (3).  
  9.7   Upon request, the license holder must provide the consumer or 
  9.8   consumer's legal representative and case manager copies of the 
  9.9   revised policies and procedures; 
  9.10     (5) before implementing revisions to policies and 
  9.11  procedures under this chapter, inform all employees of the 
  9.12  revised policies and procedures; and 
  9.13     (6) document and maintain relevant information related to 
  9.14  the policies and procedures in this chapter. 
  9.15     Sec. 9.  Minnesota Statutes 2002, section 245B.08, 
  9.16  subdivision 1, is amended to read: 
  9.17     Subdivision 1.  [ALTERNATIVE METHODS OF DETERMINING 
  9.18  COMPLIANCE.] (a) In addition to methods specified in chapter 
  9.19  245A, the commissioner may use alternative methods and new 
  9.20  regulatory strategies to determine compliance with this 
  9.21  section.  The commissioner may use sampling techniques to ensure 
  9.22  compliance with this section.  Notwithstanding section 245A.09, 
  9.23  subdivision 7, paragraph (d) (e), the commissioner may also 
  9.24  extend periods of licensure, not to exceed five years, for 
  9.25  license holders who have demonstrated substantial and consistent 
  9.26  compliance with sections 245B.02 to 245B.07 and have 
  9.27  consistently maintained the health and safety of consumers and 
  9.28  have demonstrated by alternative methods in paragraph (b) that 
  9.29  they meet or exceed the requirements of this section.  For 
  9.30  purposes of this section, "substantial and consistent 
  9.31  compliance" means that during the current licensing period: 
  9.32     (1) the license holder's license has not been made 
  9.33  conditional, suspended, or revoked; 
  9.34     (2) there have been no substantiated allegations of 
  9.35  maltreatment against the license holder; 
  9.36     (3) there have been no program deficiencies that have been 
 10.1   identified that would jeopardize the health or safety of 
 10.2   consumers being served; and 
 10.3      (4) the license holder is in substantial compliance with 
 10.4   the other requirements of chapter 245A and other applicable laws 
 10.5   and rules. 
 10.6      (b) To determine the length of a license, the commissioner 
 10.7   shall consider: 
 10.8      (1) information from affected consumers, and the license 
 10.9   holder's responsiveness to consumers' concerns and 
 10.10  recommendations; 
 10.11     (2) self assessments and peer reviews of the standards of 
 10.12  this section, corrective actions taken by the license holder, 
 10.13  and sharing the results of the inspections with consumers, the 
 10.14  consumers' families, and others, as requested; 
 10.15     (3) length of accreditation by an independent accreditation 
 10.16  body, if applicable; 
 10.17     (4) information from the county where the license holder is 
 10.18  located; and 
 10.19     (5) information from the license holder demonstrating 
 10.20  performance that meets or exceeds the minimum standards of this 
 10.21  chapter. 
 10.22     (c) The commissioner may reduce the length of the license 
 10.23  if the license holder fails to meet the criteria in paragraph 
 10.24  (a) and the conditions specified in paragraph (b). 
 10.25     Sec. 10.  [ADULT FOSTER CARE; INCREASED CAPACITY TO FIVE 
 10.26  BEDS.] 
 10.27     Subdivision 1.  [REQUIREMENTS.] Notwithstanding section 
 10.28  245A.11, subdivision 2a, paragraph (a), the commissioner may 
 10.29  issue an adult foster care license with a capacity for five 
 10.30  adults when the capacity is recommended by the county licensing 
 10.31  agency of the county in which the facility is located and it is 
 10.32  verified in the recommendation that: 
 10.33     (1) the facility meets the physical environment 
 10.34  requirements of the adult foster care licensing rule; 
 10.35     (2) the five-bed living arrangement is specified for each 
 10.36  resident in one of the following: 
 11.1      (i) an individualized plan of care; 
 11.2      (ii) the individual service plan under section 256B.092, 
 11.3   subdivision 1b, where required; or 
 11.4      (iii) the individual resident placement agreement under 
 11.5   Minnesota Rules, part 9555.5105, subpart 19, where required; and 
 11.6      (3) the license holder has obtained signed informed consent 
 11.7   from each resident or each resident's legal representative that 
 11.8   documents the resident's informed choice to live in the home. 
