HF 1780

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 04/19/2013 11:51am

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

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

REDESIGNING HOME AND COMMUNITY-BASED SERVICES

Section 1.

new text begin [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Basis and scope. new text end

new text begin (a) Upon federal approval, the commissioner
shall establish a medical assistance state plan option for the provision of home and
community-based personal assistance service and supports called "community first
services and supports (CFSS)."
new text end

new text begin (b) CFSS is a participant-controlled method of selecting and providing services
and supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports
to perform that function.
new text end

new text begin (c) CFSS is available statewide to eligible individuals to assist with accomplishing
activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
health-related procedures and tasks through hands-on assistance to complete the task or
supervision and cueing to complete the task; and to assist with acquiring, maintaining, and
enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures
and tasks. CFSS allows payment for certain supports and goods such as environmental
modifications and technology that are intended to replace or decrease the need for human
assistance.
new text end

new text begin (d) Upon federal approval, CFSS will replace the personal care assistance program
under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in
this subdivision have the meanings given.
new text end

new text begin (b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
dressing, bathing, mobility, positioning, and transferring.
new text end

new text begin (c) "Agency-provider model" means a method of CFSS under which a qualified
agency provides services and supports through the agency's own employees and policies.
The agency must allow the participant to have a significant role in the selection and
dismissal of support workers of their choice for the delivery of their specific services
and supports.
new text end

new text begin (d) "Behavior" means a category to determine the home care rating and is based on the
criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
others, or destruction of property that requires the immediate response of another person.
new text end

new text begin (e) "Complex health-related needs" means a category to determine the home care
rating and is based on the criteria in section 256B.0659.
new text end

new text begin (f) "Community first services and supports" or "CFSS" means the assistance and
supports program under this section needed for accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through hands-on assistance
to complete the task or supervision and cueing to complete the task, or the purchase of
goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
human assistance.
new text end

new text begin (g) "Community first services and supports service delivery plan" or "service delivery
plan" means a written summary of the services and supports, that is based on the community
support plan identified in section 256B.0911 and coordinated services and support plan
and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
by the participant to meet the assessed needs, using a person-centered planning process.
new text end

new text begin (h) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.
new text end

new text begin (i) "Dependency" in activities of daily living means a person requires assistance to
begin and complete one or more of the activities of daily living.
new text end

new text begin (j) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary
to use the flexible spending model under subdivision 13, that include but are not limited
to: participant education and technical assistance; CFSS service delivery planning and
budgeting; billing, making payments, and monitoring of spending; and assisting the
participant in fulfilling employer-related requirements in accordance with Section 3504 of
the IRS code and the IRS Revenue Procedure 70-6.
new text end

new text begin (k) "Flexible spending model" means a service delivery method of CFSS that uses
an individualized CFSS service delivery plan and service budget and assistance from the
financial management services contractor to facilitate participant employment of support
workers and the acquisition of supports and goods.
new text end

new text begin (l) "Health-related procedures and tasks" means procedures and tasks related to
the specific needs of an individual that can be delegated or assigned by a state-licensed
healthcare or behavioral health professional and performed by a support worker.
new text end

new text begin (m) "Instrumental activities of daily living" means activities related to living
independently in the community, including but not limited to: meal planning, preparation,
and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
assistance with medications; managing money; communicating needs, preferences, and
activities; arranging supports; and assistance with traveling around and participating
in the community.
new text end

new text begin (n) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include
but are not limited to a health care agent or an attorney-in-fact authorized through a health
care directive or power of attorney.
new text end

new text begin (o) "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication and includes any of the following supports:
new text end

new text begin (1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
new text end

new text begin (2) organizing medications as directed by the participant or the participant's
representative; and
new text end

new text begin (3) providing verbal or visual reminders to perform regularly scheduled medications.
new text end

new text begin (p) "Participant's representative" means a parent, family member, advocate, or
other adult authorized by the participant to serve as a representative in connection with
the provision of CFSS. This authorization must be in writing or by another method
that clearly indicates the participant's free choice. The participant's representative must
have no financial interest in the provision of any services included in the participant's
service delivery plan and must be capable of providing the support necessary to assist
the participant in the use of CFSS. If through the assessment process described in
subdivision 5 a participant is determined to be in need of a participant's representative, one
must be selected. If the participant is unable to assist in the selection of a participant's
representative, the legal representative shall appoint one. Two persons may be designated
as a participant's representative for reasons such as divided households and court-ordered
custodies. Duties of a participant's representatives may include:
new text end

new text begin (1) being available while care is provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
new text end

new text begin (2) monitoring CFSS services to ensure the participant's CFSS service delivery
plan is being followed; and
new text end

new text begin (3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
new text end

new text begin (q) "Person-centered planning process" means a process that is driven by the
participant for discovering and planning services and supports that ensures the participant
makes informed choices and decisions. The person-centered planning process must:
new text end

new text begin (1) include people chosen by the participant;
new text end

new text begin (2) provide necessary information and support to ensure that the participant directs
the process to the maximum extent possible, and is enabled to make informed choices
and decisions;
new text end

new text begin (3) be timely and occur at time and locations of convenience to the participant;
new text end

new text begin (4) reflect cultural considerations of the participant;
new text end

new text begin (5) include strategies for solving conflict or disagreement within the process,
including clear conflict-of-interest guidelines for all planning;
new text end

new text begin (6) offers choices to the participant regarding the services and supports they receive
and from whom;
new text end

new text begin (7) include a method for the participant to request updates to the plan; and
new text end

new text begin (8) record the alternative home and community-based settings that were considered
by the participant.
new text end

new text begin (r) "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same provider.
new text end

new text begin (s) "Support specialist" means a professional with the skills and ability to assist the
participant using either the agency provider model under subdivision 11 or the flexible
spending model under subdivision 13, in services including, but not limited to assistance
regarding:
new text end

new text begin (1) the development, implementation, and evaluation of the CFSS service delivery
plan under subdivision 6;
new text end

new text begin (2) recruitment, training, or supervision, including supervision of health-related
tasks or behavioral supports appropriately delegated by a health care professional, and
evaluation of support workers; and
new text end

new text begin (3) facilitating the use of informal and community supports, goods, or resources.
new text end

new text begin (t) "Support worker" means an employee of the agency provider or of the participant
who has direct contact with the participant and provides services as specified within the
participant's service delivery plan.
new text end

new text begin (u) "Wages and benefits" means the hourly wages and salaries, the employer's
share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
compensation, mileage reimbursement, health and dental insurance, life insurance,
disability insurance, long-term care insurance, uniform allowance, contributions to
employee retirement accounts, or other forms of employee compensation and benefits.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) CFSS is available to a person who meets one of the
following:
new text end

new text begin (1) is a recipient of medical assistance as determined under section 256B.055,
256B.056, or 256B.057, subdivisions 5 and 9;
new text end

new text begin (2) is a recipient of the alternative care program under section 256B.0913;
new text end

new text begin (3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
or 256B.49; or
new text end

new text begin (4) has medical services identified in a participant's individualized education
program and is eligible for services as determined in section 256B.0625, subdivision 26.
new text end

new text begin (b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
new text end

new text begin (1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911;
new text end

new text begin (2) is not a recipient under the family support grant under section 252.32;
new text end

new text begin (3) lives in the person's own apartment or home including a family foster care setting
licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
noncertified boarding care or boarding and lodging establishments under chapter 157;
unless transitioning into the community from an institution; and
new text end

new text begin (4) has not been excluded or disenrolled from the flexible spending model.
new text end

new text begin (c) The commissioner shall disenroll or exclude participants from the flexible
spending model and transfer them to the agency-provider model under the following
circumstances that include but are not limited to:
new text end

new text begin (1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period;
new text end

new text begin (2) when a participant exits the flexible spending service delivery model during the
participant's service plan year. Upon transfer, the participant shall not access the flexible
spending model for the remainder of that service plan year; or
new text end

new text begin (3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the service
delivery model. The commissioner must develop policies for determining if a participant
is unable to manage responsibilities under a service model.
new text end

new text begin (d) A participant may appeal in writing to the department to contest the department's
decision under paragraph (c), clause (3), to remove or exclude the participant from the
flexible spending model.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility for other services. new text end

new text begin Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state
plan medical assistance benefit or other services available through alternative care.
new text end

new text begin Subd. 5. new text end

new text begin Assessment requirements. new text end

new text begin (a) The assessment of functional need must:
new text end

new text begin (1) be conducted by a certified assessor according to the criteria established in
section 256B.0911;
new text end

new text begin (2) be conducted face-to-face, initially and at least annually thereafter, or when there
is a significant change in the participant's condition or a change in the need for services
and supports; and
new text end

new text begin (3) be completed using the format established by the commissioner.
new text end

new text begin (b) A participant who is residing in a facility may be assessed and choose CFSS for
the purpose of using CFSS to return to the community as described in subdivisions 3
and 7, paragraph (a), clause (5).
new text end

new text begin (c) The results of the assessment and any recommendations and authorizations for
CFSS must be determined and communicated in writing by the lead agency's certified
assessor as defined in section 256B.0911 to the participant and the agency-provider or
financial management services provider chosen by the participant within 40 calendar days
and must include the participant's right to appeal under section 256.045.
new text end

new text begin Subd. 6. new text end

new text begin Community first services and support service delivery plan. new text end

new text begin (a) The
CFSS service delivery plan must be developed, implemented, and evaluated through a
person-centered planning process by the participant, or the participant's representative
or legal representative who may be assisted by a support specialist. The CFSS service
delivery plan must reflect the services and supports that are important to the participant
and for the participant to meet the needs assessed by the certified assessor and identified
in the community support plan under section 256B.0911 or the coordinated services and
support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
service delivery plan must be reviewed by the participant and the agency-provider or
financial management services contractor at least annually upon reassessment, or when
there is a significant change in the participant's condition, or a change in the need for
services and supports.
new text end

new text begin (b) The commissioner shall establish the format and criteria for the CFSS service
delivery plan.
new text end

new text begin (c) The CFSS service delivery plan must be person-centered and:
new text end

new text begin (1) specify the agency-provider or financial management services contractor selected
by the participant;
new text end

new text begin (2) reflect the setting in which the participant resides that is chosen by the participant;
new text end

new text begin (3) reflect the participant's strengths and preferences;
new text end

new text begin (4) include the means to address the clinical and support needs as identified through
an assessment of functional needs;
new text end

new text begin (5) include individually identified goals and desired outcomes;
new text end

new text begin (6) reflect the services and supports, paid and unpaid, that will assist the participant
to achieve identified goals, and the providers of those services and supports, including
natural supports;
new text end

new text begin (7) identify the amount and frequency of face-to-face supports and amount and
frequency of remote supports and technology that will be used;
new text end

new text begin (8) identify risk factors and measures in place to minimize them, including
individualized backup plans;
new text end

new text begin (9) be understandable to the participant and the individuals providing support;
new text end

new text begin (10) identify the individual or entity responsible for monitoring the plan;
new text end

new text begin (11) be finalized and agreed to in writing by the participant and signed by all
individuals and providers responsible for its implementation;
new text end

new text begin (12) be distributed to the participant and other people involved in the plan; and
new text end

new text begin (13) prevent the provision of unnecessary or inappropriate care.
new text end

new text begin (d) The total units of agency-provider services or the budget allocation amount for
the flexible spending model include both annual totals and a monthly average amount
that cover the number of months of the service authorization. The amount used each
month may vary, but additional funds must not be provided above the annual service
authorization amount unless a change in condition is assessed and authorized by the
certified assessor and documented in the community support plan, coordinated services
and supports plan, and service delivery plan.
new text end

new text begin Subd. 7. new text end

new text begin Community first services and supports; covered services. new text end

new text begin Services
and supports covered under CFSS include:
new text end

new text begin (1) assistance to accomplish activities of daily living (ADLs), instrumental activities
of daily living (IADLs), and health-related procedures and tasks through hands-on
assistance to complete the task or supervision and cueing to complete the task;
new text end

new text begin (2) assistance to acquire, maintain, or enhance the skills necessary for the participant
to accomplish activities of daily living, instrumental activities of daily living, or
health-related tasks;
new text end

new text begin (3) expenditures for items, services, supports, environmental modifications, or
goods, including assistive technology. These expenditures must:
new text end

new text begin (i) relate to a need identified in a participant's CFSS service delivery plan;
new text end

new text begin (ii) increase independence or substitute for human assistance to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs; and
new text end

new text begin (iii) fit within the annual limit of the participant's approved service allocation
or budget;
new text end

new text begin (4) observation and redirection for episodes where there is a need for redirection
due to participant behaviors or intervention needed due to a participant's symptoms. An
assessment of behaviors must meet the criteria in this clause. A recipient qualifies as
having a need for assistance due to behaviors if the recipient's behavior requires assistance
at least four times per week and shows one or more of the following behaviors:
new text end

new text begin (i) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;
new text end

new text begin (ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
new text end

new text begin (iii) increased need for assistance for recipients who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased;
new text end

new text begin (5) back-up systems or mechanisms, such as the use of pagers or other electronic
devices, to ensure continuity of the participant's services and supports;
new text end

new text begin (6) transition costs, including:
new text end

new text begin (i) deposits for rent and utilities;
new text end

new text begin (ii) first month's rent and utilities;
new text end

new text begin (iii) bedding;
new text end

new text begin (iv) basic kitchen supplies;
new text end

new text begin (v) other necessities, to the extent that these necessities are not otherwise covered
under any other funding that the participant is eligible to receive; and
new text end

new text begin (vi) other required necessities for an individual to make the transition from a nursing
facility, institution for mental diseases, or intermediate care facility for persons with
developmental disabilities to a community-based home setting where the participant
resides; and
new text end

new text begin (7) services by a support specialist defined under subdivision 2 that are chosen
by the participant.
new text end

new text begin Subd. 8. new text end

new text begin Determination of CFSS service methodology. new text end

new text begin (a) All community first
services and supports must be authorized by the commissioner or the commissioner's
designee before services begin except for the assessments established in section
256B.0911. The authorization for CFSS must be completed within 30 days after receiving
a complete request.
new text end

new text begin (b) The amount of CFSS authorized must be based on the recipient's home
care rating. The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner identifying
the following for a recipient:
new text end

new text begin (1) the total number of dependencies of activities of daily living as defined in
subdivision 2;
new text end

new text begin (2) the presence of complex health-related needs as defined in subdivision 2; and
new text end

new text begin (3) the presence of Level I behavior as defined in subdivision 2.
new text end

new text begin (c) For purposes meeting the criteria in paragraph (b), the methodology to determine
the total minutes for CFSS for each home care rating is based on the median paid units
per day for each home care rating from fiscal year 2007 data for the PCA program. Each
home care rating has a base number of minutes assigned. Additional minutes are added
through the assessment and identification of the following:
new text end

new text begin (1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in subdivision 2;
new text end

new text begin (2) 30 additional minutes per day for each complex health-related function as
defined in subdivision 2; and
new text end

new text begin (3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
new text end

new text begin Subd. 9. new text end

new text begin Noncovered services. new text end

new text begin (a) Services or supports that are not eligible for
payment under this section include those that:
new text end

new text begin (1) are not authorized by the certified assessor or included in the written service
delivery plan;
new text end

new text begin (2) are provided prior to the authorization of services and the approval of the written
CFSS service delivery plan;
new text end

new text begin (3) are duplicative of other paid services in the written service delivery plan;
new text end

new text begin (4) supplant natural unpaid supports that are provided voluntarily to the participant
and are selected by the participant in lieu of a support worker and appropriately meeting
the participant's needs;
new text end

new text begin (5) are not effective means to meet the participant's needs; and
new text end

new text begin (6) are available through other funding sources, including, but not limited to, funding
through Title IV-E of the Social Security Act.
new text end

new text begin (b) Additional services, goods, or supports that are not covered include:
new text end

new text begin (1) those that are not for the direct benefit of the participant;
new text end

new text begin (2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;
new text end

new text begin (3) insurance, except for insurance costs related to employee coverage;
new text end

new text begin (4) room and board costs for the participant with the exception of allowable
transition costs in subdivision 7, clause (6);
new text end

new text begin (5) services, supports, or goods that are not related to the assessed needs;
new text end

new text begin (6) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;
new text end

new text begin (7) assistive technology devices and assistive technology services other than those
for back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
new text end

new text begin (8) medical supplies and equipment;
new text end

new text begin (9) environmental modifications, except as specified in subdivision 7;
new text end

new text begin (10) expenses for travel, lodging, or meals related to training the participant, the
participant's representative, legal representative, or paid or unpaid caregivers that exceed
$500 in a 12-month period;
new text end

new text begin (11) experimental treatments;
new text end

new text begin (12) any service or good covered by other medical assistance state plan services,
including prescription and over-the-counter medications, compounds, and solutions and
related fees, including premiums and co-payments;
new text end

new text begin (13) membership dues or costs, except when the service is necessary and appropriate
to treat a physical condition or to improve or maintain the participant's physical condition.
The condition must be identified in the participant's CFSS plan and monitored by a
physician enrolled in a Minnesota health care program;
new text end

new text begin (14) vacation expenses other than the cost of direct services;
new text end

new text begin (15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need; and
new text end

new text begin (16) tickets and related costs to attend sporting or other recreational or entertainment
events.
new text end

new text begin Subd. 10. new text end

new text begin Provider qualifications and general requirements. new text end

new text begin (a)
Agency-providers delivering services under the agency-provider model under subdivision
11 or financial management service (FMS) contractors under subdivision 13 shall:
new text end

new text begin (1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standards;
new text end

new text begin (2) comply with medical assistance provider enrollment requirements;
new text end

new text begin (3) demonstrate compliance with law and policies of CFSS as determined by the
commissioner;
new text end

new text begin (4) comply with background study requirements under chapter 245C;
new text end

new text begin (5) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers and support specialists;
new text end

new text begin (6) not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family member
or participants' representatives;
new text end

new text begin (7) pay support workers and support specialists based upon actual hours of services
provided;
new text end

new text begin (8) withhold and pay all applicable federal and state payroll taxes;
new text end

new text begin (9) make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
new text end

new text begin (10) enter into a written agreement with the participant, participant's representative,
or legal representative that assigns roles and responsibilities to be performed before
services, supports, or goods are provided using a format established by the commissioner;
new text end

new text begin (11) report suspected neglect and abuse to the common entry point according to
sections 256B.0651 and 626.557; and
new text end

new text begin (12) provide the participant with a copy of the service-related rights under
subdivision 19 at the start of services and supports.
new text end

new text begin (b) The commissioner shall develop policies and procedures designed to ensure
program integrity and fiscal accountability for goods and services provided in this section.
new text end

new text begin Subd. 11. new text end

new text begin Agency-provider model. new text end

new text begin (a) The agency-provider model is limited to
the services provided by support workers and support specialists who are employed by
an agency-provider that is licensed according to chapter 245A or meets other criteria
established by the commissioner, including required training.
new text end

new text begin (b) The agency-provider shall allow the participant to retain the ability to have a
significant role in the selection and dismissal of the support workers for the delivery of the
services and supports specified in the service delivery plan.
new text end

new text begin (c) A participant may use authorized units of CFSS services as needed within
a service authorization that is not greater than 12 months. Using authorized units
agency-provider services or the budget allocation amount for the flexible spending model
flexibly does not increase the total amount of services and supports authorized for a
participant or included in the participant's service delivery plan.
new text end

new text begin (d) A participant may share CFSS services. Two or three CFSS participants may
share services at the same time provided by the same support worker.
new text end

new text begin (e) The agency-provider must use a minimum of 72.5 percent of the revenue
generated by the medical assistance payment for CFSS for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist must not be used in making this calculation.
new text end

new text begin (f) The agency-provider model must be used by individuals who have been restricted
by the Minnesota restricted recipient program.
new text end

new text begin Subd. 12. new text end

new text begin Requirements for initial enrollment of CFSS provider agencies. new text end

new text begin (a)
All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
agency in a format determined by the commissioner, information and documentation that
includes, but is not limited to, the following:
new text end

new text begin (1) the CFSS provider agency's current contact information including address,
telephone number, and e-mail address;
new text end

new text begin (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
new text end

new text begin (3) proof of fidelity bond coverage in the amount of $20,000;
new text end

new text begin (4) proof of workers' compensation insurance coverage;
new text end

new text begin (5) proof of liability insurance;
new text end

new text begin (6) a description of the CFSS provider agency's organization identifying the names
or all owners, managing employees, staff, board of directors, and the affiliations of the
directors, owners, or staff to other service providers;
new text end

new text begin (7) a copy of the CFSS provider agency's written policies and procedures including:
hiring of employees; training requirements; service delivery; and employee and consumer
safety including process for notification and resolution of consumer grievances,
identification and prevention of communicable diseases, and employee misconduct;
new text end

new text begin (8) copies of all other forms the CFSS provider agency uses in the course of daily
business including, but not limited to:
new text end

new text begin (i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
the standard time sheet for CFSS services approved by the commissioner, and a letter
requesting approval of the CFSS provider agency's nonstandard time sheet;
new text end

new text begin (ii) the CFSS provider agency's template for the CFSS care plan; and
new text end

new text begin (iii) the CFSS provider agency's template for the written agreement in subdivision
21 for recipients using the CFSS choice option, if applicable;
new text end

new text begin (9) a list of all training and classes that the CFSS provider agency requires of its
staff providing CFSS services;
new text end

new text begin (10) documentation that the CFSS provider agency and staff have successfully
completed all the training required by this section;
new text end

new text begin (11) documentation of the agency's marketing practices;
new text end

new text begin (12) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;
new text end

new text begin (13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for CFSS services for employee personal
care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist shall not be used in making this calculation; and
new text end

new text begin (14) documentation that the agency does not burden recipients' free exercise of their
right to choose service providers by requiring personal care assistants to sign an agreement
not to work with any particular CFSS recipient or for another CFSS provider agency after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.
new text end

new text begin (b) CFSS provider agencies shall provide the information specified in paragraph
(a) to the commissioner.
new text end

new text begin (c) All CFSS provider agencies shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day
management and operations of the agency to complete mandatory training as determined
by the commissioner. Employees in management and supervisory positions and owners
who are active in the day-to-day operations of an agency who have completed the required
training as an employee with a CFSS provider agency do not need to repeat the required
training if they are hired by another agency, if they have completed the training within
the past three years. CFSS provider agency billing staff shall complete training about
CFSS program financial management. Any new owners or employees in management
and supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. CFSS provider agencies
certified for participation in Medicare as home health agencies are exempt from the
training required in this subdivision.
new text end

