1st Engrossment - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to health; modifying the Minnesota Health 1.3 Care Administrative Simplification Act; modifying 1.4 maternal and child health provisions; modifying 1.5 provisions for speech-language pathologists, 1.6 audiologists, unlicensed mental health practitioners, 1.7 alcohol and drug counselors, and hearing instrument 1.8 dispensers; amending Minnesota Statutes 1998, sections 1.9 62J.51, by adding subdivisions; 62J.52, subdivisions 1.10 1, 2, and 5; 62J.60, subdivision 1; 145.881, 1.11 subdivision 2; 145.882, subdivision 7, and by adding a 1.12 subdivision; 145.885, subdivision 2; 148.511; 148.515, 1.13 subdivision 3; 148.517, by adding a subdivision; 1.14 148B.60, subdivision 3; 148B.68, subdivision 1; 1.15 148B.69, by adding a subdivision; 148B.71, subdivision 1.16 1; 148C.01, subdivisions 2, 7, 9, 10, and by adding a 1.17 subdivision; 148C.03, subdivision 1; 148C.04, by 1.18 adding subdivisions; 148C.06, subdivision 1; 148C.09, 1.19 subdivisions 1 and 1a; 148C.11, subdivision 1; 1.20 153A.13, subdivision 9, and by adding subdivisions; 1.21 153A.14, subdivisions 1, 2a, 2h, 4, 4a, and by adding 1.22 subdivisions; and 153A.15, subdivision 1; proposing 1.23 coding for new law in Minnesota Statutes, chapter 62J; 1.24 repealing Minnesota Statutes 1998, sections 145.882, 1.25 subdivisions 3 and 4; and 148C.04, subdivision 5. 1.26 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.27 Section 1. Minnesota Statutes 1998, section 62J.51, is 1.28 amended by adding a subdivision to read: 1.29 Subd. 19a. [UNIFORM EXPLANATION OF BENEFITS 1.30 DOCUMENT.] "Uniform explanation of benefits document" means the 1.31 document associated with and explaining the details of a group 1.32 purchaser's claim adjudication for services rendered, which is 1.33 sent to a patient. 1.34 Sec. 2. Minnesota Statutes 1998, section 62J.51, is 1.35 amended by adding a subdivision to read: 2.1 Subd. 19b. [UNIFORM REMITTANCE ADVICE REPORT.] "Uniform 2.2 remittance advice report" means the document associated with and 2.3 explaining the details of a group purchaser's claim adjudication 2.4 for services rendered, which is sent to a provider. 2.5 Sec. 3. Minnesota Statutes 1998, section 62J.52, 2.6 subdivision 1, is amended to read: 2.7 Subdivision 1. [UNIFORM BILLING FORM HCFA 1450.] (a) On 2.8 and after January 1, 1996, all institutional inpatient hospital 2.9 services, ancillary services,andinstitutionally owned or 2.10 operated outpatient services rendered by providers in Minnesota, 2.11 and institutional or noninstitutional home health services that 2.12 are not being billed using an equivalent electronic billing 2.13 format, must be billed using the uniform billing form HCFA 1450, 2.14 except as provided in subdivision 5. 2.15 (b) The instructions and definitions for the use of the 2.16 uniform billing form HCFA 1450 shall be in accordance with the 2.17 uniform billing form manual specified by the commissioner. In 2.18 promulgating these instructions, the commissioner may utilize 2.19 the manual developed by the National Uniform Billing Committee, 2.20 as adopted and finalized by the Minnesota uniform billing 2.21 committee. 2.22 (c) Services to be billed using the uniform billing form 2.23 HCFA 1450 include: institutional inpatient hospital services 2.24 and distinct units in the hospital such as psychiatric unit 2.25 services, physical therapy unit services, swing bed (SNF) 2.26 services, inpatient state psychiatric hospital services, 2.27 inpatient skilled nursing facility services, home health 2.28 services (Medicare part A), and hospice services; ancillary 2.29 services, where benefits are exhausted or patient has no 2.30 Medicare part A, from hospitals, state psychiatric hospitals, 2.31 skilled nursing facilities, and home health (Medicare part B); 2.32andinstitutional owned or operated outpatient services such as 2.33 waivered services, hospital outpatient services, including 2.34 ambulatory surgical center services, hospital referred 2.35 laboratory services, hospital-based ambulance services, and 2.36 other hospital outpatient services, skilled nursing facilities, 3.1 home health, including infusion therapy, freestanding renal 3.2 dialysis centers, comprehensive outpatient rehabilitation 3.3 facilities (CORF), outpatient rehabilitation facilities (ORF), 3.4 rural health clinics, and community mental health centers,; home 3.5 health services such as home health intravenous therapy 3.6 providers, waivered services, personal care attendants, and 3.7 hospice; and any other health care provider certified by the 3.8 Medicare program to use this form. 3.9 (d) On and after January 1, 1996, a mother and newborn 3.10 child must be billed separately, and must not be combined on one 3.11 claim form. 3.12 Sec. 4. Minnesota Statutes 1998, section 62J.52, 3.13 subdivision 2, is amended to read: 3.14 Subd. 2. [UNIFORM BILLING FORM HCFA 1500.] (a) On and 3.15 after January 1, 1996, all noninstitutional health care services 3.16 rendered by providers in Minnesota except dental or pharmacy 3.17 providers, that are not currently being billed using an 3.18 equivalent electronic billing format, must be billed using the 3.19 health insurance claim form HCFA 1500, except as provided in 3.20 subdivision 5. 3.21 (b) The instructions and definitions for the use of the 3.22 uniform billing form HCFA 1500 shall be in accordance with the 3.23 manual developed by the administrative uniformity committee 3.24 entitled standards for the use of the HCFA 1500 form, dated 3.25 February 1994, as further defined by the commissioner. 3.26 (c) Services to be billed using the uniform billing form 3.27 HCFA 1500 include physician services and supplies, durable 3.28 medical equipment, noninstitutional ambulance services, 3.29 independent ancillary services including occupational therapy, 3.30 physical therapy, speech therapy and audiology, podiatry 3.31 services, optometry services, mental health licensed 3.32 professional services, substance abuse licensed professional 3.33 services, nursing practitioner professional services, certified 3.34 registered nurse anesthetists, chiropractors, physician 3.35 assistants, laboratories, medical suppliers, and other health 3.36 care providers such ashome health intravenous therapy4.1providers, personal care attendants,day activity centers,4.2waivered services, hospice, and other home health services,and 4.3 freestanding ambulatory surgical centers. 4.4 Sec. 5. Minnesota Statutes 1998, section 62J.52, 4.5 subdivision 5, is amended to read: 4.6 Subd. 5. [STATE AND FEDERAL HEALTH CARE PROGRAMS.] (a) 4.7 Skilled nursing facilities and ICF/MR services billed to state 4.8 and federal health care programs administered by the department 4.9 of human services shall use the form designated by the 4.10 department of human services. 4.11 (b) On and after July 1, 1996, state and federal health 4.12 care programs administered by the department of human services 4.13 shall accept the HCFA 1450 for community mental health center 4.14 services and shall accept the HCFA 1500 for freestanding 4.15 ambulatory surgical center services. 4.16 (c) State and federal health care programs administered by 4.17 the department of human services shall be authorized to use the 4.18 forms designated by the department of human services for 4.19 pharmacy servicesand for child and teen checkup services. 4.20 (d) State and federal health care programs administered by 4.21 the department of human services shall accept the form 4.22 designated by the department of human services, and the HCFA 4.23 1500 for supplies, medical supplies, or durable medical 4.24 equipment. Health care providers may choose which form to 4.25 submit. 4.26 (e) Personal care attendant and waivered services billed on 4.27 a fee-for-service basis directly to state and federal health 4.28 care programs administered by the department of human services 4.29 shall use either the HCFA 1450 or the HCFA 1500 form, as 4.30 designated by the department of human services. 4.31 Sec. 6. [62J.581] [STANDARDS FOR MINNESOTA UNIFORM HEALTH 4.32 CARE REIMBURSEMENT DOCUMENTS.] 4.33 Subdivision 1. [MINNESOTA UNIFORM REMITTANCE ADVICE 4.34 REPORT.] All group purchasers and payers shall provide a uniform 4.35 remittance advice report to health care providers when a claim 4.36 is adjudicated. The uniform remittance advice report shall 5.1 comply with the standards prescribed in this section. 5.2 Subd. 2. [MINNESOTA UNIFORM EXPLANATION OF BENEFITS 5.3 DOCUMENT.] All group purchasers and payers shall provide a 5.4 uniform explanation of benefits document to health care patients 5.5 when a claim is adjudicated. The uniform explanation of 5.6 benefits document shall comply with the standards prescribed in 5.7 this section. 5.8 Subd. 3. [SCOPE.] For purposes of sections 62J.50 to 5.9 62J.61, the uniform remittance advice report and the uniform 5.10 explanation of benefits document format specified in subdivision 5.11 4 shall apply to all health care services delivered by a health 5.12 care provider or health care provider organization in Minnesota, 5.13 regardless of the location of the payer. Health care services 5.14 not paid on an individual claims basis, such as capitated 5.15 payments, are not included in this section. A health plan 5.16 company is excluded from the requirements in subdivisions 1 and 5.17 2 if they comply with section 62A.01, subdivisions 2 and 3. 5.18 Subd. 4. [SPECIFICATIONS.] The uniform remittance advice 5.19 report and the uniform explanation of benefits document shall be 5.20 provided by use of a paper document conforming to the 5.21 specifications in this section or by use of the ANSI X12N 835 5.22 standard electronic format as established under Public Law 5.23 Number 104-191, sections 1171 to 1179, Statutes at Large, volume 5.24 110, page 1936, and as updated from time to time for the 5.25 remittance advice. The commissioner, after consulting with the 5.26 administrative uniformity committee, shall specify the data 5.27 elements and definitions for the uniform remittance advice 5.28 report and the uniform explanation of benefits document. 