 11.9      Subd. 2.  [SUNSET.] The commissioner may not issue a new 
 11.10  license for five adults after June 30, 2007.  Programs licensed 
 11.11  for five adults under subdivision 1 on June 30, 2007, may 
 11.12  continue to be licensed for five adults after June 30, 2007, 
 11.13  provided the requirements of subdivision 1 are met. 
 11.14     Sec. 11.  [RECOMMENDATIONS REGARDING INCREASED CAPACITY FOR 
 11.15  ADULT FOSTER CARE.] 
 11.16     After consultation with interested stakeholders, including 
 11.17  representatives of county agencies, service providers, persons 
 11.18  living in licensed adult foster care homes, including those with 
 11.19  disabilities using home and community-based waiver services, 
 11.20  their families, and advocacy organizations, the commissioner 
 11.21  shall make recommendations on the size limit for family and 
 11.22  corporate licensed adult foster care settings, propose any 
 11.23  necessary changes in statute, and estimate any fiscal 
 11.24  implications in order to increase housing options for persons 
 11.25  eligible for adult foster care.  The recommendations shall be 
 11.26  provided to the chairs of the house and senate health and human 
 11.27  services policy and finance committees and the ranking minority 
 11.28  members by February 1, 2004. 
 11.29                             ARTICLE 2
 11.30                          CONTINUING CARE
 11.31     Section 1.  Minnesota Statutes 2002, section 256B.0623, 
 11.32  subdivision 2, is amended to read: 
 11.33     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 11.34  following terms have the meanings given them. 
 11.35     (a) "Adult rehabilitative mental health services" means 
 11.36  mental health services which are rehabilitative and enable the 
 12.1   recipient to develop and enhance psychiatric stability, social 
 12.2   competencies, personal and emotional adjustment, and independent 
 12.3   living and community skills, when these abilities are impaired 
 12.4   by the symptoms of mental illness.  Adult rehabilitative mental 
 12.5   health services are also appropriate when provided to enable a 
 12.6   recipient to retain stability and functioning, if the recipient 
 12.7   would be at risk of significant functional decompensation or 
 12.8   more restrictive service settings without these services. 
 12.9      (1) Adult rehabilitative mental health services instruct, 
 12.10  assist, and support the recipient in areas such as:  
 12.11  interpersonal communication skills, community resource 
 12.12  utilization and integration skills, crisis assistance, relapse 
 12.13  prevention skills, health care directives, budgeting and 
 12.14  shopping skills, healthy lifestyle skills and practices, cooking 
 12.15  and nutrition skills, transportation skills, medication 
 12.16  education and monitoring, mental illness symptom management 
 12.17  skills, household management skills, employment-related skills, 
 12.18  and transition to community living services. 
 12.19     (2) These services shall be provided to the recipient on a 
 12.20  one-to-one basis in the recipient's home or another community 
 12.21  setting or in groups. 
 12.22     (b) "Medication education services" means services provided 
 12.23  individually or in groups which focus on educating the recipient 
 12.24  about mental illness and symptoms; the role and effects of 
 12.25  medications in treating symptoms of mental illness; and the side 
 12.26  effects of medications.  Medication education is coordinated 
 12.27  with medication management services and does not duplicate it.  
 12.28  Medication education services are provided by physicians, 
 12.29  pharmacists, physician's assistants, or registered nurses. 
 12.30     (c) "Transition to community living services" means 
 12.31  services which maintain continuity of contact between the 
 12.32  rehabilitation services provider and the recipient and which 
 12.33  facilitate discharge from a hospital, residential treatment 
 12.34  program under Minnesota Rules, chapter 9505, board and lodging 
 12.35  facility, or nursing home.  Transition to community living 
 12.36  services are not intended to provide other areas of adult 
 13.1   rehabilitative mental health services.  
 13.2      Sec. 2.  Minnesota Statutes 2002, section 256B.0623, 
 13.3   subdivision 4, is amended to read: 
 13.4      Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) The provider 
 13.5   entity must be: 
 13.6      (1) a county operated entity certified by the state; or 
 13.7      (2) a noncounty entity certified by the entity's host 
 13.8   county certified by the state following the certification 
 13.9   process and procedures developed by the commissioner. 
 13.10     (b) The certification process is a determination as to 
 13.11  whether the entity meets the standards in this subdivision.  The 
 13.12  certification must specify which adult rehabilitative mental 
 13.13  health services the entity is qualified to provide. 
