1.1 	A bill for an act
1.2 	relating to state government; modifying certain health and human services data 
1.3 	practices provisions; establishing community first services and supports and 
1.4 	Northstar Care for Children; modifying provisions relating to vital records, 
1.5 	reporting suspected maltreatment, child custody, background studies, and fraud 
1.6 	investigations; program integrity; waiver provider standards; licensing home 
1.7 	care providers; establishing penalties; establishing an advisory council; licensing 
1.8 	alkaline hydrolysis facilities; establishing a state-based risk adjustment system 
1.9 	assessment;amending Minnesota Statutes 2012, sections 144.051, by adding 
1.10 	subdivisions; 243.166, subdivision 7; 245A.11, subdivision 7b; 245C.04, by 
1.11 	adding a subdivision; 245C.08, subdivision 1; 245D.05; 245D.06; 245D.10; 
1.12 	256.01, by adding a subdivision; 256B.69, by adding a subdivision; 626.557, 
1.13 	subdivisions 4, 9, 9e; proposing coding for new law in Minnesota Statutes, 
1.14 	chapters 144A; 149A; 245D; 256B.
1.15 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.16 	ARTICLE 1
1.17 	REDESIGNING HOME AND COMMUNITY-BASED SERVICES

1.18 	Section 1. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
1.19 		Subdivision 1.Basis and scope. (a) Upon federal approval, the commissioner 
1.20 	shall establish a medical assistance state plan option for the provision of home and 
1.21 	community-based personal assistance service and supports called "community first 
1.22 	services and supports (CFSS)."
1.23 	(b) CFSS is a participant-controlled method of selecting and providing services 
1.24 	and supports that allows the participant maximum control of the services and supports. 
1.25 	Participants may choose the degree to which they direct and manage their supports by 
1.26 	choosing to have a significant and meaningful role in the management of services and 
2.1 	supports including by directly employing support workers with the necessary supports 
2.2 	to perform that function.
2.3 	(c) CFSS is available statewide to eligible individuals to assist with accomplishing 
2.4 	activities of daily living (ADLs), instrumental activities of daily living (IADLs), and 
2.5 	health-related procedures and tasks through hands-on assistance to complete the task or 
2.6 	supervision and cueing to complete the task; and to assist with acquiring, maintaining, and 
2.7 	enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures 
2.8 	and tasks. CFSS allows payment for certain supports and goods such as environmental 
2.9 	modifications and technology that are intended to replace or decrease the need for human 
2.10 	assistance.
2.11 	(d) Upon federal approval, CFSS will replace the personal care assistance program 
2.12 	under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
2.13 		Subd. 2.Definitions. (a) For the purposes of this section, the terms defined in 
2.14 	this subdivision have the meanings given.
2.15 	(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, 
2.16 	dressing, bathing, mobility, positioning, and transferring.
2.17 	(c) "Agency-provider model" means a method of CFSS under which a qualified 
2.18 	agency provides services and supports through the agency's own employees and policies. 
2.19 	The agency must allow the participant to have a significant role in the selection and 
2.20 	dismissal of support workers of their choice for the delivery of their specific services 
2.21 	and supports.
2.22 	(d) "Behavior" means a category to determine the home care rating and is based on the 
2.23 	criteria in section 256B.0659. "Level I behavior" means physical aggression towards self, 
2.24 	others, or destruction of property that requires the immediate response of another person.
2.25 	(e) "Complex health-related needs" means a category to determine the home care 
2.26 	rating and is based on the criteria in section 256B.0659.
2.27 	(f) "Community first services and supports" or "CFSS" means the assistance and 
2.28 	supports program under this section needed for accomplishing activities of daily living, 
2.29 	instrumental activities of daily living, and health-related tasks through hands-on assistance 
2.30 	to complete the task or supervision and cueing to complete the task, or the purchase of 
2.31 	goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for 
2.32 	human assistance.
2.33 	(g) "Community first services and supports service delivery plan" or "service delivery 
2.34 	plan" means a written summary of the services and supports, that is based on the community 
2.35 	support plan identified in section 256B.0911 and coordinated services and support plan 
3.1 	and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined 
3.2 	by the participant to meet the assessed needs, using a person-centered planning process.
3.3 	(h) "Critical activities of daily living" means transferring, mobility, eating, and 
3.4 	toileting.
3.5 	(i) "Dependency" in activities of daily living means a person requires assistance to 
3.6 	begin and complete one or more of the activities of daily living.
3.7 	(j) "Financial management services contractor or vendor" means a qualified 
3.8 	organization having a written contract with the department to provide services necessary 
3.9 	to use the flexible spending model under subdivision 13, that include but are not limited 
3.10 	to: participant education and technical assistance; CFSS service delivery planning and 
3.11 	budgeting; billing, making payments, and monitoring of spending; and assisting the 
3.12 	participant in fulfilling employer-related requirements in accordance with Section 3504 of 
3.13 	the IRS code and the IRS Revenue Procedure 70-6.
3.14 	(k) "Flexible spending model" means a service delivery method of CFSS that uses 
3.15 	an individualized CFSS service delivery plan and service budget and assistance from the 
3.16 	financial management services contractor to facilitate participant employment of support 
3.17 	workers and the acquisition of supports and goods.
3.18 	(l) "Health-related procedures and tasks" means procedures and tasks related to 
3.19 	the specific needs of an individual that can be delegated or assigned by a state-licensed 
3.20 	healthcare or behavioral health professional and performed by a support worker.
3.21 	(m) "Instrumental activities of daily living" means activities related to living 
3.22 	independently in the community, including but not limited to: meal planning, preparation, 
3.23 	and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning; 
3.24 	assistance with medications; managing money; communicating needs, preferences, and 
3.25 	activities; arranging supports; and assistance with traveling around and participating 
3.26 	in the community.
3.27 	(n) "Legal representative" means parent of a minor, a court-appointed guardian, or 
3.28 	another representative with legal authority to make decisions about services and supports 
3.29 	for the participant. Other representatives with legal authority to make decisions include 
3.30 	but are not limited to a health care agent or an attorney-in-fact authorized through a health 
3.31 	care directive or power of attorney.
3.32 	(o) "Medication assistance" means providing verbal or visual reminders to take 
3.33 	regularly scheduled medication and includes any of the following supports:
3.34 	(1) under the direction of the participant or the participant's representative, bringing 
3.35 	medications to the participant including medications given through a nebulizer, opening a 
3.36 	container of previously set up medications, emptying the container into the participant's 
4.1 	hand, opening and giving the medication in the original container to the participant, or 
4.2 	bringing to the participant liquids or food to accompany the medication;
4.3 	(2) organizing medications as directed by the participant or the participant's 
4.4 	representative; and
4.5 	(3) providing verbal or visual reminders to perform regularly scheduled medications.
4.6 	(p) "Participant's representative" means a parent, family member, advocate, or 
4.7 	other adult authorized by the participant to serve as a representative in connection with 
4.8 	the provision of CFSS. This authorization must be in writing or by another method 
4.9 	that clearly indicates the participant's free choice. The participant's representative must 
4.10 	have no financial interest in the provision of any services included in the participant's 
4.11 	service delivery plan and must be capable of providing the support necessary to assist 
4.12 	the participant in the use of CFSS. If through the assessment process described in 
4.13 	subdivision 5 a participant is determined to be in need of a participant's representative, one 
4.14 	must be selected. If the participant is unable to assist in the selection of a participant's 
4.15 	representative, the legal representative shall appoint one. Two persons may be designated 
4.16 	as a participant's representative for reasons such as divided households and court-ordered 
4.17 	custodies. Duties of a participant's representatives may include:
4.18 	(1) being available while care is provided in a method agreed upon by the participant 
4.19 	or the participant's legal representative and documented in the participant's CFSS service 
4.20 	delivery plan;
4.21 	(2) monitoring CFSS services to ensure the participant's CFSS service delivery 
4.22 	plan is being followed; and
4.23 	(3) reviewing and signing CFSS time sheets after services are provided to provide 
4.24 	verification of the CFSS services.
4.25 	(q) "Person-centered planning process" means a process that is driven by the 
4.26 	participant for discovering and planning services and supports that ensures the participant 
4.27 	makes informed choices and decisions. The person-centered planning process must:
4.28 	(1) include people chosen by the participant;
4.29 	(2) provide necessary information and support to ensure that the participant directs 
4.30 	the process to the maximum extent possible, and is enabled to make informed choices 
4.31 	and decisions;
4.32 	(3) be timely and occur at time and locations of convenience to the participant;
4.33 	(4) reflect cultural considerations of the participant;
4.34 	(5) include strategies for solving conflict or disagreement within the process, 
4.35 	including clear conflict-of-interest guidelines for all planning;
5.1 	(6) offers choices to the participant regarding the services and supports they receive 
5.2 	and from whom;
5.3 	(7) include a method for the participant to request updates to the plan; and
5.4 	(8) record the alternative home and community-based settings that were considered 
5.5 	by the participant.
5.6 	(r) "Shared services" means the provision of CFSS services by the same CFSS 
5.7 	support worker to two or three participants who voluntarily enter into an agreement to 
5.8 	receive services at the same time and in the same setting by the same provider.
5.9 	(s) "Support specialist" means a professional with the skills and ability to assist the 
5.10 	participant using either the agency provider model under subdivision 11 or the flexible 
5.11 	spending model under subdivision 13, in services including, but not limited to assistance 
5.12 	regarding:
5.13 	(1) the development, implementation, and evaluation of the CFSS service delivery 
5.14 	plan under subdivision 6;
5.15 	(2) recruitment, training, or supervision, including supervision of health-related 
5.16 	tasks or behavioral supports appropriately delegated by a health care professional, and 
5.17 	evaluation of support workers; and
5.18 	(3) facilitating the use of informal and community supports, goods, or resources.
5.19 	(t) "Support worker" means an employee of the agency provider or of the participant 
5.20 	who has direct contact with the participant and provides services as specified within the 
5.21 	participant's service delivery plan.
5.22 	(u) "Wages and benefits" means the hourly wages and salaries, the employer's 
5.23 	share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' 
5.24 	compensation, mileage reimbursement, health and dental insurance, life insurance, 
5.25 	disability insurance, long-term care insurance, uniform allowance, contributions to 
5.26 	employee retirement accounts, or other forms of employee compensation and benefits.
5.27 		Subd. 3.Eligibility. (a) CFSS is available to a person who meets one of the 
5.28 	following:
5.29 	(1) is a recipient of medical assistance as determined under section 256B.055, 
5.30 	256B.056, or 256B.057, subdivisions 5 and 9;
5.31 	(2) is a recipient of the alternative care program under section 256B.0913;
5.32 	(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093, 
5.33 	or 256B.49; or
5.34 	(4) has medical services identified in a participant's individualized education 
5.35 	program and is eligible for services as determined in section 256B.0625, subdivision 26.
6.1 	(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also 
6.2 	meet all of the following:
6.3 	(1) require assistance and be determined dependent in one activity of daily living or 
6.4 	Level I behavior based on assessment under section 256B.0911;
6.5 	(2) is not a recipient under the family support grant under section 252.32;
6.6 	(3) lives in the person's own apartment or home including a family foster care setting 
6.7 	licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a 
6.8 	noncertified boarding care or boarding and lodging establishments under chapter 157; 
6.9 	unless transitioning into the community from an institution; and
6.10 	(4) has not been excluded or disenrolled from the flexible spending model. 
6.11 	(c) The commissioner shall disenroll or exclude participants from the flexible 
6.12 	spending model and transfer them to the agency-provider model under the following 
6.13 	circumstances that include but are not limited to:
6.14 	(1) when a participant has been restricted by the Minnesota restricted recipient 
6.15 	program, the participant may be excluded for a specified time period;
6.16 	(2) when a participant exits the flexible spending service delivery model during the 
6.17 	participant's service plan year. Upon transfer, the participant shall not access the flexible 
6.18 	spending model for the remainder of that service plan year; or
6.19 	(3) when the department determines that the participant or participant's representative 
6.20 	or legal representative cannot manage participant responsibilities under the service 
6.21 	delivery model. The commissioner must develop policies for determining if a participant 
6.22 	is unable to manage responsibilities under a service model.
6.23 	(d) A participant may appeal in writing to the department to contest the department's 
6.24 	decision under paragraph (c), clause (3), to remove or exclude the participant from the 
6.25 	flexible spending model.
6.26 		Subd. 4.Eligibility for other services. Selection of CFSS by a participant must not 
6.27 	restrict access to other medically necessary care and services furnished under the state 
6.28 	plan medical assistance benefit or other services available through alternative care.
6.29 		Subd. 5.Assessment requirements. (a) The assessment of functional need must:
6.30 	(1) be conducted by a certified assessor according to the criteria established in 
6.31 	section 256B.0911;
6.32 	(2) be conducted face-to-face, initially and at least annually thereafter, or when there 
6.33 	is a significant change in the participant's condition or a change in the need for services 
6.34 	and supports; and
6.35 	(3) be completed using the format established by the commissioner.
7.1 	(b) A participant who is residing in a facility may be assessed and choose CFSS for 
7.2 	the purpose of using CFSS to return to the community as described in subdivisions 3 
7.3 	and 7, paragraph (a), clause (5).
7.4 	(c) The results of the assessment and any recommendations and authorizations for 
7.5 	CFSS must be determined and communicated in writing by the lead agency's certified 
7.6 	assessor as defined in section 256B.0911 to the participant and the agency-provider or 
7.7 	financial management services provider chosen by the participant within 40 calendar days 
7.8 	and must include the participant's right to appeal under section 256.045.
7.9 		Subd. 6.Community first services and support service delivery plan. (a) The 
7.10 	CFSS service delivery plan must be developed, implemented, and evaluated through a 
7.11 	person-centered planning process by the participant, or the participant's representative 
7.12 	or legal representative who may be assisted by a support specialist. The CFSS service 
7.13 	delivery plan must reflect the services and supports that are important to the participant 
7.14 	and for the participant to meet the needs assessed by the certified assessor and identified 
7.15 	in the community support plan under section 256B.0911 or the coordinated services and 
7.16 	support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS 
7.17 	service delivery plan must be reviewed by the participant and the agency-provider or 
7.18 	financial management services contractor at least annually upon reassessment, or when 
7.19 	there is a significant change in the participant's condition, or a change in the need for 
7.20 	services and supports.
7.21 	(b) The commissioner shall establish the format and criteria for the CFSS service 
7.22 	delivery plan.
7.23 	(c) The CFSS service delivery plan must be person-centered and:
7.24 	(1) specify the agency-provider or financial management services contractor selected 
7.25 	by the participant;
7.26 	(2) reflect the setting in which the participant resides that is chosen by the participant;
7.27 	(3) reflect the participant's strengths and preferences;
7.28 	(4) include the means to address the clinical and support needs as identified through 
7.29 	an assessment of functional needs;
7.30 	(5) include individually identified goals and desired outcomes;
7.31 	(6) reflect the services and supports, paid and unpaid, that will assist the participant 
7.32 	to achieve identified goals, and the providers of those services and supports, including 
7.33 	natural supports;
7.34 	(7) identify the amount and frequency of face-to-face supports and amount and 
7.35 	frequency of remote supports and technology that will be used;
8.1 	(8) identify risk factors and measures in place to minimize them, including 
8.2 	individualized backup plans;
8.3 	(9) be understandable to the participant and the individuals providing support;
8.4 	(10) identify the individual or entity responsible for monitoring the plan;
8.5 	(11) be finalized and agreed to in writing by the participant and signed by all 
8.6 	individuals and providers responsible for its implementation;
8.7 	(12) be distributed to the participant and other people involved in the plan; and
8.8 	(13) prevent the provision of unnecessary or inappropriate care.
8.9 	(d) The total units of agency-provider services or the budget allocation amount for 
8.10 	the flexible spending model include both annual totals and a monthly average amount 
8.11 	that cover the number of months of the service authorization. The amount used each 
8.12 	month may vary, but additional funds must not be provided above the annual service 
8.13 	authorization amount unless a change in condition is assessed and authorized by the 
8.14 	certified assessor and documented in the community support plan, coordinated services 
8.15 	and supports plan, and service delivery plan.
8.16 		Subd. 7.Community first services and supports; covered services.  Services 
8.17 	and supports covered under CFSS include:
8.18 	(1) assistance to accomplish activities of daily living (ADLs), instrumental activities 
8.19 	of daily living (IADLs), and health-related procedures and tasks through hands-on 
8.20 	assistance to complete the task or supervision and cueing to complete the task;
8.21 	(2) assistance to acquire, maintain, or enhance the skills necessary for the participant 
8.22 	to accomplish activities of daily living, instrumental activities of daily living, or 
8.23 	health-related tasks;
8.24 	(3) expenditures for items, services, supports, environmental modifications, or 
8.25 	goods, including assistive technology. These expenditures must:
8.26 	(i) relate to a need identified in a participant's CFSS service delivery plan; 
8.27 	(ii) increase independence or substitute for human assistance to the extent that 
8.28 	expenditures would otherwise be made for human assistance for the participant's assessed 
8.29 	needs; and
8.30 	(iii) fit within the annual limit of the participant's approved service allocation 
8.31 	or budget;
8.32 	(4) observation and redirection for episodes where there is a need for redirection 
8.33 	due to participant behaviors or intervention needed due to a participant's symptoms. An 
8.34 	assessment of behaviors must meet the criteria in this clause. A recipient qualifies as 
8.35 	having a need for assistance due to behaviors if the recipient's behavior requires assistance 
8.36 	at least four times per week and shows one or more of the following behaviors:
9.1 	(i) physical aggression towards self or others, or destruction of property that requires 
9.2 	the immediate response of another person;
9.3 	(ii) increased vulnerability due to cognitive deficits or socially inappropriate 
9.4 	behavior; or
9.5 	(iii) increased need for assistance for recipients who are verbally aggressive or 
9.6 	resistive to care so that time needed to perform activities of daily living is increased;
9.7 	(5) back-up systems or mechanisms, such as the use of pagers or other electronic 
9.8 	devices, to ensure continuity of the participant's services and supports;
9.9 	(6) transition costs, including:
9.10 	(i) deposits for rent and utilities;
9.11 	(ii) first month's rent and utilities;
9.12 	(iii) bedding;
9.13 	(iv) basic kitchen supplies;
9.14 	(v) other necessities, to the extent that these necessities are not otherwise covered 
9.15 	under any other funding that the participant is eligible to receive; and
9.16 	(vi) other required necessities for an individual to make the transition from a nursing 
9.17 	facility, institution for mental diseases, or intermediate care facility for persons with 
9.18 	developmental disabilities to a community-based home setting where the participant 
9.19 	resides; and
9.20 	(7) services by a support specialist defined under subdivision 2 that are chosen 
9.21 	by the participant.
9.22 		Subd. 8.Determination of CFSS service methodology. (a) All community first 
9.23 	services and supports must be authorized by the commissioner or the commissioner's 
9.24 	designee before services begin except for the assessments established in section 
9.25 	256B.0911. The authorization for CFSS must be completed within 30 days after receiving 
9.26 	a complete request.
9.27 	(b) The amount of CFSS authorized must be based on the recipient's home 
9.28 	care rating. The home care rating shall be determined by the commissioner or the 
9.29 	commissioner's designee based on information submitted to the commissioner identifying 
9.30 	the following for a recipient:
9.31 	(1) the total number of dependencies of activities of daily living as defined in 
9.32 	subdivision 2;
9.33 	(2) the presence of complex health-related needs as defined in subdivision 2; and
9.34 	(3) the presence of Level I behavior as defined in subdivision 2.
9.35 	(c) For purposes meeting the criteria in paragraph (b), the methodology to determine 
9.36 	the total minutes for CFSS for each home care rating is based on the median paid units 
10.1 	per day for each home care rating from fiscal year 2007 data for the PCA program. Each 
10.2 	home care rating has a base number of minutes assigned. Additional minutes are added 
10.3 	through the assessment and identification of the following:
10.4 	(1) 30 additional minutes per day for a dependency in each critical activity of daily 
10.5 	living as defined in subdivision 2;
10.6 	(2) 30 additional minutes per day for each complex health-related function as 
10.7 	defined in subdivision 2; and
10.8 	(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
10.9 		Subd. 9.Noncovered services. (a) Services or supports that are not eligible for 
10.10 	payment under this section include those that:
10.11 	(1) are not authorized by the certified assessor or included in the written service 
10.12 	delivery plan;
10.13 	(2) are provided prior to the authorization of services and the approval of the written 
10.14 	CFSS service delivery plan;
10.15 	(3) are duplicative of other paid services in the written service delivery plan;
10.16 	(4) supplant natural unpaid supports that are provided voluntarily to the participant 
10.17 	and are selected by the participant in lieu of a support worker and appropriately meeting 
10.18 	the participant's needs;
10.19 	(5) are not effective means to meet the participant's needs; and
10.20 	(6) are available through other funding sources, including, but not limited to, funding 
10.21 	through Title IV-E of the Social Security Act.
10.22 	(b) Additional services, goods, or supports that are not covered include:
10.23 	(1) those that are not for the direct benefit of the participant;
10.24 	(2) any fees incurred by the participant, such as Minnesota health care programs fees 
10.25 	and co-pays, legal fees, or costs related to advocate agencies;
10.26 	(3) insurance, except for insurance costs related to employee coverage;
10.27 	(4) room and board costs for the participant with the exception of allowable 
10.28 	transition costs in subdivision 7, clause (6);
10.29 	(5) services, supports, or goods that are not related to the assessed needs;
10.30 	(6) special education and related services provided under the Individuals with 
10.31 	Disabilities Education Act and vocational rehabilitation services provided under the 
10.32 	Rehabilitation Act of 1973;
10.33 	(7) assistive technology devices and assistive technology services other than those 
10.34 	for back-up systems or mechanisms to ensure continuity of service and supports listed in 
10.35 	subdivision 7;
10.36 	(8) medical supplies and equipment;
11.1 	(9) environmental modifications, except as specified in subdivision 7;
11.2 	(10) expenses for travel, lodging, or meals related to training the participant, the 
11.3 	participant's representative, legal representative, or paid or unpaid caregivers that exceed 
11.4 	$500 in a 12-month period;
11.5 	(11) experimental treatments;
11.6 	(12) any service or good covered by other medical assistance state plan services, 
11.7 	including prescription and over-the-counter medications, compounds, and solutions and 
11.8 	related fees, including premiums and co-payments;
11.9 	(13) membership dues or costs, except when the service is necessary and appropriate 
11.10 	to treat a physical condition or to improve or maintain the participant's physical condition. 
11.11 	The condition must be identified in the participant's CFSS plan and monitored by a 
11.12 	physician enrolled in a Minnesota health care program;
11.13 	(14) vacation expenses other than the cost of direct services;
11.14 	(15) vehicle maintenance or modifications not related to the disability, health 
11.15 	condition, or physical need; and
11.16 	(16) tickets and related costs to attend sporting or other recreational or entertainment 
11.17 	events.
11.18 		Subd. 10.Provider qualifications and general requirements. (a) 
11.19 	Agency-providers delivering services under the agency-provider model under subdivision 
11.20 	11 or financial management service (FMS) contractors under subdivision 13 shall:
11.21 	(1) enroll as a medical assistance Minnesota health care programs provider and meet 
11.22 	all applicable provider standards;
11.23 	(2) comply with medical assistance provider enrollment requirements;
11.24 	(3) demonstrate compliance with law and policies of CFSS as determined by the 
11.25 	commissioner;
11.26 	(4) comply with background study requirements under chapter 245C;
11.27 	(5) verify and maintain records of all services and expenditures by the participant, 
11.28 	including hours worked by support workers and support specialists;
11.29 	(6) not engage in any agency-initiated direct contact or marketing in person, by 
11.30 	telephone, or other electronic means to potential participants, guardians, family member 
11.31 	or participants' representatives;
11.32 	(7) pay support workers and support specialists based upon actual hours of services 
11.33 	provided;
11.34 	(8) withhold and pay all applicable federal and state payroll taxes;
11.35 	(9) make arrangements and pay unemployment insurance, taxes, workers' 
11.36 	compensation, liability insurance, and other benefits, if any;
12.1 	(10) enter into a written agreement with the participant, participant's representative, 
12.2 	or legal representative that assigns roles and responsibilities to be performed before 
12.3 	services, supports, or goods are provided using a format established by the commissioner;
12.4 	(11) report suspected neglect and abuse to the common entry point according to 
12.5 	sections 256B.0651 and 626.557; and
12.6 	(12) provide the participant with a copy of the service-related rights under 
12.7 	subdivision 19 at the start of services and supports.
12.8 	(b) The commissioner shall develop policies and procedures designed to ensure 
12.9 	program integrity and fiscal accountability for goods and services provided in this section.
12.10 		Subd. 11.Agency-provider model. (a) The agency-provider model is limited to 
12.11 	the services provided by support workers and support specialists who are employed by 
12.12 	an agency-provider that is licensed according to chapter 245A or meets other criteria 
12.13 	established by the commissioner, including required training.
12.14 	(b) The agency-provider shall allow the participant to retain the ability to have a 
12.15 	significant role in the selection and dismissal of the support workers for the delivery of the 
12.16 	services and supports specified in the service delivery plan.
12.17 	(c) A participant may use authorized units of CFSS services as needed within 
12.18 	a service authorization that is not greater than 12 months. Using authorized units 
12.19 	agency-provider services or the budget allocation amount for the flexible spending model 
12.20 	flexibly does not increase the total amount of services and supports authorized for a 
12.21 	participant or included in the participant's service delivery plan.
12.22 	(d) A participant may share CFSS services. Two or three CFSS participants may 
12.23 	share services at the same time provided by the same support worker.
12.24 	(e) The agency-provider must use a minimum of 72.5 percent of the revenue 
12.25 	generated by the medical assistance payment for CFSS for support worker wages and 
12.26 	benefits. The agency-provider must document how this requirement is being met. The 
12.27 	revenue generated by the support specialist and the reasonable costs associated with the 
12.28 	support specialist must not be used in making this calculation.
12.29 	(f) The agency-provider model must be used by individuals who have been restricted 
12.30 	by the Minnesota restricted recipient program.
12.31 		Subd. 12.Requirements for initial enrollment of CFSS provider agencies. (a) 
12.32 	All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider 
12.33 	agency in a format determined by the commissioner, information and documentation that 
12.34 	includes, but is not limited to, the following:
12.35 	(1) the CFSS provider agency's current contact information including address, 
12.36 	telephone number, and e-mail address;
13.1 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
13.2 	provider's payments from Medicaid in the previous year, whichever is less;
13.3 	(3) proof of fidelity bond coverage in the amount of $20,000;
13.4 	(4) proof of workers' compensation insurance coverage;
13.5 	(5) proof of liability insurance;
13.6 	(6) a description of the CFSS provider agency's organization identifying the names 
13.7 	or all owners, managing employees, staff, board of directors, and the affiliations of the 
13.8 	directors, owners, or staff to other service providers;
13.9 	(7) a copy of the CFSS provider agency's written policies and procedures including: 
13.10 	hiring of employees; training requirements; service delivery; and employee and consumer 
13.11 	safety including process for notification and resolution of consumer grievances, 
13.12 	identification and prevention of communicable diseases, and employee misconduct;
13.13 	(8) copies of all other forms the CFSS provider agency uses in the course of daily 
13.14 	business including, but not limited to:
13.15 	(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from 
13.16 	the standard time sheet for CFSS services approved by the commissioner, and a letter 
13.17 	requesting approval of the CFSS provider agency's nonstandard time sheet;
13.18 	(ii) the CFSS provider agency's template for the CFSS care plan; and
13.19 	(iii) the CFSS provider agency's template for the written agreement in subdivision 
13.20 	21 for recipients using the CFSS choice option, if applicable;
13.21 	(9) a list of all training and classes that the CFSS provider agency requires of its 
13.22 	staff providing CFSS services;
13.23 	(10) documentation that the CFSS provider agency and staff have successfully 
13.24 	completed all the training required by this section;
13.25 	(11) documentation of the agency's marketing practices;
13.26 	(12) disclosure of ownership, leasing, or management of all residential properties 
13.27 	that is used or could be used for providing home care services;
13.28 	(13) documentation that the agency will use the following percentages of revenue 
13.29 	generated from the medical assistance rate paid for CFSS services for employee personal 
13.30 	care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The 
13.31 	revenue generated by the support specialist and the reasonable costs associated with the 
13.32 	support specialist shall not be used in making this calculation; and
13.33 	(14) documentation that the agency does not burden recipients' free exercise of their 
13.34 	right to choose service providers by requiring personal care assistants to sign an agreement 
13.35 	not to work with any particular CFSS recipient or for another CFSS provider agency after 
14.1 	leaving the agency and that the agency is not taking action on any such agreements or 
14.2 	requirements regardless of the date signed.
14.3 	(b) CFSS provider agencies shall provide the information specified in paragraph 
14.4 	(a) to the commissioner.
14.5 	(c) All CFSS provider agencies shall require all employees in management and 
14.6 	supervisory positions and owners of the agency who are active in the day-to-day 
14.7 	management and operations of the agency to complete mandatory training as determined 
14.8 	by the commissioner. Employees in management and supervisory positions and owners 
14.9 	who are active in the day-to-day operations of an agency who have completed the required 
14.10 	training as an employee with a CFSS provider agency do not need to repeat the required 
14.11 	training if they are hired by another agency, if they have completed the training within 
14.12 	the past three years. CFSS provider agency billing staff shall complete training about 
14.13 	CFSS program financial management. Any new owners or employees in management 
14.14 	and supervisory positions involved in the day-to-day operations are required to complete 
14.15 	mandatory training as a requisite of working for the agency. CFSS provider agencies 
14.16 	certified for participation in Medicare as home health agencies are exempt from the 
14.17 	training required in this subdivision.
14.18 		Subd. 13.Flexible spending model. (a) Under the flexible spending model 
14.19 	participants can exercise more responsibility and control over the services and supports 
14.20 	described and budgeted within the CFSS service delivery plan. Under this model:
14.21 	(1) participants directly employ support workers;
14.22 	(2) participants may use a budget allocation to obtain supports and goods as defined 
14.23 	in subdivision 7; and
14.24 	(3) from the financial management services (FMS) contractor the participant may 
14.25 	choose a range of support assistance services relating to:
14.26 	(i) planning, budgeting, and management of services and support;
14.27 	(ii) the participant's employment, training, supervision, and evaluation of workers;
14.28 	(iii) acquisition and payment for supports and goods; and
14.29 	(iv) evaluation of individual service outcomes as needed for the scope of the 
14.30 	participant's degree of control and responsibility.
14.31 	(b) Participants who are unable to fulfill any of the functions listed in paragraph (a) 
14.32 	may authorize a legal representative or participant's representative to do so on their behalf.
14.33 	(c) The FMS contractor shall not provide CFSS services and supports under the 
14.34 	agency-provider service model. The FMS contractor shall provide service functions as 
14.35 	determined by the commissioner that include but are not limited to:
14.36 	(1) information and consultation about CFSS;
15.1 	(2) assistance with the development of the service delivery plan and flexible 
15.2 	spending model as requested by the participant;
15.3 	(3) billing and making payments for flexible spending model expenditures;
15.4 	(4) assisting participants in fulfilling employer-related requirements according to 
15.5 	Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability, 
15.6 	regulation 137036-08, which includes assistance with filing and paying payroll taxes, and 
15.7 	obtaining worker compensation coverage;
15.8 	(5) data recording and reporting of participant spending; and
15.9 	(6) other duties established in the contract with the department.
15.10 	(d) A participant who requests to purchase goods and supports along with support 
15.11 	worker services under the agency-provider model must use flexible spending model 
15.12 	with a service delivery plan that specifies the amount of services to be authorized to the 
15.13 	agency-provider and the expenditures to be paid by the FMS contractor.
15.14 	(e) The FMS contractor shall:
15.15 	(1) not limit or restrict the participant's choice of service or support providers or 
15.16 	service delivery models as authorized by the commissioner;
15.17 	(2) provide the participant and the targeted case manager, if applicable, with a 
15.18 	monthly written summary of the spending for services and supports that were billed 
15.19 	against the spending budget;
15.20 	(3) be knowledgeable of state and federal employment regulations under the Fair 
15.21 	Labor Standards Act of 1938, and comply with the requirements under the Internal 
15.22 	Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax 
15.23 	Liability for vendor or fiscal employer agent, and any requirements necessary to process 
15.24 	employer and employee deductions, provide appropriate and timely submission of 
15.25 	employer tax liabilities, and maintain documentation to support medical assistance claims;
15.26 	(4) have current and adequate liability insurance and bonding and sufficient cash 
15.27 	flow as determined by the commission and have on staff or under contract a certified 
15.28 	public accountant or an individual with a baccalaureate degree in accounting;
15.29 	(5) assume fiscal accountability for state funds designated for the program; and
15.30 	(6) maintain documentation of receipts, invoices, and bills to track all services and 
15.31 	supports expenditures for any goods purchased and maintain time records of support 
15.32 	workers. The documentation and time records must be maintained for a minimum of 
15.33 	five years from the claim date and be available for audit or review upon request by the 
15.34 	commissioner. Claims submitted by the FMS contractor to the commissioner for payment 
15.35 	must correspond with services, amounts, and time periods as authorized in the participant's 
15.36 	spending budget and service plan.
16.1 	(f) The commissioner of human services shall:
16.2 	(1) establish rates and payment methodology for the FMS contractor;
16.3 	(2) identify a process to ensure quality and performance standards for the FMS 
16.4 	contractor and ensure statewide access to FMS contractors; and
16.5 	(3) establish a uniform protocol for delivering and administering CFSS services 
16.6 	to be used by eligible FMS contractors.
16.7 	(g) Participants who are disenrolled from the model shall be transferred to the 
16.8 	agency-provider model.
16.9 		Subd. 14.Participant's responsibilities under flexible spending model. (a) A 
16.10 	participant using the flexible spending model must use a FMS contractor or vendor that is 
16.11 	under contract with the department. Upon a determination of eligibility and completion of 
16.12 	the assessment and community support plan, the participant shall choose a FMS contractor 
16.13 	from a list of eligible vendors maintained by the department.
16.14 	(b) When the participant, participant's representative, or legal representative chooses 
16.15 	to be the employer of the support worker, they are responsible for recruiting, interviewing, 
16.16 	hiring, training, scheduling, supervising, and discharging direct support workers.
16.17 	(c) In addition to the employer responsibilities in paragraph (b), the participant, 
16.18 	participant's representative, or legal representative is responsible for:
16.19 	(1) tracking the services provided and all expenditures for goods or other supports;
16.20 	(2) preparing and submitting time sheets, signed by both the participant and support 
16.21 	worker, to the FMS contractor on a regular basis and in a timely manner according to 
16.22 	the FMS contractor's procedures;
16.23 	(3) notifying the FMS contractor within ten days of any changes in circumstances 
16.24 	affecting the CFSS service plan or in the participant's place of residence including, but 
16.25 	not limited to, any hospitalization of the participant or change in the participant's address, 
16.26 	telephone number, or employment;
16.27 	(4) notifying the FMS contractor of any changes in the employment status of each 
16.28 	participant support worker; and
16.29 	(5) reporting any problems resulting from the quality of services rendered by the 
16.30 	support worker to the FMS contractor. If the participant is unable to resolve any problems 
16.31 	resulting from the quality of service rendered by the support worker with the assistance of 
16.32 	the FMS contractor, the participant shall report the situation to the department.
16.33 		Subd. 15.Documentation of support services provided. (a) Support services 
16.34 	provided to a participant by a support worker employed by either an agency-provider 
16.35 	or the participant acting as the employer must be documented daily by each support 
16.36 	worker, on a time sheet form approved by the commissioner. All documentation may be 
17.1 	Web-based, electronic, or paper documentation. The completed form must be submitted 
17.2 	on a monthly basis to the provider or the participant and the FMS contractor selected by 
17.3 	the participant to provide assistance with meeting the participant's employer obligations 
17.4 	and kept in the recipient's health record.
17.5 	(b) The activity documentation must correspond to the written service delivery plan 
17.6 	and be reviewed by the agency provider or the participant and the FMS contractor when 
17.7 	the participant is acting as the employer of the support worker.
17.8 	(c) The time sheet must be on a form approved by the commissioner documenting 
17.9 	time the support worker provides services in the home. The following criteria must be 
17.10 	included in the time sheet:
17.11 	(1) full name of the support worker and individual provider number;
17.12 	(2) provider name and telephone numbers, if an agency-provider is responsible for 
17.13 	delivery services under the written service plan;
17.14 	(3) full name of the participant;
17.15 	(4) consecutive dates, including month, day, and year, and arrival and departure 
17.16 	times with a.m. or p.m. notations;
17.17 	(5) signatures of the participant or the participant's representative;
17.18 	(6) personal signature of the support worker;
17.19 	(7) any shared care provided, if applicable;
17.20 	(8) a statement that it is a federal crime to provide false information on CFSS 
17.21 	billings for medical assistance payments; and
17.22 	(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
17.23 		Subd. 16.Support workers requirements. (a) Support workers shall:
17.24 	(1) enroll with the department as a support worker after a background study under 
17.25 	chapter 245C has been completed and the support worker has received a notice from the 
17.26 	commissioner that:
17.27 	(i) the support worker is not disqualified under section 245C.14; or
17.28 	(ii) is disqualified, but the support worker has received a set-aside of the 
17.29 	disqualification under section 245C.22;
17.30 	(2) have the ability to effectively communicate with the participant or the 
17.31 	participant's representative;
17.32 	(3) have the skills and ability to provide the services and supports according to the 
17.33 	person's CFSS service delivery plan and respond appropriately to the participant's needs;
17.34 	(4) not be a participant of CFSS;
17.35 	(5) complete the basic standardized training as determined by the commissioner 
17.36 	before completing enrollment. The training must be available in languages other than 
18.1 	English and to those who need accommodations due to disabilities. Support worker 
18.2 	training must include successful completion of the following training components: basic 
18.3 	first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles 
18.4 	and responsibilities of support workers including information about basic body mechanics, 
18.5 	emergency preparedness, orientation to positive behavioral practices, orientation to 
18.6 	responding to a mental health crisis, fraud issues, time cards and documentation, and an 
18.7 	overview of person-centered planning and self-direction. Upon completion of the training 
18.8 	components, the support worker must pass the certification test to provide assistance 
18.9 	to participants;
18.10 	(6) complete training and orientation on the participant's individual needs; and
18.11 	(7) maintain the privacy and confidentiality of the participant, and not independently 
18.12 	determine the medication dose or time for medications for the participant.
18.13 	(b) The commissioner may deny or terminate a support worker's provider enrollment 
18.14 	and provider number if the support worker:
18.15 	(1) lacks the skills, knowledge, or ability to adequately or safely perform the 
18.16 	required work;
18.17 	(2) fails to provide the authorized services required by the participant employer;
18.18 	(3) has been intoxicated by alcohol or drugs while providing authorized services to 
18.19 	the participant or while in the participant's home;
18.20 	(4) has manufactured or distributed drugs while providing authorized services to the 
18.21 	participant or while in the participant's home; or
18.22 	(5) has been excluded as a provider by the commissioner of human services, or the 
18.23 	United States Department of Health and Human Services, Office of Inspector General, 
18.24 	from participation in Medicaid, Medicare, or any other federal health care program.
18.25 	(c) A support worker may appeal in writing to the commissioner to contest the 
18.26 	decision to terminate the support worker's provider enrollment and provider number.
18.27 		Subd. 17.Support specialist requirements and payments. The commissioner 
18.28 	shall develop qualifications, scope of functions, and payment rates and service limits for a 
18.29 	support specialist that may provide additional or specialized assistance necessary to plan, 
18.30 	implement, arrange, augment, or evaluate services and supports.
18.31 		Subd. 18.Service unit and budget allocation requirements. (a) For the 
18.32 	agency-provider model, services will be authorized in units of service. The total service 
18.33 	unit amount must be established based upon the assessed need for CFSS services, and 
18.34 	must not exceed the maximum number of units available as determined by section 
18.35 	256B.0652, subdivision 6. The unit rate established by the commissioner is used with 
18.36 	assessed units to determine the maximum available CFSS allocation.
19.1 	(b) For the flexible spending model, services and supports are authorized under 
19.2 	a budget limit.
19.3 	(c) The maximum available CFSS participant budget allocation shall be established 
19.4 	by multiplying the number of units authorized under subdivision 8 by the payment rate 
19.5 	established by the commissioner.
19.6 		Subd. 19.Support system. (a) The commissioner shall provide information, 
19.7 	consultation, training, and assistance to ensure the participant is able to manage the 
19.8 	services and supports and budgets, if applicable. This support shall include individual 
19.9 	consultation on how to select and employ workers, manage responsibilities under CFSS, 
19.10 	and evaluate personal outcomes.
19.11 	(b) The commissioner shall provide assistance with the development of risk 
19.12 	management agreements.
19.13 		Subd. 20.Service-related rights. Participants must be provided with adequate 
19.14 	information, counseling, training, and assistance, as needed, to ensure that the participant 
19.15 	is able to choose and manage services, models, and budgets. This support shall include 
19.16 	information regarding: (1) person-centered planning; (2) the range and scope of individual 
19.17 	choices; (3) the process for changing plans, services and budgets; (4) the grievance 
19.18 	process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks 
19.19 	and responsibilities; and (8) risk management. A participant who appeals a reduction in 
19.20 	previously authorized CFSS services may continue previously authorized services pending 
19.21 	an appeal under section 256.045. The commissioner must ensure that the participant 
19.22 	has a copy of the most recent service delivery plan that contains a detailed explanation 
19.23 	of which areas of covered CFSS are reduced, and provide notice of the amount of the 
19.24 	budget reduction, and the reasons for the reduction in the participant's notice of denial, 
19.25 	termination, or reduction.
19.26 		Subd. 21.Development and Implementation Council. The commissioner 
19.27 	shall establish a Development and Implementation Council of which the majority of 
19.28 	members are individuals with disabilities, elderly individuals, and their representatives. 
19.29 	The commissioner shall consult and collaborate with the council when developing and 
19.30 	implementing this section.
19.31 		Subd. 22.Quality assurance and risk management system. (a) The commissioner 
19.32 	shall establish quality assurance and risk management measures for use in developing and 
19.33 	implementing CFSS including those that (1) recognize the roles and responsibilities of those 
19.34 	involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets 
19.35 	based upon a recipient's resources and capabilities. Risk management measures must 
19.36 	include background studies, and backup and emergency plans, including disaster planning.
20.1 	(b) The commissioner shall provide ongoing technical assistance and resource and 
20.2 	educational materials for CFSS participants.
20.3 	(c) Performance assessment measures, such as a participant's satisfaction with the 
20.4 	services and supports, and ongoing monitoring of health and well-being shall be identified 
20.5 	in consultation with the council established in subdivision 21.
20.6 		Subd. 23.Commissioner's access. When the commissioner is investigating a 
20.7 	possible overpayment of Medicaid funds, the commissioner must be given immediate 
20.8 	access without prior notice to the agency provider or FMS contractor's office during 
20.9 	regular business hours and to documentation and records related to services provided and 
20.10 	submission of claims for services provided. Denying the commissioner access to records 
20.11 	is cause for immediate suspension of payment and terminating the agency provider's 
20.12 	enrollment according to section 256B.064 or terminating the FMS contract.
20.13 		Subd. 24.CFSS agency-providers; background studies. CFSS agency-providers 
20.14 	enrolled to provide personal care assistance services under the medical assistance program 
20.15 	shall comply with the following:
20.16 	(1) owners who have a five percent interest or more and all managing employees 
20.17 	are subject to a background study as provided in chapter 245C. This applies to currently 
20.18 	enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS 
20.19 	agency-provider. "Managing employee" has the same meaning as Code of Federal 
20.20 	Regulations, title 42, section 455. An organization is barred from enrollment if:
20.21 	(i) the organization has not initiated background studies on owners managing 
20.22 	employees; or
20.23 	(ii) the organization has initiated background studies on owners and managing 
20.24 	employees, but the commissioner has sent the organization a notice that an owner or 
20.25 	managing employee of the organization has been disqualified under section 245C.14, and 
20.26 	the owner or managing employee has not received a set-aside of the disqualification 
20.27 	under section 245C.22;
20.28 	(2) a background study must be initiated and completed for all support specialists; and
20.29 	(3) a background study must be initiated and completed for all support workers.