5.29 Subd. 5. [EFFECTIVE DATE.] The requirements in 5.30 subdivisions 1 and 2 are effective 12 months after standards for 5.31 the electronic remittance advice transaction are effective under 5.32 Public Law Number 104-191, sections 1171 to 1179, Statutes at 5.33 Large, volume 110, page 1936, and as updated from time to time. 5.34 The requirements in subdivisions 1 and 2 apply regardless of 5.35 when the health care service was provided to the patient. 5.36 Sec. 7. Minnesota Statutes 1998, section 62J.60, 6.1 subdivision 1, is amended to read: 6.2 Subdivision 1. [MINNESOTA HEALTH CARE IDENTIFICATION 6.3 CARD.] All individuals with health care coverage shall be issued 6.4 health care identification cards by group purchasers as of 6.5 January 1, 1998, unless the requirements of section 62A.01, 6.6 subdivisions 2 and 3, are met. The health care identification 6.7 cards shall comply with the standards prescribed in this section. 6.8 Sec. 8. Minnesota Statutes 1998, section 145.881, 6.9 subdivision 2, is amended to read: 6.10 Subd. 2. [DUTIES.] The advisory task force shall meet on a 6.11 regular basis to perform the following duties: 6.12 (a) review and report on the health care needs of mothers 6.13 and children throughout the state of Minnesota; 6.14 (b) review and report on the type, frequency and impact of 6.15 maternal and child health care services provided to mothers and 6.16 children under existing maternal and child health care programs, 6.17 including programs administered by the commissioner of health; 6.18 (c) establish, review, and report to the commissioner a 6.19 list of program guidelines and criteria which the advisory task 6.20 force considers essential to providing an effective maternal and 6.21 child health care program to low income populations and high 6.22 risk persons and fulfilling the purposes defined in section 6.23 145.88; 6.24 (d) review staff recommendations of the department of 6.25 health regarding maternal and child health grant awards before 6.26 the awards are made; 6.27 (e) make recommendations to the commissioner for the use of 6.28 other federal and state funds available to meet maternal and 6.29 child health needs; 6.30 (f) make recommendations to the commissioner of health on 6.31 priorities for funding the following maternal and child health 6.32 services: (1) prenatal, delivery and postpartum care, (2) 6.33 comprehensive health care for children, especially from birth 6.34 through five years of age, (3) adolescent health services, (4) 6.35 family planning services, (5) preventive dental care, (6) 6.36 special services for chronically ill and handicapped children 7.1 and (7) any other services which promote the health of mothers 7.2 and children;and7.3 (g) make recommendations to the commissioner of health on 7.4 the process to distribute, award and administer the maternal and 7.5 child health block grant funds; and 7.6 (h) review the measures that are used to define the 7.7 variables of the funding distribution formula in section 7.8 145.882, subdivision 4a, every two years and make 7.9 recommendations to the commissioner of health for changes based 7.10 upon principles established by the advisory task force for this 7.11 purpose. 7.12 Sec. 9. Minnesota Statutes 1998, section 145.882, is 7.13 amended by adding a subdivision to read: 7.14 Subd. 4a. [ALLOCATION TO COMMUNITY HEALTH BOARDS.] (a) 7.15 Federal maternal and child health block grant money remaining 7.16 after distributions made under subdivision 2 and money 7.17 appropriated for allocation to community health boards must be 7.18 allocated according to paragraphs (b) to (d) to community health 7.19 boards as defined in section 145A.02, subdivision 5. 7.20 (b) All community health boards must receive 95 percent of 7.21 the funding awarded to them for the 1998-1999 funding cycle. If 7.22 the amount of state and federal funding available is less than 7.23 95 percent of the amount awarded to community health boards for 7.24 the 1998-1999 funding cycle, the available funding must be 7.25 apportioned to reflect a proportional decrease for each 7.26 recipient. 7.27 (c) The federal and state funding remaining after 7.28 distributions made under paragraph (b) must be allocated to each 7.29 community health board based on the following three variables: 7.30 (1) 25 percent based on the maternal and child population 7.31 in the area served by the community health board; 7.32 (2) 50 percent based on the health risk factors of the 7.33 maternal and child population in the area served by the 7.34 community health board; and 7.35 (3) 25 percent based on the income of the maternal and 7.36 child population in the area served by the community health 8.1 board. 8.2 (d) Each variable must be expressed as a city or county 8.3 score consisting of the city or county frequency of each 8.4 variable divided by the statewide frequency of the variable. A 8.5 total score for each city or county jurisdiction must be 8.6 computed by totaling the scores of the three factors. Each 8.7 community health board must be allocated an amount equal to the 8.8 total score obtained for the city, county, or counties in its 8.9 area multiplied by the amount of money available. 8.10 Sec. 10. Minnesota Statutes 1998, section 145.882, 8.11 subdivision 7, is amended to read: 8.12 Subd. 7. [USE OF BLOCK GRANT MONEY.] (a) Maternal and 8.13 child health block grant money allocated to a community health 8.14 board or community health services area under this section must 8.15 be used for qualified programs for high risk and low-income 8.16 individuals. Block grant money must be used for programs that: 8.17 (1) specifically address the highest risk populations, 8.18 particularly low-income and minority groups with a high rate of 8.19 infant mortality and children with low birth weight, by 8.20 providing services, including prepregnancy family planning 8.21 services, calculated to produce measurable decreases in infant 8.22 mortality rates, instances of children with low birth weight, 8.23 and medical complications associated with pregnancy and 8.24 childbirth, including infant mortality, low birth rates, and 8.25 medical complications arising from chemical abuse by a mother 8.26 during pregnancy; 8.27 (2) specifically target pregnant women whose age, medical 8.28 condition, maternal history, or chemical abuse substantially 8.29 increases the likelihood of complications associated with 8.30 pregnancy and childbirth or the birth of a child with an 8.31 illness, disability, or special medical needs; 8.32 (3) specifically address the health needs of young children 8.33 whohave orare likely to have a chronic disease or disability 8.34 or special medical needs, including physical, neurological, 8.35 emotional, and developmental problems that arise from chemical 8.36 abuse by a mother during pregnancy; 9.1 (4) provide family planning and preventive medical care for 9.2 specifically identified target populations, such as minority and 9.3 low-income teenagers, in a manner calculated to decrease the 9.4 occurrence of inappropriate pregnancy and minimize the risk of 9.5 complications associated with pregnancy and childbirth; or 9.6 (5) specifically address the frequency and severity of 9.7 childhood injuries and other child and adolescent health 9.8 problems in high risk target populations by providing services 9.9 calculated to produce measurable decreases in mortality and 9.10 morbidity.However, money may be used for this purpose only if9.11the community health board's application includes program9.12components for the purposes in clauses (1) to (4) in the9.13proposed geographic service area and the total expenditure for9.14injury-related programs under this clause does not exceed ten9.15percent of the total allocation under subdivision 3.9.16(b) Maternal and child health block grant money may be used9.17for purposes other than the purposes listed in this subdivision9.18only under the following conditions:9.19(1) the community health board or community health services9.20area can demonstrate that existing programs fully address the9.21needs of the highest risk target populations described in this9.22subdivision; or9.23(2) the money is used to continue projects that received9.24funding before creation of the maternal and child health block9.25grant in 1981.9.26(c)(b) Projects that received funding before creation of 9.27 the maternal and child health block grant in 1981, must be9.28allocated at least the amount of maternal and child health9.29special project grant funds received in 1989, unless (1) the9.30local board of health provides equivalent alternative funding9.31for the project from another source; or (2) the local board of9.32health demonstrates that the need for the specific services9.33provided by the project has significantly decreased as a result9.34of changes in the demographic characteristics of the population,9.35or other factors that have a major impact on the demand for9.36services. If the amount of federal funding to the state for the10.1maternal and child health block grant is decreased, these10.2projects must receive a proportional decrease as required in10.3subdivision 1. Increases in allocation amounts to local boards10.4of health under subdivision 4 may be used to increase funding10.5levels for these projectsmay be continued at the discretion of 10.6 the community health board. 10.7 Sec. 11. Minnesota Statutes 1998, section 145.885, 10.8 subdivision 2, is amended to read: 10.9 Subd. 2. [ADDITIONAL REQUIREMENTS FOR COMMUNITY BOARDS OF 10.10 HEALTH.] Applications by community health boards as defined in 10.11 section 145A.02, subdivision 5, under section 145.882, 10.12 subdivision34a, must also contain a summary of the process 10.13 used to develop the local program, including evidence that the 10.14 community health board notified local public and private 10.15 providers of the availability of funding through the community 10.16 health board for maternal and child health services; a list of 10.17 all public and private agency requests for grants submitted to 10.18 the community health board indicating which requests were 10.19 included in the grant application; and an explanation of how 10.20 priorities were established for selecting the requests to be 10.21 included in the grant application. The community health board 10.22 shall include, with the grant application, a written statement 10.23 of the criteria to be applied to public and private agency 10.24 requests for funding. 