 13.14     (c) If an entity seeks to provide services outside its host 
 13.15  county, it A noncounty provider entity must obtain additional 
 13.16  certification from each county in which it will provide 
 13.17  services.  The additional certification must be based on the 
 13.18  adequacy of the entity's knowledge of that county's local health 
 13.19  and human service system, and the ability of the entity to 
 13.20  coordinate its services with the other services available in 
 13.21  that county.  A county-operated entity must obtain this 
 13.22  additional certification from any other county in which it will 
 13.23  provide services. 
 13.24     (d) Recertification must occur at least every two three 
 13.25  years. 
 13.26     (e) The commissioner may intervene at any time and 
 13.27  decertify providers with cause.  The decertification is subject 
 13.28  to appeal to the state.  A county board may recommend that the 
 13.29  state decertify a provider for cause. 
 13.30     (f) The adult rehabilitative mental health services 
 13.31  provider entity must meet the following standards: 
 13.32     (1) have capacity to recruit, hire, manage, and train 
 13.33  mental health professionals, mental health practitioners, and 
 13.34  mental health rehabilitation workers; 
 13.35     (2) have adequate administrative ability to ensure 
 13.36  availability of services; 
 14.1      (3) ensure adequate preservice and inservice and ongoing 
 14.2   training for staff; 
 14.3      (4) ensure that mental health professionals, mental health 
 14.4   practitioners, and mental health rehabilitation workers are 
 14.5   skilled in the delivery of the specific adult rehabilitative 
 14.6   mental health services provided to the individual eligible 
 14.7   recipient; 
 14.8      (5) ensure that staff is capable of implementing culturally 
 14.9   specific services that are culturally competent and appropriate 
 14.10  as determined by the recipient's culture, beliefs, values, and 
 14.11  language as identified in the individual treatment plan; 
 14.12     (6) ensure enough flexibility in service delivery to 
 14.13  respond to the changing and intermittent care needs of a 
 14.14  recipient as identified by the recipient and the individual 
 14.15  treatment plan; 
 14.16     (7) ensure that the mental health professional or mental 
 14.17  health practitioner, who is under the clinical supervision of a 
 14.18  mental health professional, involved in a recipient's services 
 14.19  participates in the development of the individual treatment 
 14.20  plan; 
 14.21     (8) assist the recipient in arranging needed crisis 
 14.22  assessment, intervention, and stabilization services; 
 14.23     (9) ensure that services are coordinated with other 
 14.24  recipient mental health services providers and the county mental 
 14.25  health authority and the federally recognized American Indian 
 14.26  authority and necessary others after obtaining the consent of 
 14.27  the recipient.  Services must also be coordinated with the 
 14.28  recipient's case manager or care coordinator if the recipient is 
 14.29  receiving case management or care coordination services; 
 14.30     (10) develop and maintain recipient files, individual 
 14.31  treatment plans, and contact charting; 
 14.32     (11) develop and maintain staff training and personnel 
 14.33  files; 
 14.34     (12) submit information as required by the state; 
 14.35     (13) establish and maintain a quality assurance plan to 
 14.36  evaluate the outcome of services provided; 
 15.1      (14) keep all necessary records required by law; 
 15.2      (15) deliver services as required by section 245.461; 
 15.3      (16) comply with all applicable laws; 
 15.4      (17) be an enrolled Medicaid provider; 
 15.5      (18) maintain a quality assurance plan to determine 
 15.6   specific service outcomes and the recipient's satisfaction with 
 15.7   services; and 
 15.8      (19) develop and maintain written policies and procedures 
 15.9   regarding service provision and administration of the provider 
 15.10  entity. 
 15.11     (g) The commissioner shall develop statewide procedures for 
 15.12  provider certification, including timelines for counties to 
 15.13  certify qualified providers. 
 15.14     Sec. 3.  Minnesota Statutes 2002, section 256B.0623, 
 15.15  subdivision 6, is amended to read: 
 15.16     Subd. 6.  [REQUIRED TRAINING AND SUPERVISION.] (a) Mental 
 15.17  health rehabilitation workers must receive ongoing continuing 
 15.18  education training of at least 30 hours every two years in areas 
 15.19  of mental illness and mental health services and other areas 
 15.20  specific to the population being served.  Mental health 
 15.21  rehabilitation workers must also be subject to the ongoing 
 15.22  direction and clinical supervision standards in paragraphs (c) 
 15.23  and (d). 