20.30 	EFFECTIVE DATE. This section is effective upon federal approval. The 
20.31 	commissioner of human services shall notify the revisor of statutes when this occurs.

20.32 	Sec. 2. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:
20.33 		Subd. 4.Reporting. (a) Except as provided in paragraph (b), a mandated reporter 
20.34 	shall immediately make an oral report to the common entry point. The common entry 
20.35 	point may accept electronic reports submitted through a Web-based reporting system 
21.1 	established by the commissioner. Use of a telecommunications device for the deaf or other 
21.2 	similar device shall be considered an oral report. The common entry point may not require 
21.3 	written reports. To the extent possible, the report must be of sufficient content to identify 
21.4 	the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, 
21.5 	any evidence of previous maltreatment, the name and address of the reporter, the time, 
21.6 	date, and location of the incident, and any other information that the reporter believes 
21.7 	might be helpful in investigating the suspected maltreatment. A mandated reporter may 
21.8 	disclose not public data, as defined in section 13.02, and medical records under sections 
21.9 	144.291 to 144.298, to the extent necessary to comply with this subdivision.
21.10 	(b) A boarding care home that is licensed under sections 144.50 to 144.58 and 
21.11 	certified under Title 19 of the Social Security Act, a nursing home that is licensed under 
21.12 	section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a 
21.13 	hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under 
21.14 	Code of Federal Regulations, title 42, section 482.66, may submit a report electronically 
21.15 	to the common entry point instead of submitting an oral report. The report may be a 
21.16 	duplicate of the initial report the facility submits electronically to the commissioner of 
21.17 	health to comply with the reporting requirements under Code of Federal Regulations, title 
21.18 	42, section 483.13. The commissioner of health may modify these reporting requirements 
21.19 	to include items required under paragraph (a) that are not currently included in the 
21.20 	electronic reporting form.

21.21 	EFFECTIVE DATE. This section is effective July 1, 2014.

21.22 	Sec. 3. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:
21.23 		Subd. 9.Common entry point designation. (a) Each county board shall designate 
21.24 	a common entry point for reports of suspected maltreatment. Two or more county boards 
21.25 	may jointly designate a single The commissioner of human services shall establish a
21.26 	 common entry point effective July 1, 2014. The common entry point is the unit responsible 
21.27 	for receiving the report of suspected maltreatment under this section.
21.28 	(b) The common entry point must be available 24 hours per day to take calls from 
21.29 	reporters of suspected maltreatment. The common entry point shall use a standard intake 
21.30 	form that includes:
21.31 	(1) the time and date of the report;
21.32 	(2) the name, address, and telephone number of the person reporting;
21.33 	(3) the time, date, and location of the incident;
21.34 	(4) the names of the persons involved, including but not limited to, perpetrators, 
21.35 	alleged victims, and witnesses;
22.1 	(5) whether there was a risk of imminent danger to the alleged victim;
22.2 	(6) a description of the suspected maltreatment;
22.3 	(7) the disability, if any, of the alleged victim;
22.4 	(8) the relationship of the alleged perpetrator to the alleged victim;
22.5 	(9) whether a facility was involved and, if so, which agency licenses the facility;
22.6 	(10) any action taken by the common entry point;
22.7 	(11) whether law enforcement has been notified;
22.8 	(12) whether the reporter wishes to receive notification of the initial and final 
22.9 	reports; and
22.10 	(13) if the report is from a facility with an internal reporting procedure, the name, 
22.11 	mailing address, and telephone number of the person who initiated the report internally.
22.12 	(c) The common entry point is not required to complete each item on the form prior 
22.13 	to dispatching the report to the appropriate lead investigative agency.
22.14 	(d) The common entry point shall immediately report to a law enforcement agency 
22.15 	any incident in which there is reason to believe a crime has been committed.
22.16 	(e) If a report is initially made to a law enforcement agency or a lead investigative 
22.17 	agency, those agencies shall take the report on the appropriate common entry point intake 
22.18 	forms and immediately forward a copy to the common entry point.
22.19 	(f) The common entry point staff must receive training on how to screen and 
22.20 	dispatch reports efficiently and in accordance with this section.
22.21 	(g) The commissioner of human services shall maintain a centralized database 
22.22 	for the collection of common entry point data, lead investigative agency data including 
22.23 	maltreatment report disposition, and appeals data. The common entry point shall 
22.24 	have access to the centralized database and must log the reports into the database and 
22.25 	immediately identify and locate prior reports of abuse, neglect, or exploitation.
22.26 	(h) When appropriate, the common entry point staff must refer calls that do not 
22.27 	allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations 
22.28 	that might resolve the reporter's concerns.
22.29 	(i) a common entry point must be operated in a manner that enables the 
22.30 	commissioner of human services to:
22.31 	(1) track critical steps in the reporting, evaluation, referral, response, disposition, 
22.32 	and investigative process to ensure compliance with all requirements for all reports;
22.33 	(2) maintain data to facilitate the production of aggregate statistical reports for 
22.34 	monitoring patterns of abuse, neglect, or exploitation;
23.1 	(3) serve as a resource for the evaluation, management, and planning of preventative 
23.2 	and remedial services for vulnerable adults who have been subject to abuse, neglect, 
23.3 	or exploitation;
23.4 	(4) set standards, priorities, and policies to maximize the efficiency and effectiveness 
23.5 	of the common entry point; and
23.6 	(5) track and manage consumer complaints related to the common entry point.
23.7 	(j) The commissioners of human services and health shall collaborate on the 
23.8 	creation of a system for referring reports to the lead investigative agencies. This system 
23.9 	shall enable the commissioner of human services to track critical steps in the reporting, 
23.10 	evaluation, referral, response, disposition, investigation, notification, determination, and 
23.11 	appeal processes.

23.12 	Sec. 4. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:
23.13 		Subd. 9e.Education requirements. (a) The commissioners of health, human 
23.14 	services, and public safety shall cooperate in the development of a joint program for 
23.15 	education of lead investigative agency investigators in the appropriate techniques for 
23.16 	investigation of complaints of maltreatment. This program must be developed by July 
23.17 	1, 1996. The program must include but need not be limited to the following areas: (1) 
23.18 	information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4) 
23.19 	conclusions based on evidence; (5) interviewing skills, including specialized training to 
23.20 	interview people with unique needs; (6) report writing; (7) coordination and referral 
23.21 	to other necessary agencies such as law enforcement and judicial agencies; (8) human 
23.22 	relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family 
23.23 	systems and the appropriate methods for interviewing relatives in the course of the 
23.24 	assessment or investigation; (10) the protective social services that are available to protect 
23.25 	alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by 
23.26 	which lead investigative agency investigators and law enforcement workers cooperate in 
23.27 	conducting assessments and investigations in order to avoid duplication of efforts; and 
23.28 	(12) data practices laws and procedures, including provisions for sharing data.
23.29 	(b) The commissioner of human services shall conduct an outreach campaign to 
23.30 	promote the common entry point for reporting vulnerable adult maltreatment. This 
23.31 	campaign shall use the Internet and other means of communication.
23.32 	(b) (c) The commissioners of health, human services, and public safety shall offer at 
23.33 	least annual education to others on the requirements of this section, on how this section is 
23.34 	implemented, and investigation techniques.
24.1 	(c) (d) The commissioner of human services, in coordination with the commissioner 
24.2 	of public safety shall provide training for the common entry point staff as required in this 
24.3 	subdivision and the program courses described in this subdivision, at least four times 
24.4 	per year. At a minimum, the training shall be held twice annually in the seven-county 
24.5 	metropolitan area and twice annually outside the seven-county metropolitan area. The 
24.6 	commissioners shall give priority in the program areas cited in paragraph (a) to persons 
24.7 	currently performing assessments and investigations pursuant to this section.
24.8 	(d) (e) The commissioner of public safety shall notify in writing law enforcement 
24.9 	personnel of any new requirements under this section. The commissioner of public 
24.10 	safety shall conduct regional training for law enforcement personnel regarding their 
24.11 	responsibility under this section.
24.12 	(e) (f) Each lead investigative agency investigator must complete the education 
24.13 	program specified by this subdivision within the first 12 months of work as a lead 
24.14 	investigative agency investigator.
24.15 	A lead investigative agency investigator employed when these requirements take 
24.16 	effect must complete the program within the first year after training is available or as soon 
24.17 	as training is available.
24.18 	All lead investigative agency investigators having responsibility for investigation 
24.19 	duties under this section must receive a minimum of eight hours of continuing education 
24.20 	or in-service training each year specific to their duties under this section.

24.21 	ARTICLE 2
24.22 	DEPARTMENT OF HUMAN SERVICES PROGRAM INTEGRITY

24.23 	Section 1. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:
24.24 		Subd. 7.Use of data. (a) Except as otherwise provided in subdivision 7a or sections 
24.25 	244.052 and 299C.093, the data provided under this section is private data on individuals 
24.26 	under section 13.02, subdivision 12.
24.27 	(b)  The data may be used only for by law enforcement and corrections agencies for
24.28 	 law enforcement and corrections purposes.
24.29 	(c) The commissioner of human services is authorized to have access to the data for:
24.30 	(1) state-operated services, as defined in section 246.014, are also authorized to 
24.31 	have access to the data for the purposes described in section 246.13, subdivision 2, 
24.32 	paragraph (b); and
24.33 	(2) purposes of completing background studies under chapter 245C.

25.1 	Sec. 2. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision 
25.2 	to read:
25.3 		Subd. 4a.Agency background studies. (a) The commissioner shall develop 
25.4 	and implement an electronic process for the regular transfer of new criminal history 
25.5 	information that is added to the Minnesota court information system. The commissioner's 
25.6 	system must include for review only information that relates to individuals who have been 
25.7 	the subject of a background study under this chapter that remain affiliated with the agency 
25.8 	that initiated the background study. For purposes of this paragraph, an individual remains 
25.9 	affiliated with an agency that initiated the background study until the agency informs the 
25.10 	commissioner that the individual is no longer affiliated. When any individual no longer 
25.11 	affiliated according to this paragraph returns to a position requiring a background study 
25.12 	under this chapter, the agency with whom the individual is again affiliated shall initiate 
25.13 	a new background study regardless of the length of time the individual was no longer 
25.14 	affiliated with the agency.
25.15 	(b) The commissioner shall develop and implement an online system for agencies that 
25.16 	initiate background studies under this chapter to access and maintain records of background 
25.17 	studies initiated by that agency. The system must show all active background study subjects 
25.18 	affiliated with that agency and the status of each individual's background study. Each 
25.19 	agency that initiates background studies must use this system to notify the commissioner 
25.20 	of discontinued affiliation for purposes of the processes required under paragraph (a).

25.21 	Sec. 3. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:
25.22 		Subdivision 1.Background studies conducted by Department of Human 
25.23 	Services. (a) For a background study conducted by the Department of Human Services, 
25.24 	the commissioner shall review:
25.25 	(1) information related to names of substantiated perpetrators of maltreatment of 
25.26 	vulnerable adults that has been received by the commissioner as required under section 
25.27 	626.557, subdivision 9c, paragraph (j);
25.28 	(2) the commissioner's records relating to the maltreatment of minors in licensed 
25.29 	programs, and from findings of maltreatment of minors as indicated through the social 
25.30 	service information system;
25.31 	(3) information from juvenile courts as required in subdivision 4 for individuals 
25.32 	listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
25.33 	(4) information from the Bureau of Criminal Apprehension, including information 
25.34 	regarding a background study subject's registration in Minnesota as a predatory offender 
25.35 	under section 243.166;
26.1 	(5) except as provided in clause (6), information from the national crime information 
26.2 	system when the commissioner has reasonable cause as defined under section 245C.05, 
26.3 	subdivision 5; and
26.4 	(6) for a background study related to a child foster care application for licensure or 
26.5 	adoptions, the commissioner shall also review:
26.6 	(i) information from the child abuse and neglect registry for any state in which the 
26.7 	background study subject has resided for the past five years; and
26.8 	(ii) information from national crime information databases, when the background 
26.9 	study subject is 18 years of age or older.
26.10 	(b) Notwithstanding expungement by a court, the commissioner may consider 
26.11 	information obtained under paragraph (a), clauses (3) and (4), unless the commissioner 
26.12 	received notice of the petition for expungement and the court order for expungement is 
26.13 	directed specifically to the commissioner.
26.14 	(c) The commissioner shall also review criminal history information received 
26.15 	according to section 245C.04, subdivision 4a, from the Minnesota court information 
26.16 	system that relates to individuals who have already been studied under this chapter and 
26.17 	who remain affiliated with the agency that initiated the background study.

26.18 	ARTICLE 3
26.19 	WAIVER PROVIDER STANDARDS

26.20 	Section 1. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to 
26.21 	read:
26.22 		Subd. 7b.Adult foster care data privacy and security. (a) An adult foster care
26.23 	 or community residential setting license holder who creates, collects, records, maintains, 
26.24 	stores, or discloses any individually identifiable recipient data, whether in an electronic 
26.25 	or any other format, must comply with the privacy and security provisions of applicable 
26.26 	privacy laws and regulations, including:
26.27 	(1) the federal Health Insurance Portability and Accountability Act of 1996 
26.28 	(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations, 
26.29 	title 45, part 160, and subparts A and E of part 164; and
26.30 	(2) the Minnesota Government Data Practices Act as codified in chapter 13.
26.31 	(b) For purposes of licensure, the license holder shall be monitored for compliance 
26.32 	with the following data privacy and security provisions:
26.33 	(1) the license holder must control access to data on foster care recipients residents 
26.34 	served by the program according to the definitions of public and private data on individuals 
26.35 	under section 13.02; classification of the data on individuals as private under section 
27.1 	13.46, subdivision 2; and control over the collection, storage, use, access, protection, 
27.2 	and contracting related to data according to section 13.05, in which the license holder is 
27.3 	assigned the duties of a government entity;
27.4 	(2) the license holder must provide each foster care recipient resident served by 
27.5 	the program with a notice that meets the requirements under section 13.04, in which 
27.6 	the license holder is assigned the duties of the government entity, and that meets the 
27.7 	requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall 
27.8 	describe the purpose for collection of the data, and to whom and why it may be disclosed 
27.9 	pursuant to law. The notice must inform the recipient individual that the license holder 
27.10 	uses electronic monitoring and, if applicable, that recording technology is used;
27.11 	(3) the license holder must not install monitoring cameras in bathrooms;
27.12 	(4) electronic monitoring cameras must not be concealed from the foster care 
27.13 	recipients residents served by the program; and
27.14 	(5) electronic video and audio recordings of foster care recipients residents served 
27.15 	by the program shall be stored by the license holder for five days unless: (i) a foster care 
27.16 	recipient resident served by the program or legal representative requests that the recording 
27.17 	be held longer based on a specific report of alleged maltreatment; or (ii) the recording 
27.18 	captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or 
27.19 	a crime under chapter 609. When requested by a recipient resident served by the program
27.20 	 or when a recording captures an incident or event of alleged maltreatment or a crime, the 
27.21 	license holder must maintain the recording in a secured area for no longer than 30 days 
27.22 	to give the investigating agency an opportunity to make a copy of the recording. The 
27.23 	investigating agency will maintain the electronic video or audio recordings as required in 
27.24 	section 626.557, subdivision 12b.
27.25 	(c) The commissioner shall develop, and make available to license holders and 
27.26 	county licensing workers, a checklist of the data privacy provisions to be monitored 
27.27 	for purposes of licensure.

27.28 	Sec. 2. Minnesota Statutes 2012, section 245D.05, is amended to read:
27.29 	245D.05 HEALTH SERVICES.
27.30 		Subdivision 1.Health needs. (a) The license holder is responsible for providing
27.31 	 meeting health services service needs assigned in the coordinated service and support plan 
27.32 	andor the coordinated service and support plan addendum, consistent with the person's 
27.33 	health needs. The license holder is responsible for promptly notifying the person or
27.34 	 the person's legal representative, if any, and the case manager of changes in a person's 
27.35 	physical and mental health needs affecting assigned health services service needs assigned 
28.1 	to the license holder in the coordinated service and support plan or the coordinated service 
28.2 	and support plan addendum, when discovered by the license holder, unless the license 
28.3 	holder has reason to know the change has already been reported. The license holder 
28.4 	must document when the notice is provided.
28.5 	(b) When assigned in the service plan, If responsibility for meeting the person's 
28.6 	health service needs has been assigned to the license holder in the coordinated service and 
28.7 	support plan or the coordinated service and support plan addendum, the license holder is 
28.8 	required to must maintain documentation on how the person's health needs will be met, 
28.9 	including a description of the procedures the license holder will follow in order to:
28.10 	(1) provide medication administration,assistance or medication assistance, or 
28.11 	medication management administration according to this chapter;
28.12 	(2) monitor health conditions according to written instructions from the person's 
28.13 	physician or a licensed health professional;
28.14 	(3) assist with or coordinate medical, dental, and other health service appointments; or
28.15 	(4) use medical equipment, devices, or adaptive aides or technology safely and 
28.16 	correctly according to written instructions from the person's physician or a licensed 
28.17 	health professional.
28.18 		Subd. 1a.Medication setup. For the purposes of this subdivision, "medication 
28.19 	setup" means the arranging of medications according to instructions from the pharmacy, 
28.20 	the prescriber, or a licensed nurse, for later administration when the license holder 
28.21 	is assigned responsibility for medication assistance or medication administration in 
28.22 	the coordinated service and support plan or the coordinated service and support plan 
28.23 	addendum. A prescription label or the prescriber's written or electronically recorded order 
28.24 	for the prescription is sufficient to constitute written instructions from the prescriber. The 
28.25 	license holder must document in the person's medication administration record: dates 
28.26 	of setup, name of medication, quantity of dose, times to be administered, and route of 
28.27 	administration at time of setup; and, when the person will be away from home, to whom 
28.28 	the medications were given.
28.29 		Subd. 1b.Medication assistance. If responsibility for medication assistance 
28.30 	is assigned to the license holder in the coordinated service and support plan or the 
28.31 	coordinated service and support plan addendum, the license holder must ensure that 
28.32 	the requirements of subdivision 2, paragraph (b), have been met when staff provides 
28.33 	medication assistance to enable a person to self-administer medication or treatment when 
28.34 	the person is capable of directing the person's own care, or when the person's legal 
28.35 	representative is present and able to direct care for the person. For the purposes of this 
28.36 	subdivision, "medication assistance" means any of the following:
29.1 	(1) bringing to the person and opening a container of previously set up medications, 
29.2 	emptying the container into the person's hand, or opening and giving the medications in 
29.3 	the original container to the person;
29.4 	(2) bringing to the person liquids or food to accompany the medication; or
29.5 	(3) providing reminders to take regularly scheduled medication or perform regularly 
29.6 	scheduled treatments and exercises.
29.7 		Subd. 2.Medication administration. (a) If responsibility for medication 
29.8 	administration is assigned to the license holder in the coordinated service and support plan 
29.9 	or the coordinated service and support plan addendum, the license holder must implement 
29.10 	the following medication administration procedures to ensure a person takes medications 
29.11 	and treatments as prescribed:
29.12 	(1) checking the person's medication record;
29.13 	(2) preparing the medication as necessary;
29.14 	(3) administering the medication or treatment to the person;
29.15 	(4) documenting the administration of the medication or treatment or the reason for 
29.16 	not administering the medication or treatment; and
29.17 	(5) reporting to the prescriber or a nurse any concerns about the medication or 
29.18 	treatment, including side effects, effectiveness, or a pattern of the person refusing to 
29.19 	take the medication or treatment as prescribed. Adverse reactions must be immediately 
29.20 	reported to the prescriber or a nurse.
29.21 	(b)(1) The license holder must ensure that the following criteria requirements in 
29.22 	clauses (2) to (4) have been met before staff that is not a licensed health professional 
29.23 	administersadministering medication or treatment:.
29.24 	(1) (2) The license holder must obtain written authorization has been obtained from 
29.25 	the person or the person's legal representative to administer medication or treatment 
29.26 	orders; and must obtain reauthorization annually as needed. If the person or the person's 
29.27 	legal representative refuses to authorize the license holder to administer medication, the 
29.28 	medication must not be administered. The refusal to authorize medication administration 
29.29 	must be reported to the prescriber as expediently as possible.
29.30 	(2) (3) The staff person has completed responsible for administering the medication 
29.31 	or treatment must complete medication administration training according to section 
29.32 	245D.09, subdivision 4, paragraph 4a, paragraphs (a) and (c), clause (2); and, as applicable 
29.33 	to the person, paragraph (d).
29.34 	(3) The medication or treatment will be administered under administration 
29.35 	procedures established for the person in consultation with a licensed health professional. 
29.36 	written instruction from the person's physician may constitute the medication 
30.1 	administration procedures. A prescription label or the prescriber's order for the 
30.2 	prescription is sufficient to constitute written instructions from the prescriber. A licensed 
30.3 	health professional may delegate medication administration procedures.
30.4 	(4) For a license holder providing intensive support services, the medication or 
30.5 	treatment must be administered according to the license holder's medication administration 
30.6 	policy and procedures as required under section 245D.11, subdivision 2, clause (3).
30.7 	(b) (c) The license holder must ensure the following information is documented in 
30.8 	the person's medication administration record:
30.9 	(1) the information on the current prescription label or the prescriber's current written 
30.10 	or electronically recorded order or prescription that includes directions for the person's 
30.11 	name, description of the medication or treatment to be provided, and the frequency and 
30.12 	other information needed to safely and correctly administering administer the medication 
30.13 	or treatment to ensure effectiveness;
30.14 	(2) information on any discomforts, risks, or other side effects that are reasonable to 
30.15 	expect, and any contraindications to its use. This information must be readily available 
30.16 	to all staff administering the medication;
30.17 	(3) the possible consequences if the medication or treatment is not taken or 
30.18 	administered as directed;
30.19 	(4) instruction from the prescriber on when and to whom to report the following:
30.20 	(i) if the a dose of medication or treatment is not administered or treatment is not 
30.21 	performed as prescribed, whether by error by the staff or the person or by refusal by 
30.22 	the person; and
30.23 	(ii) the occurrence of possible adverse reactions to the medication or treatment;
30.24 	(5) notation of any occurrence of a dose of medication not being administered or 
30.25 	treatment not performed as prescribed, whether by error by the staff or the person or by 
30.26 	refusal by the person, or of adverse reactions, and when and to whom the report was 
30.27 	made; and
30.28 	(6) notation of when a medication or treatment is started, administered, changed, or 
30.29 	discontinued.
30.30 	(c) The license holder must ensure that the information maintained in the medication 
30.31 	administration record is current and is regularly reviewed with the person or the person's 
30.32 	legal representative and the staff administering the medication to identify medication 
30.33 	administration issues or errors. At a minimum, the review must be conducted every three 
30.34 	months or more often if requested by the person or the person's legal representative. 
30.35 	Based on the review, the license holder must develop and implement a plan to correct 
31.1 	medication administration issues or errors. If issues or concerns are identified related to 
31.2 	the medication itself, the license holder must report those as required under subdivision 4.
31.3 		Subd. 3.Medication assistance. The license holder must ensure that the 
31.4 	requirements of subdivision 2, paragraph (a), have been met when staff provides assistance 
31.5 	to enable a person to self-administer medication when the person is capable of directing 
31.6 	the person's own care, or when the person's legal representative is present and able to 
31.7 	direct care for the person.
31.8 		Subd. 4.Reviewing and reporting medication and treatment issues. The 
31.9 	following medication administration issues must be reported to the person or the person's 
31.10 	legal representative and case manager as they occur or following timelines established 
31.11 	in the person's service plan or as requested in writing by the person or the person's legal 
31.12 	representative, or the case manager: (a) When assigned responsibility for medication 
31.13 	administration, the license holder must ensure that the information maintained in 
31.14 	the medication administration record is current and is regularly reviewed to identify 
31.15 	medication administration errors. At a minimum, the review must be conducted every 
31.16 	three months, or more frequently as directed in the coordinated service and support plan 
31.17 	or coordinated service and support plan addendum or as requested by the person or the 
31.18 	person's legal representative. Based on the review, the license holder must develop and 
31.19 	implement a plan to correct patterns of medication administration errors when identified.
31.20 	(b) If assigned responsibility for medication assistance or medication administration, 
31.21 	the license holder must report the following to the person's legal representative and case 
31.22 	manager as they occur or as otherwise directed in the coordinated service and support plan 
31.23 	or the coordinated service and support plan addendum:
31.24 	(1) any reports made to the person's physician or prescriber required under 
31.25 	subdivision 2, paragraph (b) (c), clause (4);
31.26 	(2) a person's refusal or failure to take or receive medication or treatment as 
31.27 	prescribed; or
31.28 	(3) concerns about a person's self-administration of medication or treatment.
31.29 		Subd. 5.Injectable medications. Injectable medications may be administered 
31.30 	according to a prescriber's order and written instructions when one of the following 
31.31 	conditions has been met:
31.32 	(1) a registered nurse or licensed practical nurse will administer the subcutaneous or 
31.33 	intramuscular injection;
31.34 	(2) a supervising registered nurse with a physician's order has delegated the 
31.35 	administration of subcutaneous injectable medication to an unlicensed staff member 
31.36 	and has provided the necessary training; or
32.1 	(3) there is an agreement signed by the license holder, the prescriber, and the 
32.2 	person or the person's legal representative specifying what subcutaneous injections may 
32.3 	be given, when, how, and that the prescriber must retain responsibility for the license 
32.4 	holder's giving the injections. A copy of the agreement must be placed in the person's 
32.5 	service recipient record.
32.6 	Only licensed health professionals are allowed to administer psychotropic 
32.7 	medications by injection.

32.8 	EFFECTIVE DATE. This section is effective January 1, 2014.

32.9 	Sec. 3. [245D.051] PSYCHOTROPIC MEDICATION USE AND MONITORING.
32.10 		Subdivision 1.Conditions for psychotropic medication administration. (a) 
32.11 	When a person is prescribed a psychotropic medication and the license holder is assigned 
32.12 	responsibility for administration of the medication in the person's coordinated service 
32.13 	and support plan or the coordinated service and support plan addendum, the license 
32.14 	holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05, 
32.15 	subdivision 2, are met.
32.16 	(b) Use of the medication must be included in the person's coordinated service and 
32.17 	support plan or in the coordinated service and support plan addendum and based on a 
32.18 	prescriber's current written or electronically recorded prescription.
32.19 	(c) The license holder must develop, implement, and maintain the following 
32.20 	documentation in the person's coordinated service and support plan addendum according 
32.21 	to the requirements in sections 245D.07 and 245D.071:
32.22 	(1) a description of the target symptoms that the psychotropic medication is to 
32.23 	alleviate; and
32.24 	(2) documentation methods the license holder will use to monitor and measure 
32.25 	changes in the target symptoms that are to be alleviated by the psychotropic medication if 
32.26 	required by the prescriber. The license holder must collect and report on medication and 
32.27 	symptom-related data as instructed by the prescriber. The license holder must provide 
32.28 	the monitoring data to the expanded support team for review every three months, or as 
32.29 	otherwise requested by the person or the person's legal representative.
32.30 	For the purposes of this section, "target symptom" refers to any perceptible 
32.31 	diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic 
32.32 	and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or 
32.33 	successive editions that has been identified for alleviation.
32.34 	(d) If a person is prescribed a psychotropic medication, monitoring the use of the 
32.35 	psychotropic medication must be assigned to the license holder in the coordinated service 
33.1 	and support plan or the coordinated service and support plan addendum. The assigned 
33.2 	license holder must monitor the psychotropic medication as required by this section.
33.3 		Subd. 2.Refusal to authorize psychotropic medication. If the person or the 
33.4 	person's legal representative refuses to authorize the administration of a psychotropic 
33.5 	medication as ordered by the prescriber, the license holder must follow the requirement 
33.6 	in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal 
33.7 	to the prescriber, the license holder must follow any directives or orders given by the 
33.8 	prescriber. A court order must be obtained to override the refusal. Refusal to authorize 
33.9 	administration of a specific psychotropic medication is not grounds for service termination 
33.10 	and does not constitute an emergency. A decision to terminate services must be reached in 
33.11 	compliance with section 245D.10, subdivision 3.