10.25 Sec. 12. Minnesota Statutes 1998, section 148.511, is 10.26 amended to read: 10.27 148.511 [SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS.] 10.28 Sections 148.511 to 148.5196 apply only to persons who are 10.29 applicants for registration, who are registered, who use 10.30 protected titles, or who represent that they are 10.31 registered. Persons who engage in the practice of 10.32 speech-language pathology or audiology and who satisfy the 10.33 qualifications for registration must register under sections 10.34 148.511 to 148.5196. Sections 148.511 to 148.5196 do not apply 10.35 to school personnel licensed by the board of teaching 10.36 underMinnesota Rules, part 8700.5505section 122A.28, provided 11.1 that school personnel practicing within the scope of their 11.2 licensed occupation preface titles protected under section 11.3 148.513 with the words "school" or "educational." 11.4 Sec. 13. Minnesota Statutes 1998, section 148.515, 11.5 subdivision 3, is amended to read: 11.6 Subd. 3. [SUPERVISED CLINICAL TRAINING REQUIRED.] (a) An 11.7 applicant must complete at least 375 hours of supervised 11.8 clinical training as a student that meets the requirements of 11.9 paragraphs (b) to (f). 11.10 (b) The supervised clinical training must be provided by 11.11 the educational institution or by one of its cooperating 11.12 programs. 11.13 (c) The first 25 hours of the supervised clinical training 11.14 must be spent in clinical observation. Those 25 hours must 11.15 concern the evaluation and treatment of children and adults with 11.16 disorders of speech, language, or hearing. 11.17 (d) All applicants must complete at least 350 hours of 11.18 supervised clinical training that concern the evaluation and 11.19 treatment of children and adults with disorders of speech, 11.20 language, and hearing. At least 250 of the 350 hours must be at 11.21 the graduate level in the area in which registration is sought. 11.22 At least 50 hours must be spent in each of three types of 11.23 clinical settings including, but not limited to, university 11.24 clinics, hospitals, private clinics, and schools, including 11.25 secondary and elementary. 11.26 (e) An applicant seeking registration as a speech-language 11.27 pathologist must: 11.28 (1) obtain 250 of the 350 supervised hours in 11.29 speech-language pathology; 11.30 (2) complete a minimum of 20 hours of the 250 hours in each 11.31 of the following eight categories: 11.32 (i) evaluation: speech disorders in children; 11.33 (ii) evaluation: speech disorders in adults; 11.34 (iii) evaluation: language disorders in children; 11.35 (iv) evaluation: language disorders in adults; 11.36 (v) treatment: speech disorders in children; 12.1 (vi) treatment: speech disorders in adults; 12.2 (vii) treatment: language disorders in children; and 12.3 (viii) treatment: language disorders in adults; 12.4 (3) complete a minimum of35 hours in audiology including:12.5(i) 15 hours in the evaluation or screening of individuals12.6with hearing disorders; and12.7(ii) 15 hours in habilitation or rehabilitation of12.8individuals with hearing impairment20 of the 350 hours in 12.9 audiology; and 12.10 (4) obtain no more than 20 hours in the major professional 12.11 area that are in related disorders. 12.12 (f) An applicant seeking registration as an audiologist 12.13 must: 12.14 (1) obtain 250 of the 350 hours in audiology; 12.15 (2) complete a minimum of40 hours in each of the following12.16four categories40 of the 250 hours in each of the first two of 12.17 the following categories, complete at least 80 hours in 12.18 categories (iii) and (iv), with at least ten hours in each of 12.19 categories (i) to (iv), and complete at least 20 hours in 12.20 category (v): 12.21 (i) evaluation: hearing in children; 12.22 (ii) evaluation: hearing in adults; 12.23 (iii) selection and use: amplification and assistive 12.24 devices for children;and12.25 (iv) selection and use: amplification and assistive 12.26 devices for adults; and 12.27 (v) treatment: hearing disorders in children and adults; 12.28 (3)complete a minimum of 20 hours in the category of the12.29treatment of hearing disorders in children and adults;12.30(4)complete a minimum of35 hours20 of the 350 hours in 12.31 speech-language pathologyunrelated to hearing impairment as12.32follows:12.33(i) 15 hours in evaluation or screening; and12.34(ii) 15 hours in treatment; and 12.35(5)(4) obtain no more than 20 hours in the major 12.36 professional area that are in related disorders. 13.1 Sec. 14. Minnesota Statutes 1998, section 148.517, is 13.2 amended by adding a subdivision to read: 13.3 Subd. 4. [TEMPORARY REGISTRATION.] (a) The commissioner 13.4 shall issue temporary registration as a speech-language 13.5 pathologist, an audiologist, or both, to applicants who have 13.6 applied for registration under this section and meet the 13.7 following requirements: 13.8 (1) submit a signed and dated affidavit stating that the 13.9 applicant is not the subject of a disciplinary action or past 13.10 disciplinary action in this or another jurisdiction and is not 13.11 disqualified on the basis of section 148.5195, subdivision 3; 13.12 and 13.13 (2) either: 13.14 (i) provide a copy of a current credential as a 13.15 speech-language pathologist, an audiologist, or both, held in 13.16 the District of Columbia or a state or territory of the United 13.17 States; or 13.18 (ii) provide a copy of a current certificate of clinical 13.19 competence issued by the American Speech-Language-Hearing 13.20 Association or its equivalent. 13.21 (b) A temporary registration issued to a person under this 13.22 subdivision expires 90 days after it is issued or on the date 13.23 the commissioner grants or denies registration, whichever occurs 13.24 first. 13.25 (c) Upon application for renewal, a temporary registration 13.26 shall be renewed once to a person who is able to demonstrate 13.27 good cause for failure to meet the requirements for registration 13.28 within the initial temporary registration period and who is not 13.29 the subject of a disciplinary action or disqualified on the 13.30 basis of section 148.5195, subdivision 3. 13.31 Sec. 15. Minnesota Statutes 1998, section 148B.60, 13.32 subdivision 3, is amended to read: 13.33 Subd. 3. [UNLICENSED MENTAL HEALTH PRACTITIONER OR 13.34 PRACTITIONER.] "Unlicensed mental health practitioner" or 13.35 "practitioner" means a person who provides or purports to 13.36 provide, for remuneration, mental health services as defined in 14.1 subdivision 4. It does not include persons licensed by the 14.2 board of medical practice under chapter 147 or registered by the 14.3 board of medical practice under chapter 147A; the board of 14.4 nursing under sections 148.171 to 148.285; the board of 14.5 psychology under sections 148.88 to 148.98; the board of social 14.6 work under sections 148B.18 to 148B.289; the board of marriage 14.7 and family therapy under sections 148B.29 to 148B.39; or another 14.8 licensing board if the person is practicing within the scope of 14.9 the license;ormembers of the clergy who are providing pastoral 14.10 services in the context of performing and fulfilling the 14.11 salaried duties and obligations required of a member of the 14.12 clergy by a religious congregation; American Indian medicine men 14.13 and women; licensed attorneys; probation officers; school 14.14 counselors employed by a school district while acting within the 14.15 scope of employment as school counselors; registered 14.16 occupational therapists; or occupational therapy assistants. 14.17 For the purposes of complaint investigation or disciplinary 14.18 action relating to an individual practitioner, the term includes: 14.19 (1) persons employed by a program licensed by the 14.20 commissioner of human services who are acting as mental health 14.21 practitioners within the scope of their employment; 14.22 (2) persons employed by a program licensed by the 14.23 commissioner of human services who are providing chemical 14.24 dependency counseling services; persons who are providing 14.25 chemical dependency counseling services in private practice; and 14.26 (3) clergy who are providing mental health services that 14.27 are equivalent to those defined in subdivision 4. 14.28 Sec. 16. Minnesota Statutes 1998, section 148B.68, 14.29 subdivision 1, is amended to read: 14.30 Subdivision 1. [PROHIBITED CONDUCT.] The commissioner may 14.31 impose disciplinary action as described in section 148B.69 14.32 against any unlicensed mental health practitioner. The 14.33 following conduct is prohibited and is grounds for disciplinary 14.34 action: 14.35 (a) Conviction of a crime, including a finding or verdict 14.36 of guilt, an admission of guilt, or a no contest plea, in any 15.1 court in Minnesota or any other jurisdiction in the United 15.2 States, reasonably related to the provision of mental health 15.3 services. Conviction, as used in this subdivision, includes a 15.4 conviction of an offense which, if committed in this state, 15.5 would be deemed a felony or gross misdemeanor without regard to 15.6 its designation elsewhere, or a criminal proceeding where a 15.7 finding or verdict of guilty is made or returned but the 15.8 adjudication of guilt is either withheld or not entered. 15.9 (b) Conviction of crimes against persons. For purposes of 15.10 this chapter, a crime against a person means violations of the 15.11 following: sections 609.185; 609.19; 609.195; 609.20; 609.205; 15.12 609.21; 609.215; 609.221; 609.222; 609.223; 609.224; 609.2242; 15.13 609.23; 609.231; 609.2325; 609.233; 609.2335; 609.235; 609.24; 15.14 609.245; 609.25; 609.255; 609.26, subdivision 1, clause (1) or 15.15 (2); 609.265; 609.342; 609.343; 609.344; 609.345; 609.365; 15.16 609.498, subdivision 1; 609.50, clause (1); 609.561; 609.562; 15.17 609.595; and 609.72, subdivision 3. 15.18 (c) Failure to comply with the self-reporting requirements 15.19 of section 148B.63, subdivision 7. 