 15.24     (b) Mental health practitioners must receive ongoing 
 15.25  continuing education training as required by their professional 
 15.26  license; or if the practitioner is not licensed, the 
 15.27  practitioner must receive ongoing continuing education training 
 15.28  of at least 30 hours every two years in areas of mental illness 
 15.29  and mental health services.  Mental health practitioners must 
 15.30  meet the ongoing clinical supervision standards in paragraph (c).
 15.31     (c) Clinical supervision may be provided by a full- or 
 15.32  part-time qualified professional employed by or under contract 
 15.33  with the provider entity.  Clinical supervision may be provided 
 15.34  by interactive videoconferencing according to procedures 
 15.35  developed by the commissioner.  A mental health professional 
 15.36  providing clinical supervision of staff delivering adult 
 16.1   rehabilitative mental health services must provide the following 
 16.2   guidance: 
 16.3      (1) review the information in the recipient's file; 
 16.4      (2) review and approve initial and updates of individual 
 16.5   treatment plans; 
 16.6      (3) meet with mental health rehabilitation workers and 
 16.7   practitioners, individually or in small groups, at least monthly 
 16.8   to discuss treatment topics of interest to the workers and 
 16.9   practitioners; 
 16.10     (4) meet with mental health rehabilitation workers and 
 16.11  practitioners, individually or in small groups, at least monthly 
 16.12  to discuss treatment plans of recipients, and approve by 
 16.13  signature and document in the recipient's file any resulting 
 16.14  plan updates; 
 16.15     (5) meet at least twice a month monthly with the directing 
 16.16  mental health practitioner, if there is one, to review needs of 
 16.17  the adult rehabilitative mental health services program, review 
 16.18  staff on-site observations and evaluate mental health 
 16.19  rehabilitation workers, plan staff training, review program 
 16.20  evaluation and development, and consult with the directing 
 16.21  practitioner; and 
 16.22     (6) be available for urgent consultation as the individual 
 16.23  recipient needs or the situation necessitates; and 
 16.24     (7) provide clinical supervision by full- or part-time 
 16.25  mental health professionals employed by or under contract with 
 16.26  the provider entity. 
 16.27     (d) An adult rehabilitative mental health services provider 
 16.28  entity must have a treatment director who is a mental health 
 16.29  practitioner or mental health professional.  The treatment 
 16.30  director must ensure the following: 
 16.31     (1) while delivering direct services to recipients, a newly 
 16.32  hired mental health rehabilitation worker must be directly 
 16.33  observed delivering services to recipients by the a mental 
 16.34  health practitioner or mental health professional for at least 
 16.35  six hours per 40 hours worked during the first 160 hours that 
 16.36  the mental health rehabilitation worker works; 
 17.1      (2) the mental health rehabilitation worker must receive 
 17.2   ongoing on-site direct service observation by a mental health 
 17.3   professional or mental health practitioner for at least six 
 17.4   hours for every six months of employment; 
 17.5      (3) progress notes are reviewed from on-site service 
 17.6   observation prepared by the mental health rehabilitation worker 
 17.7   and mental health practitioner for accuracy and consistency with 
 17.8   actual recipient contact and the individual treatment plan and 
 17.9   goals; 
 17.10     (4) immediate availability by phone or in person for 
 17.11  consultation by a mental health professional or a mental health 
 17.12  practitioner to the mental health rehabilitation services worker 
 17.13  during service provision; 
 17.14     (5) oversee the identification of changes in individual 
 17.15  recipient treatment strategies, revise the plan, and communicate 
 17.16  treatment instructions and methodologies as appropriate to 
 17.17  ensure that treatment is implemented correctly; 
 17.18     (6) model service practices which:  respect the recipient, 
 17.19  include the recipient in planning and implementation of the 
 17.20  individual treatment plan, recognize the recipient's strengths, 
 17.21  collaborate and coordinate with other involved parties and 
 17.22  providers; 
 17.23     (7) ensure that mental health practitioners and mental 
 17.24  health rehabilitation workers are able to effectively 
 17.25  communicate with the recipients, significant others, and 
 17.26  providers; and 
 17.27     (8) oversee the record of the results of on-site 
 17.28  observation and charting evaluation and corrective actions taken 
 17.29  to modify the work of the mental health practitioners and mental 
 17.30  health rehabilitation workers. 