33.12 	EFFECTIVE DATE. This section is effective January 1, 2014.

33.13 	Sec. 4. Minnesota Statutes 2012, section 245D.06, is amended to read:
33.14 	245D.06 PROTECTION STANDARDS.
33.15 		Subdivision 1.Incident response and reporting.  (a) The license holder must 
33.16 	respond to all incidents under section 245D.02, subdivision 11, that occur while providing 
33.17 	services to protect the health and safety of and minimize risk of harm to the person.
33.18 	(b) The license holder must maintain information about and report incidents to the 
33.19 	person's legal representative or designated emergency contact and case manager within 24 
33.20 	hours of an incident occurring while services are being provided, or within 24 hours of 
33.21 	discovery or receipt of information that an incident occurred, unless the license holder 
33.22 	has reason to know that the incident has already been reported, or as otherwise directed 
33.23 	in a person's coordinated service and support plan or coordinated service and support 
33.24 	plan addendum. An incident of suspected or alleged maltreatment must be reported as 
33.25 	required under paragraph (d), and an incident of serious injury or death must be reported 
33.26 	as required under paragraph (e).
33.27 	(c) When the incident involves more than one person, the license holder must not 
33.28 	disclose personally identifiable information about any other person when making the report 
33.29 	to each person and case manager unless the license holder has the consent of the person.
33.30 	(d) Within 24 hours of reporting maltreatment as required under section 626.556
33.31 	or 626.557, the license holder must inform the case manager of the report unless there is 
33.32 	reason to believe that the case manager is involved in the suspected maltreatment. The 
33.33 	license holder must disclose the nature of the activity or occurrence reported and the 
33.34 	agency that received the report.
34.1 	(e) The license holder must report the death or serious injury of the person to the legal 
34.2 	representative, if any, and case manager, as required in paragraph (b) and to  the Department 
34.3 	of Human Services Licensing Division, and the Office of Ombudsman for Mental Health 
34.4 	and Developmental Disabilities as required under section 245.94, subdivision 2a, within 
34.5 	24 hours of the death, or receipt of information that the death occurred, unless the license 
34.6 	holder has reason to know that the death has already been reported.
34.7 	(f) When a death or serious injury occurs in a facility certified as an intermediate 
34.8 	care facility for persons with developmental disabilities, the death or serious injury must 
34.9 	be reported to the Department of Health, Office of Health Facility Complaints, and the 
34.10 	Office of Ombudsman for Mental Health and Developmental Disabilities, as required 
34.11 	under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to 
34.12 	know that the death has already been reported.
34.13 	(f) (g) The license holder must conduct a an internal review of incident reports of 
34.14 	deaths and serious injuries that occurred while services were being provided and that 
34.15 	were not reported by the program as alleged or suspected maltreatment, for identification 
34.16 	of incident patterns, and implementation of corrective action as necessary to reduce 
34.17 	occurrences. The review must include an evaluation of whether related policies and 
34.18 	procedures were followed, whether the policies and procedures were adequate, whether 
34.19 	there is a need for additional staff training, whether the reported event is similar to past 
34.20 	events with the persons or the services involved, and whether there is a need for corrective 
34.21 	action by the license holder to protect the health and safety of persons receiving services. 
34.22 	Based on the results of this review, the license holder must develop, document, and 
34.23 	implement a corrective action plan designed to correct current lapses and prevent future 
34.24 	lapses in performance by staff or the license holder, if any.
34.25 	(h) The license holder must verbally report the emergency use of manual restraint of 
34.26 	a person as required in paragraph (b), within 24 hours of the occurrence. The license holder 
34.27 	must ensure the written report and internal review of all incident reports of the emergency 
34.28 	use of manual restraints are completed according to the requirements in section 245D.061.
34.29 		Subd. 2.Environment and safety. The license holder must:
34.30 	(1) ensure the following when the license holder is the owner, lessor, or tenant 
34.31 	of the an unlicensed service site:
34.32 	(i) the service site is a safe and hazard-free environment;
34.33 	(ii) doors are locked or toxic substances or dangerous items normally accessible are 
34.34 	inaccessible to persons served by the program are stored in locked cabinets, drawers, or 
34.35 	containers only to protect the safety of a person receiving services and not as a substitute 
34.36 	for staff supervision or interactions with a person who is receiving services. If doors are 
35.1 	locked or toxic substances or dangerous items normally accessible to persons served by the 
35.2 	program are stored in locked cabinets, drawers, or containers are made inaccessible, the 
35.3 	license holder must justify and document how this determination was made in consultation 
35.4 	with the person or person's legal representative, and how access will otherwise be provided 
35.5 	to the person and all other affected persons receiving services; and document an assessment 
35.6 	of the physical plant, its environment, and its population identifying the risk factors which 
35.7 	require toxic substances or dangerous items to be inaccessible and a statement of specific 
35.8 	measures to be taken to minimize the safety risk to persons receiving services;
35.9 	(iii) doors are locked from the inside to prevent a person from exiting only when 
35.10 	necessary to protect the safety of a person receiving services and not as a substitute for 
35.11 	staff supervision or interactions with the person. If doors are locked from the inside, the 
35.12 	license holder must document an assessment of the physical plant, the environment and 
35.13 	the population served, identifying the risk factors which require the use of locked doors, 
35.14 	and a statement of specific measures to be taken to minimize the safety risk to persons 
35.15 	receiving services at the service site; and
35.16 	(iii) (iv) a staff person is available on site who is trained in basic first aid and, when 
35.17 	required in a person's coordinated service and support plan or coordinated service and 
35.18 	support plan addendum, cardiopulmonary resuscitation, whenever persons are present and 
35.19 	staff are required to be at the site to provide direct service. The training must include 
35.20 	in-person instruction, hands-on practice, and an observed skills assessment under the 
35.21 	direct supervision of a first aid instructor;
35.22 	(2) maintain equipment, vehicles, supplies, and materials owned or leased by the 
35.23 	license holder in good condition when used to provide services;
35.24 	(3) follow procedures to ensure safe transportation, handling, and transfers of the 
35.25 	person and any equipment used by the person, when the license holder is responsible for 
35.26 	transportation of a person or a person's equipment;
35.27 	(4) be prepared for emergencies and follow emergency response procedures to 
35.28 	ensure the person's safety in an emergency; and
35.29 	(5) follow universal precautions and sanitary practices, including hand washing, for 
35.30 	infection prevention and control, and to prevent communicable diseases.
35.31 		Subd. 3.Compliance with fire and safety codes. When services are provided at a
35.32 	 service site licensed according to chapter 245A or where the license holder is the owner, 
35.33 	lessor, or tenant of the service site, the license holder must document compliance with 
35.34 	applicable building codes, fire and safety codes, health rules, and zoning ordinances, or 
35.35 	document that an appropriate waiver has been granted.
36.1 		Subd. 4.Funds and property. (a) Whenever the license holder assists a person 
36.2 	with the safekeeping of funds or other property according to section 245A.04, subdivision 
36.3 	13, the license holder must have obtain written authorization to do so from the person or 
36.4 	the person's legal representative and the case manager. Authorization must be obtained 
36.5 	within five working days of service initiation and renewed annually thereafter. At the time 
36.6 	initial authorization is obtained, the license holder must survey, document, and implement 
36.7 	the preferences of the person or the person's legal representative and the case manager 
36.8 	for frequency of receiving a statement that itemizes receipts and disbursements of funds 
36.9 	or other property. The license holder must document changes to these preferences when 
36.10 	they are requested.
36.11 	(b) A license holder or staff person may not accept powers-of-attorney from a 
36.12 	person receiving services from the license holder for any purpose, and may not accept an 
36.13 	appointment as guardian or conservator of a person receiving services from the license 
36.14 	holder. This does not apply to license holders that are Minnesota counties or other 
36.15 	units of government or to staff persons employed by license holders who were acting 
36.16 	as power-of-attorney, guardian, or conservator attorney-in-fact for specific individuals 
36.17 	prior to April 23, 2012 implementation of this chapter. The license holder must maintain 
36.18 	documentation of the power-of-attorney, guardianship, or conservatorship in the service 
36.19 	recipient record.
36.20 	(c) Upon the transfer or death of a person, any funds or other property of the person 
36.21 	must be surrendered to the person or the person's legal representative, or given to the 
36.22 	executor or administrator of the estate in exchange for an itemized receipt.
36.23 		Subd. 5.Prohibitions. (a) The license holder is prohibited from using psychotropic 
36.24 	medication chemical restraints, mechanical restraint practices, manual restraints, time out, 
36.25 	or seclusion as a substitute for adequate staffing, for a behavioral or therapeutic program 
36.26 	to reduce or eliminate behavior, as punishment, or for staff convenience, or for any reason 
36.27 	other than as prescribed.
36.28 	(b) The license holder is prohibited from using restraints or seclusion under any 
36.29 	circumstance, unless the commissioner has approved a variance request from the license 
36.30 	holder that allows for the emergency use of restraints and seclusion according to terms 
36.31 	and conditions approved in the variance. Applicants and license holders who have 
36.32 	reason to believe they may be serving an individual who will need emergency use of 
36.33 	restraints or seclusion may request a variance on the application or reapplication, and 
36.34 	the commissioner shall automatically review the request for a variance as part of the 
36.35 	application or reapplication process. License holders may also request the variance any 
36.36 	time after issuance of a license. In the event a license holder uses restraint or seclusion for 
37.1 	any reason without first obtaining a variance as required, the license holder must report 
37.2 	the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the 
37.3 	occurrence and request the required variance.
37.4 	(b) For the purposes of this subdivision, "chemical restraint" means the 
37.5 	administration of a drug or medication to control the person's behavior or restrict the 
37.6 	person's freedom of movement and is not a standard treatment of dosage for the person's 
37.7 	medical or psychological condition.
37.8 	(c) For the purposes of this subdivision, "mechanical restraint practice" means the 
37.9 	use of any adaptive equipment or safety device to control the person's behavior or restrict 
37.10 	the person's freedom of movement and not as ordered by a licensed health professional. 
37.11 	Mechanical restraint practices include, but are not limited to, the use of bed rails or similar 
37.12 	devices on a bed to prevent the person from getting out of bed, chairs that prevent a person 
37.13 	from rising, or placing a person in a wheelchair so close to a wall that the wall prevents 
37.14 	the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to 
37.15 	warn staff that a person is leaving a room or area do not, in and of themselves, restrict 
37.16 	freedom of movement and should not be considered restraints.
37.17 	(d) A license holder must not use manual restraints, time out, or seclusion under any 
37.18 	circumstance, except for emergency use of manual restraints according to the requirements 
37.19 	in section 245D.061 or the use of controlled procedures with a person with a developmental 
37.20 	disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor 
37.21 	provisions. License holders implementing nonemergency use of manual restraint, or any 
37.22 	other programmatic use of mechanical restraint, time out, or seclusion with persons who 
37.23 	do not have a developmental disability that is not subject to the requirements of Minnesota 
37.24 	Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner 
37.25 	for continued use of the procedure within three months of implementation of this chapter.

37.26 	EFFECTIVE DATE. This section is effective January 1, 2014.

37.27 	Sec. 5. [245D.095] RECORD REQUIREMENTS.
37.28 		Subdivision 1.Record-keeping systems. The license holder must ensure that the 
37.29 	content and format of service recipient, personnel, and program records are uniform and 
37.30 	legible according to the requirements of this chapter.
37.31 		Subd. 2.Admission and discharge register. The license holder must keep a written 
37.32 	or electronic register, listing in chronological order the dates and names of all persons 
37.33 	served by the program who have been admitted, discharged, or transferred, including 
37.34 	service terminations initiated by the license holder and deaths.
38.1 		Subd. 3.Service recipient record. (a) The license holder must maintain a record of 
38.2 	current services provided to each person on the premises where the services are provided 
38.3 	or coordinated. When the services are provided in a licensed facility, the records must 
38.4 	be maintained at the facility, otherwise the records must be maintained at the license 
38.5 	holder's program office. The license holder must protect service recipient records against 
38.6 	loss, tampering, or unauthorized disclosure according to the requirements in sections 
38.7 	13.01 to 13.10 and 13.46.
38.8 	(b) The license holder must maintain the following information for each person:
38.9 	(1) an admission form signed by the person or the person's legal representative 
38.10 	that includes:
38.11 	(i) identifying information, including the person's name, date of birth, address, 
38.12 	and telephone number; and
38.13 	(ii) the name, address, and telephone number of the person's legal representative, if 
38.14 	any, and a primary emergency contact, the case manager, and family members or others as 
38.15 	identified by the person or case manager;
38.16 	(2) service information, including service initiation information, verification of the 
38.17 	person's eligibility for services, documentation verifying that services have been provided 
38.18 	as identified in the coordinated service and support plan or coordinated service and support 
38.19 	plan addendum according to paragraph (a), and date of admission or readmission;
38.20 	(3) health information, including medical history, special dietary needs, and 
38.21 	allergies, and when the license holder is assigned responsibility for meeting the person's 
38.22 	health service needs according to section 245D.05:
38.23 	(i) current orders for medication, treatments, or medical equipment and a signed 
38.24 	authorization from the person or the person's legal representative to administer or assist in 
38.25 	administering the medication or treatments, if applicable;
38.26 	(ii) a signed statement authorizing the license holder to act in a medical emergency 
38.27 	when the person's legal representative, if any, cannot be reached or is delayed in arriving;
38.28 	(iii) medication administration procedures;
38.29 	(iv) a medication administration record documenting the implementation of the 
38.30 	medication administration procedures, the medication administration record reviews, and 
38.31 	including any agreements for administration of injectable medications by the license 
38.32 	holder according to the requirements in section 245D.05; and
38.33 	(v) a medical appointment schedule when the license holder is assigned 
38.34 	responsibility for assisting with medical appointments;
38.35 	(4) the person's current coordinated service and support plan or that portion of the 
38.36 	plan assigned to the license holder;
39.1 	(5) copies of the individual abuse prevention plan and assessments as required under 
39.2 	section 245D.071, subdivisions 2 and 3;
39.3 	(6) a record of other service providers serving the person when the person's 
39.4 	coordinated service and support plan or coordinated service and support plan addendum 
39.5 	identifies the need for coordination between the service providers, that includes a contact 
39.6 	person and telephone numbers, services being provided, and names of staff responsible for 
39.7 	coordination;
39.8 	(7) documentation of orientation to service recipient rights according to section 
39.9 	245D.04, subdivision 1, and maltreatment reporting policies and procedures according to 
39.10 	section 245A.65, subdivision 1, paragraph (c);
39.11 	(8) copies of authorizations to handle a person's funds, according to section 245D.06, 
39.12 	subdivision 4, paragraph (a);
39.13 	(9) documentation of complaints received and grievance resolution;
39.14 	(10) incident reports involving the person, required under section 245D.06, 
39.15 	subdivision 1;
39.16 	(11) copies of written reports regarding the person's status when requested according 
39.17 	to section 245D.07, subdivision 3, progress review reports as required under section 
39.18 	245D.071, subdivision 5, progress or daily log notes that are recorded by the program, 
39.19 	and reports received from other agencies involved in providing services or care to the 
39.20 	person; and
39.21 	(12) discharge summary, including service termination notice and related 
39.22 	documentation, when applicable.
39.23 		Subd. 4.Access to service recipient records. The license holder must ensure that 
39.24 	the following people have access to the information in subdivision 1 in accordance with 
39.25 	applicable state and federal law, regulation, or rule:
39.26 	(1) the person, the person's legal representative, and anyone properly authorized 
39.27 	by the person;
39.28 	(2) the person's case manager;
39.29 	(3) staff providing services to the person unless the information is not relevant to 
39.30 	carrying out the coordinated service and support plan or coordinated service and support 
39.31 	plan addendum; and
39.32 	(4) the county child or adult foster care licensor, when services are also licensed as 
39.33 	child or adult foster care.
39.34 		Subd. 5.Personnel records. (a) The license holder must maintain a personnel 
39.35 	record of each employee to document and verify staff qualifications, orientation, and 
39.36 	training. The personnel record must include:
40.1 	(1) the employee's date of hire, completed application, an acknowledgement signed 
40.2 	by the employee that job duties were reviewed with the employee and the employee 
40.3 	understands those duties, and documentation that the employee meets the position 
40.4 	requirements as determined by the license holder;
40.5 	 (2) documentation of staff qualifications, orientation, training, and performance 
40.6 	evaluations as required under section 245D.09, subdivisions 3 to 5, including the date 
40.7 	the training was completed, the number of hours per subject area, and the name of the 
40.8 	trainer or instructor; and
40.9 	(3) a completed background study as required under chapter 245C.
40.10 	(b) For employees hired after January 1, 2014, the license holder must maintain 
40.11 	documentation in the personnel record or elsewhere, sufficient to determine the date of the 
40.12 	employee's first supervised direct contact with a person served by the program, and the 
40.13 	date of first unsupervised direct contact with a person served by the program.

40.14 	EFFECTIVE DATE. This section is effective January 1, 2014.

40.15 	Sec. 6. Minnesota Statutes 2012, section 245D.10, is amended to read:
40.16 	245D.10 POLICIES AND PROCEDURES.
40.17 		Subdivision 1.Policy and procedure requirements.  The A license holder
40.18 	 providing either basic or intensive supports and services must establish, enforce, and 
40.19 	maintain policies and procedures as required in this chapter, chapter 245A, and other 
40.20 	applicable state and federal laws and regulations governing the provision of home and 
40.21 	community-based services licensed according to this chapter.
40.22 		Subd. 2.Grievances. The license holder must establish policies and procedures 
40.23 	that provide promote service recipient rights by providing a simple complaint process for 
40.24 	persons served by the program and their authorized representatives to bring a grievance that:
40.25 	(1) provides staff assistance with the complaint process when requested, and the 
40.26 	addresses and telephone numbers of outside agencies to assist the person;
40.27 	(2) allows the person to bring the complaint to the highest level of authority in the 
40.28 	program if the grievance cannot be resolved by other staff members, and that provides 
40.29 	the name, address, and telephone number of that person;
40.30 	(3) requires the license holder to promptly respond to all complaints affecting a 
40.31 	person's health and safety. For all other complaints, the license holder must provide an 
40.32 	initial response within 14 calendar days of receipt of the complaint. All complaints must 
40.33 	be resolved within 30 calendar days of receipt or the license holder must document the 
40.34 	reason for the delay and a plan for resolution;
41.1 	(4) requires a complaint review that includes an evaluation of whether:
41.2 	(i) related policies and procedures were followed and adequate;
41.3 	(ii) there is a need for additional staff training;
41.4 	(iii) the complaint is similar to past complaints with the persons, staff, or services 
41.5 	involved; and
41.6 	(iv) there is a need for corrective action by the license holder to protect the health 
41.7 	and safety of persons receiving services;
41.8 	(5) based on the review in clause (4), requires the license holder to develop, 
41.9 	document, and implement a corrective action plan designed to correct current lapses and 
41.10 	prevent future lapses in performance by staff or the license holder, if any;
41.11 	(6) provides a written summary of the complaint and a notice of the complaint 
41.12 	resolution to the person and case manager that:
41.13 	(i) identifies the nature of the complaint and the date it was received;
41.14 	(ii) includes the results of the complaint review;
41.15 	(iii) identifies the complaint resolution, including any corrective action; and
41.16 	(7) requires that the complaint summary and resolution notice be maintained in the 
41.17 	service recipient record.
41.18 		Subd. 3.Service suspension and service termination. (a) The license holder must 
41.19 	establish policies and procedures for temporary service suspension and service termination 
41.20 	that promote continuity of care and service coordination with the person and the case 
41.21 	manager and with other licensed caregivers, if any, who also provide support to the person.
41.22 	(b) The policy must include the following requirements:
41.23 	(1) the license holder must notify the person or the person's legal representative and 
41.24 	case manager in writing of the intended termination or temporary service suspension, and 
41.25 	the person's right to seek a temporary order staying the termination of service according to 
41.26 	the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
41.27 	(2) notice of the proposed termination of services, including those situations 
41.28 	that began with a temporary service suspension, must be given at least 60 days before 
41.29 	the proposed termination is to become effective when a license holder is providing 
41.30 	independent living skills training, structured day, prevocational or supported employment 
41.31 	services to the person intensive supports and services identified in section 245D.03, 
41.32 	subdivision 1, paragraph (c), and 30 days prior to termination for all other services 
41.33 	licensed under this chapter;
41.34 	(3) the license holder must provide information requested by the person or case 
41.35 	manager when services are temporarily suspended or upon notice of termination;
42.1 	(4) prior to giving notice of service termination or temporary service suspension, 
42.2 	the license holder must document actions taken to minimize or eliminate the need for 
42.3 	service suspension or termination;
42.4 	(5) during the temporary service suspension or service termination notice period, 
42.5 	the license holder will work with the appropriate county agency to develop reasonable 
42.6 	alternatives to protect the person and others;
42.7 	(6) the license holder must maintain information about the service suspension or 
42.8 	termination, including the written termination notice, in the service recipient record; and
42.9 	(7) the license holder must restrict temporary service suspension to situations in 
42.10 	which the person's behavior causes immediate and serious danger to the health and safety 
42.11 	of the person or others conduct poses an imminent risk of physical harm to self or others 
42.12 	and less restrictive or positive support strategies would not achieve safety.
42.13 		Subd. 4.Availability of current written policies and procedures. (a) The license 
42.14 	holder must review and update, as needed, the written policies and procedures required 
42.15 	under this chapter.
42.16 	(b)(1) The license holder must inform the person and case manager of the policies 
42.17 	and procedures affecting a person's rights under section 245D.04, and provide copies of 
42.18 	those policies and procedures, within five working days of service initiation.
42.19 	(2) If a license holder only provides basic services and supports, this includes the:
42.20 	(i) grievance policy and procedure required under subdivision 2; and
42.21 	(ii) service suspension and termination policy and procedure required under 
42.22 	subdivision 3.
42.23 	(3) For all other license holders this includes the:
42.24 	(i) policies and procedures in clause (2);
42.25 	(ii) emergency use of manual restraints policy and procedure required under 
42.26 	subdivision 3a; and
42.27 	(iii) data privacy requirements under section 245D.11, subdivision 3.
42.28 	(c) The license holder must provide a written notice at least 30 days before 
42.29 	implementing any revised policies and procedures procedural revisions to policies
42.30 	 affecting a person's service-related or protection-related rights under section 245D.04 and 
42.31 	maltreatment reporting policies and procedures. The notice must explain the revision that 
42.32 	was made and include a copy of the revised policy and procedure. The license holder 
42.33 	must document the reason reasonable cause for not providing the notice at least 30 days 
42.34 	before implementing the revisions.
43.1 	(d) Before implementing revisions to required policies and procedures, the license 
43.2 	holder must inform all employees of the revisions and provide training on implementation 
43.3 	of the revised policies and procedures.
43.4 	(e) The license holder must annually notify all persons, or their legal representatives, 
43.5 	and case managers of any procedural revisions to policies required under this chapter, 
43.6 	other than those in paragraph (c). Upon request, the license holder must provide the 
43.7 	person, or the person's legal representative, and case manager with copies of the revised 
43.8 	policies and procedures.

43.9 	EFFECTIVE DATE. This section is effective January 1, 2014.

43.10 	Sec. 7. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT 
43.11 	SERVICES.
43.12 		Subdivision 1.Policy and procedure requirements. A license holder providing 
43.13 	intensive support services as identified in section 245D.03, subdivision 1, paragraph (c), 
43.14 	must establish, enforce, and maintain policies and procedures as required in this section.
43.15 		Subd. 2.Health and safety. The license holder must establish policies and 
43.16 	procedures that promote health and safety by ensuring:
43.17 	(1) use of universal precautions and sanitary practices in compliance with section 
43.18 	245D.06, subdivision 2, clause (5);
43.19 	(2) if the license holder operates a residential program, health service coordination 
43.20 	and care according to the requirements in section 245D.05, subdivision 1;
43.21 	(3) safe medication assistance and administration according to the requirements 
43.22 	in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in 
43.23 	consultation with a registered nurse, nurse practitioner, physician's assistant, or medical 
43.24 	doctor and require completion of medication administration training according to the 
43.25 	requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance 
43.26 	and administration includes, but is not limited to:
43.27 	(i) providing medication-related services for a person;
43.28 	(ii) medication setup;
43.29 	(iii) medication administration;
43.30 	(iv) medication storage and security;
43.31 	(v) medication documentation and charting;
43.32 	(vi) verification and monitoring of effectiveness of systems to ensure safe medication 
43.33 	handling and administration;
43.34 	(vii) coordination of medication refills;
43.35 	(viii) handling changes to prescriptions and implementation of those changes;
44.1 	(ix) communicating with the pharmacy; and
44.2 	(x) coordination and communication with prescriber;
44.3 	(4) safe transportation, when the license holder is responsible for transportation of 
44.4 	persons, with provisions for handling emergency situations according to the requirements 
44.5 	in section 245D.06, subdivision 2, clauses (2) to (4);
44.6 	(5) a plan for ensuring the safety of persons served by the program in emergencies as 
44.7 	defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies 
44.8 	to the license holder. A license holder with a community residential setting or a day service 
44.9 	facility license must ensure the policy and procedures comply with the requirements in 
44.10 	section 245D.22, subdivision 4;
44.11 	(6) a plan for responding to all incidents as defined in section 245D.02, subdivision 
44.12 	11; and reporting all incidents required to be reported according to section 245D.06, 
44.13 	subdivision 1. The plan must:
44.14 	(i) provide the contact information of a source of emergency medical care and 
44.15 	transportation; and
44.16 	(ii) require staff to first call 911 when the staff believes a medical emergency may be 
44.17 	life threatening, or to call the mental health crisis intervention team when the person is 
44.18 	experiencing a mental health crisis; and
44.19 	(7) a procedure for the review of incidents and emergencies to identify trends or 
44.20 	patterns, and corrective action if needed. The license holder must establish and maintain 
44.21 	a record-keeping system for the incident and emergency reports. Each incident and 
44.22 	emergency report file must contain a written summary of the incident. The license holder 
44.23 	must conduct a review of incident reports for identification of incident patterns, and 
44.24 	implementation of corrective action as necessary to reduce occurrences. Each incident 
44.25 	report must include:
44.26 	(i) the name of the person or persons involved in the incident. It is not necessary 
44.27 	to identify all persons affected by or involved in an emergency unless the emergency 
44.28 	resulted in an incident;
44.29 	(ii) the date, time, and location of the incident or emergency;
44.30 	(iii) a description of the incident or emergency;
44.31 	(iv) a description of the response to the incident or emergency and whether a person's 
44.32 	coordinated service and support plan addendum or program policies and procedures were 
44.33 	implemented as applicable;
44.34 	(v) the name of the staff person or persons who responded to the incident or 
44.35 	emergency; and
45.1 	(vi) the determination of whether corrective action is necessary based on the results 
45.2 	of the review.
45.3 		Subd. 3.Data privacy. The license holder must establish policies and procedures that 
45.4 	promote service recipient rights by ensuring data privacy according to the requirements in:
45.5 	(1) the Minnesota Government Data Practices Act, section 13.46, and all other 
45.6 	applicable Minnesota laws and rules in handling all data related to the services provided; 
45.7 	and
45.8 	(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the 
45.9 	extent that the license holder performs a function or activity involving the use of protected 
45.10 	health information as defined under Code of Federal Regulations, title 45, section 164.501, 
45.11 	including, but not limited to, providing health care services; health care claims processing 
45.12 	or administration; data analysis, processing, or administration; utilization review; quality 
45.13 	assurance; billing; benefit management; practice management; repricing; or as otherwise 
45.14 	provided by Code of Federal Regulations, title 45, section 160.103. The license holder 
45.15 	must comply with the Health Insurance Portability and Accountability Act of 1996 and 
45.16 	its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164, 
45.17 	and all applicable requirements.
45.18 		Subd. 4.Admission criteria. The license holder must establish policies and 
45.19 	procedures that promote continuity of care by ensuring that admission or service initiation 
45.20 	criteria:
45.21 	(1) is consistent with the license holder's registration information identified in the 
45.22 	requirements in section 245D.031, subdivision 2, and with the service-related rights 
45.23 	identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
45.24 	(2) identifies the criteria to be applied in determining whether the license holder 
45.25 	can develop services to meet the needs specified in the person's coordinated service and 
45.26 	support plan;
45.27 	(3) requires a license holder providing services in a health care facility to comply 
45.28 	with the requirements in section 243.166, subdivision 4b, to provide notification to 
45.29 	residents when a registered predatory offender is admitted into the program or to a 
45.30 	potential admission when the facility was already serving a registered predatory offender. 
45.31 	For purposes of this clause, "health care facility" means a facility licensed by the 
45.32 	commissioner as a residential facility under chapter 245A to provide adult foster care or 
45.33 	residential services to persons with disabilities; and
45.34 	(4) requires that when a person or the person's legal representative requests services 
45.35 	from the license holder, a refusal to admit the person must be based on an evaluation of 
45.36 	the person's assessed needs and the license holder's lack of capacity to meet the needs of 
46.1 	the person. The license holder must not refuse to admit a person based solely on the 
46.2 	type of residential services the person is receiving, or solely on the person's severity of 
46.3 	disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of 
46.4 	communication skills, physical disabilities, toilet habits, behavioral disorders, or past 
46.5 	failure to make progress. Documentation of the basis for refusal must be provided to the 
46.6 	person or the person's legal representative and case manager upon request.

46.7 	EFFECTIVE DATE. This section is effective January 1, 2014.

46.8 	ARTICLE 4
46.9 	HOME CARE PROVIDERS

46.10 	Section 1. Minnesota Statutes 2012, section 144.051, is amended by adding a 
46.11 	subdivision to read:
46.12 		Subd. 3.Data classification; private data. For providers regulated pursuant to 
46.13 	sections 144A.043 to 144A.482, the following data collected, created, or maintained by the 
46.14 	commissioner are classified as "private data" as defined in section 13.02, subdivision 12:
46.15 	(1) data submitted by or on behalf of applicants for licenses prior to issuance of 
46.16 	the license;
46.17 	(2) the identity of complainants who have made reports concerning licensees or 
46.18 	applicants unless the complainant consents to the disclosure;
46.19 	(3) the identity of individuals who provide information as part of surveys and 
46.20 	investigations;
46.21 	(4) Social Security numbers; and
46.22 	(5) health record data.

46.23 	Sec. 2. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 
46.24 	to read:
46.25 		Subd. 4.Data classification; public data. For providers regulated pursuant to 
46.26 	sections 144A.043 to 144A.482, the following data collected, created, or maintained by the 
46.27 	commissioner are classified as "public data" as defined in section 13.02, subdivision 15:
46.28 	(1) all application data on licensees, license numbers, license status;
46.29 	(2) licensing information about licenses previously held under this chapter;
46.30 	(3) correction orders, including information about compliance with the order and 
46.31 	whether the fine was paid;
46.32 	(4) final enforcement actions pursuant to chapter 14;
46.33 	(5) orders for hearing, findings of fact and conclusions of law; and
47.1 	(6) when the licensee and department agree to resolve the matter without a hearing, 
47.2 	the agreement and specific reasons for the agreement are public data.

47.3 	Sec. 3. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 
47.4 	to read:
47.5 		Subd. 5.Data classification; confidential data. For providers regulated pursuant 
47.6 	to sections 144A.043 to 144A.482, the following data collected, created, or maintained 
47.7 	by the Department of Health are classified as "confidential data" as defined in section 
47.8 	13.02, subdivision 3: active investigative data relating to the investigation of potential 
47.9 	violations of law by licensee including data from the survey process before the correction 
47.10 	order is issued by the department.

47.11 	Sec. 4. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision 
47.12 	to read:
47.13 		Subd. 6.Release of private or confidential data. For providers regulated pursuant 
47.14 	to sections 144A.043 to 144A.482, the department may release private or confidential 
47.15 	data, except Social Security numbers, to the appropriate state, federal, or local agency 
47.16 	and law enforcement office to enhance investigative or enforcement efforts or further 
47.17 	public health protective process. Types of offices include, but are not limited to, Adult 
47.18 	Protective Services, Office of the Ombudsmen for Long-Term Care and Office of the 
47.19 	Ombudsmen for Mental Health and Developmental Disabilities, the health licensing 
47.20 	boards, Department of Human Services, county or city attorney's offices, police, and local 
47.21 	or county public health offices.

47.22 	Sec. 5. [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
47.23 		Subdivision 1.License required. A home care provider may not open, operate, 
47.24 	manage, conduct, maintain, or advertise itself as a home care provider or provide home 
47.25 	care services in Minnesota without a temporary or current home care provider license 
47.26 	issued by the commissioner of health.
47.27 		Subd. 2.Determination of direct home care service. "Direct home care service" 
47.28 	means a home care service provided to a client by the home care provider or its employees, 
47.29 	and not by contract. Factors that must be considered in determining whether an individual 
47.30 	or a business entity provides at least one home care service directly include, but are not 
47.31 	limited to, whether the individual or business entity:
47.32 	(1) has the right to control, and does control, the types of services provided;
47.33 	(2) has the right to control, and does control, when and how the services are provided;
48.1 	(3) establishes the charges;
48.2 	(4) collects fees from the clients or receives payment from third-party payers on 
48.3 	the clients' behalf;
48.4 	(5) pays individuals providing services compensation on an hourly, weekly, or 
48.5 	similar basis;
48.6 	(6) treats the individuals providing services as employees for the purposes of payroll 
48.7 	taxes and workers' compensation insurance; and
48.8 	(7) holds itself out as a provider of home care services or acts in a manner that 
48.9 	leads clients or potential clients to believe that it is a home care provider providing home 
48.10 	care services.
48.11 	None of the factors listed in this subdivision is solely determinative.
48.12 		Subd. 3.Determination of regularly engaged. "Regularly engaged" means 
48.13 	providing, or offering to provide, home care services as a regular part of a business. The 
48.14 	following factors must be considered by the commissioner in determining whether an 
48.15 	individual or a business entity is regularly engaged in providing home care services:
48.16 	(1) whether the individual or business entity states or otherwise promotes that the 
48.17 	individual or business entity provides home care services;
48.18 	(2) whether persons receiving home care services constitute a substantial part of the 
48.19 	individual's or the business entity's clientele; and
48.20 	(3) whether the home care services provided are other than occasional or incidental 
48.21 	to the provision of services other than home care services.
48.22 	None of the factors listed in this subdivision is solely determinative.
48.23 		Subd. 4.Penalties for operating without license. A person involved in the 
48.24 	management, operation, or control of a home care provider that operates without an 
48.25 	appropriate license is guilty of a misdemeanor. This section does not apply to a person 
48.26 	who has no legal authority to affect or change decisions related to the management, 
48.27 	operation, or control of a home care provider.
48.28 		Subd. 5.Basic and comprehensive levels of licensure. An applicant seeking 
48.29 	to become a home care provider must apply for either a basic or comprehensive home 
48.30 	care license.
48.31 		Subd. 6.Basic home care license provider. Home care services that can be 
48.32 	provided with a basic home care license are assistive tasks provided by licensed or 
48.33 	unlicensed personnel that include:
48.34 	(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, 
48.35 	and bathing;
48.36 	(2) providing standby assistance;
49.1 	(3) providing verbal or visual reminders to the client to take regularly scheduled 
49.2 	medication which includes bringing the client previously set-up medication, medication in 
49.3 	original containers, or liquid or food to accompany the medication;
49.4 	(4) providing verbal or visual reminders to the client to perform regularly scheduled 
49.5 	treatments and exercises;
49.6 	(5) preparing modified diets ordered by a licensed health professional; and
49.7 	(6) assisting with laundry, housekeeping, meal preparation, shopping, or other 
49.8 	household chores and services if the provider is also providing at least one of the activities 
49.9 	in clauses (1) to (5)
49.10 		Subd. 7.Comprehensive home care license provider. Home care services that 
49.11 	may be provided with a comprehensive home care license include any of the basic home 
49.12 	care services listed in subdivision 6, and one or more of the following:
49.13 	(1) services of an advanced practice nurse, registered nurse, licensed practical 
49.14 	nurse, physical therapist, respiratory therapist, occupational therapist, speech-language 
49.15 	pathologist, dietician or nutritionist, or social worker;
49.16 	(2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a 
49.17 	licensed health professional within the person's scope of practice;
49.18 	(3) medication management services;
49.19 	(4) hands-on assistance with transfers and mobility;
49.20 	(5) assisting clients with eating when the clients have complicating eating problems 
49.21 	as identified in the client record or through an assessment such as difficulty swallowing, 
49.22 	recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous 
49.23 	instruments to be fed; or
49.24 	(6) providing other complex or specialty health care services.
49.25 		Subd. 8.Exemptions from home care services licensure. (a) Except as otherwise 
49.26 	provided in this chapter, home care services that are provided by the state, counties, or 
49.27 	other units of government must be licensed under this chapter.
49.28 	(b) An exemption under this subdivision does not excuse the exempted individual or 
49.29 	organization from complying with applicable provisions of the home care bill of rights 
49.30 	in section 144A.44. The following individuals or organizations are exempt from the 
49.31 	requirement to obtain a home care provider license:
49.32 	(1) an individual or organization that offers, provides, or arranges for personal care 
49.33 	assistance services under the medical assistance program as authorized under sections 
49.34 	256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
50.1 	(2) a provider that is licensed by the commissioner of human services to provide 
50.2 	semi-independent living services for persons with developmental disabilities under section 
50.3 	252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
50.4 	(3) a provider that is licensed by the commissioner of human services to provide 
50.5 	home and community-based services for persons with developmental disabilities under 
50.6 	section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
50.7 	(4) an individual or organization that provides only home management services, if 
50.8 	the individual or organization is registered under section 144A.482; or 
50.9 	(5) an individual who is licensed in this state as a nurse, dietitian, social worker, 
50.10 	occupational therapist, physical therapist, or speech-language pathologist who provides 
50.11 	health care services in the home independently and not through any contractual or 
50.12 	employment relationship with a home care provider or other organization.
50.13 		Subd. 9.Exclusions from home care licensure. The following are excluded from 
50.14 	home care licensure and are not required to provide the home care bill of rights:
50.15 	(1) an individual or business entity providing only coordination of home care that 
50.16 	includes one or more of the following:
50.17 	(i) determination of whether a client needs home care services, or assisting a client 
50.18 	in determining what services are needed;
50.19 	(ii) referral of clients to a home care provider;
50.20 	(iii) administration of payments for home care services; or
50.21 	(iv) administration of a health care home established under section 256B.0751;
50.22 	(2) an individual who is not an employee of a licensed home care provider if the 
50.23 	individual:
50.24 	(i) only provides services as an independent contractor to one or more licensed 
50.25 	home care providers;
50.26 	(ii) provides no services under direct agreements or contracts with clients; and
50.27 	(iii) is contractually bound to perform services in compliance with the contracting 
50.28 	home care provider's policies and service plans;
50.29 	(3) a business that provides staff to home care providers, such as a temporary 
50.30 	employment agency, if the business:
50.31 	(i) only provides staff under contract to licensed or exempt providers;
50.32 	(ii) provides no services under direct agreements with clients; and
50.33 	(iii) is contractually bound to perform services under the contracting home care 
50.34 	provider's direction and supervision;
51.1 	(4) any home care services conducted by and for the adherents of any recognized 
51.2 	church or religious denomination for its members through spiritual means, or by prayer 
51.3 	for healing;
51.4 	(5) an individual who only provides home care services to a relative;
51.5 	(6) an individual not connected with a home care provider that provides assistance 
51.6 	with basic home care needs if the assistance is provided primarily as a contribution and 
51.7 	not as a business;
51.8 	(7) an individual not connected with a home care provider that shares housing with 
51.9 	and provides primarily housekeeping or homemaking services to an elderly or disabled 
51.10 	person in return for free or reduced-cost housing;
51.11 	(8) an individual or provider providing home-delivered meal services;
51.12 	(9) an individual providing senior companion services and other Older American 
51.13 	Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of 
51.14 	1973, United States Code, title 42, chapter 66;
51.15 	(10) an employee of a nursing home licensed under this chapter or an employee of a 
51.16 	boarding care home licensed under sections 144.50 to 144.56 who responds to occasional 
51.17 	emergency calls from individuals residing in a residential setting that is attached to or 
51.18 	located on property contiguous to the nursing home or boarding care home;
51.19 	(11) a member of a professional corporation organized under chapter 319B that 
51.20 	does not regularly offer or provide home care services as defined in section 144A.43, 
51.21 	subdivision 3;
51.22 	(12) the following organizations established to provide medical or surgical services 
51.23 	that do not regularly offer or provide home care services as defined in section 144A.43, 
51.24 	subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit 
51.25 	corporation organized under chapter 317A, a partnership organized under chapter 323, or 
51.26 	any other entity determined by the commissioner;
51.27 	(13) an individual or agency that provides medical supplies or durable medical 
51.28 	equipment, except when the provision of supplies or equipment is accompanied by a 
51.29 	home care service;
51.30 	(14) a physician licensed under chapter 147;
51.31 	(15) an individual who provides home care services to a person with a developmental 
51.32 	disability who lives in a place of residence with a family, foster family, or primary caregiver;
51.33 	(16) a business that only provides services that are primarily instructional and not 
51.34 	medical services or health-related support services;
51.35 	(17) an individual who performs basic home care services for no more than 14 hours 
51.36 	each calendar week to no more than one client;
52.1 	(18) an individual or business licensed as hospice as defined in sections 144A.75 to 
52.2 	144A.755 who is not providing home care services independent of hospice service;
52.3 	(19) activities conducted by the commissioner of health or a board of health as 
52.4 	defined in section 145A.02, subdivision 2, including communicable disease investigations 
52.5 	or testing; or
52.6 	(20) administering or monitoring a prescribed therapy necessary to control or 
52.7 	prevent a communicable disease, or the monitoring of an individual's compliance with a 
52.8 	health directive as defined in section 144.4172, subdivision 6.