new text begin Subd. 13. new text end

new text begin Flexible spending model. new text end

new text begin (a) Under the flexible spending model
participants can exercise more responsibility and control over the services and supports
described and budgeted within the CFSS service delivery plan. Under this model:
new text end

new text begin (1) participants directly employ support workers;
new text end

new text begin (2) participants may use a budget allocation to obtain supports and goods as defined
in subdivision 7; and
new text end

new text begin (3) from the financial management services (FMS) contractor the participant may
choose a range of support assistance services relating to:
new text end

new text begin (i) planning, budgeting, and management of services and support;
new text end

new text begin (ii) the participant's employment, training, supervision, and evaluation of workers;
new text end

new text begin (iii) acquisition and payment for supports and goods; and
new text end

new text begin (iv) evaluation of individual service outcomes as needed for the scope of the
participant's degree of control and responsibility.
new text end

new text begin (b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
may authorize a legal representative or participant's representative to do so on their behalf.
new text end

new text begin (c) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model. The FMS contractor shall provide service functions as
determined by the commissioner that include but are not limited to:
new text end

new text begin (1) information and consultation about CFSS;
new text end

new text begin (2) assistance with the development of the service delivery plan and flexible
spending model as requested by the participant;
new text end

new text begin (3) billing and making payments for flexible spending model expenditures;
new text end

new text begin (4) assisting participants in fulfilling employer-related requirements according to
Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
obtaining worker compensation coverage;
new text end

new text begin (5) data recording and reporting of participant spending; and
new text end

new text begin (6) other duties established in the contract with the department.
new text end

new text begin (d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use flexible spending model
with a service delivery plan that specifies the amount of services to be authorized to the
agency-provider and the expenditures to be paid by the FMS contractor.
new text end

new text begin (e) The FMS contractor shall:
new text end

new text begin (1) not limit or restrict the participant's choice of service or support providers or
service delivery models as authorized by the commissioner;
new text end

new text begin (2) provide the participant and the targeted case manager, if applicable, with a
monthly written summary of the spending for services and supports that were billed
against the spending budget;
new text end

new text begin (3) be knowledgeable of state and federal employment regulations under the Fair
Labor Standards Act of 1938, and comply with the requirements under the Internal
Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
Liability for vendor or fiscal employer agent, and any requirements necessary to process
employer and employee deductions, provide appropriate and timely submission of
employer tax liabilities, and maintain documentation to support medical assistance claims;
new text end

new text begin (4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commission and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;
new text end

new text begin (5) assume fiscal accountability for state funds designated for the program; and
new text end

new text begin (6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support
workers. The documentation and time records must be maintained for a minimum of
five years from the claim date and be available for audit or review upon request by the
commissioner. Claims submitted by the FMS contractor to the commissioner for payment
must correspond with services, amounts, and time periods as authorized in the participant's
spending budget and service plan.
new text end

new text begin (f) The commissioner of human services shall:
new text end

new text begin (1) establish rates and payment methodology for the FMS contractor;
new text end

new text begin (2) identify a process to ensure quality and performance standards for the FMS
contractor and ensure statewide access to FMS contractors; and
new text end

new text begin (3) establish a uniform protocol for delivering and administering CFSS services
to be used by eligible FMS contractors.
new text end

new text begin (g) Participants who are disenrolled from the model shall be transferred to the
agency-provider model.
new text end

new text begin Subd. 14. new text end

new text begin Participant's responsibilities under flexible spending model. new text end

new text begin (a) A
participant using the flexible spending model must use a FMS contractor or vendor that is
under contract with the department. Upon a determination of eligibility and completion of
the assessment and community support plan, the participant shall choose a FMS contractor
from a list of eligible vendors maintained by the department.
new text end

new text begin (b) When the participant, participant's representative, or legal representative chooses
to be the employer of the support worker, they are responsible for recruiting, interviewing,
hiring, training, scheduling, supervising, and discharging direct support workers.
new text end

new text begin (c) In addition to the employer responsibilities in paragraph (b), the participant,
participant's representative, or legal representative is responsible for:
new text end

new text begin (1) tracking the services provided and all expenditures for goods or other supports;
new text end

new text begin (2) preparing and submitting time sheets, signed by both the participant and support
worker, to the FMS contractor on a regular basis and in a timely manner according to
the FMS contractor's procedures;
new text end

new text begin (3) notifying the FMS contractor within ten days of any changes in circumstances
affecting the CFSS service plan or in the participant's place of residence including, but
not limited to, any hospitalization of the participant or change in the participant's address,
telephone number, or employment;
new text end

new text begin (4) notifying the FMS contractor of any changes in the employment status of each
participant support worker; and
new text end

new text begin (5) reporting any problems resulting from the quality of services rendered by the
support worker to the FMS contractor. If the participant is unable to resolve any problems
resulting from the quality of service rendered by the support worker with the assistance of
the FMS contractor, the participant shall report the situation to the department.
new text end

new text begin Subd. 15. new text end

new text begin Documentation of support services provided. new text end

new text begin (a) Support services
provided to a participant by a support worker employed by either an agency-provider
or the participant acting as the employer must be documented daily by each support
worker, on a time sheet form approved by the commissioner. All documentation may be
Web-based, electronic, or paper documentation. The completed form must be submitted
on a monthly basis to the provider or the participant and the FMS contractor selected by
the participant to provide assistance with meeting the participant's employer obligations
and kept in the recipient's health record.
new text end

new text begin (b) The activity documentation must correspond to the written service delivery plan
and be reviewed by the agency provider or the participant and the FMS contractor when
the participant is acting as the employer of the support worker.
new text end

new text begin (c) The time sheet must be on a form approved by the commissioner documenting
time the support worker provides services in the home. The following criteria must be
included in the time sheet:
new text end

new text begin (1) full name of the support worker and individual provider number;
new text end

new text begin (2) provider name and telephone numbers, if an agency-provider is responsible for
delivery services under the written service plan;
new text end

new text begin (3) full name of the participant;
new text end

new text begin (4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;
new text end

new text begin (5) signatures of the participant or the participant's representative;
new text end

new text begin (6) personal signature of the support worker;
new text end

new text begin (7) any shared care provided, if applicable;
new text end

new text begin (8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and
new text end

new text begin (9) dates and location of recipient stays in a hospital, care facility, or incarceration.
new text end

new text begin Subd. 16. new text end

new text begin Support workers requirements. new text end

new text begin (a) Support workers shall:
new text end

new text begin (1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:
new text end

new text begin (i) the support worker is not disqualified under section 245C.14; or
new text end

new text begin (ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;
new text end

new text begin (2) have the ability to effectively communicate with the participant or the
participant's representative;
new text end

new text begin (3) have the skills and ability to provide the services and supports according to the
person's CFSS service delivery plan and respond appropriately to the participant's needs;
new text end

new text begin (4) not be a participant of CFSS;
new text end

new text begin (5) complete the basic standardized training as determined by the commissioner
before completing enrollment. The training must be available in languages other than
English and to those who need accommodations due to disabilities. Support worker
training must include successful completion of the following training components: basic
first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
and responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance
to participants;
new text end

new text begin (6) complete training and orientation on the participant's individual needs; and
new text end

new text begin (7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.
new text end

new text begin (b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
new text end

new text begin (1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;
new text end

new text begin (2) fails to provide the authorized services required by the participant employer;
new text end

new text begin (3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;
new text end

new text begin (4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
new text end

new text begin (5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.
new text end

new text begin (c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.
new text end

new text begin Subd. 17. new text end

new text begin Support specialist requirements and payments. new text end

new text begin The commissioner
shall develop qualifications, scope of functions, and payment rates and service limits for a
support specialist that may provide additional or specialized assistance necessary to plan,
implement, arrange, augment, or evaluate services and supports.
new text end

new text begin Subd. 18. new text end

new text begin Service unit and budget allocation requirements. new text end

new text begin (a) For the
agency-provider model, services will be authorized in units of service. The total service
unit amount must be established based upon the assessed need for CFSS services, and
must not exceed the maximum number of units available as determined by section
256B.0652, subdivision 6. The unit rate established by the commissioner is used with
assessed units to determine the maximum available CFSS allocation.
new text end

new text begin (b) For the flexible spending model, services and supports are authorized under
a budget limit.
new text end

new text begin (c) The maximum available CFSS participant budget allocation shall be established
by multiplying the number of units authorized under subdivision 8 by the payment rate
established by the commissioner.
new text end

new text begin Subd. 19. new text end

new text begin Support system. new text end

new text begin (a) The commissioner shall provide information,
consultation, training, and assistance to ensure the participant is able to manage the
services and supports and budgets, if applicable. This support shall include individual
consultation on how to select and employ workers, manage responsibilities under CFSS,
and evaluate personal outcomes.
new text end

new text begin (b) The commissioner shall provide assistance with the development of risk
management agreements.
new text end

new text begin Subd. 20. new text end

new text begin Service-related rights. new text end

new text begin Participants must be provided with adequate
information, counseling, training, and assistance, as needed, to ensure that the participant
is able to choose and manage services, models, and budgets. This support shall include
information regarding: (1) person-centered planning; (2) the range and scope of individual
choices; (3) the process for changing plans, services and budgets; (4) the grievance
process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
and responsibilities; and (8) risk management. A participant who appeals a reduction in
previously authorized CFSS services may continue previously authorized services pending
an appeal under section 256.045. The commissioner must ensure that the participant
has a copy of the most recent service delivery plan that contains a detailed explanation
of which areas of covered CFSS are reduced, and provide notice of the amount of the
budget reduction, and the reasons for the reduction in the participant's notice of denial,
termination, or reduction.
new text end

new text begin Subd. 21. new text end

new text begin Development and Implementation Council. new text end

new text begin The commissioner
shall establish a Development and Implementation Council of which the majority of
members are individuals with disabilities, elderly individuals, and their representatives.
The commissioner shall consult and collaborate with the council when developing and
implementing this section.
new text end

new text begin Subd. 22. new text end

new text begin Quality assurance and risk management system. new text end

new text begin (a) The commissioner
shall establish quality assurance and risk management measures for use in developing and
implementing CFSS including those that (1) recognize the roles and responsibilities of those
involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
based upon a recipient's resources and capabilities. Risk management measures must
include background studies, and backup and emergency plans, including disaster planning.
new text end

new text begin (b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for CFSS participants.
new text end

new text begin (c) Performance assessment measures, such as a participant's satisfaction with the
services and supports, and ongoing monitoring of health and well-being shall be identified
in consultation with the council established in subdivision 21.
new text end

new text begin Subd. 23. new text end

new text begin Commissioner's access. new text end

new text begin When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate
access without prior notice to the agency provider or FMS contractor's office during
regular business hours and to documentation and records related to services provided and
submission of claims for services provided. Denying the commissioner access to records
is cause for immediate suspension of payment and terminating the agency provider's
enrollment according to section 256B.064 or terminating the FMS contract.
new text end

new text begin Subd. 24. new text end

new text begin CFSS agency-providers; background studies. new text end

new text begin CFSS agency-providers
enrolled to provide personal care assistance services under the medical assistance program
shall comply with the following:
new text end

new text begin (1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
agency-provider. "Managing employee" has the same meaning as Code of Federal
Regulations, title 42, section 455. An organization is barred from enrollment if:
new text end

new text begin (i) the organization has not initiated background studies on owners managing
employees; or
new text end

new text begin (ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14, and
the owner or managing employee has not received a set-aside of the disqualification
under section 245C.22;
new text end

new text begin (2) a background study must be initiated and completed for all support specialists; and
new text end

new text begin (3) a background study must be initiated and completed for all support workers.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when this occurs.
new text end

Sec. 2.

Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:

Subd. 4.

Reporting.

(a) Except as provided in paragraph (b), a mandated reporter
shall immediately make an oral report to the common entry point. new text begin The common entry
point may accept electronic reports submitted through a Web-based reporting system
established by the commissioner. new text end Use of a telecommunications device for the deaf or other
similar device shall be considered an oral report. The common entry point may not require
written reports. To the extent possible, the report must be of sufficient content to identify
the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
any evidence of previous maltreatment, the name and address of the reporter, the time,
date, and location of the incident, and any other information that the reporter believes
might be helpful in investigating the suspected maltreatment. A mandated reporter may
disclose not public data, as defined in section 13.02, and medical records under sections
144.291 to 144.298, to the extent necessary to comply with this subdivision.

(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
certified under Title 19 of the Social Security Act, a nursing home that is licensed under
section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
to the common entry point instead of submitting an oral report. The report may be a
duplicate of the initial report the facility submits electronically to the commissioner of
health to comply with the reporting requirements under Code of Federal Regulations, title
42, section 483.13. The commissioner of health may modify these reporting requirements
to include items required under paragraph (a) that are not currently included in the
electronic reporting form.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2014.
new text end

Sec. 3.

Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:

Subd. 9.

Common entry point designation.

(a) deleted text begin Each county board shall designate
a common entry point for reports of suspected maltreatment. Two or more county boards
may jointly designate a single deleted text end new text begin The commissioner of human services shall establish a
new text end common entry point new text begin effective July 1, 2014 new text end . The common entry point is the unit responsible
for receiving the report of suspected maltreatment under this section.

(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:

(1) the time and date of the report;

(2) the name, address, and telephone number of the person reporting;

(3) the time, date, and location of the incident;

(4) the names of the persons involved, including but not limited to, perpetrators,
alleged victims, and witnesses;

(5) whether there was a risk of imminent danger to the alleged victim;

(6) a description of the suspected maltreatment;

(7) the disability, if any, of the alleged victim;

(8) the relationship of the alleged perpetrator to the alleged victim;

(9) whether a facility was involved and, if so, which agency licenses the facility;

(10) any action taken by the common entry point;

(11) whether law enforcement has been notified;

(12) whether the reporter wishes to receive notification of the initial and final
reports; and

(13) if the report is from a facility with an internal reporting procedure, the name,
mailing address, and telephone number of the person who initiated the report internally.

(c) The common entry point is not required to complete each item on the form prior
to dispatching the report to the appropriate lead investigative agency.

(d) The common entry point shall immediately report to a law enforcement agency
any incident in which there is reason to believe a crime has been committed.

(e) If a report is initially made to a law enforcement agency or a lead investigative
agency, those agencies shall take the report on the appropriate common entry point intake
forms and immediately forward a copy to the common entry point.

(f) The common entry point staff must receive training on how to screen and
dispatch reports efficiently and in accordance with this section.

(g) The commissioner of human services shall maintain a centralized database
for the collection of common entry point data, lead investigative agency data including
maltreatment report disposition, and appeals data. new text begin The common entry point shall
have access to the centralized database and must log the reports into the database and
immediately identify and locate prior reports of abuse, neglect, or exploitation.
new text end

new text begin (h) When appropriate, the common entry point staff must refer calls that do not
allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
that might resolve the reporter's concerns.
new text end

new text begin (i) a common entry point must be operated in a manner that enables the
commissioner of human services to:
new text end

new text begin (1) track critical steps in the reporting, evaluation, referral, response, disposition,
and investigative process to ensure compliance with all requirements for all reports;
new text end

new text begin (2) maintain data to facilitate the production of aggregate statistical reports for
monitoring patterns of abuse, neglect, or exploitation;
new text end

new text begin (3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect,
or exploitation;
new text end

new text begin (4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
new text end

new text begin (5) track and manage consumer complaints related to the common entry point.
new text end

new text begin (j) The commissioners of human services and health shall collaborate on the
creation of a system for referring reports to the lead investigative agencies. This system
shall enable the commissioner of human services to track critical steps in the reporting,
evaluation, referral, response, disposition, investigation, notification, determination, and
appeal processes.
new text end

Sec. 4.

Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:

Subd. 9e.

Education requirements.

(a) The commissioners of health, human
services, and public safety shall cooperate in the development of a joint program for
education of lead investigative agency investigators in the appropriate techniques for
investigation of complaints of maltreatment. This program must be developed by July
1, 1996. The program must include but need not be limited to the following areas: (1)
information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
conclusions based on evidence; (5) interviewing skills, including specialized training to
interview people with unique needs; (6) report writing; (7) coordination and referral
to other necessary agencies such as law enforcement and judicial agencies; (8) human
relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
systems and the appropriate methods for interviewing relatives in the course of the
assessment or investigation; (10) the protective social services that are available to protect
alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
which lead investigative agency investigators and law enforcement workers cooperate in
conducting assessments and investigations in order to avoid duplication of efforts; and
(12) data practices laws and procedures, including provisions for sharing data.

new text begin (b) The commissioner of human services shall conduct an outreach campaign to
promote the common entry point for reporting vulnerable adult maltreatment. This
campaign shall use the Internet and other means of communication.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The commissioners of health, human services, and public safety shall offer at
least annual education to others on the requirements of this section, on how this section is
implemented, and investigation techniques.

deleted text begin (c) deleted text end new text begin (d) new text end The commissioner of human services, in coordination with the commissioner
of public safety shall provide training for the common entry point staff as required in this
subdivision and the program courses described in this subdivision, at least four times
per year. At a minimum, the training shall be held twice annually in the seven-county
metropolitan area and twice annually outside the seven-county metropolitan area. The
commissioners shall give priority in the program areas cited in paragraph (a) to persons
currently performing assessments and investigations pursuant to this section.

deleted text begin (d) deleted text end new text begin (e) new text end The commissioner of public safety shall notify in writing law enforcement
personnel of any new requirements under this section. The commissioner of public
safety shall conduct regional training for law enforcement personnel regarding their
responsibility under this section.

deleted text begin (e) deleted text end new text begin (f) new text end Each lead investigative agency investigator must complete the education
program specified by this subdivision within the first 12 months of work as a lead
investigative agency investigator.

A lead investigative agency investigator employed when these requirements take
effect must complete the program within the first year after training is available or as soon
as training is available.

All lead investigative agency investigators having responsibility for investigation
duties under this section must receive a minimum of eight hours of continuing education
or in-service training each year specific to their duties under this section.

ARTICLE 2

DEPARTMENT OF HUMAN SERVICES PROGRAM INTEGRITY

Section 1.

Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:

Subd. 7.

Use of data.

new text begin (a) new text end Except as otherwise provided in subdivision 7a or sections
244.052 and 299C.093, the data provided under this section is private data on individuals
under section 13.02, subdivision 12.

new text begin (b) new text end The data may be used only deleted text begin for deleted text end new text begin by law enforcement and corrections agencies for
new text end law enforcement and corrections purposes.

new text begin (c) The commissioner of human services is authorized to have access to the data for:
new text end

new text begin (1) new text end state-operated services, as defined in section 246.014, deleted text begin are also authorized to
have access to the data deleted text end for the purposes described in section 246.13, subdivision 2,
paragraph (b) new text begin ; and
new text end

new text begin (2) purposes of completing background studies under chapter 245C new text end .

Sec. 2.

Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
to read:

new text begin Subd. 4a. new text end

new text begin Agency background studies. new text end

new text begin (a) The commissioner shall develop
and implement an electronic process for the regular transfer of new criminal history
information that is added to the Minnesota court information system. The commissioner's
system must include for review only information that relates to individuals who have been
the subject of a background study under this chapter that remain affiliated with the agency
that initiated the background study. For purposes of this paragraph, an individual remains
affiliated with an agency that initiated the background study until the agency informs the
commissioner that the individual is no longer affiliated. When any individual no longer
affiliated according to this paragraph returns to a position requiring a background study
under this chapter, the agency with whom the individual is again affiliated shall initiate
a new background study regardless of the length of time the individual was no longer
affiliated with the agency.
new text end

new text begin (b) The commissioner shall develop and implement an online system for agencies that
initiate background studies under this chapter to access and maintain records of background
studies initiated by that agency. The system must show all active background study subjects
affiliated with that agency and the status of each individual's background study. Each
agency that initiates background studies must use this system to notify the commissioner
of discontinued affiliation for purposes of the processes required under paragraph (a).
new text end

Sec. 3.

Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:

Subdivision 1.

Background studies conducted by Department of Human
Services.

(a) For a background study conducted by the Department of Human Services,
the commissioner shall review:

(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);

(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;

(3) information from juvenile courts as required in subdivision 4 for individuals
listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;

(4) information from the Bureau of Criminal Apprehension new text begin , including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166 new text end ;

(5) except as provided in clause (6), information from the national crime information
system when the commissioner has reasonable cause as defined under section 245C.05,
subdivision 5; and

(6) for a background study related to a child foster care application for licensure or
adoptions, the commissioner shall also review:

(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; and

(ii) information from national crime information databases, when the background
study subject is 18 years of age or older.

(b) Notwithstanding expungement by a court, the commissioner may consider
information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
received notice of the petition for expungement and the court order for expungement is
directed specifically to the commissioner.

new text begin (c) The commissioner shall also review criminal history information received
according to section 245C.04, subdivision 4a, from the Minnesota court information
system that relates to individuals who have already been studied under this chapter and
who remain affiliated with the agency that initiated the background study.
new text end

ARTICLE 3

WAIVER PROVIDER STANDARDS

Section 1.

Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to
read:

Subd. 7b.

Adult foster care data privacy and security.

(a) An adult foster care
new text begin or community residential setting new text end license holder who creates, collects, records, maintains,
stores, or discloses any individually identifiable recipient data, whether in an electronic
or any other format, must comply with the privacy and security provisions of applicable
privacy laws and regulations, including:

(1) the federal Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
title 45, part 160, and subparts A and E of part 164; and

(2) the Minnesota Government Data Practices Act as codified in chapter 13.

(b) For purposes of licensure, the license holder shall be monitored for compliance
with the following data privacy and security provisions:

(1) the license holder must control access to data on deleted text begin foster care recipients deleted text end new text begin residents
served by the program new text end according to the definitions of public and private data on individuals
under section 13.02; classification of the data on individuals as private under section
13.46, subdivision 2; and control over the collection, storage, use, access, protection,
and contracting related to data according to section 13.05, in which the license holder is
assigned the duties of a government entity;

(2) the license holder must provide each deleted text begin foster care recipient deleted text end new text begin resident served by
the program new text end with a notice that meets the requirements under section 13.04, in which
the license holder is assigned the duties of the government entity, and that meets the
requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall
describe the purpose for collection of the data, and to whom and why it may be disclosed
pursuant to law. The notice must inform the deleted text begin recipient deleted text end new text begin individual new text end that the license holder
uses electronic monitoring and, if applicable, that recording technology is used;

(3) the license holder must not install monitoring cameras in bathrooms;

(4) electronic monitoring cameras must not be concealed from the deleted text begin foster care
recipients deleted text end new text begin residents served by the program new text end ; and

(5) electronic video and audio recordings of deleted text begin foster care recipients deleted text end new text begin residents served
by the program new text end shall be stored by the license holder for five days unless: (i) a deleted text begin foster care
recipient deleted text end new text begin resident served by the program new text end or legal representative requests that the recording
be held longer based on a specific report of alleged maltreatment; or (ii) the recording
captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or
a crime under chapter 609. When requested by a deleted text begin recipient deleted text end new text begin resident served by the program
new text end or when a recording captures an incident or event of alleged maltreatment or a crime, the
license holder must maintain the recording in a secured area for no longer than 30 days
to give the investigating agency an opportunity to make a copy of the recording. The
investigating agency will maintain the electronic video or audio recordings as required in
section 626.557, subdivision 12b.