15.20 (d) Engaging in sexual contact with a client or former 15.21 client as defined in section 148A.01, or engaging in contact 15.22 that may be reasonably interpreted by a client as sexual, or 15.23 engaging in any verbal behavior that is seductive or sexually 15.24 demeaning to the patient, or engaging in sexual exploitation of 15.25 a client or former client. 15.26 (e) Advertising that is false, fraudulent, deceptive, or 15.27 misleading. 15.28 (f) Conduct likely to deceive, defraud, or harm the public; 15.29 or demonstrating a willful or careless disregard for the health, 15.30 welfare, or safety of a client; or any other practice that may 15.31 create unnecessary danger to any client's life, health, or 15.32 safety, in any of which cases, proof of actual injury need not 15.33 be established. 15.34 (g) Adjudication as mentally incompetent, or as a person 15.35 who is dangerous to self, or adjudication pursuant to chapter 15.36 253B, as chemically dependent, mentally ill, mentally retarded, 16.1 mentally ill and dangerous to the public, or as a sexual 16.2 psychopathic personality or sexually dangerous person. 16.3 (h) Inability to provide mental health services with 16.4 reasonable safety to clients. 16.5 (i) The habitual overindulgence in the use of or the 16.6 dependence on intoxicating liquors. 16.7 (j) Improper or unauthorized personal or other use of any 16.8 legend drugs as defined in chapter 151, any chemicals as defined 16.9 in chapter 151, or any controlled substance as defined in 16.10 chapter 152. 16.11 (k) Revealing a communication from, or relating to, a 16.12 client except when otherwise required or permitted by law. 16.13 (l) Failure to comply with a client's request made under 16.14 section 144.335, or to furnish a client record or report 16.15 required by law. 16.16 (m) Splitting fees or promising to pay a portion of a fee 16.17 to any other professional other than for services rendered by 16.18 the other professional to the client. 16.19 (n) Engaging in abusive or fraudulent billing practices, 16.20 including violations of the federal Medicare and Medicaid laws 16.21 or state medical assistance laws. 16.22 (o) Failure to make reports as required by section 148B.63, 16.23 or cooperate with an investigation of the office. 16.24 (p) Obtaining money, property, or services from a client, 16.25 other than reasonable fees for services provided to the client, 16.26 through the use of undue influence, harassment, duress, 16.27 deception, or fraud. 16.28 (q) Undertaking or continuing a professional relationship 16.29 with a client in which the objectivity of the professional would 16.30 be impaired. 16.31 (r) Failure to provide the client with a copy of the client 16.32 bill of rights or violation of any provision of the client bill 16.33 of rights. 16.34 (s) Violating any order issued by the commissioner. 16.35 (t) Failure to comply with sections 148B.60 to 148B.71, and 16.36 the rules adopted under those sections. 17.1 (u) Failure to comply with any additional disciplinary 17.2 grounds established by the commissioner by rule. 17.3 (v) Revocation, suspension, restriction, limitation, or 17.4 other disciplinary action against the mental health 17.5 practitioner's license, certificate, registration, or right of 17.6 practice in this or another state or jurisdiction, for offenses 17.7 that would be subject to disciplinary action in this state, or 17.8 failure to report to the office of mental health practice that 17.9 charges regarding the practitioner's license, certificate, 17.10 registration, or right of practice have been brought in this or 17.11 another state or jurisdiction. 17.12 (w) Bartering for services with a client. 17.13 Sec. 17. Minnesota Statutes 1998, section 148B.69, is 17.14 amended by adding a subdivision to read: 17.15 Subd. 7. [RELEASE TO OBTAIN NONPUBLIC DATA.] An unlicensed 17.16 mental health practitioner who is the subject of an 17.17 investigation must sign a release authorizing the commissioner 17.18 to obtain criminal conviction data, reports about abuse or 17.19 neglect of clients, and other information pertaining to 17.20 investigations of violations of statute or rules from the bureau 17.21 of criminal apprehension, the Federal Bureau of Investigation, 17.22 the department of human services, the office of health 17.23 facilities complaints, private certification organizations, 17.24 county social service agencies, the division of driver and 17.25 vehicle services in the department of public safety, adult 17.26 protection services, child protection services, and other 17.27 agencies that regulate provision of health care services. After 17.28 the commissioner gives written notice to an individual who is 17.29 the subject of an investigation, the agencies shall assist the 17.30 commissioner with the investigation by giving the commissioner 17.31 the requested data. 17.32 Sec. 18. Minnesota Statutes 1998, section 148B.71, 17.33 subdivision 1, is amended to read: 17.34 Subdivision 1. [SCOPE.] All unlicensed mental health 17.35 practitioners other than those providing services in a facility 17.36regulated under section 144.651 or a government agencyor 18.1 program licensed by the commissioner of health or the 18.2 commissioner of human services shall provide to each client 18.3 prior to providing treatment a written copy of the mental health 18.4 client bill of rights. A copy must also be posted in a 18.5 prominent location in the office of the mental health 18.6 practitioner. Reasonable accommodations shall be made for those 18.7 clients who cannot read or who have communication impairments 18.8 and those who do not read or speak English. The mental health 18.9 client bill of rights shall include the following: 18.10 (a) the name, title, business address, and telephone number 18.11 of the practitioner; 18.12 (b) the degrees, training, experience, or other 18.13 qualifications of the practitioner, followed by the following 18.14 statement in bold print: 18.15 "THE STATE OF MINNESOTA HAS NOT ADOPTED UNIFORM EDUCATIONAL 18.16 AND TRAINING STANDARDS FOR ALL MENTAL HEALTH PRACTITIONERS. 18.17 THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY." 18.18 (c) the name, business address, and telephone number of the 18.19 practitioner's supervisor, if any; 18.20 (d) notice that a client has the right to file a complaint 18.21 with the practitioner's supervisor, if any, and the procedure 18.22 for filing complaints; 18.23 (e) the name, address, and telephone number of the office 18.24 of mental health practice and notice that a client may file 18.25 complaints with the office; 18.26 (f) the practitioner's fees per unit of service, the 18.27 practitioner's method of billing for such fees, the names of any 18.28 insurance companies that have agreed to reimburse the 18.29 practitioner, or health maintenance organizations with whom the 18.30 practitioner contracts to provide service, whether the 18.31 practitioner accepts Medicare, medical assistance, or general 18.32 assistance medical care, and whether the practitioner is willing 18.33 to accept partial payment, or to waive payment, and in what 18.34 circumstances; 18.35 (g) a statement that the client has a right to reasonable 18.36 notice of changes in services or charges; 19.1 (h) a brief summary, in plain language, of the theoretical 19.2 approach used by the practitioner in treating patients; 19.3 (i) notice that the client has a right to complete and 19.4 current information concerning the practitioner's assessment and 19.5 recommended course of treatment, including the expected duration 19.6 of treatment; 19.7 (j) a statement that clients may expect courteous treatment 19.8 and to be free from verbal, physical, or sexual abuse by the 19.9 practitioner; 19.10 (k) a statement that client records and transactions with 19.11 the practitioner are confidential, unless release of these 19.12 records is authorized in writing by the client, or otherwise 19.13 provided by law; 19.14 (l) a statement of the client's right to be allowed access 19.15 to records and written information from records in accordance 19.16 with section 144.335; 19.17 (m) a statement that other services may be available in the 19.18 community, including where information concerning services is 19.19 available; 19.20 (n) a statement that the client has the right to choose 19.21 freely among available practitioners, and to change 19.22 practitioners after services have begun, within the limits of 19.23 health insurance, medical assistance, or other health programs; 19.24 (o) a statement that the client has a right to coordinated 19.25 transfer when there will be a change in the provider of 19.26 services; 19.27 (p) a statement that the client may refuse services or 19.28 treatment, unless otherwise provided by law; and 19.29 (q) a statement that the client may assert the client's 19.30 rights without retaliation. 19.31 Sec. 19. Minnesota Statutes 1998, section 148C.01, 19.32 subdivision 2, is amended to read: 19.33 Subd. 2. [ALCOHOL AND DRUG COUNSELOR.] "Alcohol and drug 19.34 counselor" or "counselor" means a person who: 19.35 (1) uses, as a representation to the public, any title, 19.36 initials, or description of services incorporating the words 20.1 "alcohol and drug counselor"; 20.2 (2) offers to render professional alcohol and drug 20.3 counseling services relative to the abuse of or the dependency 20.4 on alcohol or other drugs to the general public or groups, 20.5 organizations, corporations, institutions, or government 20.6 agencies for compensation, implying that the person is licensed 20.7 and trained, experienced or expert in alcohol and drug 20.8 counseling; 20.9 (3) holds a valid license issued under sections 148C.01 to 20.10 148C.11 to engage in the practice of alcohol and drug 20.11 counseling; or 20.12 (4) is an applicant for an alcohol and drug counseling 20.13 license. 20.14 Sec. 20. Minnesota Statutes 1998, section 148C.01, 20.15 subdivision 7, is amended to read: 20.16 Subd. 7. [ACCREDITED SCHOOL OR EDUCATIONAL PROGRAM.] 