52.9 	Sec. 6. [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION AND 
52.10 	RENEWAL.
52.11 		Subdivision 1.License applications. Each application for a home care provider 
52.12 	license must include information sufficient to show that the applicant meets the 
52.13 	requirements of licensure, including:
52.14 	(1) the applicant's name, e-mail address, physical address, and mailing address, 
52.15 	including the name of the county in which the applicant resides and has a principal 
52.16 	place of business;
52.17 	(2) the initial license fee in the amount specified in subdivision 7;
52.18 	(3) the e-mail address, physical address, mailing address, and telephone number of 
52.19 	the principal administrative office;
52.20 	(4) the e-mail address, physical address, mailing address, and telephone number of 
52.21 	each branch office, if any;
52.22 	(5) the names, e-mail and mailing addresses, and telephone numbers of all owners 
52.23 	and managerial officials;
52.24 	(6) documentation of compliance with the background study requirements of section 
52.25 	144A.476 for all persons involved in the management, operation, or control of the home 
52.26 	care provider;
52.27 	(7) documentation of a background study as required by section 144.057 for any 
52.28 	individual seeking employment, paid or volunteer, with the home care provider;
52.29 	(8) evidence of workers' compensation coverage as required by sections 176.181 
52.30 	and 176.182;
52.31 	(9) documentation of liability coverage, if the provider has it;
52.32 	(10) identification of the license level the provider is seeking;
52.33 	(11) documentation that identifies the managerial official who is in charge of 
52.34 	day-to-day operations and attestation that the person has reviewed and understands the 
52.35 	home care provider regulations;
53.1 	(12) documentation that the applicant has designated one or more owners, 
53.2 	managerial officials, or employees as an agent or agents, which shall not affect the legal 
53.3 	responsibility of any other owner or managerial official under this chapter;
53.4 	(13) the signature of the officer or managing agent on behalf of an entity, corporation, 
53.5 	association, or unit of government;
53.6 	(14) verification that the applicant has the following policies and procedures in place 
53.7 	so that if a license is issued, the applicant will implement the policies and procedures 
53.8 	and keep them current:
53.9 	(i) requirements in sections 626.556, reporting of maltreatment of minors, and 
53.10 	626.557, reporting of maltreatment of vulnerable adults;
53.11 	(ii) conducting and handling background studies on employees;
53.12 	(iii) orientation, training, and competency evaluations of home care staff, and a 
53.13 	process for evaluating staff performance;
53.14 	(iv) handling complaints from clients, family members, or client representatives 
53.15 	regarding staff or services provided by staff;
53.16 	(v) conducting initial evaluation of clients' needs and the providers' ability to provide 
53.17 	those services;
53.18 	(vi) conducting initial and ongoing client evaluations and assessments and how 
53.19 	changes in a client's condition are identified, managed, and communicated to staff and 
53.20 	other health care providers as appropriate;
53.21 	(vii) orientation to and implementation of the home care client bill of rights;
53.22 	(viii) infection control practices;
53.23 	(ix) reminders for medications, treatments, or exercises, if provided; and
53.24 	(x) conducting appropriate screenings, or documentation of prior screenings, to 
53.25 	show that staff are free of tuberculosis, consistent with current United States Centers for 
53.26 	Disease Control and Prevention standards; and
53.27 	(15) other information required by the department.
53.28 		Subd. 2.Comprehensive home care license applications. In addition to the 
53.29 	information and fee required in subdivision 1, applicants applying for a comprehensive 
53.30 	home care license must also provide verification that the applicant has the following 
53.31 	policies and procedures in place so that if a license is issued, the applicant will implement 
53.32 	the policies and procedures in this subdivision and keep them current:
53.33 	(1) conducting initial and ongoing assessments of the client's needs by a registered 
53.34 	nurse or appropriate licensed health professional, including how changes in the client's 
53.35 	conditions are identified, managed, and communicated to staff and other health care 
53.36 	providers, as appropriate;
54.1 	(2) ensuring that nurses and licensed health professionals have current and valid 
54.2 	licenses to practice;
54.3 	(3) medication and treatment management;
54.4 	(4) delegation of home care tasks by registered nurses or licensed health professionals;
54.5 	(5) supervision of registered nurses and licensed health professionals; and
54.6 	(6) supervision of unlicensed personnel performing delegated home care tasks.
54.7 		Subd. 3.License renewal. (a) Except as provided in section 144A.475, a license 
54.8 	may be renewed for a period of one year if the licensee satisfies the following:
54.9 	(1) submits an application for renewal in the format provided by the commissioner 
54.10 	at least 30 days before expiration of the license;
54.11 	(2) submits the renewal fee in the amount specified in subdivision 7;
54.12 	(3) has provided home care services within the past 12 months;
54.13 	(4) complies with sections 144A.43 to 144A.4799;
54.14 	(5) provides information sufficient to show that the applicant meets the requirements 
54.15 	of licensure, including items required under subdivision 1;
54.16 	(6) provides verification that all policies under subdivision 1 are current; and 
54.17 	(7) provides any other information deemed necessary by the commissioner.
54.18 	(b) A renewal applicant who holds a comprehensive home care license must also 
54.19 	provide verification that policies listed under subdivision 2 are current.
54.20 		Subd. 4.Multiple units. Multiple units or branches of a licensee must be separately 
54.21 	licensed if the commissioner determines that the units cannot adequately share supervision 
54.22 	and administration of services from the main office.
54.23 		Subd. 5.Transfers prohibited; changes in ownership. Any home care license 
54.24 	issued by the commissioner may not be transferred to another party. Before acquiring 
54.25 	ownership of a home care provider business, a prospective applicant must apply for a 
54.26 	new temporary license. A change of ownership is a transfer of operational control to 
54.27 	a different business entity and includes:
54.28 	(1) transfer of the business to a different or new corporation;
54.29 	(2) in the case of a partnership, the dissolution or termination of the partnership under 
54.30 	chapter 323A, with the business continuing by a successor partnership or other entity; 
54.31 	(3) relinquishment of control of the provider to another party, including to a contract 
54.32 	management firm that is not under the control of the owner of the business' assets;
54.33 	(4) transfer of the business by a sole proprietor to another party or entity; or
54.34 	(5) in the case of a privately held corporation, the change in ownership or control of 
54.35 	50 percent or more of the outstanding voting stock.
55.1 		Subd. 6.Notification of changes of information. The temporary licensee or 
55.2 	licensee shall notify the commissioner in writing within ten working days after any 
55.3 	change in the information required in subdivision 1, except the information required in 
55.4 	subdivision 1, clause (5), is required at the time of license renewal.
55.5 		Subd. 7.Fees; application, change of ownership, and renewal. (a) An initial 
55.6 	applicant seeking a temporary home care licensure must submit the following application 
55.7 	fee to the commissioner along with a completed application:
55.8 	(1) basic home care provider, $2,100; or
55.9 	(2) comprehensive home care provider, $4,200.
55.10 	(b) A home care provider who is filing a change of ownership as required under 
55.11 	subdivision 5 must submit the following application fee to the commissioner, along with 
55.12 	the documentation required for the change of ownership:
55.13 	(1) basic home care provider, $2,100; or
55.14 	(2) comprehensive home care provider, $4,200.
55.15 	(c) A home care provider who is seeking to renew the provider's license shall pay a 
55.16 	fee to the commissioner based on revenues derived from the provision of home care 
55.17 	services during the calendar year prior to the year in which the application is submitted, 
55.18 	according to the following schedule:
55.19 	License Renewal Fee

55.20	Provider Annual Revenue
	Fee
		
55.21	greater than $1,500,000
	$6,625
		
55.22
55.23	greater than $1,275,000 and no more than 
$1,500,000
	$5,797
		
55.24
55.25	greater than $1,100,000 and no more than 
$1,275,000
	$4,969
		
55.26
55.27	greater than $950,000 and no more than 
$1,100,000
	$4,141
		
55.28
55.29	greater than $850,000 and no more than 
$950,000
	$3,727
		
55.30
55.31	greater than $750,000 and no more than 
$850,000
	$3,313
		
55.32
55.33	greater than $650,000 and no more than 
$750,000
	$2,898
		
55.34
55.35	greater than $550,000 and no more than 
$650,000
	$2,485
		
55.36
55.37	greater than $450,000 and no more than 
$550,000
	$2,070
		
55.38
55.39	greater than $350,000 and no more than 
$450,000
	$1,656
		
55.40
55.41	greater than $250,000 and no more than 
$350,000
	$1,242
		
56.1
56.2	greater than $100,000 and no more than 
$250,000
	$828
		
56.3	greater than $50,000 and no more than $100,000
	$500
		
56.4	greater than $25,000 and no more than $50,000
	$400
		
56.5	no more than $25,000
	$200
		
56.6 	(d) If requested, the home care provider shall provide the commissioner information 
56.7 	to verify the provider's annual revenues or other information as needed, including copies 
56.8 	of documents submitted to the Department of Revenue.
56.9 	(e) At each annual renewal, a home care provider may elect to pay the highest 
56.10 	renewal fee for its license category, and not provide annual revenue information to the 
56.11 	commissioner.
56.12 	(f) A temporary license or license applicant, or temporary licensee or licensee that 
56.13 	knowingly provides the commissioner incorrect revenue amounts for the purpose of 
56.14 	paying a lower license fee, shall be subject to a civil penalty in the amount of double the 
56.15 	fee the provider should have paid.
56.16 	(g) Fees and penalties collected under this section shall be deposited in the state 
56.17 	treasury and credited to the special state government revenue fund.
56.18 	(h) The license renewal fee schedule in this subdivision is effective July 1, 2016.

56.19 	Sec. 7. [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE 
56.20 	RENEWAL.
56.21 		Subdivision 1.Temporary license and renewal of license. (a) The department 
56.22 	shall review each application to determine the applicant's knowledge of and compliance 
56.23 	with Minnesota home care regulations. Before granting a temporary license or renewing a 
56.24 	license, the commissioner may further evaluate the applicant or licensee by requesting 
56.25 	additional information or documentation or by conducting an on-site survey of the 
56.26 	applicant to determine compliance with sections 144A.43 to 144A.482.
56.27 	(b) Within 14 calendar days after receiving an application for a license, 
56.28 	the commissioner shall acknowledge receipt of the application in writing. The 
56.29 	acknowledgment must indicate whether the application appears to be complete or whether 
56.30 	additional information is required before the application will be considered complete.
56.31 	(c) Within 90 days after receiving a complete application, the commissioner shall 
56.32 	issue a temporary license, renew the license, or deny the license.
56.33 	(d) The commissioner shall issue a license that contains the home care provider's 
56.34 	name, address, license level, expiration date of the license, and unique license number. All 
56.35 	licenses are valid for one year from the date of issuance.
57.1 		Subd. 2.Temporary license. (a) For new license applicants, the commissioner 
57.2 	shall issue a temporary license for either the basic or comprehensive home care level. A 
57.3 	temporary license is effective for one year from the date of issuance. Temporary licensees 
57.4 	must comply with sections 144A.43 to 144A.482.
57.5 	(b) During the temporary license year, the commissioner shall survey the temporary 
57.6 	licensee after the commissioner is notified or has evidence that the temporary licensee 
57.7 	is providing home care services.
57.8 	(c) Within five days of beginning the provision of services, the temporary 
57.9 	licensee must notify the commissioner that it is serving clients. The notification to the 
57.10 	commissioner may be mailed or e-mailed to the commissioner at the address provided by 
57.11 	the commissioner. If the temporary licensee does not provide home care services during 
57.12 	the temporary license year, then the temporary license expires at the end of the year and 
57.13 	the applicant must reapply for a temporary home care license.
57.14 	(d) A temporary licensee may request a change in the level of licensure prior to 
57.15 	being surveyed and granted a license by notifying the commissioner in writing and 
57.16 	providing additional documentation or materials required to update or complete the 
57.17 	changed temporary license application. The applicant must pay the difference between the 
57.18 	application fees when changing from the basic to the comprehensive level of licensure. 
57.19 	No refund will be made if the provider chooses to change the license application to the 
57.20 	basic level.
57.21 	(e) If the temporary licensee notifies the commissioner that the licensee has clients 
57.22 	within 45 days prior to the temporary license expiration, the commissioner may extend the 
57.23 	temporary license for up to 60 days in order to allow the commissioner to complete the 
57.24 	on-site survey required under this section and follow-up survey visits.
57.25 		Subd. 3.Temporary licensee survey. (a) If the temporary licensee is in substantial 
57.26 	compliance with the survey, the commissioner shall issue either a basic or comprehensive 
57.27 	home care license. If the temporary licensee is not in substantial compliance with the 
57.28 	survey, the commissioner shall not issue a basic or comprehensive license and there will 
57.29 	be no contested hearing right under chapter 14.
57.30 	(b) If the temporary licensee whose basic or comprehensive license has been denied 
57.31 	disagrees with the conclusions of the commissioner, then the licensee may request a 
57.32 	reconsideration by the commissioner or commissioner's designee. The reconsideration 
57.33 	request process will be conducted internally by the commissioner or commissioner's 
57.34 	designee, and chapter 14 does not apply.
58.1 	(c) The temporary licensee requesting reconsideration must make the request in 
58.2 	writing and must list and describe the reasons why the licensee disagrees with the decision 
58.3 	to deny the basic or comprehensive home care license.
58.4 	(d) A temporary licensee whose license is denied must comply with the requirements 
58.5 	for notification and transfer of clients in section 144A.475, subdivision 5.

58.6 	Sec. 8. [144A.474] SURVEYS AND INVESTIGATIONS.
58.7 		Subdivision 1.Surveys. The commissioner shall conduct surveys of each home 
58.8 	care provider. By June 30, 2016, the commissioner shall conduct a survey of home care 
58.9 	providers on a frequency of at least once every three years. Survey frequency may be 
58.10 	based on the license level, the provider's compliance history, number of clients served, 
58.11 	or other factors as determined by the department deemed necessary to ensure the health, 
58.12 	safety, and welfare of clients and compliance with the law.
58.13 		Subd. 2.Types of home care surveys. (a) "Initial full survey" means the survey of 
58.14 	a new temporary licensee conducted after the department is notified or has evidence that 
58.15 	the licensee is providing home care services to determine if the provider is in compliance 
58.16 	with home care requirements. Initial full surveys must be completed within 14 months 
58.17 	after the department's issuance of a temporary basic or comprehensive license.
58.18 	(b) "Core survey" means periodic inspection of home care providers to determine 
58.19 	ongoing compliance with the home care requirements, focusing on the essential health and 
58.20 	safety requirements. Core surveys are available to licensed home care providers who have 
58.21 	been licensed for three years and surveyed at least once in the past three years with the 
58.22 	latest survey having no widespread violations beyond Level 1 as provided in subdivision 
58.23 	11. Providers must also not have had any substantiated licensing complaints, substantiated 
58.24 	complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors 
58.25 	Act, or an enforcement action as authorized in section 144A.475 in the past three years. 
58.26 	(1) The core survey for basic license level providers shall review compliance in 
58.27 	the following areas:
58.28 	(i) reporting of maltreatment;
58.29 	(ii) orientation to and implementation of Home Care Client Bill of Rights;
58.30 	(iii) statement of home care services;
58.31 	(iv) initial evaluation of clients and initiation of services;
58.32 	(v) basic license level client review and monitoring;
58.33 	(vi) service plan implementation and changes to the service plan;
58.34 	(vii) client complaint and investigative process;
58.35 	(viii) competency of unlicensed personnel; and
59.1 	(ix) infection control.
59.2 	(2) For comprehensive license level providers, the core survey shall include 
59.3 	everything in the basic license level core survey plus these areas:
59.4 	(i) delegation to unlicensed personnel;
59.5 	(ii) assessment, monitoring, and reassessment of clients; and
59.6 	(iii) medication, treatment, and therapy management.
59.7 	(c) "Full survey" means the periodic inspection of home care providers to determine 
59.8 	ongoing compliance with the home care requirements that cover the core survey areas 
59.9 	and all the legal requirements for home care providers. A full survey is conducted for all 
59.10 	temporary licensees and for providers who do not meet the requirements needed for a core 
59.11 	survey, and when a surveyor identifies unacceptable client health or safety risks during a 
59.12 	core survey. A full survey shall include all the tasks identified as part of the core survey 
59.13 	and any additional review deemed necessary by the department, including additional 
59.14 	observation, interviewing, or records review of additional clients and staff. 
59.15 	(d) "Follow-up surveys" means surveys conducted to determine if a home care 
59.16 	provider has corrected deficient issues and systems identified during a core survey, full 
59.17 	survey, or complaint investigation. Follow-up surveys may be conducted via phone, 
59.18 	e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys, 
59.19 	shall be concluded with an exit conference and written information provided on the 
59.20 	process for requesting a reconsideration of the survey results.
59.21 	(e) Upon receiving information that a home care provider has violated or is currently 
59.22 	violating a requirement of sections 144A.43 to 144A.482, the commissioner shall 
59.23 	investigate the complaint according to sections 144A.51 to 144A.54.
59.24 		Subd. 3.Survey process. (a) The survey process for core surveys shall include the 
59.25 	following as applicable to the particular licensee and setting surveyed:
59.26 	(1) presurvey review of pertinent documents and notification to the ombudsman 
59.27 	for long-term care;
59.28 	(2) an entrance conference with available staff;
59.29 	(3) communication with managerial officials or the registered nurse in charge, if 
59.30 	available, and ongoing communication with key staff throughout the survey regarding 
59.31 	information needed by the surveyor, clarifications regarding home care requirements, and 
59.32 	applicable standards of practice;
59.33 	(4) presentation of written contact information to the provider about the survey staff 
59.34 	conducting the survey, the supervisor, and the process for requesting a reconsideration of 
59.35 	the survey results;
60.1 	(5) a brief tour of a sample of the housing with services establishments in which the 
60.2 	provider is providing home care services;
60.3 	(6) a sample selection of home care clients;
60.4 	(7) information-gathering through client and staff observations, client and staff 
60.5 	interviews, and reviews of records, policies, procedures, practices, and other agency 
60.6 	information;
60.7 	(8) interviews of clients' family members, if available, with clients' consent when the 
60.8 	client can legally give consent;
60.9 	(9) except for complaint surveys conducted by the Office of Health Facilities 
60.10 	Complaints, an exit conference, with preliminary findings shared and discussed with the 
60.11 	provider and written information provided on the process for requesting a reconsideration 
60.12 	of the survey results; and
60.13 	(10) postsurvey analysis of findings and formulation of survey results, including 
60.14 	correction orders when applicable.
60.15 		Subd. 4.Scheduling surveys. Surveys and investigations shall be conducted 
60.16 	without advance notice to home care providers. Surveyors may contact the home care 
60.17 	provider on the day of a survey to arrange for someone to be available at the survey site. 
60.18 	The contact does not constitute advance notice.
60.19 		Subd. 5.Information provided by home care provider. The home care provider 
60.20 	shall provide accurate and truthful information to the department during a survey, 
60.21 	investigation, or other licensing activities.
60.22 		Subd. 6.Providing client records. Upon request of a surveyor, home care providers 
60.23 	shall provide a list of current and past clients or client representatives that includes 
60.24 	addresses and telephone numbers and any other information requested about the services 
60.25 	to clients within a reasonable period of time.
60.26 		Subd. 7.Contacting and visiting clients. Surveyors may contact or visit a home 
60.27 	care provider's clients to gather information without notice to the home care provider. 
60.28 	Before visiting a client, a surveyor shall obtain the client's or client's representative's 
60.29 	permission by telephone, mail, or in person. Surveyors shall inform all clients or client's 
60.30 	representatives of their right to decline permission for a visit.
60.31 		Subd. 8.Correction orders. (a) A correction order may be issued whenever the 
60.32 	commissioner finds upon survey or during a complaint investigation that a home care 
60.33 	provider, a managerial official, or an employee of the provider is not in compliance with 
60.34 	sections 144A.43 to 144A.482. The correction order shall cite the specific statute and 
60.35 	document areas of noncompliance and the time allowed for correction.
61.1 	(b) The commissioner shall mail copies of any correction order within 30 calendar 
61.2 	days after an exit survey to the last known address of the home care provider. A copy of 
61.3 	each correction order and copies of any documentation supplied to the commissioner shall 
61.4 	be kept on file by the home care provider, and public documents shall be made available 
61.5 	for viewing by any person upon request. Copies may be kept electronically.
61.6 	(c) By the correction order date, the home care provider must document in the 
61.7 	provider's records any action taken to comply with the correction order. The commissioner 
61.8 	may request a copy of this documentation and the home care provider's action to respond 
61.9 	to the correction order in future surveys, upon a complaint investigation, and as otherwise 
61.10 	needed.
61.11 		Subd. 9.Follow-up surveys. For providers that have Level 3 or Level 4 violations, 
61.12 	under subdivision 11, or any violations determined to be widespread, the department shall 
61.13 	conduct a follow-up survey within 90 calendar days of the survey. When conducting a 
61.14 	follow-up survey, the surveyor will focus on whether the previous violations have been 
61.15 	corrected and may also address any new violations that are observed while evaluating the 
61.16 	corrections that have been made. If a new violation is identified on a follow-up survey, no 
61.17 	fine will be imposed unless it is not corrected on the next follow-up survey.
61.18 		Subd. 10.Performance incentive. A licensee is eligible for a performance 
61.19 	incentive if there are no violations identified in a core or full survey. The performance 
61.20 	incentive is a ten percent discount on the licensee's next home care renewal license fee.
61.21 		Subd. 11.Fines. (a) Fines and enforcement actions under this subdivision may be 
61.22 	assessed based on the level and scope of the violations described in paragraph (c) as follows:
61.23 	(1) Level 1, no fines or enforcement;
61.24 	(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement 
61.25 	mechanisms authorized in section 144A.475 for widespread violations;
61.26 	(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement 
61.27 	mechanisms authorized in section 144A.475; and
61.28 	(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the 
61.29 	enforcement mechanisms authorized in section 144A.475.
61.30 	(b) Correction orders for violations are categorized by both level and scope and 
61.31 	fines shall be assessed as follows:
61.32 	(1) Level of violation:
61.33 	(i) Level 1 is a violation that has no potential to cause more than a minimal impact 
61.34 	on the client and does not affect health or safety;
62.1 	(ii) Level 2 is a violation that did not harm a client's health or safety but had the 
62.2 	potential to have harmed a client's health or safety, but was not likely to cause serious 
62.3 	injury, impairment, or death;
62.4 	(iii) Level 3 is a violation that harmed a client's health or safety, not including 
62.5 	serious injury, impairment, or death, or a violation that has the potential to lead to serious 
62.6 	injury, impairment, or death; and
62.7 	(iv) Level 4 is a violation that results in serious injury, impairment, or death.
62.8 	(2) Scope of violation:
62.9 	(i) Isolated, when one or a limited number of clients are affected or one or a limited 
62.10 	number of staff are involved or the situation has occurred only occasionally;
62.11 	(ii) Pattern, when more than a limited number of clients are affected, more than a 
62.12 	limited number of staff are involved, or the situation has occurred repeatedly but is not 
62.13 	found to be pervasive; and
62.14 	(iii) Widespread, when problems are pervasive or represent a systemic failure that 
62.15 	has affected or has the potential to affect a large portion or all of the clients.
62.16 	(c) If the commissioner finds that the applicant or a home care provider required 
62.17 	to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the 
62.18 	date specified in the correction order or conditional license resulting from a survey or 
62.19 	complaint investigation, the commissioner may impose a fine. A notice of noncompliance 
62.20 	with a correction order must be mailed to the applicant's or provider's last known address. 
62.21 	The noncompliance notice must list the violations not corrected.
62.22 	(d) The license holder must pay the fines assessed on or before the payment date 
62.23 	specified. If the license holder fails to fully comply with the order, the commissioner 
62.24 	may issue a second fine or suspend the license until the license holder complies by 
62.25 	paying the fine. A timely appeal shall stay payment of the fine until the commissioner 
62.26 	issues a final order.
62.27 	(e) A license holder shall promptly notify the commissioner in writing when a 
62.28 	violation specified in the order is corrected. If upon reinspection the commissioner 
62.29 	determines that a violation has not been corrected as indicated by the order, the 
62.30 	commissioner may issue a second fine. The commissioner shall notify the license holder by 
62.31 	mail to the last known address in the licensing record that a second fine has been assessed. 
62.32 	The license holder may appeal the second fine as provided under this subdivision.
62.33 	(f) A home care provider that has been assessed a fine under this subdivision has a 
62.34 	right to a reconsideration or a hearing under this section and chapter 14.
63.1 	(g) When a fine has been assessed, the license holder may not avoid payment by 
63.2 	closing, selling, or otherwise transferring the licensed program to a third party. In such an 
63.3 	event, the license holder shall be liable for payment of the fine. 
63.4 	(h) In addition to any fine imposed under this section, the commissioner may assess 
63.5 	costs related to an investigation that results in a final order assessing a fine or other 
63.6 	enforcement action authorized by this chapter.
63.7 	(i) Fines collected under this subdivision shall be deposited in the state government 
63.8 	special revenue fund and credited to an account separate from the revenue collected under 
63.9 	section 144A.472. Subject to an appropriation by the legislature, the revenue from the 
63.10 	fines collected may be used by the commissioner for special projects to improve home care 
63.11 	in Minnesota as recommended by the advisory council established in section 144A.4799.
63.12 		Subd. 12.Reconsideration. (a) The commissioner shall make available to home 
63.13 	care providers a correction order reconsideration process. This process may be used 
63.14 	to challenge the correction order issued, including the level and scope described in 
63.15 	subdivision 11, and any fine assessed. During the correction order reconsideration 
63.16 	request, the issuance for the correction orders under reconsideration are not stayed, but 
63.17 	the department shall post information on the Web site with the correction order that the 
63.18 	licensee has requested a reconsideration and that the review is pending.
63.19 	(b) A licensed home care provider may request from the commissioner, in writing, 
63.20 	a correction order reconsideration regarding any correction order issued to the provider. 
63.21 	The correction order reconsideration shall not be reviewed by any surveyor, investigator, 
63.22 	or supervisor that participated in the writing or reviewing of the correction order 
63.23 	being disputed. The correction order reconsiderations may be conducted in person, by 
63.24 	telephone, by another electronic form, or in writing, as determined by the commissioner. 
63.25 	The commissioner shall respond in writing to the request from a home care provider 
63.26 	for a correction order reconsideration within 60 days of the date the provider requests a 
63.27 	reconsideration. The commissioner's response shall identify the commissioner's decision 
63.28 	regarding each citation challenged by the home care provider.
63.29 	(c) The findings of a correction order reconsideration process shall be one or more of 
63.30 	the following:
63.31 	(1) supported in full, the correction order is supported in full, with no deletion of 
63.32 	findings to the citation;
63.33 	(2) supported in substance, the correction order is supported, but one or more 
63.34 	findings are deleted or modified without any change in the citation;
63.35 	(3) correction order cited an incorrect home care licensing requirement, the correction 
63.36 	order is amended by changing the correction order to the appropriate statutory reference;
64.1 	(4) correction order was issued under an incorrect citation, the correction order is 
64.2 	amended to be issued under the more appropriate correction order citation;
64.3 	(5) the correction order is rescinded;
64.4 	(6) fine is amended, it is determined that the fine assigned to the correction order 
64.5 	was applied incorrectly; or
64.6 	(7) the level or scope of the citation is modified based on the reconsideration.
64.7 	(d) If the correction order findings are changed by the commissioner, the 
64.8 	commissioner shall update the correction order Web site.
64.9 		Subd. 13.Home care surveyor training. (a) Before conducting a home care 
64.10 	survey, each home care surveyor must receive training on the following topics:
64.11 	(1) Minnesota home care licensure requirements;
64.12 	(2) Minnesota Home Care Client Bill of Rights;
64.13 	(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
64.14 	(4) principles of documentation;
64.15 	(5) survey protocol and processes;
64.16 	(6) Offices of the Ombudsman roles;
64.17 	(7) Office of Health Facility Complaints;
64.18 	(8) Minnesota landlord-tenant and housing with services laws;
64.19 	(9) types of payors for home care services; and
64.20 	(10) Minnesota Nurse Practice Act for nurse surveyors.
64.21 	(b) Materials used for the training in paragraph (a) shall be posted on the department 
64.22 	Web site. Requisite understanding of these topics will be reviewed as part of the quality 
64.23 	improvement plan in section 28.