(c) The commissioner shall develop, and make available to license holders and
county licensing workers, a checklist of the data privacy provisions to be monitored
for purposes of licensure.

Sec. 2.

Minnesota Statutes 2012, section 245D.05, is amended to read:

245D.05 HEALTH SERVICES.

Subdivision 1.

Health needs.

(a) The license holder is responsible for deleted text begin providing
deleted text end new text begin meeting new text end health deleted text begin services deleted text end new text begin service needs new text end assigned in the new text begin coordinated new text end service new text begin and support new text end plan
deleted text begin and deleted text end new text begin or the coordinated service and support plan addendum, new text end consistent with the person's
health needs. The license holder is responsible for promptly notifying deleted text begin the person or
deleted text end the person's legal representative new text begin , if any, new text end and the case manager of changes in a person's
physical and mental health needs affecting deleted text begin assigned deleted text end health deleted text begin services deleted text end new text begin service needs assigned
to the license holder in the coordinated service and support plan or the coordinated service
and support plan addendum new text end , when discovered by the license holder, unless the license
holder has reason to know the change has already been reported. The license holder
must document when the notice is provided.

(b) deleted text begin When assigned in the service plan, deleted text end new text begin If responsibility for meeting the person's
health service needs has been assigned to the license holder in the coordinated service and
support plan or the coordinated service and support plan addendum, new text end the license holder deleted text begin is
required to deleted text end new text begin must new text end maintain documentation on how the person's health needs will be met,
including a description of the procedures the license holder will follow in order to:

(1) provide medication deleted text begin administration, deleted text end new text begin assistance or new text end medication deleted text begin assistance, or
medication management deleted text end new text begin administration new text end according to this chapter;

(2) monitor health conditions according to written instructions from deleted text begin the person's
physician o deleted text end r a licensed health professional;

(3) assist with or coordinate medical, dental, and other health service appointments; or

(4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from deleted text begin the person's physician or deleted text end a licensed
health professional.

new text begin Subd. 1a. new text end

new text begin Medication setup. new text end

new text begin For the purposes of this subdivision, "medication
setup" means the arranging of medications according to instructions from the pharmacy,
the prescriber, or a licensed nurse, for later administration when the license holder
is assigned responsibility for medication assistance or medication administration in
the coordinated service and support plan or the coordinated service and support plan
addendum. A prescription label or the prescriber's written or electronically recorded order
for the prescription is sufficient to constitute written instructions from the prescriber. The
license holder must document in the person's medication administration record: dates
of setup, name of medication, quantity of dose, times to be administered, and route of
administration at time of setup; and, when the person will be away from home, to whom
the medications were given.
new text end

new text begin Subd. 1b. new text end

new text begin Medication assistance. new text end

new text begin If responsibility for medication assistance
is assigned to the license holder in the coordinated service and support plan or the
coordinated service and support plan addendum, the license holder must ensure that
the requirements of subdivision 2, paragraph (b), have been met when staff provides
medication assistance to enable a person to self-administer medication or treatment when
the person is capable of directing the person's own care, or when the person's legal
representative is present and able to direct care for the person. For the purposes of this
subdivision, "medication assistance" means any of the following:
new text end

new text begin (1) bringing to the person and opening a container of previously set up medications,
emptying the container into the person's hand, or opening and giving the medications in
the original container to the person;
new text end

new text begin (2) bringing to the person liquids or food to accompany the medication; or
new text end

new text begin (3) providing reminders to take regularly scheduled medication or perform regularly
scheduled treatments and exercises.
new text end

Subd. 2.

Medication administration.

(a) new text begin If responsibility for medication
administration is assigned to the license holder in the coordinated service and support plan
or the coordinated service and support plan addendum, the license holder must implement
the following medication administration procedures to ensure a person takes medications
and treatments as prescribed:
new text end

new text begin (1) checking the person's medication record;
new text end

new text begin (2) preparing the medication as necessary;
new text end

new text begin (3) administering the medication or treatment to the person;
new text end

new text begin (4) documenting the administration of the medication or treatment or the reason for
not administering the medication or treatment; and
new text end

new text begin (5) reporting to the prescriber or a nurse any concerns about the medication or
treatment, including side effects, effectiveness, or a pattern of the person refusing to
take the medication or treatment as prescribed. Adverse reactions must be immediately
reported to the prescriber or a nurse.
new text end

new text begin (b)(1) new text end The license holder must ensure that the deleted text begin following criteria deleted text end new text begin requirements in
clauses (2) to (4) new text end have been met before deleted text begin staff that is not a licensed health professional
administers deleted text end new text begin administering new text end medication or treatment deleted text begin : deleted text end new text begin .
new text end

deleted text begin (1) deleted text end new text begin (2) The license holder must obtain new text end written authorization deleted text begin has been obtained deleted text end from
the person or the person's legal representative to administer medication or treatment
deleted text begin orders; deleted text end new text begin and must obtain reauthorization annually as needed. If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.
new text end

deleted text begin (2) deleted text end new text begin (3) new text end The staff person deleted text begin has completed deleted text end new text begin responsible for administering the medication
or treatment must complete new text end medication administration training according to section
245D.09, subdivision deleted text begin 4 deleted text end deleted text begin , paragraph deleted text end new text begin 4a, paragraphs (a) and new text end (c), deleted text begin clause (2); deleted text end and new text begin , as applicable
to the person, paragraph (d).
new text end

deleted text begin (3) The medication or treatment will be administered under administration
procedures established for the person in consultation with a licensed health professional.
written instruction from the person's physician may constitute the medication
administration procedures. A prescription label or the prescriber's order for the
prescription is sufficient to constitute written instructions from the prescriber. A licensed
health professional may delegate medication administration procedures.
deleted text end

new text begin (4) For a license holder providing intensive support services, the medication or
treatment must be administered according to the license holder's medication administration
policy and procedures as required under section 245D.11, subdivision 2, clause (3).
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The license holder must ensure the following information is documented in
the person's medication administration record:

(1) the information on the new text begin current new text end prescription label or the prescriber's new text begin current written
or electronically recorded new text end order new text begin or prescription new text end that includes deleted text begin directions for deleted text end new text begin the person's
name, description of the medication or treatment to be provided, and the frequency and
other information needed to new text end safely and correctly deleted text begin administering deleted text end new text begin administer new text end the medication
new text begin or treatment new text end to ensure effectiveness;

(2) information on any deleted text begin discomforts, deleted text end risks deleted text begin , deleted text end or other side effects that are reasonable to
expect, and any contraindications to its use new text begin . This information must be readily available
to all staff administering the medication new text end ;

(3) the possible consequences if the medication or treatment is not taken or
administered as directed;

(4) instruction deleted text begin from the prescriber deleted text end on when and to whom to report the following:

(i) if deleted text begin the deleted text end new text begin a dose of new text end medication deleted text begin or treatment deleted text end is not administered new text begin or treatment is not
performed new text end as prescribed, whether by error by the staff or the person or by refusal by
the person; and

(ii) the occurrence of possible adverse reactions to the medication or treatment;

(5) notation of any occurrence of new text begin a dose of new text end medication not being administered new text begin or
treatment not performed new text end as prescribed new text begin , whether by error by the staff or the person or by
refusal by the person, new text end or of adverse reactions, and when and to whom the report was
made; and

(6) notation of when a medication or treatment is started, new text begin administered, new text end changed, or
discontinued.

deleted text begin (c) The license holder must ensure that the information maintained in the medication
administration record is current and is regularly reviewed with the person or the person's
legal representative and the staff administering the medication to identify medication
administration issues or errors. At a minimum, the review must be conducted every three
months or more often if requested by the person or the person's legal representative.
Based on the review, the license holder must develop and implement a plan to correct
medication administration issues or errors. If issues or concerns are identified related to
the medication itself, the license holder must report those as required under subdivision 4.
deleted text end

deleted text begin Subd. 3. deleted text end

deleted text begin Medication assistance. deleted text end

deleted text begin The license holder must ensure that the
requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
to enable a person to self-administer medication when the person is capable of directing
the person's own care, or when the person's legal representative is present and able to
direct care for the person.
deleted text end

Subd. 4.

new text begin Reviewing and new text end reporting medication and treatment issues.

deleted text begin The
following medication administration issues must be reported to the person or the person's
legal representative and case manager as they occur or following timelines established
in the person's service plan or as requested in writing by the person or the person's legal
representative, or the case manager: deleted text end new text begin (a) When assigned responsibility for medication
administration, the license holder must ensure that the information maintained in
the medication administration record is current and is regularly reviewed to identify
medication administration errors. At a minimum, the review must be conducted every
three months, or more frequently as directed in the coordinated service and support plan
or coordinated service and support plan addendum or as requested by the person or the
person's legal representative. Based on the review, the license holder must develop and
implement a plan to correct patterns of medication administration errors when identified.
new text end

new text begin (b) If assigned responsibility for medication assistance or medication administration,
the license holder must report the following to the person's legal representative and case
manager as they occur or as otherwise directed in the coordinated service and support plan
or the coordinated service and support plan addendum:
new text end

(1) any reports made to the person's physician or prescriber required under
subdivision 2, paragraph deleted text begin (b) deleted text end new text begin (c) new text end , clause (4);

(2) a person's refusal or failure to take new text begin or receive new text end medication or treatment as
prescribed; or

(3) concerns about a person's self-administration of medication new text begin or treatment new text end .

Subd. 5.

Injectable medications.

Injectable medications may be administered
according to a prescriber's order and written instructions when one of the following
conditions has been met:

(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
intramuscular injection;

(2) a supervising registered nurse with a physician's order has delegated the
administration of subcutaneous injectable medication to an unlicensed staff member
and has provided the necessary training; or

(3) there is an agreement signed by the license holder, the prescriber, and the
person or the person's legal representative specifying what subcutaneous injections may
be given, when, how, and that the prescriber must retain responsibility for the license
holder's giving the injections. A copy of the agreement must be placed in the person's
service recipient record.

Only licensed health professionals are allowed to administer psychotropic
medications by injection.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

Sec. 3.

new text begin [245D.051] PSYCHOTROPIC MEDICATION USE AND MONITORING.
new text end

new text begin Subdivision 1. new text end

new text begin Conditions for psychotropic medication administration. new text end

new text begin (a)
When a person is prescribed a psychotropic medication and the license holder is assigned
responsibility for administration of the medication in the person's coordinated service
and support plan or the coordinated service and support plan addendum, the license
holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
subdivision 2, are met.
new text end

new text begin (b) Use of the medication must be included in the person's coordinated service and
support plan or in the coordinated service and support plan addendum and based on a
prescriber's current written or electronically recorded prescription.
new text end

new text begin (c) The license holder must develop, implement, and maintain the following
documentation in the person's coordinated service and support plan addendum according
to the requirements in sections 245D.07 and 245D.071:
new text end

new text begin (1) a description of the target symptoms that the psychotropic medication is to
alleviate; and
new text end

new text begin (2) documentation methods the license holder will use to monitor and measure
changes in the target symptoms that are to be alleviated by the psychotropic medication if
required by the prescriber. The license holder must collect and report on medication and
symptom-related data as instructed by the prescriber. The license holder must provide
the monitoring data to the expanded support team for review every three months, or as
otherwise requested by the person or the person's legal representative.
new text end

new text begin For the purposes of this section, "target symptom" refers to any perceptible
diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
successive editions that has been identified for alleviation.
new text end

new text begin (d) If a person is prescribed a psychotropic medication, monitoring the use of the
psychotropic medication must be assigned to the license holder in the coordinated service
and support plan or the coordinated service and support plan addendum. The assigned
license holder must monitor the psychotropic medication as required by this section.
new text end

new text begin Subd. 2. new text end

new text begin Refusal to authorize psychotropic medication. new text end

new text begin If the person or the
person's legal representative refuses to authorize the administration of a psychotropic
medication as ordered by the prescriber, the license holder must follow the requirement
in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
to the prescriber, the license holder must follow any directives or orders given by the
prescriber. A court order must be obtained to override the refusal. Refusal to authorize
administration of a specific psychotropic medication is not grounds for service termination
and does not constitute an emergency. A decision to terminate services must be reached in
compliance with section 245D.10, subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

Sec. 4.

Minnesota Statutes 2012, section 245D.06, is amended to read:

245D.06 PROTECTION STANDARDS.

Subdivision 1.

Incident response and reporting.

(a) The license holder must
respond to deleted text begin all deleted text end incidents under section 245D.02, subdivision 11, that occur while providing
services to protect the health and safety of and minimize risk of harm to the person.

(b) The license holder must maintain information about and report incidents to the
person's legal representative or designated emergency contact and case manager within 24
hours of an incident occurring while services are being provided, deleted text begin or deleted text end within 24 hours of
discovery or receipt of information that an incident occurred, unless the license holder
has reason to know that the incident has already been reported new text begin , or as otherwise directed
in a person's coordinated service and support plan or coordinated service and support
plan addendum new text end . An incident of suspected or alleged maltreatment must be reported as
required under paragraph (d), and an incident of serious injury or death must be reported
as required under paragraph (e).

(c) When the incident involves more than one person, the license holder must not
disclose personally identifiable information about any other person when making the report
to each person and case manager unless the license holder has the consent of the person.

(d) Within 24 hours of reporting maltreatment as required under section 626.556
or 626.557, the license holder must inform the case manager of the report unless there is
reason to believe that the case manager is involved in the suspected maltreatment. The
license holder must disclose the nature of the activity or occurrence reported and the
agency that received the report.

(e) The license holder must report the death or serious injury of the person deleted text begin to the legal
representative, if any, and case manager, deleted text end new text begin as required in paragraph (b) and to new text end the Department
of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
and Developmental Disabilities as required under section 245.94, subdivision 2a, within
24 hours of the death, or receipt of information that the death occurred, unless the license
holder has reason to know that the death has already been reported.

new text begin (f) When a death or serious injury occurs in a facility certified as an intermediate
care facility for persons with developmental disabilities, the death or serious injury must
be reported to the Department of Health, Office of Health Facility Complaints, and the
Office of Ombudsman for Mental Health and Developmental Disabilities, as required
under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
know that the death has already been reported.
new text end

deleted text begin (f) deleted text end new text begin (g) new text end The license holder must conduct deleted text begin a deleted text end new text begin an internal new text end review of incident reports new text begin of
deaths and serious injuries that occurred while services were being provided and that
were not reported by the program as alleged or suspected maltreatment new text end , for identification
of incident patterns, and implementation of corrective action as necessary to reduce
occurrences. new text begin The review must include an evaluation of whether related policies and
procedures were followed, whether the policies and procedures were adequate, whether
there is a need for additional staff training, whether the reported event is similar to past
events with the persons or the services involved, and whether there is a need for corrective
action by the license holder to protect the health and safety of persons receiving services.
Based on the results of this review, the license holder must develop, document, and
implement a corrective action plan designed to correct current lapses and prevent future
lapses in performance by staff or the license holder, if any.
new text end

new text begin (h) The license holder must verbally report the emergency use of manual restraint of
a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
must ensure the written report and internal review of all incident reports of the emergency
use of manual restraints are completed according to the requirements in section 245D.061.
new text end

Subd. 2.

Environment and safety.

The license holder must:

(1) ensure the following when the license holder is the owner, lessor, or tenant
of deleted text begin the deleted text end new text begin an unlicensed new text end service site:

(i) the service site is a safe and hazard-free environment;

(ii) deleted text begin doors are locked or deleted text end toxic substances or dangerous items deleted text begin normally accessible deleted text end new text begin are
inaccessible new text end to persons served by the program deleted text begin are stored in locked cabinets, drawers, or
containers deleted text end only to protect the safety of a person receiving services and not as a substitute
for staff supervision or interactions with a person who is receiving services. If deleted text begin doors are
locked or deleted text end toxic substances or dangerous items deleted text begin normally accessible to persons served by the
program are stored in locked cabinets, drawers, or containers deleted text end new text begin are made inaccessible new text end , the
license holder must deleted text begin justify and document how this determination was made in consultation
with the person or person's legal representative, and how access will otherwise be provided
to the person and all other affected persons receiving services; and deleted text end new text begin document an assessment
of the physical plant, its environment, and its population identifying the risk factors which
require toxic substances or dangerous items to be inaccessible and a statement of specific
measures to be taken to minimize the safety risk to persons receiving services;
new text end

new text begin (iii) doors are locked from the inside to prevent a person from exiting only when
necessary to protect the safety of a person receiving services and not as a substitute for
staff supervision or interactions with the person. If doors are locked from the inside, the
license holder must document an assessment of the physical plant, the environment and
the population served, identifying the risk factors which require the use of locked doors,
and a statement of specific measures to be taken to minimize the safety risk to persons
receiving services at the service site; and
new text end

deleted text begin (iii) deleted text end new text begin (iv) new text end a staff person is available on site who is trained in basic first aid new text begin and, when
required in a person's coordinated service and support plan or coordinated service and
support plan addendum, cardiopulmonary resuscitation, new text end whenever persons are present and
staff are required to be at the site to provide direct service new text begin . The training must include
in-person instruction, hands-on practice, and an observed skills assessment under the
direct supervision of a first aid instructor new text end ;

(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition when used to provide services;

(3) follow procedures to ensure safe transportation, handling, and transfers of the
person and any equipment used by the person, when the license holder is responsible for
transportation of a person or a person's equipment;

(4) be prepared for emergencies and follow emergency response procedures to
ensure the person's safety in an emergency; and

(5) follow new text begin universal precautions and new text end sanitary practices new text begin , including hand washing, new text end for
infection new text begin prevention and new text end control new text begin , new text end and to prevent communicable diseases.

deleted text begin Subd. 3. deleted text end

deleted text begin Compliance with fire and safety codes. deleted text end

deleted text begin When services are provided at deleted text end deleted text begin a
deleted text end deleted text begin service site deleted text end deleted text begin licensed according to chapter 245A or deleted text end deleted text begin where the license deleted text end deleted text begin holder is the owner,
lessor, or tenant of the service site, the license holder must document deleted text end deleted text begin compliance with
applicable building codes, fire and safety codes, health rules, and zoning deleted text end deleted text begin ordinances, or
document that an appropriate waiver has been granted.
deleted text end

Subd. 4.

Funds and property.

(a) Whenever the license holder assists a person
with the safekeeping of funds or other property according to section 245A.04, subdivision
13, the license holder must deleted text begin have deleted text end new text begin obtain new text end written authorization to do so from the person new text begin or
the person's legal representative new text end and the case manager. new text begin Authorization must be obtained
within five working days of service initiation and renewed annually thereafter. At the time
initial authorization is obtained, the license holder must survey, document, and implement
the preferences of the person or the person's legal representative and the case manager
for frequency of receiving a statement that itemizes receipts and disbursements of funds
or other property. The license holder must document changes to these preferences when
they are requested.
new text end

(b) A license holder or staff person may not accept powers-of-attorney from a
person receiving services from the license holder for any purpose deleted text begin , and may not accept an
appointment as guardian or conservator of a person receiving services from the license
holder deleted text end . This does not apply to license holders that are Minnesota counties or other
units of government or to staff persons employed by license holders who were acting
as deleted text begin power-of-attorney, guardian, or conservator deleted text end new text begin attorney-in-fact new text end for specific individuals
prior to deleted text begin April 23, 2012 deleted text end new text begin implementation of this chapter new text end . The license holder must maintain
documentation of the power-of-attorney deleted text begin , guardianship, or conservatorship deleted text end in the service
recipient record.

new text begin (c) Upon the transfer or death of a person, any funds or other property of the person
must be surrendered to the person or the person's legal representative, or given to the
executor or administrator of the estate in exchange for an itemized receipt.
new text end

Subd. 5.

Prohibitions.