20.17 "Accredited school or educational program" means a school of 20.18 alcohol and drug counseling, university, college, or other 20.19 post-secondary education programthat offers no less than the20.20required number of education and practicum hours as described in20.21section 148C.04, subdivision 3, and the core functions as20.22defined in subdivision 9, andthat, at the time the student 20.23 completes the program, is accredited by a regional accrediting 20.24 association whose standards are substantially equivalent to 20.25 those of the North Central Association of Colleges and 20.26 Post-Secondary Education Institutions or an accrediting 20.27 association that evaluates schools of alcohol and drug 20.28 counseling for inclusion of the education, practicum, and core 20.29 function standards in this chapter. 20.30 Sec. 21. Minnesota Statutes 1998, section 148C.01, 20.31 subdivision 9, is amended to read: 20.32 Subd. 9. [CORE FUNCTIONS.] "Core functions" means the 20.33 following services provided in alcohol and drugdependency20.34 treatment: 20.35 (1) "Screening" means the process by which a client is 20.36 determined appropriate and eligible for admission to a 21.1 particular program. 21.2 (2) "Intake" means the administrative and initial 21.3 assessment procedures for admission to a program. 21.4 (3) "Orientation" means describing to the client the 21.5 general nature and goals of the program; rules governing client 21.6 conduct and infractions that can lead to disciplinary action or 21.7 discharge from the program; in a nonresidential program, the 21.8 hours during which services are available; treatment costs to be 21.9 borne by the client, if any; and client's rights. 21.10 (4) "Assessment" means those procedures by which a 21.11 counselor identifies and evaluates an individual's strengths, 21.12 weaknesses, problems, and needsfor the development of theto 21.13 develop a treatment plan or make recommendations for level of 21.14 care placement. 21.15 (5) "Treatment planning" means the process by which the 21.16 counselor and the client identify and rank problems needing 21.17 resolution; establish agreed upon immediate and long-term goals; 21.18 and decide on a treatment process and the sources to be utilized. 21.19 (6) "Counseling" means the utilization of special skills to 21.20 assist individuals, families, or groups in achieving objectives 21.21 through exploration of a problem and its ramifications; 21.22 examination of attitudes and feelings; consideration of 21.23 alternative solutions; and decision making. 21.24 (7) "Case management" means activities which bring 21.25 services, agencies, resources, or people together within a 21.26 planned framework of action toward the achievement of 21.27 established goals. 21.28 (8) "Crisis intervention" means those services which 21.29 respond to an alcohol or other drug user's needs during acute 21.30 emotional or physical distress. 21.31 (9) "Client education" means the provision of information 21.32 to clients who are receiving or seeking counseling concerning 21.33 alcohol and other drug abuse and the available services and 21.34 resources. 21.35 (10) "Referral" means identifying the needs of the client 21.36 which cannot be met by the counselor or agency and assisting the 22.1 client to utilize the support systems and available community 22.2 resources. 22.3 (11) "Reports and recordkeeping" means charting the results 22.4 of the assessment and treatment plan, writing reports, progress 22.5 notes, discharge summaries, and other client-related data. 22.6 (12) "Consultation with other professionals regarding 22.7 client treatment and services" means communicating with other 22.8 professionals in regard to client treatment and services to 22.9 assure comprehensive, quality care for the client. 22.10 Sec. 22. Minnesota Statutes 1998, section 148C.01, 22.11 subdivision 10, is amended to read: 22.12 Subd. 10. [PRACTICE OF ALCOHOL AND DRUG COUNSELING.] 22.13 "Practice of alcohol and drug counseling" means the observation, 22.14 description, evaluation, interpretation, and modification of 22.15 human behavior as it relates to the harmful or pathological use 22.16 or abuse of alcohol or other drugs by the application of the 22.17 core functions. The practice of alcohol and drug counseling 22.18 includes, but is not limited to, the following activities, 22.19 regardless of whether the counselor receives compensation for 22.20 the activities: 22.21 (1) assisting clients who use alcohol or drugs, evaluating 22.22 that use, and recognizing dependency if it exists; 22.23 (2) assisting clients with alcohol or other drug problems 22.24 to gain insight and motivation aimed at resolving those 22.25 problems; 22.26 (3) providing experienced professional guidance, 22.27 assistance, and support for the client's efforts to develop and 22.28 maintain a responsible functional lifestyle; 22.29 (4) recognizing problems outside the scope of the 22.30 counselor's training, skill, or competence and referring the 22.31 client to other appropriate professional services; 22.32 (5) assessing the level of alcohol or other drug use 22.33 involvement; 22.34 (6) individual planning to prevent a return to harmful 22.35 alcohol or chemical use; 22.36 (7) alcohol and other drug abuse education for clients; 23.1 (8) consultation with other professionals;and23.2 (9) gaining cultural competence through ongoing training 23.3 and education according to standards established by rule; and 23.4 (10) providing the above services, as needed, to family 23.5 members or others who are directly affected by someone using 23.6 alcohol or other drugs. 23.7 Sec. 23. Minnesota Statutes 1998, section 148C.01, is 23.8 amended by adding a subdivision to read: 23.9 Subd. 18. [PSYCHOMETRICALLY VALID AND 23.10 RELIABLE.] "Psychometrically valid and reliable" means developed 23.11 on the basis of role delineation, validation, reliability, 23.12 passing point, and sensitivity review factors, according to 23.13 generally accepted standards. 23.14 Sec. 24. Minnesota Statutes 1998, section 148C.03, 23.15 subdivision 1, is amended to read: 23.16 Subdivision 1. [GENERAL.] The commissioner shall, after 23.17 consultation with the advisory council or a committee 23.18 established by rule: 23.19 (a) adopt and enforce rules for licensure of alcohol and 23.20 drug counselors, including establishing standards and methods of 23.21 determining whether applicants and licensees are qualified under 23.22 section 148C.04. The rules must provide for examinations and 23.23 establish standards for the regulation of professional conduct. 23.24 The rules must be designed to protect the public; 23.25 (b) develop and, at least twice a year, administer an 23.26 examination to assess applicants' knowledge and skills. The 23.27 commissioner may contract for the administration of an 23.28 examinationapproved by the International Certification23.29Reciprocity Consortium/Alcohol and Other Drug Abuse23.30(ICRC/AODA)with an entity designated by the commissioner. The 23.31 examinations must be psychometrically valid and reliable; must 23.32 be written and oral, with the oral examination based on a 23.33 written case presentation; must minimize cultural bias,; and 23.34 must be balanced in various theories relative to the practice of 23.35 alcohol and drug counseling; 23.36 (c) issue licenses to individuals qualified under sections 24.1 148C.01 to 148C.11; 24.2 (d) issue copies of the rules for licensure to all 24.3 applicants; 24.4 (e) adopt rules to establish and implement procedures, 24.5 including a standard disciplinary process and rules of 24.6 professional conduct; 24.7 (f) carry out disciplinary actions against licensees; 24.8 (g) establish, with the advice and recommendations of the 24.9 advisory council, written internal operating procedures for 24.10 receiving and investigating complaints and for taking 24.11 disciplinary actions as appropriate; 24.12 (h) educate the public about the existence and content of 24.13 the rules for alcohol and drug counselor licensing to enable 24.14 consumers to file complaints against licensees who may have 24.15 violated the rules; 24.16 (i) evaluate the rules in order to refine and improve the 24.17 methods used to enforce the commissioner's standards; 24.18 (j) set, collect, and adjust license fees for alcohol and 24.19 drug counselors so that the total fees collected will as closely 24.20 as possible equal anticipated expenditures during the biennium, 24.21 as provided in section 16A.1285; fees for initial and renewal 24.22 application and examinations; late fees for counselors who 24.23 submit license renewal applications after the renewal deadline; 24.24 and a surcharge fee. The surcharge fee must include an amount 24.25 necessary to recover, over a five-year period, the 24.26 commissioner's direct expenditures for the adoption of the rules 24.27 providing for the licensure of alcohol and drug counselors. All 24.28 fees received shall be deposited in the state treasury and 24.29 credited to the special revenue fund; and 24.30 (k) prepare reports on activities related to the licensure 24.31 of alcohol and drug counselors according to this subdivision by 24.32 October 1 of each even-numbered year. Copies of the reports 24.33 shall be delivered to the legislature in accordance with section 24.34 3.195 and to the governor. The reports shall contain the 24.35 following information on the commissioner's activities relating 24.36 to the licensure of alcohol and drug counselors, for the 25.1 two-year period ending the previous June 30: 25.2 (1) a general statement of the activities; 25.3 (2) the number of staff hours spent on the activities; 25.4 (3) the receipts and disbursements of funds; 25.5 (4) the names of advisory council members and their 25.6 addresses, occupations, and dates of appointment and 25.7 reappointment; 25.8 (5) the names and job classifications of employees; 25.9 (6) a brief summary of rules proposed or adopted during the 25.10 reporting period with appropriate citations to the State 25.11 Register and published rules; 25.12 (7) the number of persons having each type of license 25.13 issued by the commissioner as of June 30 in the year of the 25.14 report; 25.15 (8) the locations and dates of the administration of 25.16 examinations by the commissioner; 25.17 (9) the number of persons examined by the commissioner with 25.18 the persons subdivided into groups