64.24 	Sec. 9. [144A.475] ENFORCEMENT.
64.25 		Subdivision 1.Conditions. (a) The commissioner may refuse to grant a temporary 
64.26 	license, renew a license, suspend or revoke a license, or impose a conditional license if the 
64.27 	home care provider or owner or managerial official of the home care provider:
64.28 	(1) is in violation of, or during the term of the license has violated, any of the 
64.29 	requirements in sections 144A.471 to 144A.482;
64.30 	(2) permits, aids, or abets the commission of any illegal act in the provision of 
64.31 	home care;
64.32 	(3) performs any act detrimental to the health, safety, and welfare of a client;
64.33 	(4) obtains the license by fraud or misrepresentation;
64.34 	(5) knowingly made or makes a false statement of a material fact in the application 
64.35 	for a license or in any other record or report required by this chapter;
65.1 	(6) denies representatives of the department access to any part of the home care 
65.2 	provider's books, records, files, or employees;
65.3 	(7) interferes with or impedes a representative of the department in contacting the 
65.4 	home care provider's clients;
65.5 	(8) interferes with or impedes a representative of the department in the enforcement 
65.6 	of this chapter or has failed to fully cooperate with an inspection, survey, or investigation 
65.7 	by the department;
65.8 	(9) destroys or makes unavailable any records or other evidence relating to the home 
65.9 	care provider's compliance with this chapter;
65.10 	(10) refuses to initiate a background study under section 144.057 or 245A.04;
65.11 	(11) fails to timely pay any fines assessed by the department;
65.12 	(12) violates any local, city, or township ordinance relating to home care services;
65.13 	(13) has repeated incidents of personnel performing services beyond their 
65.14 	competency level; or
65.15 	(14) has operated beyond the scope of the home care provider's license level.
65.16 	(b) A violation by a contractor providing the home care services of the home care 
65.17 	provider is a violation by the home care provider.
65.18 		Subd. 2.Terms to suspension or conditional license. A suspension or conditional 
65.19 	license designation may include terms that must be completed or met before a suspension 
65.20 	or conditional license designation is lifted. A conditional license designation may include 
65.21 	restrictions or conditions that are imposed on the provider. Terms for a suspension or 
65.22 	conditional license may include one or more of the following and the scope of each will be 
65.23 	determined by the commissioner:
65.24 	(1) requiring a consultant to review, evaluate, and make recommended changes to 
65.25 	the home care provider's practices and submit reports to the commissioner at the cost of 
65.26 	the home care provider;
65.27 	(2) requiring supervision of the home care provider or staff practices at the cost 
65.28 	of the home care provider by an unrelated person who has sufficient knowledge and 
65.29 	qualifications to oversee the practices and who will submit reports to the commissioner;
65.30 	(3) requiring the home care provider or employees to obtain training at the cost of 
65.31 	the home care provider;
65.32 	(4) requiring the home care provider to submit reports to the commissioner;
65.33 	(5) prohibiting the home care provider from taking any new clients for a period 
65.34 	of time; or
65.35 	(6) any other action reasonably required to accomplish the purpose of this 
65.36 	subdivision and section 144A.45, subdivision 2.
66.1 		Subd. 3.Notice. Prior to any suspension, revocation, or refusal to renew a license, 
66.2 	the home care provider shall be entitled to notice and a hearing as provided by sections 
66.3 	14.57 to 14.69. In addition to any other remedy provided by law, the commissioner may, 
66.4 	without a prior contested case hearing, temporarily suspend a license or prohibit delivery 
66.5 	of services by a provider for not more than 90 days if the commissioner determines that 
66.6 	the health or safety of a consumer is in imminent danger, provided:
66.7 	(1) advance notice is given to the home care provider;
66.8 	(2) after notice, the home care provider fails to correct the problem;
66.9 	(3) the commissioner has reason to believe that other administrative remedies are not 
66.10 	likely to be effective; and
66.11 	(4) there is an opportunity for a contested case hearing within the 90 days.
66.12 		Subd. 4.Time limits for appeals. To appeal the assessment of civil penalties 
66.13 	under section 144A.45, subdivision 2, clause (5), and an action against a license under 
66.14 	this section, a provider must request a hearing no later than 15 days after the provider 
66.15 	receives notice of the action.
66.16 		Subd. 5.Plan required. (a) The process of suspending or revoking a license 
66.17 	must include a plan for transferring affected clients to other providers by the home care 
66.18 	provider, which will be monitored by the commissioner. Within three business days of 
66.19 	being notified of the final revocation or suspension action, the home care provider shall 
66.20 	provide the commissioner, the lead agencies as defined in section 256B.0911, and the 
66.21 	ombudsman for long-term care with the following information:
66.22 	(1) a list of all clients, including full names and all contact information on file;
66.23 	(2) a list of each client's representative or emergency contact person, including full 
66.24 	names and all contact information on file;
66.25 	(3) the location or current residence of each client;
66.26 	(4) the payor sources for each client, including payor source identification numbers; 
66.27 	and
66.28 	(5) for each client, a copy of the client's service plan, and a list of the types of 
66.29 	services being provided.
66.30 	(b) The revocation or suspension notification requirement is satisfied by mailing the 
66.31 	notice to the address in the license record. The home care provider shall cooperate with 
66.32 	the commissioner and the lead agencies during the process of transferring care of clients to 
66.33 	qualified providers. Within three business days of being notified of the final revocation or 
66.34 	suspension action, the home care provider must notify and disclose to each of the home 
66.35 	care provider's clients, or the client's representative or emergency contact persons, that 
67.1 	the commissioner is taking action against the home care provider's license by providing a 
67.2 	copy of the revocation or suspension notice issued by the commissioner.
67.3 		Subd. 6.Owners and managerial officials; refusal to grant license. (a) The 
67.4 	owner and managerial officials of a home care provider whose Minnesota license has not 
67.5 	been renewed or that has been revoked because of noncompliance with applicable laws or 
67.6 	rules shall not be eligible to apply for nor will be granted a home care license, including 
67.7 	other licenses under this chapter, or be given status as an enrolled personal care assistance 
67.8 	provider agency or personal care assistant by the Department of Human Services under 
67.9 	section 256B.0659 for five years following the effective date of the nonrenewal or 
67.10 	revocation. If the owner and managerial officials already have enrollment status, their 
67.11 	enrollment will be terminated by the Department of Human Services.
67.12 	(b) The commissioner shall not issue a license to a home care provider for five 
67.13 	years following the effective date of license nonrenewal or revocation if the owner or 
67.14 	managerial official, including any individual who was an owner or managerial official 
67.15 	of another home care provider, had a Minnesota license that was not renewed or was 
67.16 	revoked as described in paragraph (a).
67.17 	(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall 
67.18 	suspend or revoke, the license of any home care provider that includes any individual 
67.19 	as an owner or managerial official who was an owner or managerial official of a home 
67.20 	care provider whose Minnesota license was not renewed or was revoked as described in 
67.21 	paragraph (a) for five years following the effective date of the nonrenewal or revocation.
67.22 	(d) The commissioner shall notify the home care provider 30 days in advance of 
67.23 	the date of nonrenewal, suspension, or revocation of the license. Within ten days after 
67.24 	the receipt of the notification, the home care provider may request, in writing, that the 
67.25 	commissioner stay the nonrenewal, revocation, or suspension of the license. The home 
67.26 	care provider shall specify the reasons for requesting the stay; the steps that will be taken 
67.27 	to attain or maintain compliance with the licensure laws and regulations; any limits on the 
67.28 	authority or responsibility of the owners or managerial officials whose actions resulted in 
67.29 	the notice of nonrenewal, revocation, or suspension; and any other information to establish 
67.30 	that the continuing affiliation with these individuals will not jeopardize client health, safety, 
67.31 	or well-being. The commissioner shall determine whether the stay will be granted within 
67.32 	30 days of receiving the provider's request. The commissioner may propose additional 
67.33 	restrictions or limitations on the provider's license and require that the granting of the stay 
67.34 	be contingent upon compliance with those provisions. The commissioner shall take into 
67.35 	consideration the following factors when determining whether the stay should be granted:
68.1 	(1) the threat that continued involvement of the owners and managerial officials with 
68.2 	the home care provider poses to client health, safety, and well-being;
68.3 	(2) the compliance history of the home care provider; and
68.4 	(3) the appropriateness of any limits suggested by the home care provider.
68.5 	If the commissioner grants the stay, the order shall include any restrictions or 
68.6 	limitation on the provider's license. The failure of the provider to comply with any 
68.7 	restrictions or limitations shall result in the immediate removal of the stay and the 
68.8 	commissioner shall take immediate action to suspend, revoke, or not renew the license.
68.9 		Subd. 7.Request for hearing. A request for a hearing must be in writing and must:
68.10 	(1) be mailed or delivered to the department or the commissioner's designee;
68.11 	(2) contain a brief and plain statement describing every matter or issue contested; and
68.12 	(3) contain a brief and plain statement of any new matter that the applicant or home 
68.13 	care provider believes constitutes a defense or mitigating factor.
68.14 		Subd. 8.Informal conference. At any time, the applicant or home care provider 
68.15 	and the commissioner may hold an informal conference to exchange information, clarify 
68.16 	issues, or resolve issues.
68.17 		Subd. 9.Injunctive relief. In addition to any other remedy provided by law, the 
68.18 	commissioner may bring an action in district court to enjoin a person who is involved in 
68.19 	the management, operation, or control of a home care provider or an employee of the 
68.20 	home care provider from illegally engaging in activities regulated by sections 144A.43 to 
68.21 	144A.482. The commissioner may bring an action under this subdivision in the district 
68.22 	court in Ramsey County or in the district in which a home care provider is providing 
68.23 	services. The court may grant a temporary restraining order in the proceeding if continued 
68.24 	activity by the person who is involved in the management, operation, or control of a home 
68.25 	care provider, or by an employee of the home care provider, would create an imminent 
68.26 	risk of harm to a recipient of home care services.
68.27 		Subd. 10.Subpoena. In matters pending before the commissioner under sections 
68.28 	144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance 
68.29 	of witnesses and the production of all necessary papers, books, records, documents, and 
68.30 	other evidentiary material. If a person fails or refuses to comply with a subpoena or 
68.31 	order of the commissioner to appear or testify regarding any matter about which the 
68.32 	person may be lawfully questioned or to produce any papers, books, records, documents, 
68.33 	or evidentiary materials in the matter to be heard, the commissioner may apply to the 
68.34 	district court in any district, and the court shall order the person to comply with the 
68.35 	commissioner's order or subpoena. The commissioner of health may administer oaths to 
68.36 	witnesses or take their affirmation. Depositions may be taken in or outside the state in the 
69.1 	manner provided by law for the taking of depositions in civil actions. A subpoena or other 
69.2 	process or paper may be served on a named person anywhere in the state by an officer 
69.3 	authorized to serve subpoenas in civil actions, with the same fees and mileage and in the 
69.4 	same manner as prescribed by law for a process issued out of a district court. A person 
69.5 	subpoenaed under this subdivision shall receive the same fees, mileage, and other costs 
69.6 	that are paid in proceedings in district court.

69.7 	Sec. 10. [144A.476] BACKGROUND STUDIES.
69.8 		Subdivision 1.Prior criminal convictions; owner and managerial officials. (a) 
69.9 	Before the commissioner issues a temporary license or renews a license, an owner or 
69.10 	managerial official is required to complete a background study under section 144.057. No 
69.11 	person may be involved in the management, operation, or control of a home care provider 
69.12 	if the person has been disqualified under chapter 245C. If an individual is disqualified 
69.13 	under section 144.056 or chapter 245C, the individual may request reconsideration of 
69.14 	the disqualification. If the individual requests reconsideration and the commissioner 
69.15 	sets aside or rescinds the disqualification, the individual is eligible to be involved in the 
69.16 	management, operation, or control of the provider. If an individual has a disqualification 
69.17 	under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's 
69.18 	disqualification is barred from a set aside, and the individual must not be involved in the 
69.19 	management, operation, or control of the provider.
69.20 	(b) For purposes of this section, owners of a home care provider subject to the 
69.21 	background check requirement are those individuals whose ownership interest provides 
69.22 	sufficient authority or control to affect or change decisions related to the operation of the 
69.23 	home care provider. An owner includes a sole proprietor, a general partner, or any other 
69.24 	individual whose individual ownership interest can affect the management and direction 
69.25 	of the policies of the home care provider.
69.26 	(c) For the purposes of this section, managerial officials subject to the background 
69.27 	check requirement are individuals who provide direct contact as defined in section 245C.02, 
69.28 	subdivision 11, or individuals who have the responsibility for the ongoing management or 
69.29 	direction of the policies, services, or employees of the home care provider. Data collected 
69.30 	under this subdivision shall be classified as private data under section 13.02, subdivision 12.
69.31 	(d) The department shall not issue any license if the applicant or owner or managerial 
69.32 	official has been unsuccessful in having a background study disqualification set aside 
69.33 	under section 144.057 and chapter 245C; if the owner or managerial official, as an owner 
69.34 	or managerial official of another home care provider, was substantially responsible for 
69.35 	the other home care provider's failure to substantially comply with sections 144A.43 to 
70.1 	144A.482; or if an owner that has ceased doing business, either individually or as an 
70.2 	owner of a home care provider, was issued a correction order for failing to assist clients in 
70.3 	violation of this chapter.
70.4 		Subd. 2.Employees, contractors, and volunteers. (a) Employees, contractors, 
70.5 	and volunteers of a home care provider are subject to the background study required by 
70.6 	section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall 
70.7 	be construed to prohibit a home care provider from requiring self-disclosure of criminal 
70.8 	conviction information.
70.9 	(b) Termination of an employee in good faith reliance on information or records 
70.10 	obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not 
70.11 	subject the home care provider to civil liability or liability for unemployment benefits.

70.12 	Sec. 11. [144A.477] COMPLIANCE.
70.13 		Subdivision 1.Medicare-certified providers; coordination of surveys. If feasible, 
70.14 	the commissioner shall survey licensees to determine compliance with this chapter at the 
70.15 	same time as surveys for certification for Medicare if Medicare certification is based on 
70.16 	compliance with the federal conditions of participation and on survey and enforcement 
70.17 	by the Department of Health as agent for the United States Department of Health and 
70.18 	Human Services.
70.19 		Subd. 2.Medicare-certified providers; equivalent requirements. For home care 
70.20 	providers licensed to provide comprehensive home care services that are also certified for 
70.21 	participation in Medicare as a home health agency under Code of Federal Regulations, 
70.22 	title 42, part 484, the following state licensure regulations are considered equivalent to 
70.23 	the federal requirements:
70.24 	(1) quality management, section 144A.479, subdivision 3;
70.25 	(2) personnel records, section 144A.479, subdivision 7;
70.26 	(3) acceptance of clients, section 144A.4791, subdivision 4;
70.27 	(4) referrals, section 144A.4791, subdivision 5;
70.28 	(5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792, 
70.29 	subdivisions 2 and 3;
70.30 	(6) individualized monitoring and reassessment, sections 144A.4791, subdivision 
70.31 	8, and 144A.4792, subdivisions 2 and 3;
70.32 	(7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792, 
70.33 	subdivision 5, and 144A.4793, subdivision 3;
70.34 	(8) client complaint and investigation process, section 144A.4791, subdivision 11;
70.35 	(9) prescription orders, section 144A.4792, subdivisions 13 to 16;
71.1 	(10) client records, section 144A.4794, subdivisions 1 to 3;
71.2 	(11) qualifications for unlicensed personnel performing delegated tasks, section 
71.3 	144A.4795;
71.4 	(12) training and competency staff, section 144A.4795;
71.5 	(13) training and competency for unlicensed personnel, section 144A.4795, 
71.6 	subdivision 7;
71.7 	(14) delegation of home care services, section 144A.4795, subdivision 4;
71.8 	(15) availability of contact person, section 144A.4797, subdivision 1; and
71.9 	(16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
71.10 	Violations of requirements in clauses (1) to (16) may lead to enforcement actions 
71.11 	under section 144A.474.

71.12 	Sec. 12. [144A.478] INNOVATION VARIANCE.
71.13 		Subdivision 1.Definition. For purposes of this section, "innovation variance" 
71.14 	means a specified alternative to a requirement of this chapter. An innovation variance 
71.15 	may be granted to allow a home care provider to offer home care services of a type or 
71.16 	in a manner that is innovative, will not impair the services provided, will not adversely 
71.17 	affect the health, safety, or welfare of the clients, and is likely to improve the services 
71.18 	provided. The innovative variance cannot change any of the client's rights under section 
71.19 	144A.44, home care bill of rights.
71.20 		Subd. 2.Conditions. The commissioner may impose conditions on the granting of 
71.21 	an innovation variance that the commissioner considers necessary.
71.22 		Subd. 3.Duration and renewal. The commissioner may limit the duration of any 
71.23 	innovation variance and may renew a limited innovation variance.
71.24 		Subd. 4.Applications; innovation variance. An application for innovation 
71.25 	variance from the requirements of this chapter may be made at any time, must be made in 
71.26 	writing to the commissioner, and must specify the following:
71.27 	(1) the statute or law from which the innovation variance is requested;
71.28 	(2) the time period for which the innovation variance is requested;
71.29 	(3) the specific alternative action that the licensee proposes;
71.30 	(4) the reasons for the request; and
71.31 	(5) justification that an innovation variance will not impair the services provided, 
71.32 	will not adversely affect the health, safety, or welfare of clients, and is likely to improve 
71.33 	the services provided.
71.34 	The commissioner may require additional information from the home care provider before 
71.35 	acting on the request.
72.1 		Subd. 5.Grants and denials. The commissioner shall grant or deny each request 
72.2 	for an innovation variance in writing within 45 days of receipt of a complete request. 
72.3 	Notice of a denial shall contain the reasons for the denial. The terms of a requested 
72.4 	innovation variance may be modified upon agreement between the commissioner and 
72.5 	the home care provider.
72.6 		Subd. 6.Violation of innovation variances. A failure to comply with the terms of 
72.7 	an innovation variance shall be deemed to be a violation of this chapter.
72.8 		Subd. 7.Revocation or denial of renewal. The commissioner shall revoke or 
72.9 	deny renewal of an innovation variance if:
72.10 	(1) it is determined that the innovation variance is adversely affecting the health, 
72.11 	safety, or welfare of the licensee's clients;
72.12 	(2) the home care provider has failed to comply with the terms of the innovation 
72.13 	variance;
72.14 	(3) the home care provider notifies the commissioner in writing that it wishes to 
72.15 	relinquish the innovation variance and be subject to the statute previously varied; or
72.16 	(4) the revocation or denial is required by a change in law.

72.17 	Sec. 13. [144A.479] HOME CARE PROVIDER RESPONSIBILITIES; 
72.18 	BUSINESS OPERATION.
72.19 		Subdivision 1.Display of license. The original current license must be displayed 
72.20 	in the home care providers' principal business office and copies must be displayed in 
72.21 	any branch office. The home care provider must provide a copy of the license to any 
72.22 	person who requests it.
72.23 		Subd. 2.Advertising. Home care providers shall not use false, fraudulent, 
72.24 	or misleading advertising in the marketing of services. For purposes of this section, 
72.25 	advertising includes any verbal, written, or electronic means of communicating to 
72.26 	potential clients about the availability, nature, or terms of home care services.
72.27 		Subd. 3.Quality management. The home care provider shall engage in quality 
72.28 	management appropriate to the size of the home care provider and relevant to the type 
72.29 	of services the home care provider provides. The quality management activity means 
72.30 	evaluating the quality of care by periodically reviewing client services, complaints made, 
72.31 	and other issues that have occurred and determining whether changes in services, staffing, 
72.32 	or other procedures need to be made in order to ensure safe and competent services to 
72.33 	clients. Documentation about quality management activity must be available for two 
72.34 	years. Information about quality management must be available to the commissioner at 
72.35 	the time of the survey, investigation, or renewal.
73.1 		Subd. 4.Provider restrictions. (a) This subdivision does not apply to licensees 
73.2 	that are Minnesota counties or other units of government.
73.3 	(b) A home care provider or staff cannot accept powers-of-attorney from clients for 
73.4 	any purpose, and may not accept appointments as guardians or conservators of clients.
73.5 	(c) A home care provider cannot serve as a client's representative. 
73.6 		Subd. 5.Handling of client's finances and property. (a) A home care provider 
73.7 	may assist clients with household budgeting, including paying bills and purchasing 
73.8 	household goods, but may not otherwise manage a client's property. A home care provider 
73.9 	must provide a client with receipts for all transactions and purchases paid with the clients' 
73.10 	funds. When receipts are not available, the transaction or purchase must be documented. 
73.11 	A home care provider must maintain records of all such transactions.
73.12 	(b) A home care provider or staff may not borrow a client's funds or personal or 
73.13 	real property, nor in any way convert a client's property to the home care provider's or 
73.14 	staff's possession.
73.15 	(c) Nothing in this section precludes a home care provider or staff from accepting 
73.16 	gifts of minimal value, or precludes the acceptance of donations or bequests made to a 
73.17 	home care provider that are exempt from income tax under section 501(c) of the Internal 
73.18 	Revenue Code of 1986.
73.19 		Subd. 6.Reporting maltreatment of vulnerable adults and minors. (a) All 
73.20 	home care providers must comply with requirements for the reporting of maltreatment 
73.21 	of minors in section 626.556 and the requirements for the reporting of maltreatment 
73.22 	of vulnerable adults in section 626.557. Home care providers must report suspected 
73.23 	maltreatment of minors and vulnerable adults to the common entry point. Each home 
73.24 	care provider must establish and implement a written procedure to ensure that all cases 
73.25 	of suspected maltreatment are reported.
73.26 	(b) Each home care provider must develop and implement an individual abuse 
73.27 	prevention plan for each vulnerable minor or adult for whom home care services are 
73.28 	provided by a home care provider. The plan shall contain an individualized review or 
73.29 	assessment of the person's susceptibility to abuse by another individual, including other 
73.30 	vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors; 
73.31 	and statements of the specific measures to be taken to minimize the risk of abuse to that 
73.32 	person and other vulnerable adults or minors. For purposes of the abuse prevention plan, 
73.33 	the term abuse includes self-abuse.
73.34 		Subd. 7.Employee records. The home care provider must maintain current records 
73.35 	of each paid employee, regularly scheduled volunteers providing home care services, and 
74.1 	of each individual contractor providing home care services. The records must include 
74.2 	the following information:
74.3 	(1) evidence of current professional licensure, registration, or certification, if 
74.4 	licensure, registration, or certification is required by this statute, or other rules;
74.5 	(2) records of orientation, required annual training and infection control training, 
74.6 	and competency evaluations;
74.7 	(3) current job description, including qualifications, responsibilities, and 
74.8 	identification of staff providing supervision;
74.9 	(4) documentation of annual performance reviews which identify areas of 
74.10 	improvement needed and training needs;
74.11 	(5) for individuals providing home care services, verification that required health 
74.12 	screenings under section 144A.4798 have taken place and the dates of those screenings; and
74.13 	(6) documentation of the background study as required under section 144.057.
74.14 	Each employee record must be retained for at least three years after a paid employee, 
74.15 	home care volunteer, or contractor ceases to be employed by or under contract with the 
74.16 	home care provider. If a home care provider ceases operation, employee records must be 
74.17 	maintained for three years.

74.18 	Sec. 14. [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH 
74.19 	RESPECT TO CLIENTS.
74.20 		Subdivision 1.Home care bill of rights; notification to client. (a) The home 
74.21 	care provider shall provide the client or the client's representative a written notice of the 
74.22 	rights under section 144A.44 in a language that the client or the client's representative 
74.23 	can understand before the initiation of services to that client. If a written version is not 
74.24 	available, the home care bill of rights must be communicated to the client or client's 
74.25 	representative in a language they can understand.
74.26 	(b) In addition to the text of the home care bill of rights in section 144A.44, 
74.27 	subdivision 1, the notice shall also contain the following statement describing how to file 
74.28 	a complaint with these offices.
74.29 	"If you have a complaint about the provider or the person providing your 
74.30 	home care services, you may call, write, or visit the Office of Health Facility 
74.31 	Complaints, Minnesota Department of Health. You may also contact the Office of 
74.32 	Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health 
74.33 	and Developmental Disabilities."
74.34 	The statement should include the telephone number, Web site address, e-mail 
74.35 	address, mailing address, and street address of the Office of Health Facility Complaints at 
75.1 	the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care, 
75.2 	and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The 
75.3 	statement should also include the home care provider's name, address, e-mail, telephone 
75.4 	number, and name or title of the person at the provider to whom problems or complaints 
75.5 	may be directed. It must also include a statement that the home care provider will not 
75.6 	retaliate because of a complaint.
75.7 	(c) The home care provider shall obtain written acknowledgment of the client's 
75.8 	receipt of the home care bill of rights or shall document why an acknowledgment cannot 
75.9 	be obtained. The acknowledgment may be obtained from the client or the client's 
75.10 	representative. Acknowledgment of receipt shall be retained in the client's record.
75.11 		Subd. 2.Notice of services for dementia, Alzheimer's disease, or related 
75.12 	disorders. The home care provider that provides services to clients with dementia shall 
75.13 	provide in written or electronic form, to clients and families or other persons who request 
75.14 	it, a description of the training program and related training it provides, including the 
75.15 	categories of employees trained, the frequency of training, and the basic topics covered. 
75.16 	This information satisfies the disclosure requirements in section 325F.72, subdivision 
75.17 	2, clause (4).
75.18 		Subd. 3.Statement of home care services. Prior to the initiation of services, 
75.19 	a home care provider must provide to the client or the client's representative a written 
75.20 	statement which identifies if they have a basic or comprehensive home care license, the 
75.21 	services they are authorized to provide, and which services they cannot provide under the 
75.22 	scope of their license. The home care provider shall obtain written acknowledgment 
75.23 	from the clients that they have provided the statement or must document why they could 
75.24 	not obtain the acknowledgment.
75.25 		Subd. 4.Acceptance of clients. No home care provider may accept a person as a 
75.26 	client unless the home care provider has staff, sufficient in qualifications, competency, 
75.27 	and numbers, to adequately provide the services agreed to in the service plan and that 
75.28 	are within the provider's scope of practice.
75.29 		Subd. 5.Referrals. If a home care provider reasonably believes that a client is in 
75.30 	need of another medical or health service, including a licensed health professional, or 
75.31 	social service provider, the home care provider shall:
75.32 	(1) determine the client's preferences with respect to obtaining the service; and
75.33 	(2) inform the client of resources available, if known, to assist the client in obtaining 
75.34 	services.
75.35 		Subd. 6.Initiation of services. When a provider initiates services and the 
75.36 	individualized review or assessment required in subdivisions 7 and 8 has not been 
76.1 	completed, the provider must complete a temporary plan and agreement with the client for 
76.2 	services.
76.3 		Subd. 7.Basic individualized client review and monitoring. (a) When services 
76.4 	being provided are basic home care services, an individualized initial review of the client's 
76.5 	needs and preferences must be conducted at the client's residence with the client or client's 
76.6 	representative. This initial review must be completed within 30 days after the initiation of 
76.7 	the home care services.
76.8 	(b) Client monitoring and review must be conducted as needed based on changes 
76.9 	in the needs of the client and cannot exceed 90 days from the date of the last review. 
76.10 	The monitoring and review may be conducted at the client's residence or through the 
76.11 	utilization of telecommunication methods based on practice standards that meet the 
76.12 	individual client's needs.
76.13 		Subd. 8.Comprehensive assessment, monitoring, and reassessment. (a) When 
76.14 	the services being provided are comprehensive home care services, an individualized 
76.15 	initial assessment must be conducted in-person by a registered nurse. When the services 
76.16 	are provided by other licensed health professionals, the assessment must be conducted by 
76.17 	the appropriate health professional. This initial assessment must be completed within five 
76.18 	days after initiation of home care services.
76.19 	(b) Client monitoring and reassessment must be conducted in the client's home no 
76.20 	more than 14 days after initiation of services.
76.21 	(c) Ongoing client monitoring and reassessment must be conducted as needed based 
76.22 	on changes in the needs of the client and cannot exceed 90 days from the last date of the 
76.23 	assessment. The monitoring and reassessment may be conducted at the client's residence 
76.24 	or through the utilization of telecommunication methods based on practice standards that 
76.25 	meet the individual client's needs.
76.26 		Subd. 9.Service plan, implementation, and revisions to service plan. (a) No later 
76.27 	than 14 days after the initiation of services, a home care provider shall finalize a current 
76.28 	written service plan.
76.29 	(b) The service plan and any revisions must include a signature or other 
76.30 	authentication by the home care provider and by the client or the client's representative 
76.31 	documenting agreement on the services to be provided. The service plan must be revised, 
76.32 	if needed, based on client review or reassessment under subdivisions 7 and 8. The provider 
76.33 	must provide information to the client about changes to the provider's fee for services and 
76.34 	how to contact the Office of the Ombudsman for Long-Term Care.
76.35 	(c) The home care provider must implement and provide all services required by 
76.36 	the current service plan.
77.1 	(d) The service plan and revised service plan must be entered into the client's record, 
77.2 	including notice of a change in a client's fees when applicable.
77.3 	(e) Staff providing home care services must be informed of the current written 
77.4 	service plan.
77.5 	(f) The service plan must include:
77.6 	(1) a description of the home care services to be provided, the fees for services, and 
77.7 	the frequency of each service, according to the client's current review or assessment and 
77.8 	client preferences;
77.9 	(2) the identification of the staff or categories of staff who will provide the services;
77.10 	(3) the schedule and methods of monitoring reviews or assessments of the client;
77.11 	(4) the frequency of sessions of supervision of staff and type of personnel who 
77.12 	will supervise staff; and
77.13 	(5) a contingency plan that includes:
77.14 	(i) the action to be taken by the home care provider and by the client or client's 
77.15 	representative if the scheduled service cannot be provided;
77.16 	(ii) information and method for a client or client's representative to contact the 
77.17 	home care provider;
77.18 	(iii) names and contact information of persons the client wishes to have notified 
77.19 	in an emergency or if there is a significant adverse change in the client's condition, 
77.20 	including identification of and information as to who has authority to sign for the client in 
77.21 	an emergency; and
77.22 	(iv) the circumstances in which emergency medical services are not to be summoned 
77.23 	consistent with chapters 145B and 145C, and declarations made by the client under those 
77.24 	chapters.
77.25 		Subd. 10.Termination of service plan. (a) If a home care provider terminates a 
77.26 	service plan with a client, and the client continues to need home care services, the home 
77.27 	care provider shall provide the client and the client's representative, if any, with a written 
77.28 	notice of termination which includes the following information:
77.29 	(1) the effective date of termination;
77.30 	(2) the reason for termination;
77.31 	(3) a list of known licensed home care providers in the client's immediate geographic 
77.32 	area;
77.33 	(4) a statement that the home care provider will participate in a coordinated transfer 
77.34 	of care of the client to another home care provider, health care provider, or caregiver, as 
77.35 	required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
78.1 	(5) the name and contact information of a person employed by the home care 
78.2 	provider with whom the client may discuss the notice of termination; and
78.3 	(6) if applicable, a statement that the notice of termination of home care services 
78.4 	does not constitute notice of termination of the housing with services contract with a 
78.5 	housing with services establishment.
78.6 	(b) When the home care provider voluntarily discontinues services to all clients, the 
78.7 	home care provider must notify the commissioner, lead agencies, and the ombudsman for 
78.8 	long-term care about its clients and comply with the requirements in this subdivision.
78.9 		Subd. 11.Client complaint and investigative process. (a) The home care 
78.10 	provider must have a written policy and system for receiving, investigating, reporting, 
78.11 	and attempting to resolve complaints from its clients or clients' representatives. The 
78.12 	policy should clearly identify the process by which clients may file a complaint or concern 
78.13 	about home care services and an explicit statement that the home care provider will not 
78.14 	discriminate or retaliate against a client for expressing concerns or complaints. A home 
78.15 	care provider must have a process in place to conduct investigations of complaints made 
78.16 	by the client or the client's representative about the services in the client's plan that are or 
78.17 	are not being provided or other items covered in the client's home care bill of rights. This 
78.18 	complaint system must provide reasonable accommodations for any special needs of the 
78.19 	client or client's representative if requested.
78.20 	(b) The home care provider must document the complaint, name of the client, 
78.21 	investigation, and resolution of each complaint filed. The home care provider must 
78.22 	maintain a record of all activities regarding complaints received, including the date the 
78.23 	complaint was received, and the home care provider's investigation and resolution of the 
78.24 	complaint. This complaint record must be kept for each event for at least two years after 
78.25 	the date of entry and must be available to the commissioner for review.
78.26 	(c) The required complaint system must provide for written notice to each client or 
78.27 	client's representative that includes:
78.28 	(1) the client's right to complain to the home care provider about the services received;
78.29 	(2) the name or title of the person or persons with the home care provider to contact 
78.30 	with complaints;
78.31 	(3) the method of submitting a complaint to the home care provider; and
78.32 	(4) a statement that the provider is prohibited against retaliation according to 
78.33 	paragraph (d).
78.34 	(d) A home care provider must not take any action that negatively affects a client 
78.35 	in retaliation for a complaint made or a concern expressed by the client or the client's 
78.36 	representative.
79.1 		Subd. 12.Disaster planning and emergency preparedness plan. The home care 
79.2 	provider must have a written plan of action to facilitate the management of the client's care 
79.3 	and services in response to a natural disaster, such as flood and storms, or other emergencies 
79.4 	that may disrupt the home care provider's ability to provide care or services. The licensee 
79.5 	must provide adequate orientation and training of staff on emergency preparedness.
79.6 		Subd. 13.Request for discontinuation of life-sustaining treatment. (a) If a 
79.7 	client, family member, or other caregiver of the client requests that an employee or other 
79.8 	agent of the home care provider discontinue a life-sustaining treatment, the employee or 
79.9 	agent receiving the request:
79.10 	(1) shall take no action to discontinue the treatment; and
79.11 	(2) shall promptly inform their supervisor or other agent of the home care provider 
79.12 	of the client's request.
79.13 	(b) Upon being informed of a request for termination of treatment, the home care 
79.14 	provider shall promptly:
79.15 	(1) inform the client that the request will be made known to the physician who 
79.16 	ordered the client's treatment;
79.17 	(2) inform the physician of the client's request; and
79.18 	(3) work with the client and the client's physician to comply with the provisions of 
79.19 	the Health Care Directive Act in chapter 145C.
79.20 	(c) This section does not require the home care provider to discontinue treatment, 
79.21 	except as may be required by law or court order.
79.22 	(d) This section does not diminish the rights of clients to control their treatments, 
79.23 	refuse services, or terminate their relationships with the home care provider.
79.24 	(e) This section shall be construed in a manner consistent with chapter 145B or 
79.25 	145C, whichever applies, and declarations made by clients under those chapters.