(a) The license holder is prohibited from using deleted text begin psychotropic
medication deleted text end new text begin chemical restraints, mechanical restraint practices, manual restraints, time out,
or seclusion new text end as a substitute for adequate staffing new text begin , for a behavioral or therapeutic program
to reduce or eliminate behavior new text end , as punishment, new text begin or new text end for staff convenience deleted text begin , or for any reason
other than as prescribed deleted text end .

deleted text begin (b) The license holder is prohibited from using restraints or seclusion under any
circumstance, unless the commissioner has approved a variance request from the license
holder that allows for the emergency use of restraints and seclusion according to terms
and conditions approved in the variance. Applicants and license holders who have
reason to believe they may be serving an individual who will need emergency use of
restraints or seclusion may request a variance on the application or reapplication, and
the commissioner shall automatically review the request for a variance as part of the
application or reapplication process. License holders may also request the variance any
time after issuance of a license. In the event a license holder uses restraint or seclusion for
any reason without first obtaining a variance as required, the license holder must report
the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the
occurrence and request the required variance.
deleted text end

new text begin (b) For the purposes of this subdivision, "chemical restraint" means the
administration of a drug or medication to control the person's behavior or restrict the
person's freedom of movement and is not a standard treatment of dosage for the person's
medical or psychological condition.
new text end

new text begin (c) For the purposes of this subdivision, "mechanical restraint practice" means the
use of any adaptive equipment or safety device to control the person's behavior or restrict
the person's freedom of movement and not as ordered by a licensed health professional.
Mechanical restraint practices include, but are not limited to, the use of bed rails or similar
devices on a bed to prevent the person from getting out of bed, chairs that prevent a person
from rising, or placing a person in a wheelchair so close to a wall that the wall prevents
the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to
warn staff that a person is leaving a room or area do not, in and of themselves, restrict
freedom of movement and should not be considered restraints.
new text end

new text begin (d) A license holder must not use manual restraints, time out, or seclusion under any
circumstance, except for emergency use of manual restraints according to the requirements
in section 245D.061 or the use of controlled procedures with a person with a developmental
disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor
provisions. License holders implementing nonemergency use of manual restraint, or any
other programmatic use of mechanical restraint, time out, or seclusion with persons who
do not have a developmental disability that is not subject to the requirements of Minnesota
Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner
for continued use of the procedure within three months of implementation of this chapter.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

Sec. 5.

new text begin [245D.095] RECORD REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Record-keeping systems. new text end

new text begin The license holder must ensure that the
content and format of service recipient, personnel, and program records are uniform and
legible according to the requirements of this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Admission and discharge register. new text end

new text begin The license holder must keep a written
or electronic register, listing in chronological order the dates and names of all persons
served by the program who have been admitted, discharged, or transferred, including
service terminations initiated by the license holder and deaths.
new text end

new text begin Subd. 3. new text end

new text begin Service recipient record. new text end

new text begin (a) The license holder must maintain a record of
current services provided to each person on the premises where the services are provided
or coordinated. When the services are provided in a licensed facility, the records must
be maintained at the facility, otherwise the records must be maintained at the license
holder's program office. new text end new text begin The license holder must protect service recipient records against
loss, tampering, or unauthorized disclosure according to the requirements in sections
13.01 to 13.10 and 13.46.
new text end

new text begin (b) The license holder must maintain the following information for each person:
new text end

new text begin (1) an admission form signed by the person or the person's legal representative
that includes:
new text end

new text begin (i) identifying information, including the person's name, date of birth, address,
and telephone number; and
new text end

new text begin (ii) the name, address, and telephone number of the person's legal representative, if
any, and a primary emergency contact, the case manager, and family members or others as
identified by the person or case manager;
new text end

new text begin (2) service information, including service initiation information, verification of the
person's eligibility for services, documentation verifying that services have been provided
as identified in the coordinated service and support plan or coordinated service and support
plan addendum according to paragraph (a), and date of admission or readmission;
new text end

new text begin (3) health information, including medical history, special dietary needs, and
allergies, and when the license holder is assigned responsibility for meeting the person's
health service needs according to section 245D.05:
new text end

new text begin (i) current orders for medication, treatments, or medical equipment and a signed
authorization from the person or the person's legal representative to administer or assist in
administering the medication or treatments, if applicable;
new text end

new text begin (ii) a signed statement authorizing the license holder to act in a medical emergency
when the person's legal representative, if any, cannot be reached or is delayed in arriving;
new text end

new text begin (iii) medication administration procedures;
new text end

new text begin (iv) a medication administration record documenting the implementation of the
medication administration procedures, the medication administration record reviews, and
including any agreements for administration of injectable medications by the license
holder according to the requirements in section 245D.05; and
new text end

new text begin (v) a medical appointment schedule when the license holder is assigned
responsibility for assisting with medical appointments;
new text end

new text begin (4) the person's current coordinated service and support plan or that portion of the
plan assigned to the license holder;
new text end

new text begin (5) copies of the individual abuse prevention plan and assessments as required under
section 245D.071, subdivisions 2 and 3;
new text end

new text begin (6) a record of other service providers serving the person when the person's
coordinated service and support plan or coordinated service and support plan addendum
identifies the need for coordination between the service providers, that includes a contact
person and telephone numbers, services being provided, and names of staff responsible for
coordination;
new text end

new text begin (7) documentation of orientation to service recipient rights according to section
245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
section 245A.65, subdivision 1, paragraph (c);
new text end

new text begin (8) copies of authorizations to handle a person's funds, according to section 245D.06,
subdivision 4, paragraph (a);
new text end

new text begin (9) documentation of complaints received and grievance resolution;
new text end

new text begin (10) incident reports involving the person, required under section 245D.06,
subdivision 1;
new text end

new text begin (11) copies of written reports regarding the person's status when requested according
to section 245D.07, subdivision 3, progress review reports as required under section
245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
and reports received from other agencies involved in providing services or care to the
person; and
new text end

new text begin (12) discharge summary, including service termination notice and related
documentation, when applicable.
new text end

new text begin Subd. 4. new text end

new text begin Access to service recipient records. new text end

new text begin The license holder must ensure that
the following people have access to the information in subdivision 1 in accordance with
applicable state and federal law, regulation, or rule:
new text end

new text begin (1) the person, the person's legal representative, and anyone properly authorized
by the person;
new text end

new text begin (2) the person's case manager;
new text end

new text begin (3) staff providing services to the person unless the information is not relevant to
carrying out the coordinated service and support plan or coordinated service and support
plan addendum; and
new text end

new text begin (4) the county child or adult foster care licensor, when services are also licensed as
child or adult foster care.
new text end

new text begin Subd. 5. new text end

new text begin Personnel records. new text end

new text begin (a) The license holder must maintain a personnel
record of each employee to document and verify staff qualifications, orientation, and
training. The personnel record must include:
new text end

new text begin (1) the employee's date of hire, completed application, an acknowledgement signed
by the employee that job duties were reviewed with the employee and the employee
understands those duties, and documentation that the employee meets the position
requirements as determined by the license holder;
new text end

new text begin (2) documentation of staff qualifications, orientation, training, and performance
evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
the training was completed, the number of hours per subject area, and the name of the
trainer or instructor; and
new text end

new text begin (3) a completed background study as required under chapter 245C.
new text end

new text begin (b) For employees hired after January 1, 2014, the license holder must maintain
documentation in the personnel record or elsewhere, sufficient to determine the date of the
employee's first supervised direct contact with a person served by the program, and the
date of first unsupervised direct contact with a person served by the program.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

Sec. 6.

Minnesota Statutes 2012, section 245D.10, is amended to read:

245D.10 POLICIES AND PROCEDURES.

Subdivision 1.

Policy and procedure requirements.

deleted text begin The deleted text end new text begin A new text end license holder
new text begin providing either basic or intensive supports and services new text end must establish, enforce, and
maintain policies and procedures as required in this chapter new text begin , chapter 245A, and other
applicable state and federal laws and regulations governing the provision of home and
community-based services licensed according to this chapter new text end .

Subd. 2.

Grievances.

The license holder must establish policies and procedures
that deleted text begin provide deleted text end new text begin promote service recipient rights by providing new text end a simple complaint process for
persons served by the program and their authorized representatives to bring a grievance that:

(1) provides staff assistance with the complaint process when requested, and the
addresses and telephone numbers of outside agencies to assist the person;

(2) allows the person to bring the complaint to the highest level of authority in the
program if the grievance cannot be resolved by other staff members, and that provides
the name, address, and telephone number of that person;

(3) requires the license holder to promptly respond to all complaints affecting a
person's health and safety. For all other complaints, the license holder must provide an
initial response within 14 calendar days of receipt of the complaint. All complaints must
be resolved within 30 calendar days of receipt or the license holder must document the
reason for the delay and a plan for resolution;

(4) requires a complaint review that includes an evaluation of whether:

(i) related policies and procedures were followed and adequate;

(ii) there is a need for additional staff training;

(iii) the complaint is similar to past complaints with the persons, staff, or services
involved; and

(iv) there is a need for corrective action by the license holder to protect the health
and safety of persons receiving services;

(5) based on the review in clause (4), requires the license holder to develop,
document, and implement a corrective action plan designed to correct current lapses and
prevent future lapses in performance by staff or the license holder, if any;

(6) provides a written summary of the complaint and a notice of the complaint
resolution to the person and case manager that:

(i) identifies the nature of the complaint and the date it was received;

(ii) includes the results of the complaint review;

(iii) identifies the complaint resolution, including any corrective action; and

(7) requires that the complaint summary and resolution notice be maintained in the
service recipient record.

Subd. 3.

Service suspension and service termination.

(a) The license holder must
establish policies and procedures for temporary service suspension and service termination
that promote continuity of care and service coordination with the person and the case
manager and with other licensed caregivers, if any, who also provide support to the person.

(b) The policy must include the following requirements:

(1) the license holder must notify the person new text begin or the person's legal representative new text end and
case manager in writing of the intended termination or temporary service suspension, and
the person's right to seek a temporary order staying the termination of service according to
the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);

(2) notice of the proposed termination of services, including those situations
that began with a temporary service suspension, must be given at least 60 days before
the proposed termination is to become effective when a license holder is providing
deleted text begin independent living skills training, structured day, prevocational or supported employment
services to the person deleted text end new text begin intensive supports and services identified in section 245D.03,
subdivision 1, paragraph (c) new text end , and 30 days prior to termination for all other services
licensed under this chapter;

(3) the license holder must provide information requested by the person or case
manager when services are temporarily suspended or upon notice of termination;

(4) prior to giving notice of service termination or temporary service suspension,
the license holder must document actions taken to minimize or eliminate the need for
service suspension or termination;

(5) during the temporary service suspension or service termination notice period,
the license holder will work with the appropriate county agency to develop reasonable
alternatives to protect the person and others;

(6) the license holder must maintain information about the service suspension or
termination, including the written termination notice, in the service recipient record; and

(7) the license holder must restrict temporary service suspension to situations in
which the person's deleted text begin behavior causes immediate and serious danger to the health and safety
of the person or others deleted text end new text begin conduct poses an imminent risk of physical harm to self or others
and less restrictive or positive support strategies would not achieve safety new text end .

Subd. 4.

Availability of current written policies and procedures.

(a) The license
holder must review and update, as needed, the written policies and procedures required
under this chapter.

(b) new text begin (1) new text end The license holder must inform the person and case manager of the policies
and procedures affecting a person's rights under section 245D.04, and provide copies of
those policies and procedures, within five working days of service initiation.

new text begin (2) If a license holder only provides basic services and supports, this includes the:
new text end

new text begin (i) grievance policy and procedure required under subdivision 2; and
new text end

new text begin (ii) service suspension and termination policy and procedure required under
subdivision 3.
new text end

new text begin (3) For all other license holders this includes the:
new text end

new text begin (i) policies and procedures in clause (2);
new text end

new text begin (ii) emergency use of manual restraints policy and procedure required under
subdivision 3a; and
new text end

new text begin (iii) data privacy requirements under section 245D.11, subdivision 3.
new text end

(c) The license holder must provide a written notice at least 30 days before
implementing any deleted text begin revised policies and procedures deleted text end new text begin procedural revisions to policies
new text end affecting a person's new text begin service-related or protection-related new text end rights under section 245D.04 new text begin and
maltreatment reporting policies and procedures new text end . The notice must explain the revision that
was made and include a copy of the revised policy and procedure. The license holder
must document the deleted text begin reason deleted text end new text begin reasonable cause new text end for not providing the notice at least 30 days
before implementing the revisions.

(d) Before implementing revisions to required policies and procedures, the license
holder must inform all employees of the revisions and provide training on implementation
of the revised policies and procedures.

new text begin (e) The license holder must annually notify all persons, or their legal representatives,
and case managers of any procedural revisions to policies required under this chapter,
other than those in paragraph (c). Upon request, the license holder must provide the
person, or the person's legal representative, and case manager with copies of the revised
policies and procedures.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

Sec. 7.

new text begin [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Policy and procedure requirements. new text end

new text begin A license holder providing
intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
must establish, enforce, and maintain policies and procedures as required in this section.
new text end

new text begin Subd. 2. new text end

new text begin Health and safety. new text end

new text begin The license holder must establish policies and
procedures that promote health and safety by ensuring:
new text end

new text begin (1) use of universal precautions and sanitary practices in compliance with section
245D.06, subdivision 2, clause (5);
new text end

new text begin (2) if the license holder operates a residential program, health service coordination
and care according to the requirements in section 245D.05, subdivision 1;
new text end

new text begin (3) safe medication assistance and administration according to the requirements
in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
doctor and require completion of medication administration training according to the
requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance
and administration includes, but is not limited to:
new text end

new text begin (i) providing medication-related services for a person;
new text end

new text begin (ii) medication setup;
new text end

new text begin (iii) medication administration;
new text end

new text begin (iv) medication storage and security;
new text end

new text begin (v) medication documentation and charting;
new text end

new text begin (vi) verification and monitoring of effectiveness of systems to ensure safe medication
handling and administration;
new text end

new text begin (vii) coordination of medication refills;
new text end

new text begin (viii) handling changes to prescriptions and implementation of those changes;
new text end

new text begin (ix) communicating with the pharmacy; and
new text end

new text begin (x) coordination and communication with prescriber;
new text end

new text begin (4) safe transportation, when the license holder is responsible for transportation of
persons, with provisions for handling emergency situations according to the requirements
in section 245D.06, subdivision 2, clauses (2) to (4);
new text end

new text begin (5) a plan for ensuring the safety of persons served by the program in emergencies as
defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
to the license holder. A license holder with a community residential setting or a day service
facility license must ensure the policy and procedures comply with the requirements in
section 245D.22, subdivision 4;
new text end

new text begin (6) a plan for responding to all incidents as defined in section 245D.02, subdivision
11; and reporting all incidents required to be reported according to section 245D.06,
subdivision 1. The plan must:
new text end

new text begin (i) provide the contact information of a source of emergency medical care and
transportation; and
new text end

new text begin (ii) require staff to first call 911 when the staff believes a medical emergency may be
life threatening, or to call the mental health crisis intervention team when the person is
experiencing a mental health crisis; and
new text end

new text begin (7) a procedure for the review of incidents and emergencies to identify trends or
patterns, and corrective action if needed. The license holder must establish and maintain
a record-keeping system for the incident and emergency reports. Each incident and
emergency report file must contain a written summary of the incident. The license holder
must conduct a review of incident reports for identification of incident patterns, and
implementation of corrective action as necessary to reduce occurrences. Each incident
report must include:
new text end

new text begin (i) the name of the person or persons involved in the incident. It is not necessary
to identify all persons affected by or involved in an emergency unless the emergency
resulted in an incident;
new text end

new text begin (ii) the date, time, and location of the incident or emergency;
new text end

new text begin (iii) a description of the incident or emergency;
new text end

new text begin (iv) a description of the response to the incident or emergency and whether a person's
coordinated service and support plan addendum or program policies and procedures were
implemented as applicable;
new text end

new text begin (v) the name of the staff person or persons who responded to the incident or
emergency; and
new text end

new text begin (vi) the determination of whether corrective action is necessary based on the results
of the review.
new text end

new text begin Subd. 3. new text end

new text begin Data privacy. new text end

new text begin The license holder must establish policies and procedures that
promote service recipient rights by ensuring data privacy according to the requirements in:
new text end

new text begin (1) the Minnesota Government Data Practices Act, section 13.46, and all other
applicable Minnesota laws and rules in handling all data related to the services provided;
and
new text end

new text begin (2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
extent that the license holder performs a function or activity involving the use of protected
health information as defined under Code of Federal Regulations, title 45, section 164.501,
including, but not limited to, providing health care services; health care claims processing
or administration; data analysis, processing, or administration; utilization review; quality
assurance; billing; benefit management; practice management; repricing; or as otherwise
provided by Code of Federal Regulations, title 45, section 160.103. The license holder
must comply with the Health Insurance Portability and Accountability Act of 1996 and
its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
and all applicable requirements.
new text end

new text begin Subd. 4. new text end

new text begin Admission criteria. new text end

new text begin The license holder must establish policies and
procedures that promote continuity of care by ensuring that admission or service initiation
criteria:
new text end

new text begin (1) is consistent with the license holder's registration information identified in the
requirements in section 245D.031, subdivision 2, and with the service-related rights
identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
new text end

new text begin (2) identifies the criteria to be applied in determining whether the license holder
can develop services to meet the needs specified in the person's coordinated service and
support plan;
new text end

new text begin (3) requires a license holder providing services in a health care facility to comply
with the requirements in section 243.166, subdivision 4b, to provide notification to
residents when a registered predatory offender is admitted into the program or to a
potential admission when the facility was already serving a registered predatory offender.
For purposes of this clause, "health care facility" means a facility licensed by the
commissioner as a residential facility under chapter 245A to provide adult foster care or
residential services to persons with disabilities; and
new text end

new text begin (4) requires that when a person or the person's legal representative requests services
from the license holder, a refusal to admit the person must be based on an evaluation of
the person's assessed needs and the license holder's lack of capacity to meet the needs of
the person. The license holder must not refuse to admit a person based solely on the
type of residential services the person is receiving, or solely on the person's severity of
disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
communication skills, physical disabilities, toilet habits, behavioral disorders, or past
failure to make progress. Documentation of the basis for refusal must be provided to the
person or the person's legal representative and case manager upon request.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
new text end

ARTICLE 4

HOME CARE PROVIDERS

Section 1.

Minnesota Statutes 2012, section 144.051, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Data classification; private data. new text end

new text begin For providers regulated pursuant to
sections 144A.043 to 144A.482, the following data collected, created, or maintained by the
commissioner are classified as "private data" as defined in section 13.02, subdivision 12:
new text end

new text begin (1) data submitted by or on behalf of applicants for licenses prior to issuance of
the license;
new text end

new text begin (2) the identity of complainants who have made reports concerning licensees or
applicants unless the complainant consents to the disclosure;
new text end

new text begin (3) the identity of individuals who provide information as part of surveys and
investigations;
new text end

new text begin (4) Social Security numbers; and
new text end

new text begin (5) health record data.
new text end

Sec. 2.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Data classification; public data. new text end

new text begin For providers regulated pursuant to
sections 144A.043 to 144A.482, the following data collected, created, or maintained by the
commissioner are classified as "public data" as defined in section 13.02, subdivision 15:
new text end

new text begin (1) all application data on licensees, license numbers, license status;
new text end

new text begin (2) licensing information about licenses previously held under this chapter;
new text end

new text begin (3) correction orders, including information about compliance with the order and
whether the fine was paid;
new text end

new text begin (4) final enforcement actions pursuant to chapter 14;
new text end

new text begin (5) orders for hearing, findings of fact and conclusions of law; and
new text end

new text begin (6) when the licensee and department agree to resolve the matter without a hearing,
the agreement and specific reasons for the agreement are public data.
new text end

Sec. 3.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Data classification; confidential data. new text end

new text begin For providers regulated pursuant
to sections 144A.043 to 144A.482, the following data collected, created, or maintained
by the Department of Health are classified as "confidential data" as defined in section
13.02, subdivision 3: active investigative data relating to the investigation of potential
violations of law by licensee including data from the survey process before the correction
order is issued by the department.
new text end

Sec. 4.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Release of private or confidential data. new text end

new text begin For providers regulated pursuant
to sections 144A.043 to 144A.482, the department may release private or confidential
data, except Social Security numbers, to the appropriate state, federal, or local agency
and law enforcement office to enhance investigative or enforcement efforts or further
public health protective process. Types of offices include, but are not limited to, Adult
Protective Services, Office of the Ombudsmen for Long-Term Care and Office of the
Ombudsmen for Mental Health and Developmental Disabilities, the health licensing
boards, Department of Human Services, county or city attorney's offices, police, and local
or county public health offices.
new text end

Sec. 5.

new text begin [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin License required. new text end

new text begin A home care provider may not open, operate,
manage, conduct, maintain, or advertise itself as a home care provider or provide home
care services in Minnesota without a temporary or current home care provider license
issued by the commissioner of health.
new text end

new text begin Subd. 2. new text end

new text begin Determination of direct home care service. new text end

new text begin "Direct home care service"
means a home care service provided to a client by the home care provider or its employees,
and not by contract. Factors that must be considered in determining whether an individual
or a business entity provides at least one home care service directly include, but are not
limited to, whether the individual or business entity:
new text end

new text begin (1) has the right to control, and does control, the types of services provided;
new text end

new text begin (2) has the right to control, and does control, when and how the services are provided;
new text end

new text begin (3) establishes the charges;
new text end

new text begin (4) collects fees from the clients or receives payment from third-party payers on
the clients' behalf;
new text end

new text begin (5) pays individuals providing services compensation on an hourly, weekly, or
similar basis;
new text end

new text begin (6) treats the individuals providing services as employees for the purposes of payroll
taxes and workers' compensation insurance; and
new text end

new text begin (7) holds itself out as a provider of home care services or acts in a manner that
leads clients or potential clients to believe that it is a home care provider providing home
care services.
new text end

new text begin None of the factors listed in this subdivision is solely determinative.
new text end

new text begin Subd. 3. new text end

new text begin Determination of regularly engaged. new text end

new text begin "Regularly engaged" means
providing, or offering to provide, home care services as a regular part of a business. The
following factors must be considered by the commissioner in determining whether an
individual or a business entity is regularly engaged in providing home care services:
new text end

new text begin (1) whether the individual or business entity states or otherwise promotes that the
individual or business entity provides home care services;
new text end

new text begin (2) whether persons receiving home care services constitute a substantial part of the
individual's or the business entity's clientele; and
new text end

new text begin (3) whether the home care services provided are other than occasional or incidental
to the provision of services other than home care services.
new text end

new text begin None of the factors listed in this subdivision is solely determinative.
new text end

new text begin Subd. 4. new text end

new text begin Penalties for operating without license. new text end

new text begin A person involved in the
management, operation, or control of a home care provider that operates without an
appropriate license is guilty of a misdemeanor. This section does not apply to a person
who has no legal authority to affect or change decisions related to the management,
operation, or control of a home care provider.
new text end

new text begin Subd. 5. new text end

new text begin Basic and comprehensive levels of licensure. new text end

new text begin An applicant seeking
to become a home care provider must apply for either a basic or comprehensive home
care license.
new text end

new text begin Subd. 6. new text end

new text begin Basic home care license provider. new text end

new text begin Home care services that can be
provided with a basic home care license are assistive tasks provided by licensed or
unlicensed personnel that include:
new text end

new text begin (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting,
and bathing;
new text end

new text begin (2) providing standby assistance;
new text end

new text begin (3) providing verbal or visual reminders to the client to take regularly scheduled
medication which includes bringing the client previously set-up medication, medication in
original containers, or liquid or food to accompany the medication;
new text end

new text begin (4) providing verbal or visual reminders to the client to perform regularly scheduled
treatments and exercises;
new text end

new text begin (5) preparing modified diets ordered by a licensed health professional; and
new text end

new text begin (6) assisting with laundry, housekeeping, meal preparation, shopping, or other
household chores and services if the provider is also providing at least one of the activities
in clauses (1) to (5)
new text end

new text begin Subd. 7. new text end

new text begin Comprehensive home care license provider. new text end

new text begin Home care services that
may be provided with a comprehensive home care license include any of the basic home
care services listed in subdivision 6, and one or more of the following:
new text end

new text begin (1) services of an advanced practice nurse, registered nurse, licensed practical
nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
pathologist, dietician or nutritionist, or social worker;
new text end

new text begin (2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a
licensed health professional within the person's scope of practice;
new text end