 17.31     (e) A mental health practitioner who is providing treatment 
 17.32  direction for a provider entity must receive supervision at 
 17.33  least monthly from a mental health professional to: 
 17.34     (1) identify and plan for general needs of the recipient 
 17.35  population served; 
 17.36     (2) identify and plan to address provider entity program 
 18.1   needs and effectiveness; 
 18.2      (3) identify and plan provider entity staff training and 
 18.3   personnel needs and issues; and 
 18.4      (4) plan, implement, and evaluate provider entity quality 
 18.5   improvement programs.  
 18.6      Sec. 4.  Minnesota Statutes 2002, section 256B.0623, 
 18.7   subdivision 8, is amended to read: 
 18.8      Subd. 8.  [DIAGNOSTIC ASSESSMENT.] Providers of adult 
 18.9   rehabilitative mental health services must complete a diagnostic 
 18.10  assessment as defined in section 245.462, subdivision 9, within 
 18.11  five days after the recipient's second visit or within 30 days 
 18.12  after intake, whichever occurs first.  In cases where a 
 18.13  diagnostic assessment is available that reflects the recipient's 
 18.14  current status, and has been completed within 180 days preceding 
 18.15  admission, an update must be completed.  An update shall include 
 18.16  a written summary by a mental health professional of the 
 18.17  recipient's current mental health status and service needs.  If 
 18.18  the recipient's mental health status has changed significantly 
 18.19  since the adult's most recent diagnostic assessment, a new 
 18.20  diagnostic assessment is required.  For initial implementation 
 18.21  of adult rehabilitative mental health services, until June 30, 
 18.22  2005, a diagnostic assessment that reflects the recipient's 
 18.23  current status and has been completed within the past three 
 18.24  years preceding admission is acceptable. 
 18.25     Sec. 5.  Minnesota Statutes 2002, section 256B.0625, 
 18.26  subdivision 19c, is amended to read: 
 18.27     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 18.28  personal care assistant services provided by an individual who 
 18.29  is qualified to provide the services according to subdivision 
 18.30  19a and section 256B.0627, where the services are prescribed by 
 18.31  a physician in accordance with a plan of treatment and are 
 18.32  supervised by the recipient or a qualified professional.  
 18.33  "Qualified professional" means a mental health professional as 
 18.34  defined in section 245.462, subdivision 18, or 245.4871, 
 18.35  subdivision 27; or a registered nurse as defined in sections 
 18.36  148.171 to 148.285, or a licensed social worker as defined in 
 19.1   section 148B.21.  As part of the assessment, the county public 
 19.2   health nurse will assist the recipient or responsible party to 
 19.3   identify the most appropriate person to provide supervision of 
 19.4   the personal care assistant.  The qualified professional shall 
 19.5   perform the duties described in Minnesota Rules, part 9505.0335, 
 19.6   subpart 4.  
 19.7                              ARTICLE 3 
 19.8                            MISCELLANEOUS 
 19.9      Section 1.  Minnesota Statutes 2002, section 253B.05, is 
 19.10  amended by adding a subdivision to read: 
 19.11     Subd. 5.  [DETOXIFICATION.] If a person is intoxicated in 
 19.12  public and held under this section for detoxification, a 
 19.13  treatment facility may release the person without providing 
 19.14  notice under subdivision 3, paragraph (c), as soon as the 
 19.15  treatment facility determines the person is no longer 
 19.16  intoxicated.  Notice must be provided to the peace officer or 
 19.17  health officer who transported the person, or the appropriate 
 19.18  law enforcement agency, if the officer or agency requests 
 19.19  notification. 
 19.20     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 19.21  following final enactment. 
 19.22     Sec. 2.  [MEDICAL ASSISTANCE FOR MENTAL HEALTH SERVICES 
 19.23  PROVIDED IN OUT-OF-HOME PLACEMENT SETTINGS.] 
 19.24     The commissioner of human services, in consultation with 
 19.25  the commissioner of corrections and representatives of counties, 
 19.26  health care providers, and other stakeholders, shall develop a 
 19.27  plan to secure medical assistance funding for mental 
 19.28  health-related services provided in out-of-home placement 
 19.29  settings, including treatment foster care, group homes, and 
 19.30  residential programs licensed under Minnesota Statutes, chapters 
 19.31  241 and 245A.  The plan must include fiscal estimates and 
 19.32  related information and draft legislation.  Treatment foster 
 19.33  care services must be provided by a child placing agency 
 19.34  licensed under Minnesota Rules, parts 9545.0755 to 9545.0845 or 
 19.35  9543.0010 to 9543.0150.  The commissioner shall submit the plan 
 19.36  to the legislature by January 15, 2004.