79.26 	Sec. 15. [144A.4792] MEDICATION MANAGEMENT.
79.27 		Subdivision 1.Medication management services; comprehensive home care 
79.28 	license. (a) This subdivision applies only to home care providers with a comprehensive 
79.29 	home care license that provides medication management services to clients. Medication 
79.30 	management services may not be provided by a home care provider that has a basic 
79.31 	home care license.
79.32 	(b) A comprehensive home care provider who provides medication management 
79.33 	services must develop, implement, and maintain current written medication management 
79.34 	policies and procedures. The policies and procedures must be developed under the 
80.1 	supervision and direction of a registered nurse, licensed health professional, or pharmacist 
80.2 	consistent with current practice standards and guidelines.
80.3 	(c) The written policies and procedures must address requesting and receiving 
80.4 	prescriptions for medications; preparing and giving medications; verifying that 
80.5 	prescription drugs are administered as prescribed; documenting medication management 
80.6 	activities; controlling and storing medications; monitoring and evaluating medication use; 
80.7 	resolving medication errors; communicating with the prescriber, pharmacist, and client 
80.8 	and client representative, if any; disposing of unused medications; and educating clients 
80.9 	and client representatives about medications. When controlled substances are being 
80.10 	managed, the policies and procedures must also identify how the provider will ensure 
80.11 	security and accountability for the overall management, control, and disposition of those 
80.12 	substances in compliance with state and federal regulations and with subdivision 22.
80.13 		Subd. 2.Provision of medication management services. (a) For each client who 
80.14 	requests medication management services, the comprehensive home care provider shall, 
80.15 	prior to providing medication management services, have a registered nurse, licensed 
80.16 	health professional, or authorized prescriber under section 151.37 conduct an assessment 
80.17 	to determine what medication management services will be provided and how the services 
80.18 	will be provided. This assessment must be conducted face-to-face with the client. The 
80.19 	assessment must include an identification and review of all medications the client is known 
80.20 	to be taking. The review and identification must include indications for medications, side 
80.21 	effects, contraindications, allergic or adverse reactions, and actions to address these issues.
80.22 	(b) The assessment must identify interventions needed in management of 
80.23 	medications to prevent diversion of medication by the client or others who may have 
80.24 	access to the medications. "Diversion of medications" means the misuse, theft, or illegal 
80.25 	or improper disposition of medications.
80.26 		Subd. 3.Individualized medication monitoring and reassessment. The 
80.27 	comprehensive home care provider must monitor and reassess the client's medication 
80.28 	management services as needed under subdivision 14 when the client presents with 
80.29 	symptoms or other issues that may be medication-related and, at a minimum, annually.
80.30 		Subd. 4.Client refusal. The home care provider must document in the client's 
80.31 	record any refusal for an assessment for medication management by the client. The 
80.32 	provider must discuss with the client the possible consequences of the client's refusal and 
80.33 	document the discussion in the client's record.
80.34 		Subd. 5.Individualized medication management plan. (a) For each client 
80.35 	receiving medication management services, the comprehensive home care provider must 
80.36 	prepare and include in the service plan a written statement of the medication management 
81.1 	services that will be provided to the client. The provider must develop and maintain a 
81.2 	current individualized medication management record for each client based on the client's 
81.3 	assessment that must contain the following: 
81.4 	(1) a statement describing the medication management services that will be provided;
81.5 	(2) a description of storage of medications based on the client's needs and 
81.6 	preferences, risk of diversion, and consistent with the manufacturer's directions;
81.7 	(3) documentation of specific client instructions relating to the administration 
81.8 	of medications;
81.9 	(4) identification of persons responsible for monitoring medication supplies and 
81.10 	ensuring that medication refills are ordered on a timely basis;
81.11 	(5) identification of medication management tasks that may be delegated to 
81.12 	unlicensed personnel; 
81.13 	(6) procedures for staff notifying a registered nurse or appropriate licensed health 
81.14 	professional when a problem arises with medication management services; and
81.15 	(7) any client-specific requirements relating to documenting medication 
81.16 	administration, verifications that all medications are administered as prescribed, and 
81.17 	monitoring of medication use to prevent possible complications or adverse reactions.
81.18 	(b) The medication management record must be current and updated when there are 
81.19 	any changes.
81.20 		Subd. 6.Administration of medication. Medications may be administered by a 
81.21 	nurse, physician, or other licensed health practitioner authorized to administer medications 
81.22 	or by unlicensed personnel who have been delegated medication administration tasks by 
81.23 	a registered nurse.
81.24 		Subd. 7.Delegation of medication administration. When administration of 
81.25 	medications is delegated to unlicensed personnel, the comprehensive home care provider 
81.26 	must ensure that the registered nurse has:
81.27 	(1) instructed the unlicensed personnel in the proper methods to administer the 
81.28 	medications, and the unlicensed personnel has demonstrated ability to competently follow 
81.29 	the procedures;
81.30 	(2) specified, in writing, specific instructions for each client and documented those 
81.31 	instructions in the client's records; and
81.32 	(3) communicated with the unlicensed personnel about the individual needs of 
81.33 	the client.
81.34 		Subd. 8.Documentation of administration of medications. Each medication 
81.35 	administered by comprehensive home care provider staff must be documented in the 
81.36 	client's record. The documentation must include the signature and title of the person 
82.1 	who administered the medication. The documentation must include the medication 
82.2 	name, dosage, date and time administered, and method and route of administration. The 
82.3 	staff must document the reason why medication administration was not completed as 
82.4 	prescribed and document any follow-up procedures that were provided to meet the client's 
82.5 	needs when medication was not administered as prescribed and in compliance with the 
82.6 	client's medication management plan.
82.7 		Subd. 9.Documentation of medication set-up. Documentation of dates of 
82.8 	medication set-up, name of medication, quantity of dose, times to be administered, route 
82.9 	of administration, and name of person completing medication set-up must be done at 
82.10 	time of set-up.
82.11 		Subd. 10.Medication management for clients who will be away from home. (a) 
82.12 	A home care provider that is providing medication management services to the client and 
82.13 	controls the client's access to the medications must develop and implement policies and 
82.14 	procedures for giving accurate and current medications to clients for planned or unplanned 
82.15 	times away from home according to the client's individualized medication management 
82.16 	plan. The policy and procedures must state that:
82.17 	(1) for planned time away, the medications must be obtained from the pharmacy or 
82.18 	set up by the registered nurse according to appropriate state and federal laws and nursing 
82.19 	standards of practice;
82.20 	(2) for unplanned time away, when the pharmacy is not able to provide the 
82.21 	medications, a licensed nurse or unlicensed personnel shall give the client or client's 
82.22 	representative medications in amounts and dosages needed for the length of the anticipated 
82.23 	absence, not to exceed 120 hours;
82.24 	(3) the client, or the client's representative, must be provided written information 
82.25 	on medications, including any special instructions for administering or handling the 
82.26 	medications, including controlled substances;
82.27 	(4) the medications must be placed in a medication container or containers 
82.28 	appropriate to the provider's medication system and must be labeled with the client's name 
82.29 	and the dates and times that the medications are scheduled; and
82.30 	(5) the client or client's representative must be provided in writing the home care 
82.31 	provider's name and information on how to contact the home care provider.
82.32 	(b) For unplanned time away when the licensed nurse is not available, the registered 
82.33 	nurse may delegate this task to unlicensed personnel if:
82.34 	(1) the registered nurse has trained the unlicensed staff and determined the 
82.35 	unlicensed staff is competent to follow the procedures for giving medications to clients;
83.1 	(2) the registered nurse has developed written procedures for the unlicensed 
83.2 	personnel, including any special instructions or procedures regarding controlled substances 
83.3 	that are prescribed for the client. The procedures must address:
83.4 	(i) the type of container or containers to be used for the medications appropriate to 
83.5 	the provider's medication system;
83.6 	(ii) how the container or containers must be labeled;
83.7 	(iii) the written information about the medications to be given to the client or client's 
83.8 	representative;
83.9 	(iv) how the unlicensed staff must document in the client's record that medications 
83.10 	have been given to the client or the client's representative, including documenting the date 
83.11 	the medications were given to the client or the client's representative and who received the 
83.12 	medications, the person who gave the medications to the client, the number of medications 
83.13 	that were given to the client, and other required information;
83.14 	(v) how the registered nurse shall be notified that medications have been given to 
83.15 	the client or client's representative and whether the registered nurse needs to be contacted 
83.16 	before the medications are given to the client or the client's representative; and
83.17 	(vi) a review by the registered nurse of the completion of this task to verify that this 
83.18 	task was completed accurately by the unlicensed personnel.
83.19 		Subd. 11.Prescribed and nonprescribed medication. The comprehensive home 
83.20 	care provider must determine whether the comprehensive home care provider shall require 
83.21 	a prescription for all medications the provider manages. The comprehensive home care 
83.22 	provider must inform the client or the client's representative whether the comprehensive 
83.23 	home care provider requires a prescription for all over-the-counter and dietary supplements 
83.24 	before the comprehensive home care provider agrees to manage those medications.
83.25 		Subd. 12.Medications; over-the-counter; dietary supplements not prescribed.
 83.26 	A comprehensive home care provider providing medication management services for 
83.27 	over-the-counter drugs or dietary supplements must retain those items in the original labeled 
83.28 	container with directions for use prior to setting up for immediate or later administration. 
83.29 	The provider must verify that the medications are up-to-date and stored as appropriate.
83.30 		Subd. 13.Prescriptions. There must be a current written or electronically recorded 
83.31 	prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed 
83.32 	medications that the comprehensive home care provider is managing for the client.
83.33 		Subd. 14.Renewal of prescriptions. Prescriptions must be renewed at least 
83.34 	every 12 months or more frequently as indicated by the assessment in subdivision 2. 
83.35 	Prescriptions for controlled substances must comply with chapter 152.
84.1 		Subd. 15.Verbal prescription orders. Verbal prescription orders from an 
84.2 	authorized prescriber must be received by a nurse or pharmacist. The order must be 
84.3 	handled according to Minnesota Rules, part 6800.6200. 
84.4 		Subd. 16.Written or electronic prescription. When a written or electronic 
84.5 	prescription is received, it must be communicated to the registered nurse in charge and 
84.6 	recorded or placed in the client's record.
84.7 		Subd. 17.Records confidential. A prescription or order received verbally, in 
84.8 	writing, or electronically must be kept confidential according to sections 144.291 to 
84.9 	144.298 and 144A.44.
84.10 		Subd. 18.Medications provided by client or family members. When the 
84.11 	comprehensive home care provider is aware of any medications or dietary supplements 
84.12 	that are being used by the client and are not included in the assessment for medication 
84.13 	management services, the staff must advise the registered nurse and document that in 
84.14 	the client's record.
84.15 		Subd. 19.Storage of medications. A comprehensive home care provider providing 
84.16 	storage of medications outside of the client's private living space must store all prescription 
84.17 	medications in securely locked and substantially constructed compartments according to 
84.18 	the manufacturer's directions and permit only authorized personnel to have access.
84.19 		Subd. 20.Prescription drugs. A prescription drug, prior to being set up for 
84.20 	immediate or later administration, must be kept in the original container in which it was 
84.21 	dispensed by the pharmacy bearing the original prescription label with legible information 
84.22 	including the expiration or beyond-use date of a time-dated drug.
84.23 		Subd. 21.Prohibitions. No prescription drug supply for one client may be used or 
84.24 	saved for use by anyone other than the client.
84.25 		Subd. 22.Disposition of medications. (a) Any current medications being managed 
84.26 	by the comprehensive home care provider must be given to the client or the client's 
84.27 	representative when the client's service plan ends or medication management services 
84.28 	are no longer part of the service plan. Medications that have been stored in the client's 
84.29 	private living space for a client that is deceased or that have been discontinued or that have 
84.30 	expired may be given to the client or the client's representative for disposal.
84.31 	(b) The comprehensive home care provider will dispose of any medications 
84.32 	remaining with the comprehensive home care provider that are discontinued or expired or 
84.33 	upon the termination of the service contract or the client's death according to state and 
84.34 	federal regulations for disposition of medications and controlled substances.
84.35 	(c) Upon disposition, the comprehensive home care provider must document in the 
84.36 	client's record the disposition of the medication including the medication's name, strength, 
85.1 	prescription number as applicable, quantity, to whom the medications were given, date of 
85.2 	disposition, and names of staff and other individuals involved in the disposition.
85.3 		Subd. 23.Loss or spillage. (a) Comprehensive home care providers providing 
85.4 	medication management must develop and implement procedures for loss or spillage of all 
85.5 	controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must 
85.6 	require that when a spillage of a controlled substance occurs, a notation must be made 
85.7 	in the client's record explaining the spillage and the actions taken. The notation must 
85.8 	be signed by the person responsible for the spillage and include verification that any 
85.9 	contaminated substance was disposed of according to state or federal regulations.
85.10 	(b) The procedures must require the comprehensive home care provider of 
85.11 	medication management to investigate any known loss or unaccounted for prescription 
85.12 	drugs and take appropriate action required under state or federal regulations and document 
85.13 	the investigation in required records.

85.14 	Sec. 16. [144A.4793] TREATMENT AND THERAPY MANAGEMENT 
85.15 	SERVICES.
85.16 		Subdivision 1.Providers with a comprehensive home care license. This section 
85.17 	applies only to home care providers with a comprehensive home care license that provide 
85.18 	treatment or therapy management services to clients. Treatment or therapy management 
85.19 	services cannot be provided by a home care provider that has a basic home care license.
85.20 		Subd. 2.Policies and procedures. (a) A comprehensive home care provider who 
85.21 	provides treatment and therapy management services must develop, implement, and 
85.22 	maintain up-to-date written treatment or therapy management policies and procedures. 
85.23 	The policies and procedures must be developed under the supervision and direction of 
85.24 	a registered nurse or appropriate licensed health professional consistent with current 
85.25 	practice standards and guidelines.
85.26 	(b) The written policies and procedures must address requesting and receiving 
85.27 	orders or prescriptions for treatments or therapies, providing the treatment or therapy, 
85.28 	documenting of treatment or therapy activities, educating and communicating with clients 
85.29 	about treatments or therapy they are receiving, monitoring and evaluating the treatment 
85.30 	and therapy, and communicating with the prescriber.
85.31 		Subd. 3.Individualized treatment or therapy management plan. For each 
85.32 	client receiving management of ordered or prescribed treatments or therapy services, the 
85.33 	comprehensive home care provider must prepare and include in the service plan a written 
85.34 	statement of the treatment or therapy services that will be provided to the client. The 
86.1 	provider must also develop and maintain a current individualized treatment and therapy 
86.2 	management record for each client which must contain at least the following: 
86.3 	(1) a statement of the type of services that will be provided;
86.4 	(2) documentation of specific client instructions relating to the treatments or therapy 
86.5 	administration;
86.6 	(3) identification of treatment or therapy tasks that will be delegated to unlicensed 
86.7 	personnel; 
86.8 	(4) procedures for notifying a registered nurse or appropriate licensed health 
86.9 	professional when a problem arises with treatments or therapy services; and
86.10 	(5) any client-specific requirements relating to documentation of treatment 
86.11 	and therapy received, verification that all treatment and therapy was administered as 
86.12 	prescribed, and monitoring of treatment or therapy to prevent possible complications or 
86.13 	adverse reactions. The treatment or therapy management record must be current and 
86.14 	updated when there are any changes.
86.15 		Subd. 4.Administration of treatments and therapy. Ordered or prescribed 
86.16 	treatments or therapies must be administered by a nurse, physician, or other licensed health 
86.17 	professional authorized to perform the treatment or therapy, or may be delegated or assigned 
86.18 	to unlicensed personnel by the licensed health professional according to the appropriate 
86.19 	practice standards for delegation or assignment. When administration of a treatment or 
86.20 	therapy is delegated or assigned to unlicensed personnel, the home care provider must 
86.21 	ensure that the registered nurse or authorized licensed health professional has:
86.22 	(1) instructed the unlicensed personnel in the proper methods with respect to each 
86.23 	client and the unlicensed personnel has demonstrated the ability to competently follow 
86.24 	the procedures;
86.25 	(2) specified, in writing, specific instructions for each client and documented those 
86.26 	instructions in the client's record; and
86.27 	(3) communicated with the unlicensed personnel about the individual needs of 
86.28 	the client.
86.29 		Subd. 5.Documentation of administration of treatments and therapies. Each 
86.30 	treatment or therapy administered by a comprehensive home care provider must be 
86.31 	documented in the client's record. The documentation must include the signature and title 
86.32 	of the person who administered the treatment or therapy and must include the date and 
86.33 	time of administration. When treatment or therapies are not administered as ordered or 
86.34 	prescribed, the provider must document the reason why it was not administered and any 
86.35 	follow-up procedures that were provided to meet the client's needs.
87.1 		Subd. 6.Orders or prescriptions. There must be an up-to-date written or 
87.2 	electronically recorded order or prescription for all treatments and therapies. The order 
87.3 	must contain the name of the client, description of the treatment or therapy to be provided, 
87.4 	and the frequency and other information needed to administer the treatment or therapy.

87.5 	Sec. 17. [144A.4794] CLIENT RECORD REQUIREMENTS.
87.6 		Subdivision 1.Client record. (a) The home care provider must maintain records 
87.7 	for each client for whom it is providing services. Entries in the client records must be 
87.8 	current, legible, permanently recorded, dated, and authenticated with the name and title 
87.9 	of the person making the entry.
87.10 	(b) Client records, whether written or electronic, must be protected against loss, 
87.11 	tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable 
87.12 	relevant federal and state laws. The home care provider shall establish and implement 
87.13 	written procedures to control use, storage, and security of client's records and establish 
87.14 	criteria for release of client information.
87.15 	(c) The home care provider may not disclose to any other person any personal, 
87.16 	financial, medical, or other information about the client, except:
87.17 	(1) as may be required by law;
87.18 	(2) to employees or contractors of the home care provider, another home care 
87.19 	provider, other health care practitioner or provider, or inpatient facility needing 
87.20 	information in order to provide services to the client, but only such information that 
87.21 	is necessary for the provision of services;
87.22 	(3) to persons authorized in writing by the client or the client's representative to 
87.23 	receive the information, including third-party payers; and
87.24 	(4) to representatives of the commissioner authorized to survey or investigate home 
87.25 	care providers under this chapter or federal laws.
87.26 		Subd. 2.Access to records. The home care provider must ensure that the 
87.27 	appropriate records are readily available to employees or contractors authorized to access 
87.28 	the records. Client records must be maintained in a manner that allows for timely access, 
87.29 	printing, or transmission of the records.
87.30 		Subd. 3.Contents of client record. Contents of a client record include the 
87.31 	following for each client:
87.32 	(1) identifying information, including the client's name, date of birth, address, and 
87.33 	telephone number;
87.34 	(2) the name, address, and telephone number of an emergency contact, family 
87.35 	members, client's representative, if any, or others as identified;
88.1 	(3) names, addresses, and telephone numbers of the client's health and medical 
88.2 	service providers and other home care providers, if known;
88.3 	(4) health information, including medical history, allergies, and when the provider 
88.4 	is managing medications, treatments or therapies that require documentation, and other 
88.5 	relevant health records;
88.6 	(5) client's advance directives, if any;
88.7 	(6) the home care provider's current and previous assessments and service plans;
88.8 	(7) all records of communications pertinent to the client's home care services;
88.9 	(8) documentation of significant changes in the client's status and actions taken in 
88.10 	response to the needs of the client including reporting to the appropriate supervisor or 
88.11 	health care professional;
88.12 	(9) documentation of incidents involving the client and actions taken in response 
88.13 	to the needs of the client including reporting to the appropriate supervisor or health 
88.14 	care professional;
88.15 	(10) documentation that services have been provided as identified in the service plan;
88.16 	(11) documentation that the client has received and reviewed the home care bill 
88.17 	of rights;
88.18 	(12) documentation that the client has been provided the statement of disclosure on 
88.19 	limitations of services under section 144A.4791, subdivision 3;
88.20 	(13) documentation of complaints received and resolution;
88.21 	(14) discharge summary, including service termination notice and related 
88.22 	documentation, when applicable; and
88.23 	(15) other documentation required under this chapter and relevant to the client's 
88.24 	services or status.
88.25 		Subd. 4.Transfer of client records. If a client transfers to another home care 
88.26 	provider or other health care practitioner or provider, or is admitted to an inpatient facility, 
88.27 	the home care provider, upon request of the client or the client's representative, shall take 
88.28 	steps to ensure a coordinated transfer including sending a copy or summary of the client's 
88.29 	record to the new home care provider, facility, or the client, as appropriate.
88.30 		Subd. 5.Record retention. Following the client's discharge or termination of 
88.31 	services, a home care provider must retain a client's record for at least five years, or as 
88.32 	otherwise required by state or federal regulations. Arrangements must be made for secure 
88.33 	storage and retrieval of client records if the home care provider ceases business.

88.34 	Sec. 18. [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
89.1 		Subdivision 1.Qualifications, training, and competency. All staff providing 
89.2 	home care services must be trained and competent in the provision of home care services 
89.3 	consistent with current practice standards appropriate to the client's needs.
89.4 		Subd. 2.Licensed health professionals and nurses. (a) Licensed health 
89.5 	professionals and nurses providing home care services as an employee of a licensed home 
89.6 	care provider must possess current Minnesota license or registration to practice.
89.7 	(b) Licensed health professionals and registered nurses must be competent in 
89.8 	assessing client needs, planning appropriate home care services to meet client needs, 
89.9 	implementing services, and supervising staff if assigned.
89.10 	(c) Nothing in this section limits or expands the rights of nurses or licensed health 
89.11 	professionals to provide services within the scope of their licenses or registrations, as 
89.12 	provided by law.
89.13 		Subd. 3.Unlicensed personnel. (a) Unlicensed personnel providing basic home 
89.14 	care services must have:
89.15 	(1) successfully completed a training and competency evaluation appropriate to 
89.16 	the services provided by the home care provider and the topics listed in subdivision 7, 
89.17 	paragraph (b); or
89.18 	(2) demonstrated competency by satisfactorily completing a written or oral test on 
89.19 	the tasks the unlicensed personnel will perform and in the topics listed in subdivision 
89.20 	7, paragraph (b); and successfully demonstrate competency of topics in subdivision 7, 
89.21 	paragraph (b), clauses (5), (7), and (8), by a practical skills test.
89.22 	Unlicensed personnel providing home care services for a basic home care provider may 
89.23 	not perform delegated nursing or therapy tasks.
89.24 	(b) Unlicensed personnel performing delegated nursing tasks for a comprehensive 
89.25 	home care provider must have:
89.26 	(1) successfully completed training and demonstrated competency by successfully 
89.27 	completing a written or oral test of the topics in subdivision 7, paragraphs (b) and (c), and 
89.28 	a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5) and (7), 
89.29 	and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; or
89.30 	(2) satisfy the current requirements of Medicare for training or competency of home 
89.31 	health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, 
89.32 	section 483 or section 484.36; or
89.33 	(3) before April 19, 1993, completed a training course for nursing assistants that was 
89.34 	approved by the commissioner.
89.35 	(c) Unlicensed personnel performing therapy or treatment tasks delegated or 
89.36 	assigned by a licensed health professional must meet the requirements for delegated 
90.1 	tasks in subdivision 4 and any other training or competency requirements within the 
90.2 	licensed health professional scope of practice relating to delegation or assignment of tasks 
90.3 	to unlicensed personnel.
90.4 		Subd. 4.Delegation of home care tasks. A registered nurse or licensed health 
90.5 	professional may delegate tasks only to staff that are competent and possess the knowledge 
90.6 	and skills consistent with the complexity of the tasks and according to the appropriate 
90.7 	Minnesota Practice Act. The comprehensive home care provider must establish and 
90.8 	implement a system to communicate up-to-date information to the registered nurse or 
90.9 	licensed health professional regarding the current available staff and their competency so 
90.10 	the registered nurse or licensed health professional has sufficient information to determine 
90.11 	the appropriateness of delegating tasks to meet individual client needs and preferences.
90.12 		Subd. 5.Individual contractors. When a home care provider contracts with an 
90.13 	individual contractor excluded from licensure under section 144A.471 to provide home 
90.14 	care services, the contractor must meet the same requirements required by this section for 
90.15 	personnel employed by the home care provider.
90.16 		Subd. 6.Temporary staff. When a home care provider contracts with a temporary 
90.17 	staffing agency excluded from licensure under section 144A.471, those individuals must 
90.18 	meet the same requirements required by this section for personnel employed by the home 
90.19 	care provider and shall be treated as if they are staff of the home care provider.
90.20 		Subd. 7.Requirements for instructors, training content, and competency 
90.21 	evaluations for unlicensed personnel. (a) Instructors and competency evaluators must 
90.22 	meet the following requirements:
90.23 	(1) training and competency evaluations of unlicensed personnel providing basic 
90.24 	home care services must be conducted by individuals with work experience and training in 
90.25 	providing home care services listed in section 144A.471, subdivisions 6 and 7; and
90.26 	(2) training and competency evaluations of unlicensed personnel providing 
90.27 	comprehensive home care services must be conducted by a registered nurse, or another 
90.28 	instructor may provide training in conjunction with the registered nurse. If the home care 
90.29 	provider is providing services by licensed health professionals only, then that specific 
90.30 	training and competency evaluation may be conducted by the licensed health professionals 
90.31 	as appropriate.
90.32 	(b) Training and competency evaluations for all unlicensed personnel must include 
90.33 	the following:
90.34 	(1) documentation requirements for all services provided;
90.35 	(2) reports of changes in the client's condition to the supervisor designated by the 
90.36 	home care provider;
91.1 	(3) basic infection control, including blood-borne pathogens;
91.2 	(4) maintenance of a clean and safe environment;
91.3 	(5) appropriate and safe techniques in personal hygiene and grooming, including:
91.4 	(i) hair care and bathing;
91.5 	(ii) care of teeth, gums, and oral prosthetic devices;
91.6 	(iii) care and use of hearing aids; and
91.7 	(iv) dressing and assisting with toileting;
91.8 	(6) training on the prevention of falls for providers working with the elderly or 
91.9 	individuals at risk of falls;
91.10 	(7) standby assistance techniques and how to perform them;
91.11 	(8) medication, exercise, and treatment reminders;
91.12 	(9) basic nutrition, meal preparation, food safety, and assistance with eating;
91.13 	(10) preparation of modified diets as ordered by a licensed health professional;
91.14 	(11) communication skills that include preserving the dignity of the client and 
91.15 	showing respect for the client and the client's preferences, cultural background, and family;
91.16 	(12) awareness of confidentiality and privacy;
91.17 	(13) understanding appropriate boundaries between staff and clients and the client's 
91.18 	family;
91.19 	(14) procedures to utilize in handling various emergency situations; and
91.20 	(15) awareness of commonly used health technology equipment and assistive devices.
91.21 	(c) In addition to paragraph (b), training and competency evaluation for unlicensed 
91.22 	personnel providing comprehensive home care services must include:
91.23 	(1) observation, reporting, and documenting of client status;
91.24 	(2) basic knowledge of body functioning and changes in body functioning, injuries, 
91.25 	or other observed changes that must be reported to appropriate personnel;
91.26 	(3) reading and recording temperature, pulse, and respirations of the client;
91.27 	(4) recognizing physical, emotional, cognitive, and developmental needs of the client;
91.28 	(5) safe transfer techniques and ambulation;
91.29 	(6) range of motioning and positioning; and
91.30 	(7) administering medications or treatments as required.
91.31 	(d) When the registered nurse or licensed health professional delegates tasks, they 
91.32 	must ensure that prior to the delegation the unlicensed personnel is trained in the proper 
91.33 	methods to perform the tasks or procedures for each client and are able to demonstrate 
91.34 	the ability to competently follow the procedures and perform the tasks. If an unlicensed 
91.35 	personnel has not regularly performed the delegated home care task for a period of 24 
91.36 	consecutive months, the unlicensed personnel must demonstrate competency in the task 
92.1 	to the registered nurse or appropriate licensed health professional. The registered nurse 
92.2 	or licensed health professional must document instructions for the delegated tasks in 
92.3 	the client's record.

92.4 	Sec. 19. [144A.4796] ORIENTATION AND ANNUAL TRAINING 
92.5 	REQUIREMENTS.
92.6 		Subdivision 1.Orientation of staff and supervisors to home care. All staff 
92.7 	providing and supervising direct home care services must complete an orientation to home 
92.8 	care licensing requirements and regulations before providing home care services to clients. 
92.9 	The orientation may be incorporated into the training required under subdivision 6. The 
92.10 	orientation need only be completed once for each staff person and is not transferable 
92.11 	to another home care provider.
92.12 		Subd. 2.Content. The orientation must contain the following topics:
92.13 	(1) an overview of sections 144A.43 to 144A.4798;
92.14 	(2) introduction and review of all the provider's policies and procedures related to 
92.15 	the provision of home care services;
92.16 	(3) handling of emergencies and use of emergency services;
92.17 	(4) compliance with and reporting of the maltreatment of minors or vulnerable 
92.18 	adults under sections 626.556 and 626.557;
92.19 	(5) home care bill of rights, under section 144A.44;
92.20 	(6) handling of clients' complaints; reporting of complaints and where to report 
92.21 	complaints including information on the Office of Health Facility Complaints and the 
92.22 	Common Entry Point;
92.23 	(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care, 
92.24 	Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care 
92.25 	Ombudsman at the Department of Human Services, county managed care advocates, 
92.26 	or other relevant advocacy services; and
92.27 	(8) review of the types of home care services the employee will be providing and 
92.28 	the provider's scope of licensure.
92.29 		Subd. 3.Verification and documentation of orientation. Each home care provider 
92.30 	shall retain evidence in the employee record of each staff person having completed the 
92.31 	orientation required by this section.
92.32 		Subd. 4.Orientation to client. Staff providing home care services must be oriented 
92.33 	specifically to each individual client and the services to be provided. This orientation may 
92.34 	be provided in person, orally, in writing, or electronically.
93.1 		Subd. 5.Training required relating to Alzheimer's disease and related disorders.
 93.2 	For home care providers that provide services for persons with Alzheimer's or related 
93.3 	disorders, all direct care staff and supervisors working with those clients must receive 
93.4 	training that includes a current explanation of Alzheimer's disease and related disorders, 
93.5 	effective approaches to use to problem solve when working with a client's challenging 
93.6 	behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
93.7 		Subd. 6.Required annual training. All staff that perform direct home care 
93.8 	services must complete at least eight hours of annual training for each 12 months of 
93.9 	employment. The training may be obtained from the home care provider or another source 
93.10 	and must include topics relevant to the provision of home care services. The annual 
93.11 	training must include:
93.12 	(1) training on reporting of maltreatment of minors under section 626.556 and 
93.13 	maltreatment of vulnerable adults under section 626.557, whichever is applicable to the 
93.14 	services provided;
93.15 	(2) review of the home care bill of rights in section 144A.44;
93.16 	(3) review of infection control techniques used in the home and implementation of 
93.17 	infection control standards including a review of hand washing techniques; the need for 
93.18 	and use of protective gloves, gowns, and masks; appropriate disposal of contaminated 
93.19 	materials and equipment, such as dressings, needles, syringes, and razor blades; 
93.20 	disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of 
93.21 	communicable diseases; and
93.22 	(4) review of the provider's policies and procedures relating to the provision of home 
93.23 	care services and how to implement those policies and procedures.
93.24 		Subd. 7.Documentation. A home care provider must retain documentation in the 
93.25 	employee records of the staff that have satisfied the orientation and training requirements 
93.26 	of this section.

93.27 	Sec. 20. [144A.4797] PROVISION OF SERVICES.
93.28 		Subdivision 1.Availability of contact person to staff. (a) A home care provider 
93.29 	with a basic home care license must have a person available to staff for consultation on 
93.30 	items relating to the provision of services or about the client.
93.31 	(b) A home care provider with a comprehensive home care license must have a 
93.32 	registered nurse available for consultation to staff performing delegated nursing tasks 
93.33 	and must have an appropriate licensed health professional available if performing other 
93.34 	delegated services such as therapies.
94.1 	(c) The appropriate contact person must be readily available either in person, by 
94.2 	telephone, or by other means to the staff at times when the staff is providing services.
94.3 		Subd. 2.Supervision of staff; basic home care services. (a) Staff who perform 
94.4 	basic home care services must be supervised periodically where the services are being 
94.5 	provided to verify that the work is being performed competently and to identify problems 
94.6 	and solutions to address issues relating to the staff's ability to provide the services. The 
94.7 	supervision of the unlicensed personnel must be done by staff of the home care provider 
94.8 	having the authority, skills, and ability to provide the supervision of unlicensed personnel 
94.9 	and who can implement changes as needed, and train staff.
94.10 	(b) Supervision includes direct observation of unlicensed personnel while they 
94.11 	are providing the services and may also include indirect methods of gaining input such 
94.12 	as gathering feedback from the client. Supervisory review of staff must be provided at a 
94.13 	frequency based on the staff person's competency and performance.
94.14 	(c) For an individual who is licensed as a home care provider, this section does 
94.15 	not apply.
94.16 		Subd. 3.Supervision of staff providing delegated nursing or therapy home 
94.17 	care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be 
94.18 	supervised by an appropriate licensed health professional or a registered nurse periodically 
94.19 	where the services are being provided to verify that the work is being performed 
94.20 	competently and to identify problems and solutions related to the staff person's ability to 
94.21 	perform the tasks. Supervision of staff performing medication or treatment administration 
94.22 	shall be provided by a registered nurse or appropriate licensed health professional and 
94.23 	must include observation of the staff administering the medication or treatment and the 
94.24 	interaction with the client.
94.25 	(b) The direct supervision of staff performing delegated tasks must be provided 
94.26 	within 30 days after the individual begins working for the home care provider and 
94.27 	thereafter as needed based on performance. This requirement also applies to staff who 
94.28 	have not performed delegated tasks for one year or longer.
94.29 		Subd. 4.Documentation. A home care provider must retain documentation of 
94.30 	supervision activities in the personnel records.
94.31 		Subd. 5.Exemption. This section does not apply to an individual licensed under 
94.32 	sections 144A.43 to 144A.4799.

94.33 	Sec. 21. [144A.4798] EMPLOYEE HEALTH STATUS.
94.34 		Subdivision 1.Tuberculosis (TB) prevention and control. A home care provider 
94.35 	must establish and maintain a TB prevention and control program based on the most 
95.1 	current guidelines issued by the Centers for Disease Control and Prevention (CDC). 
95.2 	Components of a TB prevention and control program include screening all staff providing 
95.3 	home care services, both paid and unpaid, at the time of hire for active TB disease and 
95.4 	latent TB infection, and developing and implementing a written TB infection control plan. 
95.5 	The commissioner shall make the most recent CDC standards available to home care 
95.6 	providers on the department's Web site.
95.7 		Subd. 2.Communicable diseases. A home care provider must follow 
95.8 	current federal or state guidelines for prevention, control, and reporting of human 
95.9 	immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other 
95.10 	communicable diseases as defined in Minnesota Rules, part 4605.7040.

95.11 	Sec. 22. [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE 
95.12 	PROVIDER ADVISORY COUNCIL.
95.13 		Subdivision 1.Membership. The commissioner of health shall appoint eight 
95.14 	persons to a home care provider advisory council consisting of the following:
95.15 	(1) three public members as defined in section 214.02 who shall be either persons 
95.16 	who are currently receiving home care services or have family members receiving home 
95.17 	care services, or persons who have family members who have received home care services 
95.18 	within five years of the application date;
95.19 	(2) three Minnesota home care licensees representing basic and comprehensive 
95.20 	levels of licensure who may be a managerial official, an administrator, a supervising 
95.21 	registered nurse, or an unlicensed personnel performing home care tasks;
95.22 	(3) one member representing the Minnesota Board of Nursing; and
95.23 	(4) one member representing the ombudsman for long-term care.
95.24 		Subd. 2.Organizations and meetings. The advisory council shall be organized 
95.25 	and administered under section 15.059 with per diems and costs paid within the limits of 
95.26 	available appropriations. Meetings will be held quarterly and hosted by the department. 
95.27 	Subcommittees may be developed as necessary by the commissioner. Advisory council 
95.28 	meetings are subject to the Open Meeting Law under chapter 13D.
95.29 		Subd. 3.Duties. At the commissioner's request, the advisory council shall provide 
95.30 	advice regarding regulations of Department of Health licensed home care providers in 
95.31 	this chapter such as:
95.32 	(1) advice to the commissioner regarding community standards for home care 
95.33 	practices;
95.34 	(2) advice to the commissioner on enforcement of licensing standards and whether 
95.35 	certain disciplinary actions are appropriate;
96.1 	(3) advice to the commissioner about ways of distributing information to licensees 
96.2 	and consumers of home care;
96.3 	(4) advice to the commissioner about training standards;
96.4 	(5) identify emerging issues and opportunities in the home care field, including the 
96.5 	use of technology in home and telehealth capabilities; and
96.6 	(6) perform other duties as directed by the commissioner.

96.7 	Sec. 23. [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR 
96.8 	NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
96.9 		Subdivision 1.Temporary home care licenses and changes of ownership. (a) 
96.10 	Beginning January 1, 2014, all temporary license applicants must apply for either a 
96.11 	temporary basic or comprehensive home care license.
96.12 	(b) Temporary home care licenses issued beginning January 1, 2014, shall be 
96.13 	issued to licensees according to sections 144A.43 to 144A.4799, and the fees in section 
96.14 	144A.472. Licensees must comply with the requirements of this chapter.
96.15 	(c) No temporary licenses will be accepted or issued between October 1, 2013, 
96.16 	and December 31, 2013.
96.17 	(d) Beginning October 1, 2013, changes in ownership applications will require 
96.18 	payment of the new fees listed in section 144A.472.
96.19 		Subd. 2.Current home care licensees with licenses prior to July 1, 2013. (a) 
96.20 	Beginning July 1, 2014, department licensed home care providers must apply for either 
96.21 	the basic or comprehensive home care license on their regularly scheduled renewal date.
96.22 	(b) By June 30, 2015, all home care providers must either have a basic or 
96.23 	comprehensive home care license or temporary license.
96.24 		Subd. 3.Renewal application of home care licensure during transition period.
 96.25 	Renewal of home care licenses issued beginning July 1, 2014, will be issued according to 
96.26 	sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with 
96.27 	sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home 
96.28 	care licensure law in effect on June 30, 2013.
96.29 	The fees charged for licenses renewed between July 1, 2014, and June 30, 2016, 
96.30 	shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000 
96.31 	increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
96.32 	For fiscal year 2014 only, the fees for providers with revenues greater than $25,000 
96.33 	and no more than $100,000 will be $313 and for providers with revenues no more than 
96.34 	$25,000 the fee will be $125.

97.1 	Sec. 24. [144A.482] REGISTRATION OF HOME MANAGEMENT 
97.2 	PROVIDERS.
97.3 	(a) For purposes of this section, a home management provider is an individual or 
97.4 	organization that provides at least two of the following services: housekeeping, meal 
97.5 	preparation, and shopping to a person who is unable to perform these activities due to 
97.6 	illness, disability, or physical condition.
97.7 	(b) A person or organization that provides only home management services may not 
97.8 	operate in the state without a current certificate of registration issued by the commissioner 
97.9 	of health. To obtain a certificate of registration, the person or organization must annually 
97.10 	submit to the commissioner the name, mailing and physical addresses, e-mail address, and 
97.11 	telephone number of the person or organization and a signed statement declaring that the 
97.12 	person or organization is aware that the home care bill of rights applies to their clients and 
97.13 	that the person or organization will comply with the home care bill of rights provisions 
97.14 	contained in section 144A.44. A person or organization applying for a certificate must 
97.15 	also provide the name, business address, and telephone number of each of the persons 
97.16 	responsible for the management or direction of the organization. 
97.17 	(c) The commissioner shall charge an annual registration fee of $20 for persons and 
97.18 	$50 for organizations. The registration fee shall be deposited in the state treasury and 
97.19 	credited to the state government special revenue fund.
97.20 	(d) A home care provider that provides home management services and other home 
97.21 	care services must be licensed, but licensure requirements other than the home care bill of 
97.22 	rights do not apply to those employees or volunteers who provide only home management 
97.23 	services to clients who do not receive any other home care services from the provider. 
97.24 	A licensed home care provider need not be registered as a home management service 
97.25 	provider but must provide an orientation on the home care bill of rights to its employees 
97.26 	or volunteers who provide home management services.
97.27 	(e) An individual who provides home management services under this section must, 
97.28 	within 120 days after beginning to provide services, attend an orientation session approved 
97.29 	by the commissioner that provides training on the home care bill of rights and an orientation 
97.30 	on the aging process and the needs and concerns of elderly and disabled persons.
97.31 	(f) The commissioner may suspend or revoke a provider's certificate of registration 
97.32 	or assess fines for violation of the home care bill of rights. Any fine assessed for a 
97.33 	violation of the home care bill of rights by a provider registered under this section shall be 
97.34 	in the amount established in the licensure rules for home care providers. As a condition 
97.35 	of registration, a provider must cooperate fully with any investigation conducted by the 
97.36 	commissioner, including providing specific information requested by the commissioner on 
98.1 	clients served and the employees and volunteers who provide services. Fines collected 
98.2 	under this paragraph shall be deposited in the state treasury and credited to the fund 
98.3 	specified in the statute or rule in which the penalty was established.
98.4 	(g) The commissioner may use any of the powers granted in sections 144A.43 to 
98.5 	144A.4799 to administer the registration system and enforce the home care bill of rights 
98.6 	under this section.