new text begin (3) medication management services;
new text end

new text begin (4) hands-on assistance with transfers and mobility;
new text end

new text begin (5) assisting clients with eating when the clients have complicating eating problems
as identified in the client record or through an assessment such as difficulty swallowing,
recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous
instruments to be fed; or
new text end

new text begin (6) providing other complex or specialty health care services.
new text end

new text begin Subd. 8. new text end

new text begin Exemptions from home care services licensure. new text end

new text begin (a) Except as otherwise
provided in this chapter, home care services that are provided by the state, counties, or
other units of government must be licensed under this chapter.
new text end

new text begin (b) An exemption under this subdivision does not excuse the exempted individual or
organization from complying with applicable provisions of the home care bill of rights
in section 144A.44. The following individuals or organizations are exempt from the
requirement to obtain a home care provider license:
new text end

new text begin (1) an individual or organization that offers, provides, or arranges for personal care
assistance services under the medical assistance program as authorized under sections
256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
new text end

new text begin (2) a provider that is licensed by the commissioner of human services to provide
semi-independent living services for persons with developmental disabilities under section
252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
new text end

new text begin (3) a provider that is licensed by the commissioner of human services to provide
home and community-based services for persons with developmental disabilities under
section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
new text end

new text begin (4) an individual or organization that provides only home management services, if
the individual or organization is registered under section 144A.482; or
new text end

new text begin (5) an individual who is licensed in this state as a nurse, dietitian, social worker,
occupational therapist, physical therapist, or speech-language pathologist who provides
health care services in the home independently and not through any contractual or
employment relationship with a home care provider or other organization.
new text end

new text begin Subd. 9. new text end

new text begin Exclusions from home care licensure. new text end

new text begin The following are excluded from
home care licensure and are not required to provide the home care bill of rights:
new text end

new text begin (1) an individual or business entity providing only coordination of home care that
includes one or more of the following:
new text end

new text begin (i) determination of whether a client needs home care services, or assisting a client
in determining what services are needed;
new text end

new text begin (ii) referral of clients to a home care provider;
new text end

new text begin (iii) administration of payments for home care services; or
new text end

new text begin (iv) administration of a health care home established under section 256B.0751;
new text end

new text begin (2) an individual who is not an employee of a licensed home care provider if the
individual:
new text end

new text begin (i) only provides services as an independent contractor to one or more licensed
home care providers;
new text end

new text begin (ii) provides no services under direct agreements or contracts with clients; and
new text end

new text begin (iii) is contractually bound to perform services in compliance with the contracting
home care provider's policies and service plans;
new text end

new text begin (3) a business that provides staff to home care providers, such as a temporary
employment agency, if the business:
new text end

new text begin (i) only provides staff under contract to licensed or exempt providers;
new text end

new text begin (ii) provides no services under direct agreements with clients; and
new text end

new text begin (iii) is contractually bound to perform services under the contracting home care
provider's direction and supervision;
new text end

new text begin (4) any home care services conducted by and for the adherents of any recognized
church or religious denomination for its members through spiritual means, or by prayer
for healing;
new text end

new text begin (5) an individual who only provides home care services to a relative;
new text end

new text begin (6) an individual not connected with a home care provider that provides assistance
with basic home care needs if the assistance is provided primarily as a contribution and
not as a business;
new text end

new text begin (7) an individual not connected with a home care provider that shares housing with
and provides primarily housekeeping or homemaking services to an elderly or disabled
person in return for free or reduced-cost housing;
new text end

new text begin (8) an individual or provider providing home-delivered meal services;
new text end

new text begin (9) an individual providing senior companion services and other Older American
Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of
1973, United States Code, title 42, chapter 66;
new text end

new text begin (10) an employee of a nursing home licensed under this chapter or an employee of a
boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
emergency calls from individuals residing in a residential setting that is attached to or
located on property contiguous to the nursing home or boarding care home;
new text end

new text begin (11) a member of a professional corporation organized under chapter 319B that
does not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3;
new text end

new text begin (12) the following organizations established to provide medical or surgical services
that do not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
corporation organized under chapter 317A, a partnership organized under chapter 323, or
any other entity determined by the commissioner;
new text end

new text begin (13) an individual or agency that provides medical supplies or durable medical
equipment, except when the provision of supplies or equipment is accompanied by a
home care service;
new text end

new text begin (14) a physician licensed under chapter 147;
new text end

new text begin (15) an individual who provides home care services to a person with a developmental
disability who lives in a place of residence with a family, foster family, or primary caregiver;
new text end

new text begin (16) a business that only provides services that are primarily instructional and not
medical services or health-related support services;
new text end

new text begin (17) an individual who performs basic home care services for no more than 14 hours
each calendar week to no more than one client;
new text end

new text begin (18) an individual or business licensed as hospice as defined in sections 144A.75 to
144A.755 who is not providing home care services independent of hospice service;
new text end

new text begin (19) activities conducted by the commissioner of health or a board of health as
defined in section 145A.02, subdivision 2, including communicable disease investigations
or testing; or
new text end

new text begin (20) administering or monitoring a prescribed therapy necessary to control or
prevent a communicable disease, or the monitoring of an individual's compliance with a
health directive as defined in section 144.4172, subdivision 6.
new text end

Sec. 6.

new text begin [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION AND
RENEWAL.
new text end

new text begin Subdivision 1. new text end

new text begin License applications. new text end

new text begin Each application for a home care provider
license must include information sufficient to show that the applicant meets the
requirements of licensure, including:
new text end

new text begin (1) the applicant's name, e-mail address, physical address, and mailing address,
including the name of the county in which the applicant resides and has a principal
place of business;
new text end

new text begin (2) the initial license fee in the amount specified in subdivision 7;
new text end

new text begin (3) the e-mail address, physical address, mailing address, and telephone number of
the principal administrative office;
new text end

new text begin (4) the e-mail address, physical address, mailing address, and telephone number of
each branch office, if any;
new text end

new text begin (5) the names, e-mail and mailing addresses, and telephone numbers of all owners
and managerial officials;
new text end

new text begin (6) documentation of compliance with the background study requirements of section
144A.476 for all persons involved in the management, operation, or control of the home
care provider;
new text end

new text begin (7) documentation of a background study as required by section 144.057 for any
individual seeking employment, paid or volunteer, with the home care provider;
new text end

new text begin (8) evidence of workers' compensation coverage as required by sections 176.181
and 176.182;
new text end

new text begin (9) documentation of liability coverage, if the provider has it;
new text end

new text begin (10) identification of the license level the provider is seeking;
new text end

new text begin (11) documentation that identifies the managerial official who is in charge of
day-to-day operations and attestation that the person has reviewed and understands the
home care provider regulations;
new text end

new text begin (12) documentation that the applicant has designated one or more owners,
managerial officials, or employees as an agent or agents, which shall not affect the legal
responsibility of any other owner or managerial official under this chapter;
new text end

new text begin (13) the signature of the officer or managing agent on behalf of an entity, corporation,
association, or unit of government;
new text end

new text begin (14) verification that the applicant has the following policies and procedures in place
so that if a license is issued, the applicant will implement the policies and procedures
and keep them current:
new text end

new text begin (i) requirements in sections 626.556, reporting of maltreatment of minors, and
626.557, reporting of maltreatment of vulnerable adults;
new text end

new text begin (ii) conducting and handling background studies on employees;
new text end

new text begin (iii) orientation, training, and competency evaluations of home care staff, and a
process for evaluating staff performance;
new text end

new text begin (iv) handling complaints from clients, family members, or client representatives
regarding staff or services provided by staff;
new text end

new text begin (v) conducting initial evaluation of clients' needs and the providers' ability to provide
those services;
new text end

new text begin (vi) conducting initial and ongoing client evaluations and assessments and how
changes in a client's condition are identified, managed, and communicated to staff and
other health care providers as appropriate;
new text end

new text begin (vii) orientation to and implementation of the home care client bill of rights;
new text end

new text begin (viii) infection control practices;
new text end

new text begin (ix) reminders for medications, treatments, or exercises, if provided; and
new text end

new text begin (x) conducting appropriate screenings, or documentation of prior screenings, to
show that staff are free of tuberculosis, consistent with current United States Centers for
Disease Control and Prevention standards; and
new text end

new text begin (15) other information required by the department.
new text end

new text begin Subd. 2. new text end

new text begin Comprehensive home care license applications. new text end

new text begin In addition to the
information and fee required in subdivision 1, applicants applying for a comprehensive
home care license must also provide verification that the applicant has the following
policies and procedures in place so that if a license is issued, the applicant will implement
the policies and procedures in this subdivision and keep them current:
new text end

new text begin (1) conducting initial and ongoing assessments of the client's needs by a registered
nurse or appropriate licensed health professional, including how changes in the client's
conditions are identified, managed, and communicated to staff and other health care
providers, as appropriate;
new text end

new text begin (2) ensuring that nurses and licensed health professionals have current and valid
licenses to practice;
new text end

new text begin (3) medication and treatment management;
new text end

new text begin (4) delegation of home care tasks by registered nurses or licensed health professionals;
new text end

new text begin (5) supervision of registered nurses and licensed health professionals; and
new text end

new text begin (6) supervision of unlicensed personnel performing delegated home care tasks.
new text end

new text begin Subd. 3. new text end

new text begin License renewal. new text end

new text begin (a) Except as provided in section 144A.475, a license
may be renewed for a period of one year if the licensee satisfies the following:
new text end

new text begin (1) submits an application for renewal in the format provided by the commissioner
at least 30 days before expiration of the license;
new text end

new text begin (2) submits the renewal fee in the amount specified in subdivision 7;
new text end

new text begin (3) has provided home care services within the past 12 months;
new text end

new text begin (4) complies with sections 144A.43 to 144A.4799;
new text end

new text begin (5) provides information sufficient to show that the applicant meets the requirements
of licensure, including items required under subdivision 1;
new text end

new text begin (6) provides verification that all policies under subdivision 1 are current; and
new text end

new text begin (7) provides any other information deemed necessary by the commissioner.
new text end

new text begin (b) A renewal applicant who holds a comprehensive home care license must also
provide verification that policies listed under subdivision 2 are current.
new text end

new text begin Subd. 4. new text end

new text begin Multiple units. new text end

new text begin Multiple units or branches of a licensee must be separately
licensed if the commissioner determines that the units cannot adequately share supervision
and administration of services from the main office.
new text end

new text begin Subd. 5. new text end

new text begin Transfers prohibited; changes in ownership. new text end

new text begin Any home care license
issued by the commissioner may not be transferred to another party. Before acquiring
ownership of a home care provider business, a prospective applicant must apply for a
new temporary license. A change of ownership is a transfer of operational control to
a different business entity and includes:
new text end

new text begin (1) transfer of the business to a different or new corporation;
new text end

new text begin (2) in the case of a partnership, the dissolution or termination of the partnership under
chapter 323A, with the business continuing by a successor partnership or other entity;
new text end

new text begin (3) relinquishment of control of the provider to another party, including to a contract
management firm that is not under the control of the owner of the business' assets;
new text end

new text begin (4) transfer of the business by a sole proprietor to another party or entity; or
new text end

new text begin (5) in the case of a privately held corporation, the change in ownership or control of
50 percent or more of the outstanding voting stock.
new text end

new text begin Subd. 6. new text end

new text begin Notification of changes of information. new text end

new text begin The temporary licensee or
licensee shall notify the commissioner in writing within ten working days after any
change in the information required in subdivision 1, except the information required in
subdivision 1, clause (5), is required at the time of license renewal.
new text end

new text begin Subd. 7. new text end

new text begin Fees; application, change of ownership, and renewal. new text end

new text begin (a) An initial
applicant seeking a temporary home care licensure must submit the following application
fee to the commissioner along with a completed application:
new text end

new text begin (1) basic home care provider, $2,100; or
new text end

new text begin (2) comprehensive home care provider, $4,200.
new text end

new text begin (b) A home care provider who is filing a change of ownership as required under
subdivision 5 must submit the following application fee to the commissioner, along with
the documentation required for the change of ownership:
new text end

new text begin (1) basic home care provider, $2,100; or
new text end

new text begin (2) comprehensive home care provider, $4,200.
new text end

new text begin (c) A home care provider who is seeking to renew the provider's license shall pay a
fee to the commissioner based on revenues derived from the provision of home care
services during the calendar year prior to the year in which the application is submitted,
according to the following schedule:
new text end

new text begin License Renewal Fee
new text end

new text begin Provider Annual Revenue new text end	new text begin Fee new text end
new text begin greater than $1,500,000 new text end	new text begin $6,625 new text end
new text begin greater than $1,275,000 and no more than $1,500,000 new text end	new text begin $5,797 new text end
new text begin greater than $1,100,000 and no more than $1,275,000 new text end	new text begin $4,969 new text end
new text begin greater than $950,000 and no more than $1,100,000 new text end	new text begin $4,141 new text end
new text begin greater than $850,000 and no more than $950,000 new text end	new text begin $3,727 new text end
new text begin greater than $750,000 and no more than $850,000 new text end	new text begin $3,313 new text end
new text begin greater than $650,000 and no more than $750,000 new text end	new text begin $2,898 new text end
new text begin greater than $550,000 and no more than $650,000 new text end	new text begin $2,485 new text end
new text begin greater than $450,000 and no more than $550,000 new text end	new text begin $2,070 new text end
new text begin greater than $350,000 and no more than $450,000 new text end	new text begin $1,656 new text end
new text begin greater than $250,000 and no more than $350,000 new text end	new text begin $1,242 new text end
new text begin greater than $100,000 and no more than $250,000 new text end	new text begin $828 new text end
new text begin greater than $50,000 and no more than $100,000 new text end	new text begin $500 new text end
new text begin greater than $25,000 and no more than $50,000 new text end	new text begin $400 new text end
new text begin no more than $25,000 new text end	new text begin $200 new text end

new text begin (d) If requested, the home care provider shall provide the commissioner information
to verify the provider's annual revenues or other information as needed, including copies
of documents submitted to the Department of Revenue.
new text end

new text begin (e) At each annual renewal, a home care provider may elect to pay the highest
renewal fee for its license category, and not provide annual revenue information to the
commissioner.
new text end

new text begin (f) A temporary license or license applicant, or temporary licensee or licensee that
knowingly provides the commissioner incorrect revenue amounts for the purpose of
paying a lower license fee, shall be subject to a civil penalty in the amount of double the
fee the provider should have paid.
new text end

new text begin (g) Fees and penalties collected under this section shall be deposited in the state
treasury and credited to the special state government revenue fund.
new text end

new text begin (h) The license renewal fee schedule in this subdivision is effective July 1, 2016.
new text end

Sec. 7.

new text begin [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE
RENEWAL.
new text end

new text begin Subdivision 1. new text end

new text begin Temporary license and renewal of license. new text end

new text begin (a) The department
shall review each application to determine the applicant's knowledge of and compliance
with Minnesota home care regulations. Before granting a temporary license or renewing a
license, the commissioner may further evaluate the applicant or licensee by requesting
additional information or documentation or by conducting an on-site survey of the
applicant to determine compliance with sections 144A.43 to 144A.482.
new text end

new text begin (b) Within 14 calendar days after receiving an application for a license,
the commissioner shall acknowledge receipt of the application in writing. The
acknowledgment must indicate whether the application appears to be complete or whether
additional information is required before the application will be considered complete.
new text end

new text begin (c) Within 90 days after receiving a complete application, the commissioner shall
issue a temporary license, renew the license, or deny the license.
new text end

new text begin (d) The commissioner shall issue a license that contains the home care provider's
name, address, license level, expiration date of the license, and unique license number. All
licenses are valid for one year from the date of issuance.
new text end

new text begin Subd. 2. new text end

new text begin Temporary license. new text end

new text begin (a) For new license applicants, the commissioner
shall issue a temporary license for either the basic or comprehensive home care level. A
temporary license is effective for one year from the date of issuance. Temporary licensees
must comply with sections 144A.43 to 144A.482.
new text end

new text begin (b) During the temporary license year, the commissioner shall survey the temporary
licensee after the commissioner is notified or has evidence that the temporary licensee
is providing home care services.
new text end

new text begin (c) Within five days of beginning the provision of services, the temporary
licensee must notify the commissioner that it is serving clients. The notification to the
commissioner may be mailed or e-mailed to the commissioner at the address provided by
the commissioner. If the temporary licensee does not provide home care services during
the temporary license year, then the temporary license expires at the end of the year and
the applicant must reapply for a temporary home care license.
new text end

new text begin (d) A temporary licensee may request a change in the level of licensure prior to
being surveyed and granted a license by notifying the commissioner in writing and
providing additional documentation or materials required to update or complete the
changed temporary license application. The applicant must pay the difference between the
application fees when changing from the basic to the comprehensive level of licensure.
No refund will be made if the provider chooses to change the license application to the
basic level.
new text end

new text begin (e) If the temporary licensee notifies the commissioner that the licensee has clients
within 45 days prior to the temporary license expiration, the commissioner may extend the
temporary license for up to 60 days in order to allow the commissioner to complete the
on-site survey required under this section and follow-up survey visits.
new text end

new text begin Subd. 3. new text end

new text begin Temporary licensee survey. new text end

new text begin (a) If the temporary licensee is in substantial
compliance with the survey, the commissioner shall issue either a basic or comprehensive
home care license. If the temporary licensee is not in substantial compliance with the
survey, the commissioner shall not issue a basic or comprehensive license and there will
be no contested hearing right under chapter 14.
new text end

new text begin (b) If the temporary licensee whose basic or comprehensive license has been denied
disagrees with the conclusions of the commissioner, then the licensee may request a
reconsideration by the commissioner or commissioner's designee. The reconsideration
request process will be conducted internally by the commissioner or commissioner's
designee, and chapter 14 does not apply.
new text end

new text begin (c) The temporary licensee requesting reconsideration must make the request in
writing and must list and describe the reasons why the licensee disagrees with the decision
to deny the basic or comprehensive home care license.
new text end

new text begin (d) A temporary licensee whose license is denied must comply with the requirements
for notification and transfer of clients in section 144A.475, subdivision 5.
new text end

Sec. 8.

new text begin [144A.474] SURVEYS AND INVESTIGATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Surveys. new text end

new text begin The commissioner shall conduct surveys of each home
care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
providers on a frequency of at least once every three years. Survey frequency may be
based on the license level, the provider's compliance history, number of clients served,
or other factors as determined by the department deemed necessary to ensure the health,
safety, and welfare of clients and compliance with the law.
new text end

new text begin Subd. 2. new text end

new text begin Types of home care surveys. new text end

new text begin (a) "Initial full survey" means the survey of
a new temporary licensee conducted after the department is notified or has evidence that
the licensee is providing home care services to determine if the provider is in compliance
with home care requirements. Initial full surveys must be completed within 14 months
after the department's issuance of a temporary basic or comprehensive license.
new text end

new text begin (b) "Core survey" means periodic inspection of home care providers to determine
ongoing compliance with the home care requirements, focusing on the essential health and
safety requirements. Core surveys are available to licensed home care providers who have
been licensed for three years and surveyed at least once in the past three years with the
latest survey having no widespread violations beyond Level 1 as provided in subdivision
11. Providers must also not have had any substantiated licensing complaints, substantiated
complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
Act, or an enforcement action as authorized in section 144A.475 in the past three years.
new text end

new text begin (1) The core survey for basic license level providers shall review compliance in
the following areas:
new text end

new text begin (i) reporting of maltreatment;
new text end

new text begin (ii) orientation to and implementation of Home Care Client Bill of Rights;
new text end

new text begin (iii) statement of home care services;
new text end

new text begin (iv) initial evaluation of clients and initiation of services;
new text end

new text begin (v) basic license level client review and monitoring;
new text end

new text begin (vi) service plan implementation and changes to the service plan;
new text end

new text begin (vii) client complaint and investigative process;
new text end

new text begin (viii) competency of unlicensed personnel; and
new text end

new text begin (ix) infection control.
new text end

new text begin (2) For comprehensive license level providers, the core survey shall include
everything in the basic license level core survey plus these areas:
new text end

new text begin (i) delegation to unlicensed personnel;
new text end

new text begin (ii) assessment, monitoring, and reassessment of clients; and
new text end

new text begin (iii) medication, treatment, and therapy management.
new text end

new text begin (c) "Full survey" means the periodic inspection of home care providers to determine
ongoing compliance with the home care requirements that cover the core survey areas
and all the legal requirements for home care providers. A full survey is conducted for all
temporary licensees and for providers who do not meet the requirements needed for a core
survey, and when a surveyor identifies unacceptable client health or safety risks during a
core survey. A full survey shall include all the tasks identified as part of the core survey
and any additional review deemed necessary by the department, including additional
observation, interviewing, or records review of additional clients and staff.
new text end

new text begin (d) "Follow-up surveys" means surveys conducted to determine if a home care
provider has corrected deficient issues and systems identified during a core survey, full
survey, or complaint investigation. Follow-up surveys may be conducted via phone,
e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys,
shall be concluded with an exit conference and written information provided on the
process for requesting a reconsideration of the survey results.
new text end

new text begin (e) Upon receiving information that a home care provider has violated or is currently
violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
investigate the complaint according to sections 144A.51 to 144A.54.
new text end

new text begin Subd. 3. new text end

new text begin Survey process. new text end

new text begin (a) The survey process for core surveys shall include the
following as applicable to the particular licensee and setting surveyed:
new text end

new text begin (1) presurvey review of pertinent documents and notification to the ombudsman
for long-term care;
new text end

new text begin (2) an entrance conference with available staff;
new text end

new text begin (3) communication with managerial officials or the registered nurse in charge, if
available, and ongoing communication with key staff throughout the survey regarding
information needed by the surveyor, clarifications regarding home care requirements, and
applicable standards of practice;
new text end

new text begin (4) presentation of written contact information to the provider about the survey staff
conducting the survey, the supervisor, and the process for requesting a reconsideration of
the survey results;
new text end

new text begin (5) a brief tour of a sample of the housing with services establishments in which the
provider is providing home care services;
new text end

new text begin (6) a sample selection of home care clients;
new text end

new text begin (7) information-gathering through client and staff observations, client and staff
interviews, and reviews of records, policies, procedures, practices, and other agency
information;
new text end

new text begin (8) interviews of clients' family members, if available, with clients' consent when the
client can legally give consent;
new text end

new text begin (9) except for complaint surveys conducted by the Office of Health Facilities
Complaints, an exit conference, with preliminary findings shared and discussed with the
provider and written information provided on the process for requesting a reconsideration
of the survey results; and
new text end