showing age categories, sex, 25.19 and states of residency; 25.20 (10) the number of persons licensed by the commissioner 25.21 after taking the examinations referred to in clause (8) with the 25.22 persons subdivided by age categories, sex, and states of 25.23 residency; 25.24 (11) the number of persons not licensed by the commissioner 25.25 after taking the examinations referred to in clause (8) with the 25.26 persons subdivided by age categories, sex, and states of 25.27 residency; 25.28 (12) the number of persons not taking the examinations 25.29 referred to in clause (8) who were licensed by the commissioner 25.30 or who were denied licensing, the reasons for the licensing or 25.31 denial, and the persons subdivided by age categories, sex, and 25.32 states of residency; 25.33 (13) the number of persons previously licensed by the 25.34 commissioner whose licenses were revoked, suspended, or 25.35 otherwise altered in status with brief statements of the reasons 25.36 for the revocation, suspension, or alteration; 26.1 (14) the number of written and oral complaints and other 26.2 communications received by the commissioner which allege or 26.3 imply a violation of a statute or rule which the commissioner is 26.4 empowered to enforce; 26.5 (15) a summary, by specific category, of the substance of 26.6 the complaints and communications referred to in clause (14) 26.7 and, for each specific category, the responses or dispositions; 26.8 and 26.9 (16) any other objective information which the commissioner 26.10 believes will be useful in reviewing the commissioner's 26.11 activities. 26.12 Sec. 25. Minnesota Statutes 1998, section 148C.04, is 26.13 amended by adding a subdivision to read: 26.14 Subd. 6. [TEMPORARY PRACTICE REQUIREMENTS.] (a) A person 26.15 may temporarily practice alcohol and drug counseling prior to 26.16 being licensed under this chapter if the person: 26.17 (1) either: 26.18 (i) meets the associate degree education and practicum 26.19 requirements of subdivision 3, clause (1); or 26.20 (ii) meets the bachelor degree education and practicum 26.21 requirements of subdivision 4, clause (1), item (i); 26.22 (2) within 60 days of meeting the requirements of 26.23 subdivision 3, clause (1), or subdivision 4, clause (1), item 26.24 (i), requests, in writing, temporary practice status with the 26.25 commissioner on application forms according to section 26.26 148C.0351, which include the nonrefundable license fee and an 26.27 affirmation by the person's supervisor, as defined in paragraph 26.28 (b), clause (1), and which are signed and dated by the person 26.29 and the person's supervisor; 26.30 (3) has not been disqualified to practice temporarily on 26.31 the basis of a background investigation under section 148C.09, 26.32 subdivision 1a; and 26.33 (4) has been notified in writing by the commissioner that 26.34 the person is qualified to practice under this subdivision. 26.35 (b) A person practicing under this subdivision: 26.36 (1) may practice only in a program licensed by the 27.1 department of human services and under the direct, on-site 27.2 supervision of a person who is licensed under this chapter and 27.3 employed in that licensed program; 27.4 (2) is subject to the rules of professional conduct set by 27.5 rule; 27.6 (3) is not subject to the continuing education requirements 27.7 of section 148C.05; and 27.8 (4) must be licensed according to this chapter within 12 27.9 months of meeting the requirements of subdivision 3, clause (1), 27.10 or subdivision 4, clause (1), item (i). 27.11 (c) Upon written request, the commissioner may extend a 27.12 person's temporary status if the person practices in a program 27.13 described in section 148C.11, subdivision 3, paragraph (b), 27.14 clause (2). 27.15 (d) A person practicing under this subdivision may not hold 27.16 himself or herself out to the public by any title or description 27.17 stating or implying that the person is licensed to engage in the 27.18 practice of alcohol and drug counseling. 27.19 Sec. 26. Minnesota Statutes 1998, section 148C.04, is 27.20 amended by adding a subdivision to read: 27.21 Subd. 7. [EFFECT AND SUSPENSION OF TEMPORARY 27.22 PRACTICE.] Approval of a person's application for temporary 27.23 practice creates no rights to or expectation of approval from 27.24 the commissioner for licensure as an alcohol and drug 27.25 counselor. The commissioner may suspend or restrict a person's 27.26 temporary practice status according to section 148C.09. 27.27 Sec. 27. Minnesota Statutes 1998, section 148C.06, 27.28 subdivision 1, is amended to read: 27.29 Subdivision 1. [QUALIFICATIONS.] For two years from the 27.30 effective date of the rules authorized in section 148C.03, 27.31 subdivision 1, the commissioner shall issue a license to an 27.32 applicant if the applicant meets one of the following 27.33 qualifications: 27.34 (a) is credentialed as a certified chemical dependency 27.35 counselor (CCDC) or certified chemical dependency counselor 27.36 reciprocal (CCDCR) by the Institute for Chemical Dependency 28.1 Professionals of Minnesota, Inc.; graduates from an accredited 28.2 school or education program with a certificate of completion in 28.3 alcohol and drug counselor studies that includes a minimum of 28.4 270 clock hours of formal classroom education and 880 clock 28.5 hours of alcohol and drug counselor internship and passes both 28.6 the written and oral examinations according to this chapter; or 28.7 has 2,080 hours of supervised alcohol and drug counselor 28.8 experience, 270 clock hours of alcohol and drug counselor 28.9 training with a minimum of 60 hours of the training occurring 28.10 within the past five years, and 300 hours of alcohol and drug 28.11 counselor internship and successfully completes the examination 28.12 requirements in section 148C.04, subdivision 3, clauses (2) and 28.13 (3); 28.14 (b) has 6,000 hours of supervised alcohol and drug 28.15 counselor experience as defined by the core functions, 270 clock 28.16 hours of alcohol and drug counselor training with a minimum of 28.17 60 hours of this training occurring within the past five years, 28.18 300 hours of alcohol and drug counselor internship, and has 28.19 successfully completed the examination requirements in section 28.20 148C.04, subdivision 3, clauses (2) and (3); 28.21 (c) has 10,000 hours of supervised alcohol and drug 28.22 counselor experience as defined by the core functions, 270 clock 28.23 hours of alcohol and drug training with a minimum of 60 hours of 28.24 this training occurring within the past five years, and has 28.25 successfully completed the requirements in section 148C.04, 28.26 subdivision 3, clause (2) or (3), or is credentialed as a 28.27 certified chemical dependency practitioner (CCDP) by the 28.28 Institute for Chemical Dependency Professionals of Minnesota, 28.29 Inc.; or 28.30 (d) has 14,000 hours of supervised alcohol and drug 28.31 counselor experience as defined by the core functions and 270 28.32 clock hours of alcohol and drug training with a minimum of 60 28.33 hours of this training occurring within the past five years; or28.34(e) has met the special licensing criteria established28.35pursuant to section 148C.11. 28.36 Sec. 28. Minnesota Statutes 1998, section 148C.09, 29.1 subdivision 1, is amended to read: 29.2 Subdivision 1. [GROUNDS.] The commissioner may refuse to 29.3 grant a license to, or may suspend, revoke, or restrict the 29.4 license of an individual if the commissioner determines that a 29.5 licensee or applicant: 29.6 (1) is incompetent to engage in alcohol and drug counseling 29.7 practice or is found to be engaged in alcohol and drug 29.8 counseling practice in a manner harmful or dangerous to a client 29.9 or the public; 29.10 (2) has violated the rules of the commissioner or the 29.11 statutes the commissioner is empowered to enforce; or any law, 29.12 rule order, stipulation and consent order, agreement, or 29.13 settlement; 29.14 (3) has obtained or attempted to obtain a license or 29.15 license renewal by bribery or fraudulent misrepresentation; 29.16 (4) has knowingly made a false statement on the form 29.17 required to be submitted to the commissioner for licensing or 29.18 license renewal; 29.19 (5) has failed to obtain continuing education credits 29.20 required by the commissioner; 29.21 (6) has failed to demonstrate the qualifications or satisfy 29.22 the requirements for a license contained in this chapter or 29.23 rules of the commissioner. The burden of proof shall be upon 29.24 the applicant to demonstrate qualifications or satisfaction of 29.25 requirements; 29.26 (7) has been convicted of a crime, including a finding or 29.27 verdict of guilt, an admission of guilt, or a no contest plea, 29.28 in any court in Minnesota or any other jurisdiction in the 29.29 United States, reasonably related to the provision of alcohol 29.30 and drug counseling services. Conviction, as used in this 29.31 subdivision, includes conviction of an offense which, if 29.32 committed in this state, would be deemed a felony or gross 29.33 misdemeanor without regard to its designation elsewhere, or a 29.34 criminal proceeding where a finding or verdict of guilty is made 29.35 or returned but the adjudication of guilt is either withheld or 29.36 not entered; 30.1 (8) has been convicted of a crime against another person. 