98.7 	ARTICLE 5
98.8 	HEALTH DEPARTMENT

98.9 	Section 1. [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS 
98.10 	FACILITY.
98.11 		Subdivision 1.License requirement. Except as provided in section 149A.01, 
98.12 	subdivision 3, a place or premise shall not be maintained, managed, or operated which 
98.13 	is devoted to or used in the holding and alkaline hydrolysis of a dead human body 
98.14 	without possessing a valid license to operate an alkaline hydrolysis facility issued by the 
98.15 	commissioner of health.
98.16 		Subd. 2.Requirements for an alkaline hydrolysis facility. (a) An alkaline 
98.17 	hydrolysis facility licensed under this section must consist of:
98.18 	(1) a building or structure that complies with applicable local and state building 
98.19 	codes, zoning laws and ordinances, wastewater management and environmental standards, 
98.20 	containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead 
98.21 	human bodies;
98.22 	(2) a method approved by the commissioner of health to dry the hydrolyzed remains 
98.23 	and which is located within the licensed facility;
98.24 	(3) a means approved by the commissioner of health for refrigeration of dead human 
98.25 	bodies awaiting alkaline hydrolysis;
98.26 	(4) an appropriate means of processing hydrolyzed remains to a granulated 
98.27 	appearance appropriate for final disposition; and
98.28 	(5) an appropriate holding facility for dead human bodies awaiting alkaline 
98.29 	hydrolysis.
98.30 	(b) An alkaline hydrolysis facility licensed under this section may also contain a 
98.31 	display room for funeral goods.
98.32 		Subd. 3.Application procedure; documentation; initial inspection. An 
98.33 	application to license and operate an alkaline hydrolysis facility shall be submitted to the 
98.34 	commissioner of health. A completed application includes:
98.35 	(1) a completed application form, as provided by the commissioner;
99.1 	(2) proof of business form and ownership;
99.2 	(3) proof of liability insurance coverage or other financial documentation, as 
99.3 	determined by the commissioner, that demonstrates the applicant's ability to respond in 
99.4 	damages for liability arising from the ownership, maintenance management, or operation 
99.5 	of an alkaline hydrolysis facility; and
99.6 	(4) copies of wastewater and other environmental regulatory permits and 
99.7 	environmental regulatory licenses necessary to conduct operations.
99.8 	Upon receipt of the application and appropriate fee, the commissioner shall review and 
99.9 	verify all information. Upon completion of the verification process and resolution of any 
99.10 	deficiencies in the application information, the commissioner shall conduct an initial 
99.11 	inspection of the premises to be licensed. After the inspection and resolution of any 
99.12 	deficiencies found and any reinspections as may be necessary, the commissioner shall 
99.13 	make a determination, based on all the information available, to grant or deny licensure. If 
99.14 	the commissioner's determination is to grant the license, the applicant shall be notified and 
99.15 	the license shall issue and remain valid for a period prescribed on the license, but not to 
99.16 	exceed one calendar year from the date of issuance of the license. If the commissioner's 
99.17 	determination is to deny the license, the commissioner must notify the applicant in writing 
99.18 	of the denial and provide the specific reason for denial.
99.19 		Subd. 4.Nontransferability of license. A license to operate an alkaline hydrolysis 
99.20 	facility is not assignable or transferable and shall not be valid for any entity other than the 
99.21 	one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the 
99.22 	location identified on the license. A 50 percent or more change in ownership or location of 
99.23 	the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall 
99.24 	be required of two or more persons or other legal entities operating from the same location.
99.25 		Subd. 5.Display of license. Each license to operate an alkaline hydrolysis 
99.26 	facility must be conspicuously displayed in the alkaline hydrolysis facility at all times. 
99.27 	Conspicuous display means in a location where a member of the general public within the 
99.28 	alkaline hydrolysis facility will be able to observe and read the license.
99.29 		Subd. 6.Period of licensure. All licenses to operate an alkaline hydrolysis facility 
99.30 	issued by the commissioner are valid for a period of one calendar year beginning on July 1 
99.31 	and ending on June 30, regardless of the date of issuance.
99.32 		Subd. 7.Reporting changes in license information. Any change of license 
99.33 	information must be reported to the commissioner, on forms provided by the 
99.34 	commissioner, no later than 30 calendar days after the change occurs. Failure to report 
99.35 	changes is grounds for disciplinary action.
100.1 		Subd. 8.Notification to the commissioner. If the licensee is operating under a 
100.2 	wastewater or an environmental permit or license that is subsequently revoked, denied, 
100.3 	or terminated, the licensee shall notify the commissioner.
100.4 		Subd. 9.Application information. All information submitted to the commissioner 
100.5 	for a license to operate an alkaline hydrolysis facility is classified as licensing data under 
100.6 	section 13.41, subdivision 5.

100.7 	Sec. 2. [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE 
100.8 	HYDROLYSIS FACILITY.
100.9 		Subdivision 1.Renewal required. All licenses to operate an alkaline hydrolysis 
100.10 	facility issued by the commissioner expire on June 30 following the date of issuance of the 
100.11 	license and must be renewed to remain valid.
100.12 		Subd. 2.Renewal procedure and documentation. Licensees who wish to renew 
100.13 	their licenses must submit to the commissioner a completed renewal application no later 
100.14 	than June 30 following the date the license was issued. A completed renewal application 
100.15 	includes:
100.16 	(1) a completed renewal application form, as provided by the commissioner; and
100.17 	(2) proof of liability insurance coverage or other financial documentation, as 
100.18 	determined by the commissioner, that demonstrates the applicant's ability to respond in 
100.19 	damages for liability arising from the ownership, maintenance, management, or operation 
100.20 	of an alkaline hydrolysis facility.
100.21 	Upon receipt of the completed renewal application, the commissioner shall review and 
100.22 	verify the information. Upon completion of the verification process and resolution of 
100.23 	any deficiencies in the renewal application information, the commissioner shall make a 
100.24 	determination, based on all the information available, to reissue or refuse to reissue the 
100.25 	license. If the commissioner's determination is to reissue the license, the applicant shall 
100.26 	be notified and the license shall issue and remain valid for a period prescribed on the 
100.27 	license, but not to exceed one calendar year from the date of issuance of the license. If 
100.28 	the commissioner's determination is to refuse to reissue the license, section 149A.09, 
100.29 	subdivision 2, applies.
100.30 		Subd. 3.Penalty for late filing. Renewal applications received after the expiration 
100.31 	date of a license will result in the assessment of a late filing penalty. The late filing penalty 
100.32 	must be paid before the reissuance of the license and received by the commissioner no 
100.33 	later than 31 calendar days after the expiration date of the license.
100.34 		Subd. 4.Lapse of license. Licenses to operate alkaline hydrolysis facilities 
100.35 	shall automatically lapse when a completed renewal application is not received by the 
101.1 	commissioner within 31 calendar days after the expiration date of a license, or a late 
101.2 	filing penalty assessed under subdivision 3 is not received by the commissioner within 31 
101.3 	calendar days after the expiration of a license.
101.4 		Subd. 5.Effect of lapse of license. Upon the lapse of a license, the person to whom 
101.5 	the license was issued is no longer licensed to operate an alkaline hydrolysis facility in 
101.6 	Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed 
101.7 	license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue 
101.8 	any additional lawful remedies as justified by the case.
101.9 		Subd. 6.Restoration of lapsed license. The commissioner may restore a lapsed 
101.10 	license upon receipt and review of a completed renewal application, receipt of the late 
101.11 	filing penalty, and reinspection of the premises, provided that the receipt is made within 
101.12 	one calendar year from the expiration date of the lapsed license and the cease and desist 
101.13 	order issued by the commissioner has not been violated. If a lapsed license is not restored 
101.14 	within one calendar year from the expiration date of the lapsed license, the holder of the 
101.15 	lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
101.16 		Subd. 7.Reporting changes in license information. Any change of license 
101.17 	information must be reported to the commissioner, on forms provided by the 
101.18 	commissioner, no later than 30 calendar days after the change occurs. Failure to report 
101.19 	changes is grounds for disciplinary action.
101.20 		Subd. 8.Application information. All information submitted to the commissioner 
101.21 	by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is 
101.22 	classified as licensing data under section 13.41, subdivision 5.

101.23 	Sec. 3. [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE 
101.24 	HYDROLYSIS.
101.25 		Subdivision 1.License required. A dead human body may only be hydrolyzed in 
101.26 	this state at an alkaline hydrolysis facility licensed by the commissioner of health.
101.27 		Subd. 2.General requirements. Any building to be used as an alkaline hydrolysis 
101.28 	facility must comply with all applicable local and state building codes, zoning laws and 
101.29 	ordinances, wastewater management regulations, and environmental statutes, rules, and 
101.30 	standards. An alkaline hydrolysis facility must have, on site, a purpose built human 
101.31 	alkaline hydrolysis system approved by the commissioner of health, a system approved by 
101.32 	the commissioner of health for drying the hydrolyzed remains, a motorized mechanical 
101.33 	device approved by the commissioner of health for processing hydrolyzed remains and 
101.34 	must have in the building a holding facility approved by the commissioner of health for 
101.35 	the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility 
102.1 	must be secure from access by anyone except the authorized personnel of the alkaline 
102.2 	hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of 
102.3 	the alkaline hydrolysis facility personnel.
102.4 		Subd. 3.Lighting and ventilation. The room where the alkaline hydrolysis vessel 
102.5 	is located and the room where the chemical storage takes place shall be properly lit and 
102.6 	ventilated with an exhaust fan that provides at least 12 air changes per hour.
102.7 		Subd. 4.Plumbing connections. All plumbing fixtures, water supply lines, 
102.8 	plumbing vents, and waste drains shall be properly vented and connected pursuant to the 
102.9 	Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a 
102.10 	functional sink with hot and cold running water.
102.11 		Subd. 5.Flooring, walls, ceiling, doors, and windows. The room where the 
102.12 	alkaline hydrolysis vessel is located and the room where the chemical storage takes place 
102.13 	shall have nonporous flooring, so that a sanitary condition is provided. The walls and 
102.14 	ceiling of the room where the alkaline hydrolysis vessel is located and the room where 
102.15 	the chemical storage takes place shall run from floor to ceiling and be covered with tile, 
102.16 	or by plaster or sheetrock painted with washable paint or other appropriate material so 
102.17 	that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be 
102.18 	constructed to prevent odors from entering any other part of the building. All windows 
102.19 	or other openings to the outside must be screened and all windows must be treated in a 
102.20 	manner that prevents viewing into the room where the alkaline hydrolysis vessel is located 
102.21 	and the room where the chemical storage takes place. A viewing window for authorized 
102.22 	family members or their designees is not a violation of this subdivision.
102.23 		Subd. 6.Equipment and supplies. The alkaline hydrolysis facility must have a 
102.24 	functional emergency eye wash and quick drench shower.
102.25 		Subd. 7.Access and privacy. (a) The room where the alkaline hydrolysis vessel is 
102.26 	located and the room where the chemical storage takes place must be private and have no 
102.27 	general passageway through it. The room shall, at all times, be secure from the entrance of 
102.28 	unauthorized persons. Authorized persons are:
102.29 	(1) licensed morticians;
102.30 	(2) registered interns or students as described in section 149A.91, subdivision 6;
102.31 	(3) public officials or representatives in the discharge of their official duties; 
102.32 	(4) trained alkaline hydrolysis facility operators; and
102.33 	(5) the person(s) with the right to control the dead human body as defined in section 
102.34 	149A.80, subdivision 2, and their designees.
102.35 	(b) Each door allowing ingress or egress shall carry a sign that indicates that the 
102.36 	room is private and access is limited. All authorized persons who are present in or enter 
103.1 	the room where the alkaline hydrolysis vessel is located while a body is being prepared for 
103.2 	final disposition must be attired according to all applicable state and federal regulations 
103.3 	regarding the control of infectious disease and occupational and workplace health and 
103.4 	safety.
103.5 		Subd. 8.Sanitary conditions and permitted use. The room where the alkaline 
103.6 	hydrolysis vessel is located and the room where the chemical storage takes place and all 
103.7 	fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies 
103.8 	stored or used in the room must be maintained in a clean and sanitary condition at all times.
103.9 		Subd. 9.Boiler use. When a boiler is required by the manufacturer of the alkaline 
103.10 	hydrolysis vessel for its operation, all state and local regulations for that boiler must be 
103.11 	followed.
103.12 		Subd. 10.Occupational and workplace safety. All applicable provisions of state 
103.13 	and federal regulations regarding exposure to workplace hazards and accidents shall be 
103.14 	followed in order to protect the health and safety of all authorized persons at the alkaline 
103.15 	hydrolysis facility.
103.16 		Subd. 11.Licensed personnel. A licensed alkaline hydrolysis facility must employ 
103.17 	a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body. 
103.18 	It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for 
103.19 	all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for 
103.20 	compliance with this chapter and other applicable state and federal regulations regarding 
103.21 	occupational and workplace health and safety.
103.22 		Subd. 12.Authorization to hydrolyze required. No alkaline hydrolysis facility 
103.23 	shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part 
103.24 	without receiving written authorization to do so from the person or persons who have the 
103.25 	legal right to control disposition as described in section 149A.80 or the person's legal 
103.26 	designee. The written authorization must include:
103.27 	(1) the name of the deceased and the date of death of the deceased;
103.28 	(2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
103.29 	(3) the name, address, telephone number, relationship to the deceased, and signature 
103.30 	of the person or persons with legal right to control final disposition or a legal designee;
103.31 	(4) directions for the disposition of any nonhydrolyzed materials or items recovered 
103.32 	from the alkaline hydrolysis vessel;
103.33 	(5) acknowledgment that the hydrolyzed remains will be dried and mechanically 
103.34 	reduced to a granulated appearance and placed in an appropriate container and 
103.35 	authorization to place any hydrolyzed remains that a selected urn or container will not 
103.36 	accommodate into a temporary container;
104.1 	(6) acknowledgment that, even with the exercise of reasonable care, it is not possible 
104.2 	to recover all particles of the hydrolyzed remains and that some particles may inadvertently 
104.3 	become commingled with particles of other hydrolyzed remains that remain in the alkaline 
104.4 	hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
104.5 	(7) directions for the ultimate disposition of the hydrolyzed remains; and
104.6 	(8) a statement that includes, but is not limited to, the following information: 
104.7 	"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an 
104.8 	alkaline solution is used to chemically break down the human tissue and the hydrolyzable 
104.9 	alkaline hydrolysis container. After the process is complete, the liquid effluent solution 
104.10 	contains the chemical by-products of the alkaline hydrolysis process except for the 
104.11 	deceased's bone fragments. The solution is cooled and released according to local 
104.12 	environmental regulations. A water rinse is applied to the hydrolyzed remains which are 
104.13 	then dried and processed to facilitate inurnment or scattering."
104.14 		Subd. 13.Limitation of liability. A licensed alkaline hydrolysis facility acting in 
104.15 	good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an 
104.16 	authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from 
104.17 	civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis 
104.18 	facility.
104.19 		Subd. 14.Acceptance of delivery of body. (a) No dead human body shall be 
104.20 	accepted for final disposition by alkaline hydrolysis unless:
104.21 	(1) encased in an appropriate alkaline hydrolysis container;
104.22 	(2) accompanied by a disposition permit issued pursuant to section 149A.93, 
104.23 	subdivision 3, including a photocopy of the completed death record or a signed release 
104.24 	authorizing alkaline hydrolysis of the body received from the coroner or medical 
104.25 	examiner; and
104.26 	(3) accompanied by an alkaline hydrolysis authorization that complies with 
104.27 	subdivision 12.
104.28 	(b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline 
104.29 	hydrolysis container where there is:
104.30 	(1) evidence of leakage of fluids from the alkaline hydrolysis container;
104.31 	(2) a known dispute concerning hydrolysis of the body delivered;
104.32 	(3) a reasonable basis for questioning any of the representations made on the written 
104.33 	authorization to hydrolyze; or
104.34 	(4) any other lawful reason.
105.1 		Subd. 15.Bodies awaiting hydrolysis. A dead human body must be hydrolyzed 
105.2 	within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of 
105.3 	the body.
105.4 		Subd. 16.Handling of alkaline hydrolysis containers for dead human bodies.
 105.5 	All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for 
105.6 	dead human bodies shall use universal precautions and otherwise exercise all reasonable 
105.7 	precautions to minimize the risk of transmitting any communicable disease from the body. 
105.8 	No dead human body shall be removed from the container in which it is delivered.
105.9 		Subd. 17.Identification of body. All licensed alkaline hydrolysis facilities shall 
105.10 	develop, implement, and maintain an identification procedure whereby dead human 
105.11 	bodes can be identified from the time the alkaline hydrolysis facility accepts delivery 
105.12 	of the remains until the hydrolyzed remains are released to an authorized party. After 
105.13 	hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the 
105.14 	hydrolyzed remains container before the hydrolyzed remains are released from the alkaline 
105.15 	hydrolysis facility. Each identification disk, tab, or label shall have a number that shall 
105.16 	be recorded on all paperwork regarding the decedent. This procedure shall be designed 
105.17 	to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains 
105.18 	are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the 
105.19 	inability to individually identify the hydrolyzed remains is a violation of this subdivision.
105.20 		Subd. 18.Alkaline hydrolysis vessel for human remains. A licensed alkaline 
105.21 	hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains 
105.22 	in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for 
105.23 	infectious disease control.
105.24 		Subd. 19.Alkaline hydrolysis procedures; privacy. The final disposition of 
105.25 	dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is 
105.26 	written authorization from the person with the legal right to control the disposition, 
105.27 	only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline 
105.28 	hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting 
105.29 	alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline 
105.30 	hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
105.31 		Subd. 20.Alkaline hydrolysis procedures; commingling of hydrolyzed remains 
105.32 	prohibited. Except with the express written permission of the person with the legal right 
105.33 	to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one 
105.34 	dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce 
105.35 	a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have 
105.36 	been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze 
106.1 	a dead human body and other human remains at the same time and in the same alkaline 
106.2 	hydrolysis vessel. This section does not apply where commingling of human remains 
106.3 	during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental 
106.4 	and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is 
106.5 	not a violation of this subdivision.
106.6 		Subd. 21.Alkaline hydrolysis procedures; removal from alkaline hydrolysis 
106.7 	vessel. Upon completion of the alkaline hydrolysis process, reasonable efforts shall be 
106.8 	made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed 
106.9 	remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be 
106.10 	made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed 
106.11 	human remains and dispose of these materials in a lawful manner, by the alkaline 
106.12 	hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate 
106.13 	container to be transported to the processing area.
106.14 		Subd. 22.Drying device or mechanical processor procedures; commingling of 
106.15 	hydrolyzed remains prohibited. Except with the express written permission of the 
106.16 	person with the legal right to control the final disposition or otherwise provided by 
106.17 	law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed 
106.18 	human remains of more than one body at a time in the same drying device or mechanical 
106.19 	processor, or introduce the hydrolyzed human remains of a second body into a drying 
106.20 	device or mechanical processor until processing of any preceding hydrolyzed human 
106.21 	remains has been terminated and reasonable efforts have been employed to remove all 
106.22 	fragments of the preceding hydrolyzed remains. The fact that there is incidental and 
106.23 	unavoidable residue in the drying device, the mechanical processor, or any container used 
106.24 	in a prior alkaline hydrolysis process, is not a violation of this provision.
106.25 		Subd. 23.Alkaline hydrolysis procedures; processing hydrolyzed remains. The 
106.26 	hydrolyzed human remains shall be dried and then reduced by a motorized mechanical 
106.27 	device to a granulated appearance appropriate for final disposition and placed in an 
106.28 	alkaline hydrolysis remains container along with the appropriate identifying disk, tab, 
106.29 	or permanent label. Processing must take place within the licensed alkaline hydrolysis 
106.30 	facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they 
106.31 	can be identified, may be removed prior to processing the hydrolyzed remains, only by 
106.32 	staff licensed or registered by the commissioner of health; however, any dental gold and 
106.33 	silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains 
106.34 	container unless otherwise directed by the person or persons having the right to control the 
106.35 	final disposition. Every person who removes or possesses dental gold or silver, jewelry, 
106.36 	or mementos from any hydrolyzed remains without specific written permission of the 
107.1 	person or persons having the right to control those remains is guilty of a misdemeanor. 
107.2 	The fact that residue and any unavoidable dental gold or dental silver, or other precious 
107.3 	metals remain in the alkaline hydrolysis vessel or other equipment or any container used 
107.4 	in a prior hydrolysis is not a violation of this section.
107.5 		Subd. 24.Alkaline hydrolysis procedures; container of insufficient capacity.
 107.6 	If a hydrolyzed remains container is of insufficient capacity to accommodate all 
107.7 	hydrolyzed remains of a given dead human body, subject to directives provided in the 
107.8 	written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess 
107.9 	hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the 
107.10 	second container, in a manner so as not to be easily detached through incidental contact, to 
107.11 	the primary alkaline hydrolysis remains container. The secondary container shall contain a 
107.12 	duplicate of the identification disk, tab, or permanent label that was placed in the primary 
107.13 	container and all paperwork regarding the given body shall include a notation that the 
107.14 	hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature 
107.15 	hydrolyzed remains containers are not subject to the requirements of this subdivision.
107.16 		Subd. 25.Disposition procedures; commingling of hydrolyzed remains 
107.17 	prohibited. No hydrolyzed remains shall be disposed of or scattered in a manner or in 
107.18 	a location where the hydrolyzed remains are commingled with those of another person 
107.19 	without the express written permission of the person with the legal right to control 
107.20 	disposition or as otherwise provided by law. This subdivision does not apply to the 
107.21 	scattering or burial of hydrolyzed remains at sea or in a body of water from individual 
107.22 	containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to 
107.23 	the disposal in a dedicated cemetery of accumulated residue removed from an alkaline 
107.24 	hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members 
107.25 	of the same family in a common container designed for the hydrolyzed remains of more 
107.26 	than one body, or to the inurnment in a container or interment in a space that has been 
107.27 	previously designated, at the time of sale or purchase, as being intended for the inurnment 
107.28 	or interment of the hydrolyzed remains of more than one person.
107.29 		Subd. 26.Alkaline hydrolysis procedures; disposition of accumulated residue.
 107.30 	Every alkaline hydrolysis facility shall provide for the removal and disposition in a 
107.31 	dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel, 
107.32 	drying device, mechanical processor, container, or other equipment used in alkaline 
107.33 	hydrolysis. Disposition of accumulated residue shall be according to the regulations of the 
107.34 	dedicated cemetery and any applicable local ordinances.
107.35 		Subd. 27.Alkaline hydrolysis procedures; release of hydrolyzed remains.
 107.36 	Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be 
108.1 	released according to the instructions given on the written authorization to hydrolyze. If 
108.2 	the hydrolyzed remains are to be shipped, they must be securely packaged and transported 
108.3 	by a method which has an internal tracing system available and which provides for a 
108.4 	receipt signed by the person accepting delivery. Where there is a dispute over release 
108.5 	or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit 
108.6 	the hydrolyzed remains with a court of competent jurisdiction pending resolution of the 
108.7 	dispute or retain the hydrolyzed remains until the person with the legal right to control 
108.8 	disposition presents satisfactory indication that the dispute is resolved.
108.9 		Subd. 28.Unclaimed hydrolyzed remains. If, after 30 calendar days following 
108.10 	the inurnment, the hydrolyzed remains are not claimed or disposed of according to the 
108.11 	written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment 
108.12 	may give written notice, by certified mail, to the person with the legal right to control 
108.13 	the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and 
108.14 	requesting further release directions. Should the hydrolyzed remains be unclaimed 120 
108.15 	calendar days following the mailing of the written notification, the alkaline hydrolysis 
108.16 	facility or funeral establishment may dispose of the hydrolyzed remains in any lawful 
108.17 	manner deemed appropriate.
108.18 		Subd. 29.Required records. Every alkaline hydrolysis facility shall create and 
108.19 	maintain on its premises or other business location in Minnesota an accurate record of 
108.20 	every hydrolyzation provided. The record shall include all of the following information 
108.21 	for each hydrolyzation:
108.22 	(1) the name of the person or funeral establishment delivering the body for alkaline 
108.23 	hydrolysis;
108.24 	(2) the name of the deceased and the identification number assigned to the body;
108.25 	(3) the date of acceptance of delivery;
108.26 	(4) the names of the alkaline hydrolysis vessel, drying device, and mechanical 
108.27 	processor operator;
108.28 	(5) the time and date that the body was placed in and removed from the alkaline 
108.29 	hydrolysis vessel;
108.30 	(6) the time and date that processing and inurnment of the hydrolyzed remains 
108.31 	was completed;
108.32 	(7) the time, date, and manner of release of the hydrolyzed remains;
108.33 	(8) the name and address of the person who signed the authorization to hydrolyze;
108.34 	(9) all supporting documentation, including any transit or disposition permits, a 
108.35 	photocopy of the death record, and the authorization to hydrolyze; and
108.36 	(10) the type of alkaline hydrolysis container.
109.1 		Subd. 30.Retention of records. Records required under subdivision 29 shall be 
109.2 	maintained for a period of three calendar years after the release of the hydrolyzed remains. 
109.3 	Following this period and subject to any other laws requiring retention of records, the 
109.4 	alkaline hydrolysis facility may then place the records in storage or reduce them to 
109.5 	microfilm, microfiche, laser disc, or any other method that can produce an accurate 
109.6 	reproduction of the original record, for retention for a period of ten calendar years from 
109.7 	the date of release of the hydrolyzed remains. At the end of this period and subject to any 
109.8 	other laws requiring retention of records, the alkaline hydrolysis facility may destroy 
109.9 	the records by shredding, incineration, or any other manner that protects the privacy of 
109.10 	the individuals identified.

109.11 	Sec. 4. STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
 109.12 	(a) The commissioners of health, human services, and commerce, and the board of 
109.13 	MNsure, shall study whether Minnesota-based risk adjustment of the individual and small 
109.14 	group insurance market, using either the federal risk adjustment model or a state-based 
109.15 	alternative, can be more cost-effective and perform better than risk adjustment conducted 
109.16 	by federal agencies. The study shall assess the policies, infrastructure, and resources 
109.17 	necessary to satisfy the requirements of Code of Federal Regulations, title 45, section 
109.18 	153, subpart D. The study shall also evaluate the extent to which Minnesota-based risk 
109.19 	adjustment could meet requirements established in Code of Federal Regulations, title 
109.20 	45, section 153.330, including:
109.21 	(1) explaining the variation in health care costs of a given population;
109.22 	(2) linking risk factors to daily clinical practices and that which is clinically 
109.23 	meaningful to providers;
109.24 	(3) encouraging favorable behavior among health care market participants and 
109.25 	discouraging unfavorable behavior;
109.26 	(4) whether risk adjustment factors are relatively easy for stakeholders to understand 
109.27 	and participate in;
109.28 	(5) providing stable risk scores over time and across health plan products;
109.29 	(6) minimizing administrative costs;
109.30 	(7) accounting for risk selection across metal levels;
109.31 	(8) aligning each of the elements of the methodology; and
109.32 	(9) having a per-member cost equal to or lower than the projected cost of the federal 
109.33 	risk adjustment model.
109.34 	(b) In conducting the study, and notwithstanding Minnesota Rules, chapter 4653, 
109.35 	and as part of responsibilities under Minnesota Statutes, section 62U.04, subdivision 
110.1 	4, paragraph (b), the commissioner of health shall collect from health carriers in the 
110.2 	individual and small group health insurance market, beginning on January 1, 2014, and for 
110.3 	service dates in calendar year 2014, all data required for conducting risk adjustment with 
110.4 	standard risk adjusters such as the Adjusted Clinical Groups or the Hierarchical Condition 
110.5 	Category System, including but not limited to:
110.6 	(1) an indicator identifying the health plan product under which an enrollee is covered;
110.7 	(2) an indicator identifying whether an enrollee's policy is an individual or small 
110.8 	group market policy;
110.9 	(3) an indicator identifying, if applicable, the metal level of an enrollee's health plan 
110.10 	product, and whether the policy is a catastrophic policy; and
110.11 	(4) additional identified demographic data necessary to link individuals' data across 
110.12 	carriers and insurance affordability programs with 95 percent accuracy. The commissioner 
110.13 	shall not collect more than the last four digits of an individual's Social Security number.
110.14 	(c) The commissioner of health shall also assess the extent to which data collected 
110.15 	under paragraph (b) and under Minnesota Statutes, section 62U.04, subdivision 4, 
110.16 	paragraph (a), are sufficient for developing and operating a state alternative risk adjustment 
110.17 	methodology consistent with applicable federal rules by evaluating:
110.18 	(1) if the data submitted are adequately complete, accurate, and timely;
110.19 	(2) if the data should be further enriched by nontraditional risk adjusters that help 
110.20 	in better explaining variation in health care costs of a given population and account for 
110.21 	risk selection across metal levels;
110.22 	(3) whether additional data or identifiers have the potential to strengthen a 
110.23 	Minnesota-based risk adjustment approach; and
110.24 	(4) what, if any, changes to the technical infrastructure will be necessary to 
110.25 	effectively perform state-based risk adjustment.
110.26 	For purposes of this paragraph, the commissioner of health shall have the authority to 
110.27 	use identified data to validate and audit a statistically valid sample of data for each 
110.28 	health carrier in the individual and small group market. In conducting the study, the 
110.29 	commissioners shall contract with entities that do not have an economic interest in the 
110.30 	outcome of Minnesota-based risk adjustment but do have demonstrated expertise in 
110.31 	actuarial science or health economics and demonstrated experience with designing and 
110.32 	implementing risk adjustment models.
110.33 	(d) The commissioner of human services shall evaluate opportunities to maximize 
110.34 	federal funding under section 1331 of the federal Patient Protection and Affordable 
110.35 	Care Act, Public Law 111-148, and further defined through amendments to the act and 
110.36 	regulations issued under the act. The commissioner of human services shall make 
111.1 	recommendations on risk adjustment strategies to maximize federal funding to the state 
111.2 	of Minnesota.
111.3 	(e) The commissioners and board of MNsure shall submit to the legislature by March 
111.4 	15, 2014, an interim report with preliminary findings from the assessment conducted in 
111.5 	paragraphs (c) and (d). The interim report shall include legislative recommendations 
111.6 	for any necessary changes to Minnesota Statutes, section 62Q.03. A final report shall 
111.7 	be submitted by the commissioners and board of MNsure to the legislature by October 
111.8 	1, 2015. The final report must include findings from the overall assessment and a 
111.9 	recommendation whether to conduct state-based risk adjustment.
111.10 	(f) For purposes of this section, "board of MNsure" means the board established 
111.11 	under Minnesota Statutes, section 62V.03.

111.12 	ARTICLE 6
111.13 	CONTINUING CARE

111.14 	Section 1. Minnesota Statutes 2012, section 256.01, is amended by adding a 
111.15 	subdivision to read:
111.16 		Subd. 35.Commissioner must annually report certain prepaid medical 
111.17 	assistance plan data. (a) The commissioners of human services and education may share 
111.18 	private or nonpublic data to allow the commissioners to analyze the screening, diagnosis, 
111.19 	and treatment of children with autism spectrum disorder and other developmental 
111.20 	conditions. The commissioners may share the individual-level data necessary to:
111.21 	(1) measure the prevalence of autism spectrum disorder and other developmental 
111.22 	conditions; 
111.23 	(2) analyze the effectiveness of existing policies and procedures in the early 
111.24 	identification of children with autism spectrum disorder and other developmental 
111.25 	conditions;
111.26 	(3) assess the effectiveness of screening, diagnosis, and treatment to allow children 
111.27 	with autism spectrum disorder and other developmental conditions to meet developmental 
111.28 	and social-emotional milestones;
111.29 	(4) identify and address disparities in screening, diagnosis, and treatment related 
111.30 	to the native language or race and ethnicity of the child;
111.31 	(5) measure the effectiveness of public health care programs in addressing the medical 
111.32 	needs of children with autism spectrum disorder and other developmental conditions; and 
111.33 	(6) determine the capacity of educational and health care systems to meet the needs 
111.34 	of children with autism spectrum disorder and other developmental conditions.
112.1 	(b) The commissioner of human services shall use the data shared with the 
112.2 	commissioner of education under this subdivision to improve public health care program 
112.3 	performance in early screening, diagnosis, and treatment for children once data are 
112.4 	available and shall report on the results and any summary data, as defined in section 13.02, 
112.5 	subdivision 19, on the department's Web site by September 30 of each year.

112.6 	Sec. 2. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
112.7 		Subdivision 1.Purpose. This section creates a new benefit available under the 
112.8 	medical assistance state plan when federal approval consistent with the provisions in 
112.9 	subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section 
112.10 	2402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to 
112.11 	provide early intensive intervention to a child with an autism spectrum disorder diagnosis. 
112.12 	This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing 
112.13 	progress evaluation, and medically necessary treatment of autism spectrum disorder.
112.14 		Subd. 2.Definitions. (a) For the purposes of this section, the terms defined in 
112.15 	this subdivision have the meanings given.
112.16 	(b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the 
112.17 	current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
112.18 	(c) "Child" means a person under the age of seven, or for two years at any age under 
112.19 	age 18 if the person was not diagnosed with autism spectrum disorder before age five, or a 
112.20 	person under age 18 pursuant to subdivision 12.
112.21 	(d) "Commissioner" means the commissioner of human services, unless otherwise 
112.22 	specified.
112.23 	(e) "Early intensive intervention benefit" means autism treatment options based in 
112.24 	behavioral and developmental science, which may include modalities such as applied 
112.25 	behavior analysis, developmental treatment approaches, and naturalistic and parent 
112.26 	training models.
112.27 	(f) "Generalizable goals" means results or gains that are observed during a variety 
112.28 	of activities with different people, such as providers, family members, other adults, 
112.29 	and children, and in different environments including but not limited to clinics, homes, 
112.30 	schools, and the community.
112.31 		Subd. 3.Initial eligibility. This benefit is available to a child enrolled in medical 
112.32 	assistance who:
112.33 	(1) has an autism spectrum disorder diagnosis;
112.34 	(2) has had a diagnostic assessment described in subdivision 5 that recommends 
112.35 	early intensive intervention services; 
113.1 	(3) meets the criteria for medically necessary autism early intensive intervention 
113.2 	services; and
113.3 	(4) declines to enroll in the state services described in section 252.27.
113.4 		Subd. 4.Diagnosis. (a) A diagnosis must:
113.5 	(1) be based on current DSM criteria including direct observations of the child and 
113.6 	reports from parents or primary caregivers;
113.7 	(2) be completed by a professional who has expertise and training in autism spectrum 
113.8 	disorder and child development and who is a licensed physician, nurse practitioner, or 
113.9 	licensed mental health professional until the commissioner's assessment required in 
113.10 	subdivision 8, clause (7), shows there are adequate professionals to avoid access problems 
113.11 	or delays in diagnosis for young children if two professionals are required for a diagnosis 
113.12 	pursuant to clause (3); and
113.13 	(3) be completed by both a medical and mental health professional who have expertise 
113.14 	and training in autism spectrum disorder and child development when the assessment in 
113.15 	subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
113.16 	(b) Additional diagnostic assessment information including from special education 
113.17 	evaluations and licensed school personnel, and from professionals licensed in the fields of 
113.18 	medicine, speech and language, psychology, occupational therapy, and physical therapy 
113.19 	may be considered.
113.20 		Subd. 5.Diagnostic assessment. The following information and assessments must 
113.21 	be performed, reviewed, and relied upon for the eligibility determination, treatment and 
113.22 	services recommendations, and treatment plan development for the child:
113.23 	(1) an assessment of the child's developmental skills, functional behavior, needs, and 
113.24 	capacities based on direct observation of the child that must be administered by a licensed 
113.25 	mental health professional and may also include observations from family members, 
113.26 	licensed school personnel, child care providers, or other caregivers, as well as any medical 
113.27 	or assessment information from other licensed professionals such as the child's physician, 
113.28 	rehabilitation therapists, or mental health professionals; and
113.29 	(2) an assessment of parental or caregiver capacity to participate in therapy including 
113.30 	the type and level of parental or caregiver involvement and training recommended.
113.31 		Subd. 6.Treatment plan. (a) Each child's treatment plan must be:
113.32 	(1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
113.33 	(2) coordinated with medically necessary occupational, physical, and speech and 
113.34 	language therapies, special education, and other services the child and family are receiving;
113.35 	(3) family-centered;
113.36 	(4) culturally sensitive; and
114.1 	(5) individualized based on the child's developmental status and the child's and 
114.2 	family's identified needs.
114.3 	(b) The treatment plan must specify the:
114.4 	(1) child's goals, that are developmentally appropriate, functional, and generalizable;
114.5 	(2) treatment modality;
114.6 	(3) treatment intensity;
114.7 	(4) setting; and
114.8 	(5) level and type of parental or caregiver involvement.
114.9 	(c) The treatment must be supervised by a professional with expertise and training in 
114.10 	autism and child development who is a licensed physician, nurse practitioner, or mental 
114.11 	health professional.
114.12 	(d) The treatment plan must be submitted to the commissioner for approval in a 
114.13 	manner determined by the commissioner.
114.14 	(e) Services authorized must be consistent with the child's approved treatment plan.
114.15 		Subd. 7.Ongoing eligibility. (a) An independent progress evaluation conducted 
114.16 	by a licensed mental health professional with expertise and training in autism spectrum 
114.17 	disorder and child development must be completed after each six months of treatment, 
114.18 	or more frequently as determined by the commissioner, to determine if progress is being 
114.19 	made toward achieving generalizable gains and meeting functional goals contained in 
114.20 	the treatment plan.
114.21 	(b) The progress evaluation must include:
114.22 	(1) the treating provider's report;
114.23 	(2) parental or caregiver input;
114.24 	(3) an independent observation of the child, that can be performed by the child's 
114.25 	licensed special education staff;
114.26 	(4) any treatment plan modifications; and
114.27 	(5) recommendations for continued treatment services.
114.28 	(c) Progress evaluations must be submitted to the commissioner in a manner 
114.29 	determined by the commissioner.
114.30 	(d) A child who continues to achieve generalizable gains and treatment goals as 
114.31 	specified in the treatment plan is eligible to continue receiving this benefit. 
114.32 	(e) A child's treatment shall continue during the progress evaluation and during an 
114.33 	appeal if continuation of services pending appeal has been requested pursuant to section 
114.34 	256.045, subdivision 10.
114.35 		Subd. 8.Refining benefit with stakeholders. The commissioner must develop 
114.36 	the implementation details of the benefit in consultation with stakeholders and consider 
115.1 	recommendations from the Health Services Advisory Council, the Department of Human 
115.2 	Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum 
115.3 	Disorder Task Force, and the Interagency Task Force of the Departments of Health, 
115.4 	Education, and Human Services. The commissioner must release these details for a 30-day 
115.5 	public comment period prior to submission to the federal government for approval. The 
115.6 	implementation details include, but are not limited to, the following components:
115.7 	(1) a definition of the qualifications, standards, and roles of the treatment team, 
115.8 	including recommendations after stakeholder consultation on whether board-certified 
115.9 	behavior analysts and other types of professionals trained in autism spectrum disorder and 
115.10 	child development should be added as mental health or other professionals for treatment 
115.11 	supervision or other function under medical assistance;
115.12 	(2) development of initial, uniform parameters for comprehensive multidisciplinary 
115.13 	diagnostic assessment information and progress evaluation standards;
115.14 	(3) the design of an effective and consistent process for assessing parent and 
115.15 	caregiver capacity to participate in the child's early intervention treatment and methods of 
115.16 	involving the parents in the treatment of the child;
115.17 	(4) formulation of a collaborative process in which professionals have opportunities 
115.18 	to collectively inform the comprehensive, multidisciplinary diagnostic assessment and 
115.19 	progress evaluation processes and standards to support quality improvement of early 
115.20 	intensive intervention services;
115.21 	(5) coordination of this benefit and its interaction with other services provided by the 
115.22 	Departments of Human Services, Health, and Education;
115.23 	(6) evaluation, on an ongoing basis, of research regarding the program and treatment 
115.24 	modalities provided to children under this benefit; and
115.25 	(7) determination of the availability of licensed medical and mental health 
115.26 	professionals with expertise and training in autism spectrum disorder throughout the state 
115.27 	in order to assess whether there are sufficient professionals to require involvement of 
115.28 	both a medical and mental health professional to provide access and prevent delay in the 
115.29 	diagnosis and treatment of young children so as to implement subdivision 4, paragraph 
115.30 	(a), and to ensure treatment is effective, timely, and accessible.
115.31 		Subd. 9.Revision of treatment options. (a) The commissioner may revise covered 
115.32 	treatment options as needed based on outcome data and other evidence.
115.33 	(b) Before the changes become effective, the commissioner must provide public 
115.34 	notice of the changes, the reasons for the changes, and a 30-day public comment period 
115.35 	to those who request notice through an electronic list accessible to the public on the 
115.36 	department's Web site.
116.1 		Subd. 10.Coordination between agencies. The commissioners of human services 
116.2 	and education must develop the capacity to coordinate services and information including 
116.3 	diagnostic, functional, developmental, medical, and educational assessments; service 
116.4 	delivery; and progress evaluations across health and education sectors.
116.5 		Subd. 11.Federal approval of autism benefit. The provisions of subdivision 9 
116.6 	shall apply to state plan services under title XIX of the Social Security Act when federal 
116.7 	approval is granted under a 1915(i) waiver or other authority that allows children eligible 
116.8 	for medical assistance through the TEFRA option under section 256B.055, subdivision 
116.9 	12, to qualify and includes children eligible for medical assistance in families over 150 
116.10 	percent of the federal poverty guidelines.
116.11 		Subd. 12.Local school districts option to continue treatment. (a) A local school 
116.12 	district may contract with the commissioner of human services to pay the state share of 
116.13 	the benefits described under this section to continue the treatment as part of the special 
116.14 	education services offered to all students in the district diagnosed with autism spectrum 
116.15 	disorder.
116.16 	(b) A local school district may utilize third-party billing to seek reimbursement 
116.17 	for the district for any services paid by the district under this section for which private 
116.18 	insurance coverage was available to the child.