new text begin (10) postsurvey analysis of findings and formulation of survey results, including
correction orders when applicable.
new text end

new text begin Subd. 4. new text end

new text begin Scheduling surveys. new text end

new text begin Surveys and investigations shall be conducted
without advance notice to home care providers. Surveyors may contact the home care
provider on the day of a survey to arrange for someone to be available at the survey site.
The contact does not constitute advance notice.
new text end

new text begin Subd. 5. new text end

new text begin Information provided by home care provider. new text end

new text begin The home care provider
shall provide accurate and truthful information to the department during a survey,
investigation, or other licensing activities.
new text end

new text begin Subd. 6. new text end

new text begin Providing client records. new text end

new text begin Upon request of a surveyor, home care providers
shall provide a list of current and past clients or client representatives that includes
addresses and telephone numbers and any other information requested about the services
to clients within a reasonable period of time.
new text end

new text begin Subd. 7. new text end

new text begin Contacting and visiting clients. new text end

new text begin Surveyors may contact or visit a home
care provider's clients to gather information without notice to the home care provider.
Before visiting a client, a surveyor shall obtain the client's or client's representative's
permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
representatives of their right to decline permission for a visit.
new text end

new text begin Subd. 8. new text end

new text begin Correction orders. new text end

new text begin (a) A correction order may be issued whenever the
commissioner finds upon survey or during a complaint investigation that a home care
provider, a managerial official, or an employee of the provider is not in compliance with
sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
document areas of noncompliance and the time allowed for correction.
new text end

new text begin (b) The commissioner shall mail copies of any correction order within 30 calendar
days after an exit survey to the last known address of the home care provider. A copy of
each correction order and copies of any documentation supplied to the commissioner shall
be kept on file by the home care provider, and public documents shall be made available
for viewing by any person upon request. Copies may be kept electronically.
new text end

new text begin (c) By the correction order date, the home care provider must document in the
provider's records any action taken to comply with the correction order. The commissioner
may request a copy of this documentation and the home care provider's action to respond
to the correction order in future surveys, upon a complaint investigation, and as otherwise
needed.
new text end

new text begin Subd. 9. new text end

new text begin Follow-up surveys. new text end

new text begin For providers that have Level 3 or Level 4 violations,
under subdivision 11, or any violations determined to be widespread, the department shall
conduct a follow-up survey within 90 calendar days of the survey. When conducting a
follow-up survey, the surveyor will focus on whether the previous violations have been
corrected and may also address any new violations that are observed while evaluating the
corrections that have been made. If a new violation is identified on a follow-up survey, no
fine will be imposed unless it is not corrected on the next follow-up survey.
new text end

new text begin Subd. 10. new text end

new text begin Performance incentive. new text end

new text begin A licensee is eligible for a performance
incentive if there are no violations identified in a core or full survey. The performance
incentive is a ten percent discount on the licensee's next home care renewal license fee.
new text end

new text begin Subd. 11. new text end

new text begin Fines. new text end

new text begin (a) Fines and enforcement actions under this subdivision may be
assessed based on the level and scope of the violations described in paragraph (c) as follows:
new text end

new text begin (1) Level 1, no fines or enforcement;
new text end

new text begin (2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
mechanisms authorized in section 144A.475 for widespread violations;
new text end

new text begin (3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
mechanisms authorized in section 144A.475; and
new text end

new text begin (4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
enforcement mechanisms authorized in section 144A.475.
new text end

new text begin (b) Correction orders for violations are categorized by both level and scope and
fines shall be assessed as follows:
new text end

new text begin (1) Level of violation:
new text end

new text begin (i) Level 1 is a violation that has no potential to cause more than a minimal impact
on the client and does not affect health or safety;
new text end

new text begin (ii) Level 2 is a violation that did not harm a client's health or safety but had the
potential to have harmed a client's health or safety, but was not likely to cause serious
injury, impairment, or death;
new text end

new text begin (iii) Level 3 is a violation that harmed a client's health or safety, not including
serious injury, impairment, or death, or a violation that has the potential to lead to serious
injury, impairment, or death; and
new text end

new text begin (iv) Level 4 is a violation that results in serious injury, impairment, or death.
new text end

new text begin (2) Scope of violation:
new text end

new text begin (i) Isolated, when one or a limited number of clients are affected or one or a limited
number of staff are involved or the situation has occurred only occasionally;
new text end

new text begin (ii) Pattern, when more than a limited number of clients are affected, more than a
limited number of staff are involved, or the situation has occurred repeatedly but is not
found to be pervasive; and
new text end

new text begin (iii) Widespread, when problems are pervasive or represent a systemic failure that
has affected or has the potential to affect a large portion or all of the clients.
new text end

new text begin (c) If the commissioner finds that the applicant or a home care provider required
to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
date specified in the correction order or conditional license resulting from a survey or
complaint investigation, the commissioner may impose a fine. A notice of noncompliance
with a correction order must be mailed to the applicant's or provider's last known address.
The noncompliance notice must list the violations not corrected.
new text end

new text begin (d) The license holder must pay the fines assessed on or before the payment date
specified. If the license holder fails to fully comply with the order, the commissioner
may issue a second fine or suspend the license until the license holder complies by
paying the fine. A timely appeal shall stay payment of the fine until the commissioner
issues a final order.
new text end

new text begin (e) A license holder shall promptly notify the commissioner in writing when a
violation specified in the order is corrected. If upon reinspection the commissioner
determines that a violation has not been corrected as indicated by the order, the
commissioner may issue a second fine. The commissioner shall notify the license holder by
mail to the last known address in the licensing record that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
new text end

new text begin (f) A home care provider that has been assessed a fine under this subdivision has a
right to a reconsideration or a hearing under this section and chapter 14.
new text end

new text begin (g) When a fine has been assessed, the license holder may not avoid payment by
closing, selling, or otherwise transferring the licensed program to a third party. In such an
event, the license holder shall be liable for payment of the fine.
new text end

new text begin (h) In addition to any fine imposed under this section, the commissioner may assess
costs related to an investigation that results in a final order assessing a fine or other
enforcement action authorized by this chapter.
new text end

new text begin (i) Fines collected under this subdivision shall be deposited in the state government
special revenue fund and credited to an account separate from the revenue collected under
section 144A.472. Subject to an appropriation by the legislature, the revenue from the
fines collected may be used by the commissioner for special projects to improve home care
in Minnesota as recommended by the advisory council established in section 144A.4799.
new text end

new text begin Subd. 12. new text end

new text begin Reconsideration. new text end

new text begin (a) The commissioner shall make available to home
care providers a correction order reconsideration process. This process may be used
to challenge the correction order issued, including the level and scope described in
subdivision 11, and any fine assessed. During the correction order reconsideration
request, the issuance for the correction orders under reconsideration are not stayed, but
the department shall post information on the Web site with the correction order that the
licensee has requested a reconsideration and that the review is pending.
new text end

new text begin (b) A licensed home care provider may request from the commissioner, in writing,
a correction order reconsideration regarding any correction order issued to the provider.
The correction order reconsideration shall not be reviewed by any surveyor, investigator,
or supervisor that participated in the writing or reviewing of the correction order
being disputed. The correction order reconsiderations may be conducted in person, by
telephone, by another electronic form, or in writing, as determined by the commissioner.
The commissioner shall respond in writing to the request from a home care provider
for a correction order reconsideration within 60 days of the date the provider requests a
reconsideration. The commissioner's response shall identify the commissioner's decision
regarding each citation challenged by the home care provider.
new text end

new text begin (c) The findings of a correction order reconsideration process shall be one or more of
the following:
new text end

new text begin (1) supported in full, the correction order is supported in full, with no deletion of
findings to the citation;
new text end

new text begin (2) supported in substance, the correction order is supported, but one or more
findings are deleted or modified without any change in the citation;
new text end

new text begin (3) correction order cited an incorrect home care licensing requirement, the correction
order is amended by changing the correction order to the appropriate statutory reference;
new text end

new text begin (4) correction order was issued under an incorrect citation, the correction order is
amended to be issued under the more appropriate correction order citation;
new text end

new text begin (5) the correction order is rescinded;
new text end

new text begin (6) fine is amended, it is determined that the fine assigned to the correction order
was applied incorrectly; or
new text end

new text begin (7) the level or scope of the citation is modified based on the reconsideration.
new text end

new text begin (d) If the correction order findings are changed by the commissioner, the
commissioner shall update the correction order Web site.
new text end

new text begin Subd. 13. new text end

new text begin Home care surveyor training. new text end

new text begin (a) Before conducting a home care
survey, each home care surveyor must receive training on the following topics:
new text end

new text begin (1) Minnesota home care licensure requirements;
new text end

new text begin (2) Minnesota Home Care Client Bill of Rights;
new text end

new text begin (3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
new text end

new text begin (4) principles of documentation;
new text end

new text begin (5) survey protocol and processes;
new text end

new text begin (6) Offices of the Ombudsman roles;
new text end

new text begin (7) Office of Health Facility Complaints;
new text end

new text begin (8) Minnesota landlord-tenant and housing with services laws;
new text end

new text begin (9) types of payors for home care services; and
new text end

new text begin (10) Minnesota Nurse Practice Act for nurse surveyors.
new text end

new text begin (b) Materials used for the training in paragraph (a) shall be posted on the department
Web site. Requisite understanding of these topics will be reviewed as part of the quality
improvement plan in section 28.
new text end

Sec. 9.

new text begin [144A.475] ENFORCEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Conditions. new text end

new text begin (a) The commissioner may refuse to grant a temporary
license, renew a license, suspend or revoke a license, or impose a conditional license if the
home care provider or owner or managerial official of the home care provider:
new text end

new text begin (1) is in violation of, or during the term of the license has violated, any of the
requirements in sections 144A.471 to 144A.482;
new text end

new text begin (2) permits, aids, or abets the commission of any illegal act in the provision of
home care;
new text end

new text begin (3) performs any act detrimental to the health, safety, and welfare of a client;
new text end

new text begin (4) obtains the license by fraud or misrepresentation;
new text end

new text begin (5) knowingly made or makes a false statement of a material fact in the application
for a license or in any other record or report required by this chapter;
new text end

new text begin (6) denies representatives of the department access to any part of the home care
provider's books, records, files, or employees;
new text end

new text begin (7) interferes with or impedes a representative of the department in contacting the
home care provider's clients;
new text end

new text begin (8) interferes with or impedes a representative of the department in the enforcement
of this chapter or has failed to fully cooperate with an inspection, survey, or investigation
by the department;
new text end

new text begin (9) destroys or makes unavailable any records or other evidence relating to the home
care provider's compliance with this chapter;
new text end

new text begin (10) refuses to initiate a background study under section 144.057 or 245A.04;
new text end

new text begin (11) fails to timely pay any fines assessed by the department;
new text end

new text begin (12) violates any local, city, or township ordinance relating to home care services;
new text end

new text begin (13) has repeated incidents of personnel performing services beyond their
competency level; or
new text end

new text begin (14) has operated beyond the scope of the home care provider's license level.
new text end

new text begin (b) A violation by a contractor providing the home care services of the home care
provider is a violation by the home care provider.
new text end

new text begin Subd. 2. new text end

new text begin Terms to suspension or conditional license. new text end

new text begin A suspension or conditional
license designation may include terms that must be completed or met before a suspension
or conditional license designation is lifted. A conditional license designation may include
restrictions or conditions that are imposed on the provider. Terms for a suspension or
conditional license may include one or more of the following and the scope of each will be
determined by the commissioner:
new text end

new text begin (1) requiring a consultant to review, evaluate, and make recommended changes to
the home care provider's practices and submit reports to the commissioner at the cost of
the home care provider;
new text end

new text begin (2) requiring supervision of the home care provider or staff practices at the cost
of the home care provider by an unrelated person who has sufficient knowledge and
qualifications to oversee the practices and who will submit reports to the commissioner;
new text end

new text begin (3) requiring the home care provider or employees to obtain training at the cost of
the home care provider;
new text end

new text begin (4) requiring the home care provider to submit reports to the commissioner;
new text end

new text begin (5) prohibiting the home care provider from taking any new clients for a period
of time; or
new text end

new text begin (6) any other action reasonably required to accomplish the purpose of this
subdivision and section 144A.45, subdivision 2.
new text end

new text begin Subd. 3. new text end

new text begin Notice. new text end

new text begin Prior to any suspension, revocation, or refusal to renew a license,
the home care provider shall be entitled to notice and a hearing as provided by sections
14.57 to 14.69. In addition to any other remedy provided by law, the commissioner may,
without a prior contested case hearing, temporarily suspend a license or prohibit delivery
of services by a provider for not more than 90 days if the commissioner determines that
the health or safety of a consumer is in imminent danger, provided:
new text end

new text begin (1) advance notice is given to the home care provider;
new text end

new text begin (2) after notice, the home care provider fails to correct the problem;
new text end

new text begin (3) the commissioner has reason to believe that other administrative remedies are not
likely to be effective; and
new text end

new text begin (4) there is an opportunity for a contested case hearing within the 90 days.
new text end

new text begin Subd. 4. new text end

new text begin Time limits for appeals. new text end

new text begin To appeal the assessment of civil penalties
under section 144A.45, subdivision 2, clause (5), and an action against a license under
this section, a provider must request a hearing no later than 15 days after the provider
receives notice of the action.
new text end

new text begin Subd. 5. new text end

new text begin Plan required. new text end

new text begin (a) The process of suspending or revoking a license
must include a plan for transferring affected clients to other providers by the home care
provider, which will be monitored by the commissioner. Within three business days of
being notified of the final revocation or suspension action, the home care provider shall
provide the commissioner, the lead agencies as defined in section 256B.0911, and the
ombudsman for long-term care with the following information:
new text end

new text begin (1) a list of all clients, including full names and all contact information on file;
new text end

new text begin (2) a list of each client's representative or emergency contact person, including full
names and all contact information on file;
new text end

new text begin (3) the location or current residence of each client;
new text end

new text begin (4) the payor sources for each client, including payor source identification numbers;
and
new text end

new text begin (5) for each client, a copy of the client's service plan, and a list of the types of
services being provided.
new text end

new text begin (b) The revocation or suspension notification requirement is satisfied by mailing the
notice to the address in the license record. The home care provider shall cooperate with
the commissioner and the lead agencies during the process of transferring care of clients to
qualified providers. Within three business days of being notified of the final revocation or
suspension action, the home care provider must notify and disclose to each of the home
care provider's clients, or the client's representative or emergency contact persons, that
the commissioner is taking action against the home care provider's license by providing a
copy of the revocation or suspension notice issued by the commissioner.
new text end

new text begin Subd. 6. new text end

new text begin Owners and managerial officials; refusal to grant license. new text end

new text begin (a) The
owner and managerial officials of a home care provider whose Minnesota license has not
been renewed or that has been revoked because of noncompliance with applicable laws or
rules shall not be eligible to apply for nor will be granted a home care license, including
other licenses under this chapter, or be given status as an enrolled personal care assistance
provider agency or personal care assistant by the Department of Human Services under
section 256B.0659 for five years following the effective date of the nonrenewal or
revocation. If the owner and managerial officials already have enrollment status, their
enrollment will be terminated by the Department of Human Services.
new text end

new text begin (b) The commissioner shall not issue a license to a home care provider for five
years following the effective date of license nonrenewal or revocation if the owner or
managerial official, including any individual who was an owner or managerial official
of another home care provider, had a Minnesota license that was not renewed or was
revoked as described in paragraph (a).
new text end

new text begin (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall
suspend or revoke, the license of any home care provider that includes any individual
as an owner or managerial official who was an owner or managerial official of a home
care provider whose Minnesota license was not renewed or was revoked as described in
paragraph (a) for five years following the effective date of the nonrenewal or revocation.
new text end

new text begin (d) The commissioner shall notify the home care provider 30 days in advance of
the date of nonrenewal, suspension, or revocation of the license. Within ten days after
the receipt of the notification, the home care provider may request, in writing, that the
commissioner stay the nonrenewal, revocation, or suspension of the license. The home
care provider shall specify the reasons for requesting the stay; the steps that will be taken
to attain or maintain compliance with the licensure laws and regulations; any limits on the
authority or responsibility of the owners or managerial officials whose actions resulted in
the notice of nonrenewal, revocation, or suspension; and any other information to establish
that the continuing affiliation with these individuals will not jeopardize client health, safety,
or well-being. The commissioner shall determine whether the stay will be granted within
30 days of receiving the provider's request. The commissioner may propose additional
restrictions or limitations on the provider's license and require that the granting of the stay
be contingent upon compliance with those provisions. The commissioner shall take into
consideration the following factors when determining whether the stay should be granted:
new text end

new text begin (1) the threat that continued involvement of the owners and managerial officials with
the home care provider poses to client health, safety, and well-being;
new text end

new text begin (2) the compliance history of the home care provider; and
new text end

new text begin (3) the appropriateness of any limits suggested by the home care provider.
new text end

new text begin If the commissioner grants the stay, the order shall include any restrictions or
limitation on the provider's license. The failure of the provider to comply with any
restrictions or limitations shall result in the immediate removal of the stay and the
commissioner shall take immediate action to suspend, revoke, or not renew the license.
new text end

new text begin Subd. 7. new text end

new text begin Request for hearing. new text end

new text begin A request for a hearing must be in writing and must:
new text end

new text begin (1) be mailed or delivered to the department or the commissioner's designee;
new text end

new text begin (2) contain a brief and plain statement describing every matter or issue contested; and
new text end

new text begin (3) contain a brief and plain statement of any new matter that the applicant or home
care provider believes constitutes a defense or mitigating factor.
new text end

new text begin Subd. 8. new text end

new text begin Informal conference. new text end

new text begin At any time, the applicant or home care provider
and the commissioner may hold an informal conference to exchange information, clarify
issues, or resolve issues.
new text end

new text begin Subd. 9. new text end

new text begin Injunctive relief. new text end

new text begin In addition to any other remedy provided by law, the
commissioner may bring an action in district court to enjoin a person who is involved in
the management, operation, or control of a home care provider or an employee of the
home care provider from illegally engaging in activities regulated by sections 144A.43 to
144A.482. The commissioner may bring an action under this subdivision in the district
court in Ramsey County or in the district in which a home care provider is providing
services. The court may grant a temporary restraining order in the proceeding if continued
activity by the person who is involved in the management, operation, or control of a home
care provider, or by an employee of the home care provider, would create an imminent
risk of harm to a recipient of home care services.
new text end

new text begin Subd. 10. new text end

new text begin Subpoena. new text end

new text begin In matters pending before the commissioner under sections
144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance
of witnesses and the production of all necessary papers, books, records, documents, and
other evidentiary material. If a person fails or refuses to comply with a subpoena or
order of the commissioner to appear or testify regarding any matter about which the
person may be lawfully questioned or to produce any papers, books, records, documents,
or evidentiary materials in the matter to be heard, the commissioner may apply to the
district court in any district, and the court shall order the person to comply with the
commissioner's order or subpoena. The commissioner of health may administer oaths to
witnesses or take their affirmation. Depositions may be taken in or outside the state in the
manner provided by law for the taking of depositions in civil actions. A subpoena or other
process or paper may be served on a named person anywhere in the state by an officer
authorized to serve subpoenas in civil actions, with the same fees and mileage and in the
same manner as prescribed by law for a process issued out of a district court. A person
subpoenaed under this subdivision shall receive the same fees, mileage, and other costs
that are paid in proceedings in district court.
new text end

Sec. 10.

new text begin [144A.476] BACKGROUND STUDIES.
new text end

new text begin Subdivision 1. new text end

new text begin Prior criminal convictions; owner and managerial officials. new text end

new text begin (a)
Before the commissioner issues a temporary license or renews a license, an owner or
managerial official is required to complete a background study under section 144.057. No
person may be involved in the management, operation, or control of a home care provider
if the person has been disqualified under chapter 245C. If an individual is disqualified
under section 144.056 or chapter 245C, the individual may request reconsideration of
the disqualification. If the individual requests reconsideration and the commissioner
sets aside or rescinds the disqualification, the individual is eligible to be involved in the
management, operation, or control of the provider. If an individual has a disqualification
under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's
disqualification is barred from a set aside, and the individual must not be involved in the
management, operation, or control of the provider.
new text end

new text begin (b) For purposes of this section, owners of a home care provider subject to the
background check requirement are those individuals whose ownership interest provides
sufficient authority or control to affect or change decisions related to the operation of the
home care provider. An owner includes a sole proprietor, a general partner, or any other
individual whose individual ownership interest can affect the management and direction
of the policies of the home care provider.
new text end

new text begin (c) For the purposes of this section, managerial officials subject to the background
check requirement are individuals who provide direct contact as defined in section 245C.02,
subdivision 11, or individuals who have the responsibility for the ongoing management or
direction of the policies, services, or employees of the home care provider. Data collected
under this subdivision shall be classified as private data under section 13.02, subdivision 12.
new text end

new text begin (d) The department shall not issue any license if the applicant or owner or managerial
official has been unsuccessful in having a background study disqualification set aside
under section 144.057 and chapter 245C; if the owner or managerial official, as an owner
or managerial official of another home care provider, was substantially responsible for
the other home care provider's failure to substantially comply with sections 144A.43 to
144A.482; or if an owner that has ceased doing business, either individually or as an
owner of a home care provider, was issued a correction order for failing to assist clients in
violation of this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Employees, contractors, and volunteers. new text end

new text begin (a) Employees, contractors,
and volunteers of a home care provider are subject to the background study required by
section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall
be construed to prohibit a home care provider from requiring self-disclosure of criminal
conviction information.
new text end

new text begin (b) Termination of an employee in good faith reliance on information or records
obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not
subject the home care provider to civil liability or liability for unemployment benefits.
new text end

Sec. 11.