30.2 For purposes of this chapter, a crime against another person 30.3 means an offense listed in section 148B.68, subdivision 1, 30.4 paragraph (b); 30.5 (9) has failed to comply with the self-reporting 30.6 requirements of section 148C.095, subdivision 7; 30.7 (10) has engaged in sexual contact with a client, or a 30.8 former client, as defined in section 148A.01, or has engaged in 30.9 conduct that may be reasonably interpreted by a client as 30.10 sexual, or has engaged in any verbal behavior that is seductive 30.11 or sexually demeaning to the client, or has engaged in sexual 30.12 exploitation of a client or former client; 30.13 (11) has engaged in false, fraudulent, deceptive, or 30.14 misleading advertising; 30.15 (12) has engaged in conduct likely to deceive, defraud, or 30.16 harm the public; or has demonstrated a willful or careless 30.17 disregard for the health, welfare, or safety of a client; or any 30.18 other practice that may create unnecessary danger to any 30.19 client's life, health, or safety, in any of which cases, proof 30.20 of actual injury need not be established; 30.21 (13) has been adjudicated as mentally incompetent, or as a 30.22 person who has a psychopathic personality, or who is dangerous 30.23 to self, or has been adjudicated as chemically dependent, 30.24 mentally ill, mentally retarded, or mentally ill and dangerous 30.25 to the public pursuant to chapter 253B; 30.26 (14) is unable to provide alcohol and drug counseling 30.27 services with reasonable safety to clients; 30.28 (15)ishas habituallyoverindulgentoverindulged in the 30.29 use of or the dependence on alcohol within the past two years; 30.30 (16) has engaged in the improper or unauthorized personal 30.31 or other use of any legend drugs as defined in section 151.01, 30.32 any chemicals as defined in section 151.01, or any controlled 30.33 substance as defined in section 152.01 within the past two 30.34 years; 30.35 (17) reveals a communication from, or relating to, a client 30.36 except when required or permitted by law; 31.1 (18) fails to comply with a client's request for health 31.2 records made under section 144.335, or to furnish a client 31.3 record or report required by law; 31.4 (19) has engaged in fee splitting or promises to pay a 31.5 portion of a fee to any other professional other than for 31.6 services rendered by the other professional to the client; 31.7 (20) has engaged in abusive or fraudulent billing 31.8 practices, including violations of the federal Medicare and 31.9 Medicaid laws or state medical assistance laws; 31.10 (21) fails to make reports as required by section 148C.095, 31.11 or cooperate with an investigation of the commissioner; 31.12 (22) obtains money, property, or services from a client, 31.13 other than reasonable fees for services provided to the client, 31.14 through the use of undue influence, harassment, duress, 31.15 deception, or fraud; 31.16 (23) undertakes or continues a professional relationship 31.17 with a client in which the objectivity of the alcohol and drug 31.18 counselor may be impaired; 31.19 (24) engages in conduct that constitutes grounds for 31.20 discipline as established by the commissioner in rule; or 31.21 (25) engages in bartering for services with a client. 31.22 Sec. 29. Minnesota Statutes 1998, section 148C.09, 31.23 subdivision 1a, is amended to read: 31.24 Subd. 1a. [BACKGROUND INVESTIGATION.] The applicant must 31.25 sign a release authorizing the commissioner to obtain 31.26 information from the bureau of criminal apprehension, the 31.27 Federal Bureau of Investigation, the office of mental health 31.28 practice, the department of human services, the office of health 31.29 facilities complaints, and other agencies specified in the 31.30 rules. After the commissioner has given written notice to an 31.31 individual who is the subject of a background investigation, the 31.32 agencies shall assist the commissioner with the investigation by 31.33 giving the commissioner criminal conviction data, reports about 31.34abuse or neglect of clientssubstantiated maltreatment of minors 31.35 and vulnerable adults, and other information specified in the 31.36 rules. The commissioner may contract with the commissioner of 32.1 human services to obtain criminal history data from the bureau 32.2 of criminal apprehension. 32.3 Sec. 30. Minnesota Statutes 1998, section 148C.11, 32.4 subdivision 1, is amended to read: 32.5 Subdivision 1. [OTHER PROFESSIONALS.] Nothing in sections 32.6 148C.01 to 148C.10 shall prevent members of other professions or 32.7 occupations from performing functions for which they are 32.8 qualified or licensed. This exception includes, but is not 32.9 limited to, licensed physicians, registered nurses, licensed 32.10 practical nurses, licensed psychological practitioners, members 32.11 of the clergy, American Indian medicine men and women, licensed 32.12 attorneys, probation officers, licensed marriage and family 32.13 therapists, licensed social workers, licensed professional 32.14 counselors, school counselors employed by a school district 32.15 while acting within the scope of employment as school 32.16 counselors, and registered occupational therapists or 32.17 occupational therapy assistants. These persons must not, 32.18 however, use a title incorporating the words "alcohol and drug 32.19 counselor" or "licensed alcohol and drug counselor" or otherwise 32.20 hold themselves out to the public by any title or description 32.21 stating or implying that they are engaged in the practice of 32.22 alcohol and drug counseling, or that they are licensed to engage 32.23 in the practice of alcohol and drug counseling. Persons engaged 32.24 in the practice of alcohol and drug counseling are not exempt 32.25 from the commissioner's jurisdiction solely by the use of one of 32.26 the above titles. 32.27 Sec. 31. Minnesota Statutes 1998, section 153A.13, 32.28 subdivision 9, is amended to read: 32.29 Subd. 9. [SUPERVISION.] "Supervision" meanson-site32.30observing andmonitoring activities of, and accepting 32.31 responsibility for, the hearing instrument dispensing activities 32.32 of a trainee. 32.33 Sec. 32. Minnesota Statutes 1998, section 153A.13, is 32.34 amended by adding a subdivision to read: 32.35 Subd. 10. [DIRECT SUPERVISION OR DIRECTLY 32.36 SUPERVISED.] "Direct supervision" or "directly supervised" means 33.1 the on-site and contemporaneous location of a supervisor and 33.2 trainee, when the supervisor observes the trainee engaging in 33.3 hearing instrument dispensing with a consumer. 33.4 Sec. 33. Minnesota Statutes 1998, section 153A.13, is 33.5 amended by adding a subdivision to read: 33.6 Subd. 11. [INDIRECT SUPERVISION OR INDIRECTLY 33.7 SUPERVISED.] "Indirect supervision" or "indirectly supervised" 33.8 means the remote and independent performance of hearing 33.9 instrument dispensing by a trainee when authorized under section 33.10 153A.14, subdivision 4a, paragraph (b). 33.11 Sec. 34. Minnesota Statutes 1998, section 153A.14, 33.12 subdivision 1, is amended to read: 33.13 Subdivision 1. [APPLICATION FOR CERTIFICATE.] An applicant 33.14 must: 33.15 (1) be1821 years of age or older; 33.16 (2) apply to the commissioner for a certificate to dispense 33.17 hearing instruments on application forms provided by the 33.18 commissioner; 33.19 (3) at a minimum, provide the applicant's name, social 33.20 security number, business address and phone number, employer, 33.21 and information about the applicant's education, training, and 33.22 experience in testing human hearing and fitting hearing 33.23 instruments; 33.24 (4) include with the application a statement that the 33.25 statements in the application are true and correct to the best 33.26 of the applicant's knowledge and belief; 33.27 (5) include with the application a written and signed 33.28 authorization that authorizes the commissioner to make inquiries 33.29 to appropriate regulatory agencies in this or any other state 33.30 where the applicant has sold hearing instruments; 33.31 (6) submit certification to the commissioner that the 33.32 applicant's audiometric equipment has been calibrated to meet 33.33 current ANSI standards within 12 months of the date of the 33.34 application; 33.35 (7) submit evidence of continuing education credits, if 33.36 required; and 34.1 (8) submit all fees as required under section 153A.17. 34.2 Sec. 35. Minnesota Statutes 1998, section 153A.14, 34.3 subdivision 2a, is amended to read: 34.4 Subd. 2a. [EXEMPTION FROM WRITTEN EXAMINATION 34.5 REQUIREMENT.] Persons completing the audiology registration 34.6 requirements of section 148.515 after January 1, 1996, are 34.7 exempt from the written examination requirements of subdivision 34.8 2h, paragraph (a), clause (1). Minnesota registration or 34.9 American Speech-Language-Hearing Association certification as an 34.10 audiologist is not required but may be submitted as evidence 34.11 qualifying for exemption from the written examination if the 34.12 requirements are completed after January 1, 1996. Persons 34.13 qualifying for written examination exemption must fulfill the 34.14 other credentialing requirements under subdivisions 1 and 2 34.15 before a certificate may be issued by the commissioner. 34.16 Sec. 36. Minnesota Statutes 1998, section 153A.14, 34.17 subdivision 2h, is amended to read: 34.18 Subd. 2h. [CERTIFICATION BY EXAMINATION.] An applicant 34.19 must achieve a passing score, as determined by the commissioner, 34.20 on an examination according to paragraphs (a) to (c). 34.21 (a) The examination must include, but is not limited to: 34.22 (1) A written examination approved by the commissioner 34.23 covering the following areas as they pertain to hearing 34.24 instrument selling: 34.25 (i) basic physics of sound; 34.26 (ii) the anatomy and physiology of the ear; 34.27 (iii) the function of hearing instruments; 34.28 (iv) the principles of hearing instrument selection; and 34.29 (v) state and federal laws, rules, and regulations. 34.30 (2) Practical tests of proficiency in the following 34.31 techniques as they pertain to hearing instrument selling: 34.32 (i) pure tone audiometry, including air conduction testing 34.33 and bone conduction testing; 34.34 (ii) live voice or recorded voice speech audiometry 34.35 including speech recognition (discrimination) testing, most 34.36 comfortable loudness level, and uncomfortable loudness 35.1 measurements of tolerance thresholds; 35.2 (iii) masking when indicated; 35.3 (iv) recording and evaluation of audiograms and speech 35.4 audiometry to determine proper selection and fitting of a 35.5 hearing instrument; 35.6 (v) taking ear mold impressions; and 35.7 (vi) using an otoscope for the visual observation of the 35.8 entire ear canal. 