116.19 	EFFECTIVE DATE. The autism benefit under subdivisions 1 to 7, 9, and 12 is 
116.20 	effective upon federal approval for the benefit under a 1915(i) waiver or other federal 
116.21 	authority needed to meet the requirements of subdivision 11, but no earlier than March 1, 
116.22 	2014. Subdivisions 8, 10, and 11 are effective July 1, 2013.

116.23 	Sec. 3. Minnesota Statutes 2012, section 256B.69, is amended by adding a subdivision 
116.24 	to read:
116.25 		Subd. 32a.Initiatives to improve early screening, diagnosis, and treatment of 
116.26 	children with autism spectrum disorder and other developmental conditions. (a) The 
116.27 	commissioner shall require managed care plans and county-based purchasing plans, as 
116.28 	a condition of contract, to implement strategies that facilitate access for young children 
116.29 	between the ages of one and three years to periodic developmental and social-emotional 
116.30 	screenings, as recommended by the  Minnesota Interagency Developmental Screening 
116.31 	Task Force, and that those children who do not meet milestones are provided access to 
116.32 	appropriate evaluation and assessment, including treatment recommendations, expected to 
116.33 	improve the child's functioning, with the goal of meeting milestones by age five.
116.34 	(b) The managed care plans must report the following data annually:
116.35 	(1) the number of children who received a diagnostic assessment;
117.1 	(2) the total number of children ages one to six with a diagnosis of autism spectrum 
117.2 	disorder who received treatments;
117.3 	(3) the number of children identified under clause (2) reported by each 12-month 
117.4 	age group beginning with age one and ending with age six;
117.5 	(4) the types of treatments provided to children identified under clause (2), listed by 
117.6 	billing code, including the number of units billed for each child;
117.7 	(5) barriers to providing screening, diagnosis, and treatment of young children 
117.8 	between the ages of one and three years and any strategies implemented to address 
117.9 	those barriers; and
117.10 	(6) recommendations on how to measure and report on the effectiveness of the 
117.11 	strategies implemented to facilitate access for young children to provide developmental 
117.12 	and social-emotional screening, diagnosis, and treatment.

117.13 	Sec. 4. NURSING HOME LEVEL OF CARE REPORT.
 117.14 	(a) The commissioner of human services shall report on the impact of the nursing 
117.15 	home level of care implementation including the following:
117.16 	(1) the number of individuals who lost waivered services and medical assistance;
117.17 	(2) the result of the loss of  services;
117.18 	(3) information on where individuals were living before and after the nursing home 
117.19 	level of care changes took effect, to show the impact on an individual's ability to maintain 
117.20 	independence in the community; and
117.21 	(4) utilization data before and after nursing home level of care implementation for 
117.22 	those who retained medical assistance, including which essential community support 
117.23 	and personal care assistant services were used and to what extent the $400 essential 
117.24 	community support grant was sufficient to meet needs.
117.25 	(b) The commissioner of human services shall report to the chairs of the legislative 
117.26 	committees with jurisdiction over health and human services policy and finance with the 
117.27 	information required under paragraph (a) on October 1, 2014, and annually thereafter.

117.28 	ARTICLE 7
117.29 	HOME AND COMMUNITY-BASED SERVICES DISABILITY RATE SETTING

117.30 	Section 1. [256B.4914] HOME AND COMMUNITY-BASED SERVICES 
117.31 	WAIVERS; RATE SETTING.
117.32 		Subdivision 1.Application. The payment methodologies in this section apply to 
117.33 	home and community-based services waivers under sections 256B.092 and 256B.49. This 
117.34 	section does not change existing waiver policies and procedures.
118.1 		Subd. 2.Definitions. (a) For purposes of this section, the following terms have the 
118.2 	meanings given them, unless the context clearly indicates otherwise.
118.3 	(b) "Commissioner" means the commissioner of human services.
118.4 	(c) "Component value" means underlying factors that are part of the cost of providing 
118.5 	services that are built into the waiver rates methodology to calculate service rates.
118.6 	(d) "Customized living tool" means a methodology for setting service rates which 
118.7 	delineates and documents the amount of each component service included in a recipient's 
118.8 	customized living service plan.
118.9 	(e) "Disability waiver rates system" means a statewide system which establishes 
118.10 	rates that are based on uniform processes and captures the individualized nature of waiver 
118.11 	services and recipient needs.
118.12 	(f) "Lead agency" means a county, partnership of counties, or tribal agency charged 
118.13 	with administering waivered services under sections 256B.092 and 256B.49.
118.14 	(g) "Median" means the amount that divides distribution into two equal groups, 
118.15 	one-half above the median and one-half below the median.
118.16 	(h) "Payment or rate" means reimbursement to an eligible provider for services 
118.17 	provided to a qualified individual based on an approved service authorization.
118.18 	(i) "Rates management system" means a Web-based software application that uses 
118.19 	a framework and component values, as determined by the commissioner, to establish 
118.20 	service rates.
118.21 	(j) "Recipient" means a person receiving home and community-based services 
118.22 	funded under any of the disability waivers.
118.23 		Subd. 3.Applicable services. Applicable services are those authorized under the 
118.24 	state's home and community-based services waivers under sections 256B.092 and 256B.49 
118.25 	including, as defined in the federally approved home and community-based services plan:
118.26 	(1) 24-hour customized living;
118.27 	(2) adult day care;
118.28 	(3) adult day care bath;
118.29 	(4) behavioral programming;
118.30 	(5) companion services;
118.31 	(6) customized living;
118.32 	(7) day training and habilitation;
118.33 	(8) housing access coordination;
118.34 	(9) independent living skills;
118.35 	(10) in-home family support;
118.36 	(11) night supervision;
119.1 	(12) personal support;
119.2 	(13) prevocational services;
119.3 	(14) residential care services;
119.4 	(15) residential support services;
119.5 	(16) respite services;
119.6 	(17) structured day services;
119.7 	(18) supported employment services;
119.8 	(19) supported living services;
119.9 	(20) transportation services; and
119.10 	(21) other services as approved by the federal government in the state home and 
119.11 	community-based services plan.
119.12 		Subd. 4.Data collection for rate determination. (a) Rates for all applicable home 
119.13 	and community-based waivered services, including rate exceptions under subdivision 12, 
119.14 	are set via the rates management system.
119.15 	(b) Only data and information in the rates management system may be used to 
119.16 	calculate an individual's rate.
119.17 	(c) Service providers, with information from the community support plan, shall enter 
119.18 	values and information needed to calculate an individual's rate into the rates management 
119.19 	system. These values and information include:
119.20 	(1) shared staffing hours;
119.21 	(2) individual staffing hours;
119.22 	(3) staffing ratios;
119.23 	(4) information to document variable levels of service qualification for variable 
119.24 	levels of reimbursement in each framework;
119.25 	(5) shared or individualized arrangements for unit-based services, including the 
119.26 	staffing ratio; and
119.27 	(6) number of trips and miles for transportation services.
119.28 	(d) Updates to individual data shall include:
119.29 	(1) data for each individual that is updated annually when renewing service plans; and
119.30 	(2) requests by individuals or lead agencies to update a rate whenever there is a 
119.31 	change in an individual's service needs, with accompanying documentation.
119.32 	(e) Lead agencies shall review and approve values to calculate the final payment rate 
119.33 	for each individual. Lead agencies must notify the individual and the service provider 
119.34 	of the final agreed upon values and rate. If a value used was mistakenly or erroneously 
119.35 	entered and used to calculate a rate, a provider may petition lead agencies to correct it. 
119.36 	Lead agencies must respond to these requests.
120.1 		Subd. 5.Base wage index and standard component values. (a) The base wage 
120.2 	index is established to determine staffing costs associated with providing services to 
120.3 	individuals receiving home and community-based services. For purposes of developing 
120.4 	and calculating the proposed base wage, Minnesota-specific wages taken from job 
120.5 	descriptions and standard occupational classification (SOC) codes from the Bureau of 
120.6 	Labor Statistics, as defined in the most recent edition of the Occupational Handbook, shall 
120.7 	be used. The base wage index shall be calculated as follows:
120.8 	(1) for residential direct care basic staff, 50 percent of the median wage for personal 
120.9 	and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing 
120.10 	aide (SOC code 31-1012); and 20 percent of the median wage for social and human 
120.11 	services aide (SOC code 21-1093);
120.12 	(2) for residential direct care intensive staff, 20 percent of the median wage for home 
120.13 	health aide (SOC code 31-1011); 20 percent of the median wage for personal and home 
120.14 	health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 
120.15 	21-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 
120.16 	and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
120.17 	(3) for day services, 20 percent of the median wage for nursing aide (SOC code 
120.18 	31-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 
120.19 	and 60 percent of the median wage for social and human services code (SOC code 21-1093);
120.20 	(4) for residential asleep overnight staff, the wage shall be $7.66 per hour, except 
120.21 	in a family foster care setting the wage is $2.80 per hour;
120.22 	(5) for behavior program analyst staff, 100 percent of the median wage for mental 
120.23 	health counselors (SOC code 21-1014);
120.24 	(6) for behavior program professional staff, 100 percent of the median wage for 
120.25 	clinical counseling and school psychologist (SOC code 19-3031);
120.26 	(7) for behavior program specialist staff, 100 percent of the median wage for 
120.27 	psychiatric technicians (SOC code 29-2053);
120.28 	(8) for supportive living services staff, 20 percent of the median wage for nursing 
120.29 	aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC 
120.30 	code 29-2053); and 60 percent of the median wage for social and human services aide 
120.31 	(SOC code 21-1093);
120.32 	(9) for housing access coordination staff, 50 percent of the median wage for 
120.33 	community and social services specialist (SOC code 21-1099); and 50 percent of the 
120.34 	median wage for social and human services aide (SOC code 21-1093);
120.35 	(10) for in-home family support staff, 20 percent of the median wage for nursing 
120.36 	aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code 
121.1 	21-1099); 40 percent of the median wage for social and human services aide (SOC code 
121.2 	21-1093); and 10 percent of the median wage for psychiatric technician (SOC code 
121.3 	29-2053);
121.4 	(11) for independent living skills staff, 40 percent of the median wage for community 
121.5 	social service specialist (SOC code 21-1099); 50 percent of the median wage for social 
121.6 	and human services aide (SOC code 21-1093); and 10 percent of the median wage for 
121.7 	psychiatric technician (SOC code 29-2053);
121.8 	(12) for supported employment staff, 20 percent of the median wage for nursing aide 
121.9 	(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC 
121.10 	code 29-2053); and 60 percent of the median wage for social and human services aide 
121.11 	(SOC code 21-1093);
121.12 	(13) for adult companion staff, 50 percent of the median wage for personal and home 
121.13 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, 
121.14 	orderlies, and attendants (SOC code 31-1012);
121.15 	(14) for night supervision staff, 20 percent of the median wage for home health aide 
121.16 	(SOC code 31-1011); 20 percent of the median wage for personal and home health aide 
121.17 	(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012); 
121.18 	20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20 
121.19 	percent of the median wage for social and human services aide (SOC code 21-1093);
121.20 	(15) for respite staff, 50 percent of the median wage for personal and home care aide 
121.21 	(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and 
121.22 	attendants (SOC code 31-1012);
121.23 	(16) for personal support staff, 50 percent of the median wage for personal and home 
121.24 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, 
121.25 	orderlies, and attendants (SOC code 31-1012); and
121.26 	(17) for supervisory staff, the basic wage is $17.43 per hour with exception of the 
121.27 	supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
121.28 	(b) Component values for residential support services, excluding family foster 
121.29 	care, are:
121.30 	(1) supervisory span of control ratio, 11 percent;
121.31 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
121.32 	(3) employee-related cost ratio, 23.6 percent;
121.33 	(4) general administrative support ratio, 13.25 percent;
121.34 	(5) program-related expense ratio, 1.3 percent; and
121.35 	(6) absence and utilization factor ratio, 3.9 percent.
121.36 	(c) Component values for family foster care are:
122.1 	(1) supervisory span of control ratio, 11 percent;
122.2 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
122.3 	(3) employee-related cost ratio, 23.6 percent;
122.4 	(4) general administrative support ratio, 3.3 percent; and
122.5 	(5) program-related expense ratio, 1.3 percent.
122.6 	(d) Component values for day services for all services are:
122.7 	(1) supervisory span of control ratio, 11 percent;
122.8 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
122.9 	(3) employee-related cost ratio, 23.6 percent;
122.10 	(4) program plan support ratio, 5.6 percent;
122.11 	(5) client programming and support ratio, 10 percent;
122.12 	(6) general administrative support ratio, 13.25 percent;
122.13 	(7) program-related expense ratio, 1.8 percent; and
122.14 	(8) absence and utilization factor ratio, 3.9 percent.
122.15 	(e) Component values for unit-based services with program services are:
122.16 	(1) supervisory span of control ratio, 11 percent;
122.17 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
122.18 	(3) employee-related cost ratio, 23.6 percent; 
122.19 	(4) program plan supports ratio, 3.1 percent;
122.20 	(5) client programming and support ratio, 8.6 percent;
122.21 	(6) general administrative support ratio, 13.25 percent;
122.22 	(7) program-related expense ratio, 6.1 percent; and
122.23 	(8) absence and utilization factor ratio, 3.9 percent.
122.24 	(f) Component values for unit-based services without programming except respite 
122.25 	are:
122.26 	(1) supervisory span of control ratio, 11 percent;
122.27 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
122.28 	(3) employee-related cost ratio, 23.6 percent;
122.29 	(4) program plan support ratio, 3.1 percent;
122.30 	(5) client programming and support ratio, 8.6 percent;
122.31 	(6) general administrative support ratio, 13.25 percent;
122.32 	(7) program-related expense ratio, 6.1 percent; and
122.33 	(8) absence and utilization factor ratio, 3.9 percent.
122.34 	(g) Component values for unit-based services without programming for respite are:
122.35 	(1) supervisory span of control ratio, 11 percent;
122.36 	(2) employee vacation, sick, and training allowance ratio, 8.71 percent;
123.1 	(3) employee-related cost ratio, 23.6 percent;
123.2 	(4) general administrative support ratio, 13.25 percent;
123.3 	(5) program-related expense ratio, 6.1 percent; and
123.4 	(6) absence and utilization factor ratio, 3.9 percent.
123.5 	(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph 
123.6 	(a) based on the wage data by SOC from the Bureau of Labor Statistics available on 
123.7 	December 31, 2016. The commissioner shall publish these updated values and load them 
123.8 	into the rates management system. This adjustment shall occur every five years. For 
123.9 	adjustments in 2021 and later, the commissioner shall use the data available on December 
123.10 	31 of the calendar year five years prior.
123.11 	(i) On July 1, 2017, the commissioner shall update the framework components in 
123.12 	paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust 
123.13 	these values higher or lower by the percentage change in the Consumer Price Index-All 
123.14 	Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The 
123.15 	commissioner shall publish these updated values and load them into the rates management 
123.16 	system. This adjustment shall occur every five years. For adjustments in 2021 and later, 
123.17 	the commissioner shall use the data available on January 1 of the calendar year four years 
123.18 	prior and January 1 of the current calendar year.
123.19 		Subd. 6.Payments for residential support services. (a) Payments for residential 
123.20 	support services, as defined in sections 256B.092, subdivision 11, and 256B.49, 
123.21 	subdivision 22, must be calculated as follows:
123.22 	(1) determine the number of units of service to meet a recipient's needs;
123.23 	(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics 
123.24 	national and Minnesota-specific rates or rates derived by the commissioner as provided in 
123.25 	subdivision 5.  This is defined as the direct care rate;
123.26 	(3) for a recipient requiring customization for deaf or hard-of-hearing language 
123.27 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
123.28 	to the result of clause (2). This is defined as the customized direct care rate;
123.29 	(4) multiply the number of residential services direct staff hours by the appropriate 
123.30 	staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
123.31 	(5) multiply the number of direct staff hours by the product of the supervision span 
123.32 	of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision 
123.33 	wage in subdivision 5, paragraph (a), clause (17);
123.34 	(6) combine the results of clauses (4) and (5) and multiply the result by one plus 
123.35 	the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), 
123.36 	clause (2). This is defined as the direct staffing cost;
124.1 	(7) for employee-related expenses, multiply the direct staffing cost by one plus the 
124.2 	employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
124.3 	(8) for client programming and supports, the commissioner shall add $2,179; and
124.4 	(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if 
124.5 	customized for adapted transport per year.
124.6 	(b) The total rate shall be calculated using the following steps:
124.7 	(1) subtotal paragraph (a), clauses (7) to (9);
124.8 	(2) sum the standard general and administrative rate, the program-related expense 
124.9 	ratio, and the absence and utilization ratio; and
124.10 	(3) divide the result of clause (1) by one minus the result of clause (2). This is 
124.11 	the total payment amount.
124.12 		Subd. 7.Payments for day programs. Payments for services with day programs 
124.13 	including adult day care, day treatment and habilitation, prevocational services, and 
124.14 	structured day services must be calculated as follows:
124.15 	(1) determine the number of units of service to meet a recipient's needs;
124.16 	(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 
124.17 	Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
124.18 	(3) for a recipient requiring customization for deaf or hard-of-hearing language 
124.19 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
124.20 	to the result of clause (2). This is defined as the customized direct care rate;
124.21 	(4) multiply the number of day program direct staff hours by the appropriate staff 
124.22 	wage in subdivision 5, paragraph (a), or the customized direct care rate;
124.23 	(5) multiply the number of day program direct staff hours by the product of the 
124.24 	supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the 
124.25 	appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
124.26 	(6) combine the results of clauses (4) and (5) and multiply the result by one plus 
124.27 	the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), 
124.28 	clause (2). This is defined as the direct staffing rate;
124.29 	(7) for program plan support, multiply the result of clause (6) by one plus the 
124.30 	program plan support ratio in subdivision 5, paragraph (d), clause (4);
124.31 	(8) for employee-related expenses, multiply the result of clause (7) by one plus the 
124.32 	employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
124.33 	(9) for client programming and supports, multiply the result of clause (8) by one plus 
124.34 	the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
124.35 	(10) for program facility costs, add $8.30 per week with consideration of staffing 
124.36 	ratios to meet individual needs;
125.1 	(11) for adult day bath services, add $7.01 per 15-minute unit;
125.2 	(12) this is the subtotal rate;
125.3 	(13) sum the standard general and administrative rate, the program-related expense 
125.4 	ratio, and the absence and utilization factor ratio;
125.5 	(14) divide the result of clause (12) by one minus the result of clause (13). This is 
125.6 	the total payment amount;
125.7 	(15) for transportation provided as part of day training and habilitation for an 
125.8 	individual who does not require a lift, add:
125.9 	(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle 
125.10 	without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared 
125.11 	ride in a vehicle with a lift;
125.12 	(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle 
125.13 	without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared 
125.14 	ride in a vehicle with a lift;
125.15 	(iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle 
125.16 	without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared 
125.17 	ride in a vehicle with a lift; or
125.18 	(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a 
125.19 	lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a 
125.20 	vehicle with a lift;
125.21 	(16) for transportation provided as part of day training and habilitation for an 
125.22 	individual who does require a lift, add:
125.23 	(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with 
125.24 	a lift, and $15.05 for a shared ride in a vehicle with a lift;
125.25 	(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a 
125.26 	lift, and $28.16 for a shared ride in a vehicle with a lift;
125.27 	(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with 
125.28 	a lift, and $58.76 for a shared ride in a vehicle with a lift; or
125.29 	(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a 
125.30 	lift, and $80.93 for a shared ride in a vehicle with a lift.
125.31 		Subd. 8.Payments for unit-based services with programming. Payments for 
125.32 	unit-based services with programming, including behavior programming, housing access 
125.33 	coordination, in-home family support, independent living skills training, hourly supported 
125.34 	living services, and supported employment provided to an individual outside of any day or 
125.35 	residential service plan, must be calculated as follows, unless the services are authorized 
125.36 	separately under subdivision 6 or 7:
126.1 	(1) determine the number of units of service to meet a recipient's needs;
126.2 	(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics 
126.3 	Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
126.4 	(3) for a recipient requiring customization for deaf or hard-of-hearing language 
126.5 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
126.6 	to the result of clause (2). This is defined as the customized direct care rate;
126.7 	(4) multiply the number of direct staff hours by the appropriate staff wage in 
126.8 	subdivision 5, paragraph (a), or the customized direct care rate;
126.9 	(5) multiply the number of direct staff hours by the product of the supervision span 
126.10 	of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision 
126.11 	wage in subdivision 5, paragraph (a), clause (17);
126.12 	(6) combine the results of clauses (4) and (5) and multiply the result by one plus 
126.13 	the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), 
126.14 	clause (2). This is defined as the direct staffing rate;
126.15 	(7) for program plan support, multiply the result of clause (6) by one plus the 
126.16 	program plan supports ratio in subdivision 5, paragraph (e), clause (4);
126.17 	(8) for employee-related expenses, multiply the result of clause (7) by one plus the 
126.18 	employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
126.19 	(9) for client programming and supports, multiply the result of clause (8) by one plus 
126.20 	the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
126.21 	(10) this is the subtotal rate;
126.22 	(11) sum the standard general and administrative rate, the program-related expense 
126.23 	ratio, and the absence and utilization factor ratio; and
126.24 	(12) divide the result of clause (10) by one minus the result of clause (11). This is 
126.25 	the total payment amount.
126.26 		Subd. 9.Payments for unit-based services without programming. Payments for 
126.27 	unit-based services without programming including night supervision, personal support, 
126.28 	respite, and companion care provided to an individual outside of any day or residential 
126.29 	service plan must be calculated as follows unless the services are authorized separately 
126.30 	under subdivision 6 or 7:
126.31 	(1) for all services except respite, determine the number of units of service to meet 
126.32 	a recipient's needs;
126.33 	(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 
126.34 	Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
127.1 	(3) for a recipient requiring customization for deaf or hard-of-hearing language 
127.2 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
127.3 	to the result of clause (2). This is defined as the customized direct care rate;
127.4 	(4) multiply the number of direct staff hours by the appropriate staff wage in 
127.5 	subdivision 5 or the customized direct care rate;
127.6 	(5) multiply the number of direct staff hours by the product of the supervision span 
127.7 	of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision 
127.8 	wage in subdivision 5, paragraph (a), clause (17);
127.9 	(6) combine the results of clauses (4) and (5) and multiply the result by one plus 
127.10 	the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), 
127.11 	clause (2). This is defined as the direct staffing rate;
127.12 	(7) for program plan support, multiply the result of clause (6) by one plus the 
127.13 	program plan support ratio in subdivision 5, paragraph (f), clause (4);
127.14 	(8) for employee-related expenses, multiply the result of clause (7) by one plus the 
127.15 	employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
127.16 	(9) for client programming and supports, multiply the result of clause (8) by one plus 
127.17 	the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
127.18 	(10) this is the subtotal rate;
127.19 	(11) sum the standard general and administrative rate, the program-related expense 
127.20 	ratio, and the absence and utilization factor ratio;
127.21 	(12) divide the result of clause (10) by one minus the result of clause (11). This is 
127.22 	the total payment amount;
127.23 	(13) for respite services, determine the number of daily units of service to meet an 
127.24 	individual's needs;
127.25 	(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 
127.26 	Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
127.27 	(15) for a recipient requiring deaf or hard-of-hearing customization under 
127.28 	subdivision 12, add the customization rate provided in subdivision 12 to the result of 
127.29 	clause (14). This is defined as the customized direct care rate;
127.30 	(16) multiply the number of direct staff hours by the appropriate staff wage in 
127.31 	subdivision 5, paragraph (a);
127.32 	(17) multiply the number of direct staff hours by the product of the supervisory span 
127.33 	of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision 
127.34 	wage in subdivision 5, paragraph (a), clause (17);
128.1 	(18) combine the results of clauses (16) and (17) and multiply the result by one plus 
128.2 	the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g), 
128.3 	clause (2). This is defined as the direct staffing rate;
128.4 	(19) for employee-related expenses, multiply the result of clause (18) by one plus 
128.5 	the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
128.6 	(20) this is the subtotal rate;
128.7 	(21) sum the standard general and administrative rate, the program-related expense 
128.8 	ratio, and the absence and utilization factor ratio; and
128.9 	(22) divide the result of clause (20) by one minus the result of clause (21). This is 
128.10 	the total payment amount.
128.11 		Subd. 10.Updating payment values and additional information. (a) The 
128.12 	commissioner shall develop and implement uniform procedures to refine terms and update 
128.13 	or adjust values used to calculate payment rates in this section. For calendar year 2014, 
128.14 	the commissioner shall use the values, terms, and procedures provided in this section.
128.15 	(b) The commissioner shall work with stakeholders to assess efficacy of values 
128.16 	and payment rates. The commissioner shall report back to the legislature with proposed 
128.17 	changes for component values and recommendations for revisions on the schedule 
128.18 	provided in paragraphs (c) and (d).
128.19 	(c) The commissioner shall work with stakeholders to continue refining a 
128.20 	subset of component values, which are to be referred to as interim values, and report 
128.21 	recommendations to the legislature by February 15, 2014. Interim component values are: 
128.22 	transportation rates for day training and habilitation; transportation for adult day, structured 
128.23 	day, and prevocational services; geographic difference factor; day program facility rate; 
128.24 	services where monitoring technology replaces staff time; shared services for independent 
128.25 	living skills training; and supported employment and billing for indirect services.
128.26 	(d) The commissioner shall report and make recommendations to the legislature on: 
128.27 	February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After 
128.28 	2021, reports shall be provided on a four-year cycle.
128.29 	(e) The commissioner shall provide a public notice via list serve in October of each 
128.30 	year beginning October 1, 2014. The notice shall contain information detailing legislatively 
128.31 	approved changes in: calculation values including derived wage rates and related employee 
128.32 	and administrative factors; services utilization; county and tribal allocation changes; 
128.33 	and information on adjustments to be made to calculation values and timing of those 
128.34 	adjustments. Information in this notice shall be effective January 1 of the following year.
129.1 		Subd. 11.Payment implementation. Upon implementation of the payment 
129.2 	methodologies under this section, those payment rates supersede rates established in county 
129.3 	contracts for recipients receiving waiver services under section 256B.092 or 256B.49.
129.4 		Subd. 12.Customization of rates for individuals.  (a) For persons determined to 
129.5 	have higher needs based on being deaf or hard-of-hearing, the direct care costs must be 
129.6 	increased by an adjustment factor prior to calculating the rate under subdivisions 6 to 9. The 
129.7 	customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour 
129.8 	for waiver recipients who meet the respective criteria as determined by the commissioner. 
129.9 	(b) For the purposes of this section, "deaf or hard-of-hearing" means:
129.10 	(1)(i) the person has a developmental disability and an assessment score that 
129.11 	indicates a hearing impairment that is severe or that the person has no useful hearing;
129.12 	(ii) the person has a developmental disability and an expressive communications 
129.13 	score that indicates the person uses single signs or gestures, uses an augmentative 
129.14 	communication aid, or does not have functional communication, or the person's expressive 
129.15 	communications are unknown; and
129.16 	(iii) the person has a developmental disability and a communication score that 
129.17 	indicates the person comprehends signs, gestures, and modeling prompts or does not 
129.18 	comprehend verbal, visual, or gestural communication or that the person's receptive 
129.19 	communications score is unknown; or
129.20 	(2)(i) the person receives long-term care services and has an assessment score that 
129.21 	indicates they hear only very loud sounds, have no useful hearing, or a determination 
129.22 	cannot be made; and
129.23 	(ii) the person receives long-term care services and has an assessment score that 
129.24 	indicates the person communicates needs with sign language, symbol board, written 
129.25 	messages, gestures, or an interpreter; communicates with inappropriate content; makes 
129.26 	garbled sounds or displays echolalia; or does not communicate needs.
129.27 		Subd. 13.Transportation. The commissioner shall require that the purchase 
129.28 	of transportation services be cost-effective and be limited to market rates where the 
129.29 	transportation mode is generally available and accessible.
129.30 		Subd. 14.Exceptions. (a) In a format prescribed by the commissioner, lead 
129.31 	agencies must identify individuals with exceptional needs that cannot be met under the 
129.32 	disability waiver rate system. The commissioner shall use that information to evaluate 
129.33 	and, if necessary, approve an alternative payment rate for those individuals.
129.34 	(b) Lead agencies must submit exception requests to the state.
129.35 	(c) An application for a rate exception may be submitted for the following criteria:
130.1 	(1) an individual has service needs that cannot be met through additional units 
130.2 	of service; or
130.3 	(2) an individual's rate determined under subdivisions 6 to 9 results in an individual 
130.4 	being discharged.
130.5 	(d) Exception requests must include the following information:
130.6 	(1) the service needs required by each individual that are not accounted for in 
130.7 	subdivisions 6 to 9;
130.8 	(2) the service rate requested and the difference from the rate determined in 
130.9 	subdivisions 6 to 9;
130.10 	(3) a basis for the underlying costs used for the rate exception and any accompanying 
130.11 	documentation;
130.12 	(4) the duration of the rate exception; and
130.13 	(5) any contingencies for approval.
130.14 	(e) Approved rate exceptions shall be managed within lead agency allocations under 
130.15 	sections 256B.092 and 256B.49.
130.16 	(f) Individual disability waiver recipients may request that a lead agency submit an 
130.17 	exception request. A lead agency that denies such a request shall notify the individual 
130.18 	waiver recipient of its decision and the reasons for denying the request in writing no later 
130.19 	than 30 days after the individual's request has been made.
130.20 	(g) The commissioner shall determine whether to approve or deny an exception 
130.21 	request no more than 30 days after receiving the request. If the commissioner denies the 
130.22 	request, the commissioner shall notify the lead agency and the individual disability waiver 
130.23 	recipient in writing of the reasons for the denial.
130.24 	(h) The individual disability waiver recipient may appeal any denial of an exception 
130.25 	request by either the lead agency or the commissioner, pursuant to sections 256.045 and 
130.26 	256.0451. If the denial of an exception request results in the proposed demission of a 
130.27 	waiver recipient from a residential or day habilitation program, the commissioner shall 
130.28 	issue a temporary stay of demission, when requested by the disability waiver recipient, 
130.29 	consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). 
130.30 	The temporary stay shall remain in effect until the lead agency can provide an informed 
130.31 	choice of appropriate, alternative services to the disability waiver.
130.32 	(i) Providers may petition lead agencies to update values that were entered 
130.33 	incorrectly or erroneously into the rate management system, based on past service level 
130.34 	discussions and determination in subdivision 4, without applying for a rate exception.
130.35 		Subd. 15.County or tribal allocations. (a) Upon implementation of the disability 
130.36 	waiver rates management system on January 1, 2014, the commissioner shall establish 
131.1 	a method of tracking and reporting the fiscal impact of the disability waiver rates 
131.2 	management system on individual lead agencies.
131.3 	(b) Beginning on January 1, 2014, and continuing through full implementation on 
131.4 	December 31, 2017, the commissioner shall make annual adjustments to lead agencies' 
131.5 	home and community-based waivered service budget allocations to adjust for rate 
131.6 	differences and the resulting impact on county allocations upon implementation of the 
131.7 	disability waiver rates system.
131.8 		Subd. 16.Budget neutrality adjustment. The commissioner shall calculate the 
131.9 	total spending for all home and community-based waiver services under the payments 
131.10 	as defined in subdivisions 6 to 9 for all recipients as of July 1, 2013, and compare it 
131.11 	to spending for services defined for subdivisions 6 to 9 under current law. If spending 
131.12 	for services in one particular subdivision differs, there will be a percentage adjustment 
131.13 	to increase or decrease individual rates for the services defined in each subdivision so 
131.14 	aggregate spending matches projections under current law.
131.15 		Subd. 17.Implementation. (a) On January 1, 2014, the commissioner shall fully 
131.16 	implement the calculation of rates for waivered services under sections 256B.092 and 
131.17 	256B.49, without additional legislative approval.
131.18 	(b) The commissioner shall phase in the application of rates determined in 
131.19 	subdivisions 6 to 9 for two years.
131.20 	(c) The commissioner shall preserve rates in effect on December 31, 2013, for 
131.21 	the two-year period.
131.22 	(d) The commissioner shall calculate and measure the difference in cost per 
131.23 	individual using the historical rate and the rates under subdivisions 6 to 9 for all 
131.24 	individuals enrolled as of December 31, 2013. This measurement shall occur statewide 
131.25 	and for individuals in every county. The commissioner shall provide the results of this 
131.26 	analysis, by county for calendar year 2014, to the legislative committees with jurisdiction 
131.27 	over health and human services finance by February 15, 2015.
131.28 	(e) The commissioner shall calculate the average rate per unit for each service by 
131.29 	county. For individuals enrolled after January 1, 2014, individuals will receive the higher 
131.30 	of the rate produced under subdivisions 6 to 9, or the by-county average rate.
131.31 	(f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.