new text begin [144A.477] COMPLIANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Medicare-certified providers; coordination of surveys. new text end

new text begin If feasible,
the commissioner shall survey licensees to determine compliance with this chapter at the
same time as surveys for certification for Medicare if Medicare certification is based on
compliance with the federal conditions of participation and on survey and enforcement
by the Department of Health as agent for the United States Department of Health and
Human Services.
new text end

new text begin Subd. 2. new text end

new text begin Medicare-certified providers; equivalent requirements. new text end

new text begin For home care
providers licensed to provide comprehensive home care services that are also certified for
participation in Medicare as a home health agency under Code of Federal Regulations,
title 42, part 484, the following state licensure regulations are considered equivalent to
the federal requirements:
new text end

new text begin (1) quality management, section 144A.479, subdivision 3;
new text end

new text begin (2) personnel records, section 144A.479, subdivision 7;
new text end

new text begin (3) acceptance of clients, section 144A.4791, subdivision 4;
new text end

new text begin (4) referrals, section 144A.4791, subdivision 5;
new text end

new text begin (5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792,
subdivisions 2 and 3;
new text end

new text begin (6) individualized monitoring and reassessment, sections 144A.4791, subdivision
8, and 144A.4792, subdivisions 2 and 3;
new text end

new text begin (7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792,
subdivision 5, and 144A.4793, subdivision 3;
new text end

new text begin (8) client complaint and investigation process, section 144A.4791, subdivision 11;
new text end

new text begin (9) prescription orders, section 144A.4792, subdivisions 13 to 16;
new text end

new text begin (10) client records, section 144A.4794, subdivisions 1 to 3;
new text end

new text begin (11) qualifications for unlicensed personnel performing delegated tasks, section
144A.4795;
new text end

new text begin (12) training and competency staff, section 144A.4795;
new text end

new text begin (13) training and competency for unlicensed personnel, section 144A.4795,
subdivision 7;
new text end

new text begin (14) delegation of home care services, section 144A.4795, subdivision 4;
new text end

new text begin (15) availability of contact person, section 144A.4797, subdivision 1; and
new text end

new text begin (16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
new text end

new text begin Violations of requirements in clauses (1) to (16) may lead to enforcement actions
under section 144A.474.
new text end

Sec. 12.

new text begin [144A.478] INNOVATION VARIANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "innovation variance"
means a specified alternative to a requirement of this chapter. An innovation variance
may be granted to allow a home care provider to offer home care services of a type or
in a manner that is innovative, will not impair the services provided, will not adversely
affect the health, safety, or welfare of the clients, and is likely to improve the services
provided. The innovative variance cannot change any of the client's rights under section
144A.44, home care bill of rights.
new text end

new text begin Subd. 2. new text end

new text begin Conditions. new text end

new text begin The commissioner may impose conditions on the granting of
an innovation variance that the commissioner considers necessary.
new text end

new text begin Subd. 3. new text end

new text begin Duration and renewal. new text end

new text begin The commissioner may limit the duration of any
innovation variance and may renew a limited innovation variance.
new text end

new text begin Subd. 4. new text end

new text begin Applications; innovation variance. new text end

new text begin An application for innovation
variance from the requirements of this chapter may be made at any time, must be made in
writing to the commissioner, and must specify the following:
new text end

new text begin (1) the statute or law from which the innovation variance is requested;
new text end

new text begin (2) the time period for which the innovation variance is requested;
new text end

new text begin (3) the specific alternative action that the licensee proposes;
new text end

new text begin (4) the reasons for the request; and
new text end

new text begin (5) justification that an innovation variance will not impair the services provided,
will not adversely affect the health, safety, or welfare of clients, and is likely to improve
the services provided.
new text end

new text begin The commissioner may require additional information from the home care provider before
acting on the request.
new text end

new text begin Subd. 5. new text end

new text begin Grants and denials. new text end

new text begin The commissioner shall grant or deny each request
for an innovation variance in writing within 45 days of receipt of a complete request.
Notice of a denial shall contain the reasons for the denial. The terms of a requested
innovation variance may be modified upon agreement between the commissioner and
the home care provider.
new text end

new text begin Subd. 6. new text end

new text begin Violation of innovation variances. new text end

new text begin A failure to comply with the terms of
an innovation variance shall be deemed to be a violation of this chapter.
new text end

new text begin Subd. 7. new text end

new text begin Revocation or denial of renewal. new text end

new text begin The commissioner shall revoke or
deny renewal of an innovation variance if:
new text end

new text begin (1) it is determined that the innovation variance is adversely affecting the health,
safety, or welfare of the licensee's clients;
new text end

new text begin (2) the home care provider has failed to comply with the terms of the innovation
variance;
new text end

new text begin (3) the home care provider notifies the commissioner in writing that it wishes to
relinquish the innovation variance and be subject to the statute previously varied; or
new text end

new text begin (4) the revocation or denial is required by a change in law.
new text end

Sec. 13.

new text begin [144A.479] HOME CARE PROVIDER RESPONSIBILITIES;
BUSINESS OPERATION.
new text end

new text begin Subdivision 1. new text end

new text begin Display of license. new text end

new text begin The original current license must be displayed
in the home care providers' principal business office and copies must be displayed in
any branch office. The home care provider must provide a copy of the license to any
person who requests it.
new text end

new text begin Subd. 2. new text end

new text begin Advertising. new text end

new text begin Home care providers shall not use false, fraudulent,
or misleading advertising in the marketing of services. For purposes of this section,
advertising includes any verbal, written, or electronic means of communicating to
potential clients about the availability, nature, or terms of home care services.
new text end

new text begin Subd. 3. new text end

new text begin Quality management. new text end

new text begin The home care provider shall engage in quality
management appropriate to the size of the home care provider and relevant to the type
of services the home care provider provides. The quality management activity means
evaluating the quality of care by periodically reviewing client services, complaints made,
and other issues that have occurred and determining whether changes in services, staffing,
or other procedures need to be made in order to ensure safe and competent services to
clients. Documentation about quality management activity must be available for two
years. Information about quality management must be available to the commissioner at
the time of the survey, investigation, or renewal.
new text end

new text begin Subd. 4. new text end

new text begin Provider restrictions. new text end

new text begin (a) This subdivision does not apply to licensees
that are Minnesota counties or other units of government.
new text end

new text begin (b) A home care provider or staff cannot accept powers-of-attorney from clients for
any purpose, and may not accept appointments as guardians or conservators of clients.
new text end

new text begin (c) A home care provider cannot serve as a client's representative.
new text end

new text begin Subd. 5. new text end

new text begin Handling of client's finances and property. new text end

new text begin (a) A home care provider
may assist clients with household budgeting, including paying bills and purchasing
household goods, but may not otherwise manage a client's property. A home care provider
must provide a client with receipts for all transactions and purchases paid with the clients'
funds. When receipts are not available, the transaction or purchase must be documented.
A home care provider must maintain records of all such transactions.
new text end

new text begin (b) A home care provider or staff may not borrow a client's funds or personal or
real property, nor in any way convert a client's property to the home care provider's or
staff's possession.
new text end

new text begin (c) Nothing in this section precludes a home care provider or staff from accepting
gifts of minimal value, or precludes the acceptance of donations or bequests made to a
home care provider that are exempt from income tax under section 501(c) of the Internal
Revenue Code of 1986.
new text end

new text begin Subd. 6. new text end

new text begin Reporting maltreatment of vulnerable adults and minors. new text end

new text begin (a) All
home care providers must comply with requirements for the reporting of maltreatment
of minors in section 626.556 and the requirements for the reporting of maltreatment
of vulnerable adults in section 626.557. Home care providers must report suspected
maltreatment of minors and vulnerable adults to the common entry point. Each home
care provider must establish and implement a written procedure to ensure that all cases
of suspected maltreatment are reported.
new text end

new text begin (b) Each home care provider must develop and implement an individual abuse
prevention plan for each vulnerable minor or adult for whom home care services are
provided by a home care provider. The plan shall contain an individualized review or
assessment of the person's susceptibility to abuse by another individual, including other
vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors;
and statements of the specific measures to be taken to minimize the risk of abuse to that
person and other vulnerable adults or minors. For purposes of the abuse prevention plan,
the term abuse includes self-abuse.
new text end

new text begin Subd. 7. new text end

new text begin Employee records. new text end

new text begin The home care provider must maintain current records
of each paid employee, regularly scheduled volunteers providing home care services, and
of each individual contractor providing home care services. The records must include
the following information:
new text end

new text begin (1) evidence of current professional licensure, registration, or certification, if
licensure, registration, or certification is required by this statute, or other rules;
new text end

new text begin (2) records of orientation, required annual training and infection control training,
and competency evaluations;
new text end

new text begin (3) current job description, including qualifications, responsibilities, and
identification of staff providing supervision;
new text end

new text begin (4) documentation of annual performance reviews which identify areas of
improvement needed and training needs;
new text end

new text begin (5) for individuals providing home care services, verification that required health
screenings under section 144A.4798 have taken place and the dates of those screenings; and
new text end

new text begin (6) documentation of the background study as required under section 144.057.
new text end

new text begin Each employee record must be retained for at least three years after a paid employee,
home care volunteer, or contractor ceases to be employed by or under contract with the
home care provider. If a home care provider ceases operation, employee records must be
maintained for three years.
new text end

Sec. 14.

new text begin [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH
RESPECT TO CLIENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Home care bill of rights; notification to client. new text end

new text begin (a) The home
care provider shall provide the client or the client's representative a written notice of the
rights under section 144A.44 in a language that the client or the client's representative
can understand before the initiation of services to that client. If a written version is not
available, the home care bill of rights must be communicated to the client or client's
representative in a language they can understand.
new text end

new text begin (b) In addition to the text of the home care bill of rights in section 144A.44,
subdivision 1, the notice shall also contain the following statement describing how to file
a complaint with these offices.
new text end

new text begin "If you have a complaint about the provider or the person providing your
home care services, you may call, write, or visit the Office of Health Facility
Complaints, Minnesota Department of Health. You may also contact the Office of
Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health
and Developmental Disabilities."
new text end

new text begin The statement should include the telephone number, Web site address, e-mail
address, mailing address, and street address of the Office of Health Facility Complaints at
the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care,
and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
statement should also include the home care provider's name, address, e-mail, telephone
number, and name or title of the person at the provider to whom problems or complaints
may be directed. It must also include a statement that the home care provider will not
retaliate because of a complaint.
new text end

new text begin (c) The home care provider shall obtain written acknowledgment of the client's
receipt of the home care bill of rights or shall document why an acknowledgment cannot
be obtained. The acknowledgment may be obtained from the client or the client's
representative. Acknowledgment of receipt shall be retained in the client's record.
new text end

new text begin Subd. 2. new text end

new text begin Notice of services for dementia, Alzheimer's disease, or related
disorders. new text end

new text begin The home care provider that provides services to clients with dementia shall
provide in written or electronic form, to clients and families or other persons who request
it, a description of the training program and related training it provides, including the
categories of employees trained, the frequency of training, and the basic topics covered.
This information satisfies the disclosure requirements in section 325F.72, subdivision
2, clause (4).
new text end

new text begin Subd. 3. new text end

new text begin Statement of home care services. new text end

new text begin Prior to the initiation of services,
a home care provider must provide to the client or the client's representative a written
statement which identifies if they have a basic or comprehensive home care license, the
services they are authorized to provide, and which services they cannot provide under the
scope of their license. The home care provider shall obtain written acknowledgment
from the clients that they have provided the statement or must document why they could
not obtain the acknowledgment.
new text end

new text begin Subd. 4. new text end

new text begin Acceptance of clients. new text end

new text begin No home care provider may accept a person as a
client unless the home care provider has staff, sufficient in qualifications, competency,
and numbers, to adequately provide the services agreed to in the service plan and that
are within the provider's scope of practice.
new text end

new text begin Subd. 5. new text end

new text begin Referrals. new text end

new text begin If a home care provider reasonably believes that a client is in
need of another medical or health service, including a licensed health professional, or
social service provider, the home care provider shall:
new text end

new text begin (1) determine the client's preferences with respect to obtaining the service; and
new text end

new text begin (2) inform the client of resources available, if known, to assist the client in obtaining
services.
new text end

new text begin Subd. 6. new text end

new text begin Initiation of services. new text end

new text begin When a provider initiates services and the
individualized review or assessment required in subdivisions 7 and 8 has not been
completed, the provider must complete a temporary plan and agreement with the client for
services.
new text end

new text begin Subd. 7. new text end

new text begin Basic individualized client review and monitoring. new text end

new text begin (a) When services
being provided are basic home care services, an individualized initial review of the client's
needs and preferences must be conducted at the client's residence with the client or client's
representative. This initial review must be completed within 30 days after the initiation of
the home care services.
new text end

new text begin (b) Client monitoring and review must be conducted as needed based on changes
in the needs of the client and cannot exceed 90 days from the date of the last review.
The monitoring and review may be conducted at the client's residence or through the
utilization of telecommunication methods based on practice standards that meet the
individual client's needs.
new text end

new text begin Subd. 8. new text end

new text begin Comprehensive assessment, monitoring, and reassessment. new text end

new text begin (a) When
the services being provided are comprehensive home care services, an individualized
initial assessment must be conducted in-person by a registered nurse. When the services
are provided by other licensed health professionals, the assessment must be conducted by
the appropriate health professional. This initial assessment must be completed within five
days after initiation of home care services.
new text end

new text begin (b) Client monitoring and reassessment must be conducted in the client's home no
more than 14 days after initiation of services.
new text end

new text begin (c) Ongoing client monitoring and reassessment must be conducted as needed based
on changes in the needs of the client and cannot exceed 90 days from the last date of the
assessment. The monitoring and reassessment may be conducted at the client's residence
or through the utilization of telecommunication methods based on practice standards that
meet the individual client's needs.
new text end

new text begin Subd. 9. new text end

new text begin Service plan, implementation, and revisions to service plan. new text end

new text begin (a) No later
than 14 days after the initiation of services, a home care provider shall finalize a current
written service plan.
new text end

new text begin (b) The service plan and any revisions must include a signature or other
authentication by the home care provider and by the client or the client's representative
documenting agreement on the services to be provided. The service plan must be revised,
if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
must provide information to the client about changes to the provider's fee for services and
how to contact the Office of the Ombudsman for Long-Term Care.
new text end

new text begin (c) The home care provider must implement and provide all services required by
the current service plan.
new text end

new text begin (d) The service plan and revised service plan must be entered into the client's record,
including notice of a change in a client's fees when applicable.
new text end

new text begin (e) Staff providing home care services must be informed of the current written
service plan.
new text end

new text begin (f) The service plan must include:
new text end

new text begin (1) a description of the home care services to be provided, the fees for services, and
the frequency of each service, according to the client's current review or assessment and
client preferences;
new text end

new text begin (2) the identification of the staff or categories of staff who will provide the services;
new text end

new text begin (3) the schedule and methods of monitoring reviews or assessments of the client;
new text end

new text begin (4) the frequency of sessions of supervision of staff and type of personnel who
will supervise staff; and
new text end

new text begin (5) a contingency plan that includes:
new text end

new text begin (i) the action to be taken by the home care provider and by the client or client's
representative if the scheduled service cannot be provided;
new text end

new text begin (ii) information and method for a client or client's representative to contact the
home care provider;
new text end

new text begin (iii) names and contact information of persons the client wishes to have notified
in an emergency or if there is a significant adverse change in the client's condition,
including identification of and information as to who has authority to sign for the client in
an emergency; and
new text end

new text begin (iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the client under those
chapters.
new text end

new text begin Subd. 10. new text end

new text begin Termination of service plan. new text end

new text begin (a) If a home care provider terminates a
service plan with a client, and the client continues to need home care services, the home
care provider shall provide the client and the client's representative, if any, with a written
notice of termination which includes the following information:
new text end

new text begin (1) the effective date of termination;
new text end

new text begin (2) the reason for termination;
new text end

new text begin (3) a list of known licensed home care providers in the client's immediate geographic
area;
new text end

new text begin (4) a statement that the home care provider will participate in a coordinated transfer
of care of the client to another home care provider, health care provider, or caregiver, as
required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
new text end

new text begin (5) the name and contact information of a person employed by the home care
provider with whom the client may discuss the notice of termination; and
new text end

new text begin (6) if applicable, a statement that the notice of termination of home care services
does not constitute notice of termination of the housing with services contract with a
housing with services establishment.
new text end

new text begin (b) When the home care provider voluntarily discontinues services to all clients, the
home care provider must notify the commissioner, lead agencies, and the ombudsman for
long-term care about its clients and comply with the requirements in this subdivision.
new text end

new text begin Subd. 11. new text end

new text begin Client complaint and investigative process. new text end

new text begin (a) The home care
provider must have a written policy and system for receiving, investigating, reporting,
and attempting to resolve complaints from its clients or clients' representatives. The
policy should clearly identify the process by which clients may file a complaint or concern
about home care services and an explicit statement that the home care provider will not
discriminate or retaliate against a client for expressing concerns or complaints. A home
care provider must have a process in place to conduct investigations of complaints made
by the client or the client's representative about the services in the client's plan that are or
are not being provided or other items covered in the client's home care bill of rights. This
complaint system must provide reasonable accommodations for any special needs of the
client or client's representative if requested.
new text end

new text begin (b) The home care provider must document the complaint, name of the client,
investigation, and resolution of each complaint filed. The home care provider must
maintain a record of all activities regarding complaints received, including the date the
complaint was received, and the home care provider's investigation and resolution of the
complaint. This complaint record must be kept for each event for at least two years after
the date of entry and must be available to the commissioner for review.
new text end

new text begin (c) The required complaint system must provide for written notice to each client or
client's representative that includes:
new text end

new text begin (1) the client's right to complain to the home care provider about the services received;
new text end

new text begin (2) the name or title of the person or persons with the home care provider to contact
with complaints;
new text end

new text begin (3) the method of submitting a complaint to the home care provider; and
new text end

new text begin (4) a statement that the provider is prohibited against retaliation according to
paragraph (d).
new text end

new text begin (d) A home care provider must not take any action that negatively affects a client
in retaliation for a complaint made or a concern expressed by the client or the client's
representative.
new text end

new text begin Subd. 12. new text end

new text begin Disaster planning and emergency preparedness plan. new text end

new text begin The home care
provider must have a written plan of action to facilitate the management of the client's care
and services in response to a natural disaster, such as flood and storms, or other emergencies
that may disrupt the home care provider's ability to provide care or services. The licensee
must provide adequate orientation and training of staff on emergency preparedness.
new text end

new text begin Subd. 13. new text end

new text begin Request for discontinuation of life-sustaining treatment. new text end

new text begin (a) If a
client, family member, or other caregiver of the client requests that an employee or other
agent of the home care provider discontinue a life-sustaining treatment, the employee or
agent receiving the request:
new text end

new text begin (1) shall take no action to discontinue the treatment; and
new text end

new text begin (2) shall promptly inform their supervisor or other agent of the home care provider
of the client's request.
new text end

new text begin (b) Upon being informed of a request for termination of treatment, the home care
provider shall promptly:
new text end

new text begin (1) inform the client that the request will be made known to the physician who
ordered the client's treatment;
new text end

new text begin (2) inform the physician of the client's request; and
new text end

new text begin (3) work with the client and the client's physician to comply with the provisions of
the Health Care Directive Act in chapter 145C.
new text end

new text begin (c) This section does not require the home care provider to discontinue treatment,
except as may be required by law or court order.
new text end

new text begin (d) This section does not diminish the rights of clients to control their treatments,
refuse services, or terminate their relationships with the home care provider.
new text end

new text begin (e) This section shall be construed in a manner consistent with chapter 145B or
145C, whichever applies, and declarations made by clients under those chapters.
new text end

Sec. 15.

new text begin [144A.4792] MEDICATION MANAGEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Medication management services; comprehensive home care
license. new text end

new text begin (a) This subdivision applies only to home care providers with a comprehensive
home care license that provides medication management services to clients. Medication
management services may not be provided by a home care provider that has a basic
home care license.
new text end

new text begin (b) A comprehensive home care provider who provides medication management
services must develop, implement, and maintain current written medication management
policies and procedures. The policies and procedures must be developed under the
supervision and direction of a registered nurse, licensed health professional, or pharmacist
consistent with current practice standards and guidelines.
new text end

new text begin (c) The written policies and procedures must address requesting and receiving
prescriptions for medications; preparing and giving medications; verifying that
prescription drugs are administered as prescribed; documenting medication management
activities; controlling and storing medications; monitoring and evaluating medication use;
resolving medication errors; communicating with the prescriber, pharmacist, and client
and client representative, if any; disposing of unused medications; and educating clients
and client representatives about medications. When controlled substances are being
managed, the policies and procedures must also identify how the provider will ensure
security and accountability for the overall management, control, and disposition of those
substances in compliance with state and federal regulations and with subdivision 22.
new text end

new text begin Subd. 2. new text end

new text begin Provision of medication management services. new text end

new text begin (a) For each client who
requests medication management services, the comprehensive home care provider shall,
prior to providing medication management services, have a registered nurse, licensed
health professional, or authorized prescriber under section 151.37 conduct an assessment
to determine what medication management services will be provided and how the services
will be provided. This assessment must be conducted face-to-face with the client. The
assessment must include an identification and review of all medications the client is known
to be taking. The review and identification must include indications for medications, side
effects, contraindications, allergic or adverse reactions, and actions to address these issues.
new text end

new text begin (b) The assessment must identify interventions needed in management of
medications to prevent diversion of medication by the client or others who may have
access to the medications. "Diversion of medications" means the misuse, theft, or illegal
or improper disposition of medications.
new text end

new text begin Subd. 3. new text end

new text begin Individualized medication monitoring and reassessment. new text end

new text begin The
comprehensive home care provider must monitor and reassess the client's medication
management services as needed under subdivision 14 when the client presents with
symptoms or other issues that may be medication-related and, at a minimum, annually.
new text end

new text begin Subd. 4. new text end

new text begin Client refusal. new text end

new text begin The home care provider must document in the client's
record any refusal for an assessment for medication management by the client. The
provider must discuss with the client the possible consequences of the client's refusal and
document the discussion in the client's record.
new text end

new text begin Subd. 5. new text end

new text begin Individualized medication management plan. new text end

new text begin (a) For each client
receiving medication management services, the comprehensive home care provider must
prepare and include in the service plan a written statement of the medication management
services that will be provided to the client. The provider must develop and maintain a
current individualized medication management record for each client based on the client's
assessment that must contain the following:
new text end

new text begin (1) a statement describing the medication management services that will be provided;
new text end

new text begin (2) a description of storage of medications based on the client's needs and
preferences, risk of diversion, and consistent with the manufacturer's directions;
new text end

new text begin (3) documentation of specific client instructions relating to the administration
of medications;
new text end

new text begin (4) identification of persons responsible for monitoring medication supplies and
ensuring that medication refills are ordered on a timely basis;
new text end

new text begin (5) identification of medication management tasks that may be delegated to
unlicensed personnel;
new text end

new text begin (6) procedures for staff notifying a registered nurse or appropriate licensed health
professional when a problem arises with medication management services; and
new text end

new text begin (7) any client-specific requirements relating to documenting medication
administration, verifications that all medications are administered as prescribed, and
monitoring of medication use to prevent possible complications or adverse reactions.
new text end