35.9 (b) The examination shall be administered by the 35.10 commissioner at least twice a year. 35.11 (c) An applicant must achieve a passing score on all 35.12 portions of the examination within a two-year period. An 35.13 applicant who does not achieve a passing score on all portions 35.14 of the examination within a two-year period must retake the 35.15 entire examination and achieve a passing score on each portion 35.16 of the examination. An applicant who does not apply for 35.17 certification within one year of successful completion of the 35.18 examination must retake the examination and achieve a passing 35.19 score on each portion of the examination. An applicant may not 35.20 take any part of the examination more than three times in a 35.21 two-year period. 35.22 Sec. 37. Minnesota Statutes 1998, section 153A.14, 35.23 subdivision 4, is amended to read: 35.24 Subd. 4. [DISPENSING OF HEARING INSTRUMENTS WITHOUT 35.25 CERTIFICATE.] Except as provided insubdivisionsubdivisions 4a 35.26 and 4c, it is unlawful for any person not holding a valid 35.27 certificate to dispense a hearing instrument as defined in 35.28 section 153A.13, subdivision 3. A person who dispenses a 35.29 hearing instrument without the certificate required by this 35.30 section is guilty of a gross misdemeanor. 35.31 Sec. 38. Minnesota Statutes 1998, section 153A.14, 35.32 subdivision 4a, is amended to read: 35.33 Subd. 4a. [TRAINEES.] (a) A person who is not certified 35.34 under this section may dispense hearing instruments as a trainee 35.35 for a period not to exceed 12 months if the person: 35.36 (1) submits an application on forms provided by the 36.1 commissioner; 36.2 (2) is under the supervision of a certified dispenser 36.3 meeting the requirements of this subdivision; and 36.4 (3) meets all requirements for certification except passage 36.5 of the examination required by this section. 36.6 (b) A certified hearing instrument dispenser may not 36.7 supervise more than two trainees at the same time and may not 36.8 directly supervise more than one trainee at a time. The 36.9 certified dispenser is responsible for all actions or omissions 36.10 of a trainee in connection with the dispensing of hearing 36.11 instruments. A certified dispenser may not supervise a trainee 36.12 if there are any commissioner, court, or other orders, currently 36.13 in effect or issued within the last five years, that were issued 36.14 with respect to an action or omission of a certified dispenser 36.15 or a trainee under the certified dispenser's supervision. 36.16 Until taking and passing the practical examination testing, 36.17 the techniques described in subdivision 2h, paragraph (a), 36.18 clause (2), trainees must be directly supervised in all areas 36.19 described in subdivision 4b, and the activities tested by 36.20 the practical examination.Two hundred hours of on-site36.21observations must be completed within the trainee period with a36.22minimum of 100 hours involving the supervisor, trainee, and a36.23consumer. In additionThereafter, trainees may dispense hearing 36.24 instruments under indirect supervision until expiration of the 36.25 trainee period. Under indirect supervision, the trainee must 36.26 complete two monitored activities a week. Monitored activities 36.27 may be executed by correspondence, telephone, or other 36.28 telephonic devices, and include, but are not limited to, 36.29 evaluation of audiograms, written reports, and contracts. The 36.30 time spent in supervision must be recorded and the record 36.31 retained by the supervisor. 36.32 Sec. 39. Minnesota Statutes 1998, section 153A.14, is 36.33 amended by adding a subdivision to read: 36.34 Subd. 4c. [RECIPROCITY.] (a) A person applying for 36.35 certification as a hearing instrument dispenser under 36.36 subdivision 1 and who has dispensed hearing instruments in 37.1 another jurisdiction may dispense hearing instruments as a 37.2 trainee under indirect supervision if the person: 37.3 (1) satisfies provisions of subdivision 4a, paragraph (a); 37.4 (2) submits a signed and dated affidavit stating that the 37.5 applicant is not the subject of a disciplinary action or past 37.6 disciplinary action in this or another jurisdiction and is not 37.7 disqualified on the basis of section 153A.15, subdivision 1; and 37.8 (3) provides a copy of a current credential as a hearing 37.9 instrument dispenser, an audiologist, or both, held in the 37.10 District of Columbia or a state or territory of the United 37.11 States. 37.12 (b) A person becoming a trainee under this subdivision who 37.13 fails to take and pass the practical examination described in 37.14 subdivision 2h, paragraph (a), clause (2), when next offered 37.15 must cease dispensing hearing instruments unless under direct 37.16 supervision. 37.17 Sec. 40. Minnesota Statutes 1998, section 153A.14, is 37.18 amended by adding a subdivision to read: 37.19 Subd. 4d. [EXPIRATION OF TRAINEE PERIOD.] The trainee 37.20 period automatically expires two months following notice of 37.21 passing all examination requirements of subdivision 2h. 37.22 Sec. 41. Minnesota Statutes 1998, section 153A.15, 37.23 subdivision 1, is amended to read: 37.24 Subdivision 1. [PROHIBITED ACTS.] The commissioner may 37.25 take enforcement action as provided under subdivision 2 against 37.26 a dispenser of hearing instruments for the following acts and 37.27 conduct: 37.28 (1) prescribing or otherwise recommending to a consumer or 37.29 potential consumer the use of a hearing instrument, unless the 37.30 prescription from a physician or recommendation from a hearing 37.31 instrument dispenser or audiologist is in writing, is based on 37.32 an audiogram that is delivered to the consumer or potential 37.33 consumer when the prescription or recommendation is made, and 37.34 bears the following information in all capital letters of 37.35 12-point or larger boldface type: "THIS PRESCRIPTION OR 37.36 RECOMMENDATION MAY BE FILLED BY, AND HEARING INSTRUMENTS MAY BE 38.1 PURCHASED FROM, THE CERTIFIED DISPENSER OF YOUR CHOICE"; 38.2 (2) failing to give a copy of the audiogram, upon which the 38.3 prescription or recommendation is based, to the consumer when 38.4 there has been a charge for the audiogram and the consumer 38.5 requests a copy; 38.6 (3) dispensing a hearing instrument to a minor person 18 38.7 years or younger unless evaluated by an audiologist for purposes 38.8 of hearing evaluation and hearing aid evaluation; 38.9 (4) failing to provide the consumer rights brochure 38.10 required by section 153A.14, subdivision 9; 38.11(4)(5) being disciplined through a revocation, suspension, 38.12 restriction, or limitation by another state for conduct subject 38.13 to action under this chapter; 38.14(5)(6) presenting advertising that is false or misleading; 38.15(6)(7) providing the commissioner with false or misleading 38.16 statements of credentials, training, or experience; 38.17(7)(8) engaging in conduct likely to deceive, defraud, or 38.18 harm the public; or demonstrating a willful or careless 38.19 disregard for the health, welfare, or safety of a consumer; 38.20(8)(9) splitting fees or promising to pay a portion of a 38.21 fee to any other professional other than a fee for services 38.22 rendered by the other professional to the client; 38.23(9)(10) engaging in abusive or fraudulent billing 38.24 practices, including violations of federal Medicare and Medicaid 38.25 laws, Food and Drug Administration regulations, or state medical 38.26 assistance laws; 38.27(10)(11) obtaining money, property, or services from a 38.28 consumer through the use of undue influence, high pressure sales 38.29 tactics, harassment, duress, deception, or fraud; 38.30(11)(12) failing to comply with restrictions on sales of 38.31 hearing aids in sections 153A.14, subdivision 9, and 153A.19; 38.32(12)(13) performing the services of a certified hearing 38.33 instrument dispenser in an incompetent or negligent manner; 38.34(13)(14) failing to comply with the requirements of this 38.35 chapter as an employer, supervisor, or trainee; 38.36(14)(15) failing to provide information in a timely manner 39.1 in response to a request by the commissioner, commissioner's 39.2 designee, or the advisory council; 39.3(15)(16) being convicted within the past five years of 39.4 violating any laws of the United States, or any state or 39.5 territory of the United States, and the violation is a felony, 39.6 gross misdemeanor, or misdemeanor, an essential element of which 39.7 relates to hearing instrument dispensing, except as provided in 39.8 chapter 364; 39.9(16)(17) failing to cooperate with the commissioner, the 39.10 commissioner's designee, or the advisory council in any 39.11 investigation; 39.12(17)(18) failing to perform hearing instrument dispensing 39.13 with reasonable judgment, skill, or safety due to the use of 39.14 alcohol or drugs, or other physical or mental impairment; 39.15(18)(19) failing to fully disclose actions taken against 39.16 the applicant or the applicant's legal authorization to dispense 39.17 hearing instruments in this or another state; 39.18(19)(20) violating a state or federal court order or 39.19 judgment, including a conciliation court judgment, relating to 39.20 the activities of the applicant in hearing instrument 39.21 dispensing; 39.22(20)(21) having been or being disciplined by the 39.23 commissioner of the department of health, or other authority, in 39.24 this or another jurisdiction, if any of the grounds for the 39.25 discipline are the same or substantially equivalent to those in 39.26 sections 153A.13 to 153A.19; 39.27(21)(22) misrepresenting the purpose of hearing tests, or 39.28 in any way communicating that the hearing test or hearing test 39.29 protocol required by section 153A.14, subdivision 4b, is a 39.30 medical evaluation, a diagnostic hearing evaluation conducted by 39.31 an audiologist, or is other than a test to select a hearing 39.32 instrument, except that the hearing instrument dispenser can 39.33 determine the need for or recommend the consumer obtain a 39.34 medical evaluation consistent with requirements of the United 39.35 States Food and Drug Administration; 39.36(22)(23) violating any of the provisions of sections 40.1 153A.13 to 153A.19; and 40.2(23)(24) aiding or abetting another person in violating 40.3 any of the provisions of sections 153A.13 to 153A.19. 40.4 Sec. 42. [REPEALER.] 40.5 Minnesota Statutes 1998, sections 145.882, subdivisions 3 40.6 and 4; and 148C.04, subdivision 5, are repealed.