new text begin (b) The medication management record must be current and updated when there are
any changes.
new text end

new text begin Subd. 6. new text end

new text begin Administration of medication. new text end

new text begin Medications may be administered by a
nurse, physician, or other licensed health practitioner authorized to administer medications
or by unlicensed personnel who have been delegated medication administration tasks by
a registered nurse.
new text end

new text begin Subd. 7. new text end

new text begin Delegation of medication administration. new text end

new text begin When administration of
medications is delegated to unlicensed personnel, the comprehensive home care provider
must ensure that the registered nurse has:
new text end

new text begin (1) instructed the unlicensed personnel in the proper methods to administer the
medications, and the unlicensed personnel has demonstrated ability to competently follow
the procedures;
new text end

new text begin (2) specified, in writing, specific instructions for each client and documented those
instructions in the client's records; and
new text end

new text begin (3) communicated with the unlicensed personnel about the individual needs of
the client.
new text end

new text begin Subd. 8. new text end

new text begin Documentation of administration of medications. new text end

new text begin Each medication
administered by comprehensive home care provider staff must be documented in the
client's record. The documentation must include the signature and title of the person
who administered the medication. The documentation must include the medication
name, dosage, date and time administered, and method and route of administration. The
staff must document the reason why medication administration was not completed as
prescribed and document any follow-up procedures that were provided to meet the client's
needs when medication was not administered as prescribed and in compliance with the
client's medication management plan.
new text end

new text begin Subd. 9. new text end

new text begin Documentation of medication set-up. new text end

new text begin Documentation of dates of
medication set-up, name of medication, quantity of dose, times to be administered, route
of administration, and name of person completing medication set-up must be done at
time of set-up.
new text end

new text begin Subd. 10. new text end

new text begin Medication management for clients who will be away from home. new text end

new text begin (a)
A home care provider that is providing medication management services to the client and
controls the client's access to the medications must develop and implement policies and
procedures for giving accurate and current medications to clients for planned or unplanned
times away from home according to the client's individualized medication management
plan. The policy and procedures must state that:
new text end

new text begin (1) for planned time away, the medications must be obtained from the pharmacy or
set up by the registered nurse according to appropriate state and federal laws and nursing
standards of practice;
new text end

new text begin (2) for unplanned time away, when the pharmacy is not able to provide the
medications, a licensed nurse or unlicensed personnel shall give the client or client's
representative medications in amounts and dosages needed for the length of the anticipated
absence, not to exceed 120 hours;
new text end

new text begin (3) the client, or the client's representative, must be provided written information
on medications, including any special instructions for administering or handling the
medications, including controlled substances;
new text end

new text begin (4) the medications must be placed in a medication container or containers
appropriate to the provider's medication system and must be labeled with the client's name
and the dates and times that the medications are scheduled; and
new text end

new text begin (5) the client or client's representative must be provided in writing the home care
provider's name and information on how to contact the home care provider.
new text end

new text begin (b) For unplanned time away when the licensed nurse is not available, the registered
nurse may delegate this task to unlicensed personnel if:
new text end

new text begin (1) the registered nurse has trained the unlicensed staff and determined the
unlicensed staff is competent to follow the procedures for giving medications to clients;
new text end

new text begin (2) the registered nurse has developed written procedures for the unlicensed
personnel, including any special instructions or procedures regarding controlled substances
that are prescribed for the client. The procedures must address:
new text end

new text begin (i) the type of container or containers to be used for the medications appropriate to
the provider's medication system;
new text end

new text begin (ii) how the container or containers must be labeled;
new text end

new text begin (iii) the written information about the medications to be given to the client or client's
representative;
new text end

new text begin (iv) how the unlicensed staff must document in the client's record that medications
have been given to the client or the client's representative, including documenting the date
the medications were given to the client or the client's representative and who received the
medications, the person who gave the medications to the client, the number of medications
that were given to the client, and other required information;
new text end

new text begin (v) how the registered nurse shall be notified that medications have been given to
the client or client's representative and whether the registered nurse needs to be contacted
before the medications are given to the client or the client's representative; and
new text end

new text begin (vi) a review by the registered nurse of the completion of this task to verify that this
task was completed accurately by the unlicensed personnel.
new text end

new text begin Subd. 11. new text end

new text begin Prescribed and nonprescribed medication. new text end

new text begin The comprehensive home
care provider must determine whether the comprehensive home care provider shall require
a prescription for all medications the provider manages. The comprehensive home care
provider must inform the client or the client's representative whether the comprehensive
home care provider requires a prescription for all over-the-counter and dietary supplements
before the comprehensive home care provider agrees to manage those medications.
new text end

new text begin Subd. 12. new text end

new text begin Medications; over-the-counter; dietary supplements not prescribed.
new text end

new text begin A comprehensive home care provider providing medication management services for
over-the-counter drugs or dietary supplements must retain those items in the original labeled
container with directions for use prior to setting up for immediate or later administration.
The provider must verify that the medications are up-to-date and stored as appropriate.
new text end

new text begin Subd. 13. new text end

new text begin Prescriptions. new text end

new text begin There must be a current written or electronically recorded
prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
medications that the comprehensive home care provider is managing for the client.
new text end

new text begin Subd. 14. new text end

new text begin Renewal of prescriptions. new text end

new text begin Prescriptions must be renewed at least
every 12 months or more frequently as indicated by the assessment in subdivision 2.
Prescriptions for controlled substances must comply with chapter 152.
new text end

new text begin Subd. 15. new text end

new text begin Verbal prescription orders. new text end

new text begin Verbal prescription orders from an
authorized prescriber must be received by a nurse or pharmacist. The order must be
handled according to Minnesota Rules, part 6800.6200.
new text end

new text begin Subd. 16. new text end

new text begin Written or electronic prescription. new text end

new text begin When a written or electronic
prescription is received, it must be communicated to the registered nurse in charge and
recorded or placed in the client's record.
new text end

new text begin Subd. 17. new text end

new text begin Records confidential. new text end

new text begin A prescription or order received verbally, in
writing, or electronically must be kept confidential according to sections 144.291 to
144.298 and 144A.44.
new text end

new text begin Subd. 18. new text end

new text begin Medications provided by client or family members. new text end

new text begin When the
comprehensive home care provider is aware of any medications or dietary supplements
that are being used by the client and are not included in the assessment for medication
management services, the staff must advise the registered nurse and document that in
the client's record.
new text end

new text begin Subd. 19. new text end

new text begin Storage of medications. new text end

new text begin A comprehensive home care provider providing
storage of medications outside of the client's private living space must store all prescription
medications in securely locked and substantially constructed compartments according to
the manufacturer's directions and permit only authorized personnel to have access.
new text end

new text begin Subd. 20. new text end

new text begin Prescription drugs. new text end

new text begin A prescription drug, prior to being set up for
immediate or later administration, must be kept in the original container in which it was
dispensed by the pharmacy bearing the original prescription label with legible information
including the expiration or beyond-use date of a time-dated drug.
new text end

new text begin Subd. 21. new text end

new text begin Prohibitions. new text end

new text begin No prescription drug supply for one client may be used or
saved for use by anyone other than the client.
new text end

new text begin Subd. 22. new text end

new text begin Disposition of medications. new text end

new text begin (a) Any current medications being managed
by the comprehensive home care provider must be given to the client or the client's
representative when the client's service plan ends or medication management services
are no longer part of the service plan. Medications that have been stored in the client's
private living space for a client that is deceased or that have been discontinued or that have
expired may be given to the client or the client's representative for disposal.
new text end

new text begin (b) The comprehensive home care provider will dispose of any medications
remaining with the comprehensive home care provider that are discontinued or expired or
upon the termination of the service contract or the client's death according to state and
federal regulations for disposition of medications and controlled substances.
new text end

new text begin (c) Upon disposition, the comprehensive home care provider must document in the
client's record the disposition of the medication including the medication's name, strength,
prescription number as applicable, quantity, to whom the medications were given, date of
disposition, and names of staff and other individuals involved in the disposition.
new text end

new text begin Subd. 23. new text end

new text begin Loss or spillage. new text end

new text begin (a) Comprehensive home care providers providing
medication management must develop and implement procedures for loss or spillage of all
controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
require that when a spillage of a controlled substance occurs, a notation must be made
in the client's record explaining the spillage and the actions taken. The notation must
be signed by the person responsible for the spillage and include verification that any
contaminated substance was disposed of according to state or federal regulations.
new text end

new text begin (b) The procedures must require the comprehensive home care provider of
medication management to investigate any known loss or unaccounted for prescription
drugs and take appropriate action required under state or federal regulations and document
the investigation in required records.
new text end

Sec. 16.

new text begin [144A.4793] TREATMENT AND THERAPY MANAGEMENT
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Providers with a comprehensive home care license. new text end

new text begin This section
applies only to home care providers with a comprehensive home care license that provide
treatment or therapy management services to clients. Treatment or therapy management
services cannot be provided by a home care provider that has a basic home care license.
new text end

new text begin Subd. 2. new text end

new text begin Policies and procedures. new text end

new text begin (a) A comprehensive home care provider who
provides treatment and therapy management services must develop, implement, and
maintain up-to-date written treatment or therapy management policies and procedures.
The policies and procedures must be developed under the supervision and direction of
a registered nurse or appropriate licensed health professional consistent with current
practice standards and guidelines.
new text end

new text begin (b) The written policies and procedures must address requesting and receiving
orders or prescriptions for treatments or therapies, providing the treatment or therapy,
documenting of treatment or therapy activities, educating and communicating with clients
about treatments or therapy they are receiving, monitoring and evaluating the treatment
and therapy, and communicating with the prescriber.
new text end

new text begin Subd. 3. new text end

new text begin Individualized treatment or therapy management plan. new text end

new text begin For each
client receiving management of ordered or prescribed treatments or therapy services, the
comprehensive home care provider must prepare and include in the service plan a written
statement of the treatment or therapy services that will be provided to the client. The
provider must also develop and maintain a current individualized treatment and therapy
management record for each client which must contain at least the following:
new text end

new text begin (1) a statement of the type of services that will be provided;
new text end

new text begin (2) documentation of specific client instructions relating to the treatments or therapy
administration;
new text end

new text begin (3) identification of treatment or therapy tasks that will be delegated to unlicensed
personnel;
new text end

new text begin (4) procedures for notifying a registered nurse or appropriate licensed health
professional when a problem arises with treatments or therapy services; and
new text end

new text begin (5) any client-specific requirements relating to documentation of treatment
and therapy received, verification that all treatment and therapy was administered as
prescribed, and monitoring of treatment or therapy to prevent possible complications or
adverse reactions. The treatment or therapy management record must be current and
updated when there are any changes.
new text end

new text begin Subd. 4. new text end

new text begin Administration of treatments and therapy. new text end

new text begin Ordered or prescribed
treatments or therapies must be administered by a nurse, physician, or other licensed health
professional authorized to perform the treatment or therapy, or may be delegated or assigned
to unlicensed personnel by the licensed health professional according to the appropriate
practice standards for delegation or assignment. When administration of a treatment or
therapy is delegated or assigned to unlicensed personnel, the home care provider must
ensure that the registered nurse or authorized licensed health professional has:
new text end

new text begin (1) instructed the unlicensed personnel in the proper methods with respect to each
client and the unlicensed personnel has demonstrated the ability to competently follow
the procedures;
new text end

new text begin (2) specified, in writing, specific instructions for each client and documented those
instructions in the client's record; and
new text end

new text begin (3) communicated with the unlicensed personnel about the individual needs of
the client.
new text end

new text begin Subd. 5. new text end

new text begin Documentation of administration of treatments and therapies. new text end

new text begin Each
treatment or therapy administered by a comprehensive home care provider must be
documented in the client's record. The documentation must include the signature and title
of the person who administered the treatment or therapy and must include the date and
time of administration. When treatment or therapies are not administered as ordered or
prescribed, the provider must document the reason why it was not administered and any
follow-up procedures that were provided to meet the client's needs.
new text end

new text begin Subd. 6. new text end

new text begin Orders or prescriptions. new text end

new text begin There must be an up-to-date written or
electronically recorded order or prescription for all treatments and therapies. The order
must contain the name of the client, description of the treatment or therapy to be provided,
and the frequency and other information needed to administer the treatment or therapy.
new text end

Sec. 17.

new text begin [144A.4794] CLIENT RECORD REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Client record. new text end

new text begin (a) The home care provider must maintain records
for each client for whom it is providing services. Entries in the client records must be
current, legible, permanently recorded, dated, and authenticated with the name and title
of the person making the entry.
new text end

new text begin (b) Client records, whether written or electronic, must be protected against loss,
tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable
relevant federal and state laws. The home care provider shall establish and implement
written procedures to control use, storage, and security of client's records and establish
criteria for release of client information.
new text end

new text begin (c) The home care provider may not disclose to any other person any personal,
financial, medical, or other information about the client, except:
new text end

new text begin (1) as may be required by law;
new text end

new text begin (2) to employees or contractors of the home care provider, another home care
provider, other health care practitioner or provider, or inpatient facility needing
information in order to provide services to the client, but only such information that
is necessary for the provision of services;
new text end

new text begin (3) to persons authorized in writing by the client or the client's representative to
receive the information, including third-party payers; and
new text end

new text begin (4) to representatives of the commissioner authorized to survey or investigate home
care providers under this chapter or federal laws.
new text end

new text begin Subd. 2. new text end

new text begin Access to records. new text end

new text begin The home care provider must ensure that the
appropriate records are readily available to employees or contractors authorized to access
the records. Client records must be maintained in a manner that allows for timely access,
printing, or transmission of the records.
new text end

new text begin Subd. 3. new text end

new text begin Contents of client record. new text end

new text begin Contents of a client record include the
following for each client:
new text end

new text begin (1) identifying information, including the client's name, date of birth, address, and
telephone number;
new text end

new text begin (2) the name, address, and telephone number of an emergency contact, family
members, client's representative, if any, or others as identified;
new text end

new text begin (3) names, addresses, and telephone numbers of the client's health and medical
service providers and other home care providers, if known;
new text end

new text begin (4) health information, including medical history, allergies, and when the provider
is managing medications, treatments or therapies that require documentation, and other
relevant health records;
new text end

new text begin (5) client's advance directives, if any;
new text end

new text begin (6) the home care provider's current and previous assessments and service plans;
new text end

new text begin (7) all records of communications pertinent to the client's home care services;
new text end

new text begin (8) documentation of significant changes in the client's status and actions taken in
response to the needs of the client including reporting to the appropriate supervisor or
health care professional;
new text end

new text begin (9) documentation of incidents involving the client and actions taken in response
to the needs of the client including reporting to the appropriate supervisor or health
care professional;
new text end

new text begin (10) documentation that services have been provided as identified in the service plan;
new text end

new text begin (11) documentation that the client has received and reviewed the home care bill
of rights;
new text end

new text begin (12) documentation that the client has been provided the statement of disclosure on
limitations of services under section 144A.4791, subdivision 3;
new text end

new text begin (13) documentation of complaints received and resolution;
new text end

new text begin (14) discharge summary, including service termination notice and related
documentation, when applicable; and
new text end

new text begin (15) other documentation required under this chapter and relevant to the client's
services or status.
new text end

new text begin Subd. 4. new text end

new text begin Transfer of client records. new text end

new text begin If a client transfers to another home care
provider or other health care practitioner or provider, or is admitted to an inpatient facility,
the home care provider, upon request of the client or the client's representative, shall take
steps to ensure a coordinated transfer including sending a copy or summary of the client's
record to the new home care provider, facility, or the client, as appropriate.
new text end

new text begin Subd. 5. new text end

new text begin Record retention. new text end

new text begin Following the client's discharge or termination of
services, a home care provider must retain a client's record for at least five years, or as
otherwise required by state or federal regulations. Arrangements must be made for secure
storage and retrieval of client records if the home care provider ceases business.
new text end

Sec. 18.

new text begin [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
new text end

new text begin Subdivision 1. new text end

new text begin Qualifications, training, and competency. new text end

new text begin All staff providing
home care services must be trained and competent in the provision of home care services
consistent with current practice standards appropriate to the client's needs.
new text end

new text begin Subd. 2. new text end

new text begin Licensed health professionals and nurses. new text end

new text begin (a) Licensed health
professionals and nurses providing home care services as an employee of a licensed home
care provider must possess current Minnesota license or registration to practice.
new text end

new text begin (b) Licensed health professionals and registered nurses must be competent in
assessing client needs, planning appropriate home care services to meet client needs,
implementing services, and supervising staff if assigned.
new text end

new text begin (c) Nothing in this section limits or expands the rights of nurses or licensed health
professionals to provide services within the scope of their licenses or registrations, as
provided by law.
new text end

new text begin Subd. 3. new text end

new text begin Unlicensed personnel. new text end

new text begin (a) Unlicensed personnel providing basic home
care services must have:
new text end

new text begin (1) successfully completed a training and competency evaluation appropriate to
the services provided by the home care provider and the topics listed in subdivision 7,
paragraph (b); or
new text end

new text begin (2) demonstrated competency by satisfactorily completing a written or oral test on
the tasks the unlicensed personnel will perform and in the topics listed in subdivision
7, paragraph (b); and successfully demonstrate competency of topics in subdivision 7,
paragraph (b), clauses (5), (7), and (8), by a practical skills test.
new text end

new text begin Unlicensed personnel providing home care services for a basic home care provider may
not perform delegated nursing or therapy tasks.
new text end

new text begin (b) Unlicensed personnel performing delegated nursing tasks for a comprehensive
home care provider must have:
new text end

new text begin (1) successfully completed training and demonstrated competency by successfully
completing a written or oral test of the topics in subdivision 7, paragraphs (b) and (c), and
a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5) and (7),
and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; or
new text end

new text begin (2) satisfy the current requirements of Medicare for training or competency of home
health aides or nursing assistants, as provided by Code of Federal Regulations, title 42,
section 483 or section 484.36; or
new text end

new text begin (3) before April 19, 1993, completed a training course for nursing assistants that was
approved by the commissioner.
new text end

new text begin (c) Unlicensed personnel performing therapy or treatment tasks delegated or
assigned by a licensed health professional must meet the requirements for delegated
tasks in subdivision 4 and any other training or competency requirements within the
licensed health professional scope of practice relating to delegation or assignment of tasks
to unlicensed personnel.
new text end

new text begin Subd. 4. new text end

new text begin Delegation of home care tasks. new text end

new text begin A registered nurse or licensed health
professional may delegate tasks only to staff that are competent and possess the knowledge
and skills consistent with the complexity of the tasks and according to the appropriate
Minnesota Practice Act. The comprehensive home care provider must establish and
implement a system to communicate up-to-date information to the registered nurse or
licensed health professional regarding the current available staff and their competency so
the registered nurse or licensed health professional has sufficient information to determine
the appropriateness of delegating tasks to meet individual client needs and preferences.
new text end

new text begin Subd. 5. new text end

new text begin Individual contractors. new text end

new text begin When a home care provider contracts with an
individual contractor excluded from licensure under section 144A.471 to provide home
care services, the contractor must meet the same requirements required by this section for
personnel employed by the home care provider.
new text end

new text begin Subd. 6. new text end

new text begin Temporary staff. new text end

new text begin When a home care provider contracts with a temporary
staffing agency excluded from licensure under section 144A.471, those individuals must
meet the same requirements required by this section for personnel employed by the home
care provider and shall be treated as if they are staff of the home care provider.
new text end

new text begin Subd. 7. new text end

new text begin Requirements for instructors, training content, and competency
evaluations for unlicensed personnel. new text end

new text begin (a) Instructors and competency evaluators must
meet the following requirements:
new text end

new text begin (1) training and competency evaluations of unlicensed personnel providing basic
home care services must be conducted by individuals with work experience and training in
providing home care services listed in section 144A.471, subdivisions 6 and 7; and
new text end

new text begin (2) training and competency evaluations of unlicensed personnel providing
comprehensive home care services must be conducted by a registered nurse, or another
instructor may provide training in conjunction with the registered nurse. If the home care
provider is providing services by licensed health professionals only, then that specific
training and competency evaluation may be conducted by the licensed health professionals
as appropriate.
new text end

new text begin (b) Training and competency evaluations for all unlicensed personnel must include
the following:
new text end

new text begin (1) documentation requirements for all services provided;
new text end

new text begin (2) reports of changes in the client's condition to the supervisor designated by the
home care provider;
new text end

new text begin (3) basic infection control, including blood-borne pathogens;
new text end

new text begin (4) maintenance of a clean and safe environment;
new text end

new text begin (5) appropriate and safe techniques in personal hygiene and grooming, including:
new text end

new text begin (i) hair care and bathing;
new text end

new text begin (ii) care of teeth, gums, and oral prosthetic devices;
new text end

new text begin (iii) care and use of hearing aids; and
new text end

new text begin (iv) dressing and assisting with toileting;
new text end

new text begin (6) training on the prevention of falls for providers working with the elderly or
individuals at risk of falls;
new text end

new text begin (7) standby assistance techniques and how to perform them;
new text end

new text begin (8) medication, exercise, and treatment reminders;
new text end

new text begin (9) basic nutrition, meal preparation, food safety, and assistance with eating;
new text end

new text begin (10) preparation of modified diets as ordered by a licensed health professional;
new text end

new text begin (11) communication skills that include preserving the dignity of the client and
showing respect for the client and the client's preferences, cultural background, and family;
new text end

new text begin (12) awareness of confidentiality and privacy;
new text end

new text begin (13) understanding appropriate boundaries between staff and clients and the client's
family;
new text end

new text begin (14) procedures to utilize in handling various emergency situations; and
new text end

new text begin (15) awareness of commonly used health technology equipment and assistive devices.
new text end

new text begin (c) In addition to paragraph (b), training and competency evaluation for unlicensed
personnel providing comprehensive home care services must include:
new text end

new text begin (1) observation, reporting, and documenting of client status;
new text end

new text begin (2) basic knowledge of body functioning and changes in body functioning, injuries,
or other observed changes that must be reported to appropriate personnel;
new text end

new text begin (3) reading and recording temperature, pulse, and respirations of the client;
new text end

new text begin (4) recognizing physical, emotional, cognitive, and developmental needs of the client;
new text end

new text begin (5) safe transfer techniques and ambulation;
new text end

new text begin (6) range of motioning and positioning; and
new text end

new text begin (7) administering medications or treatments as required.
new text end

new text begin (d) When the registered nurse or licensed health professional delegates tasks, they
must ensure that prior to the delegation the unlicensed personnel is trained in the proper
methods to perform the tasks or procedures for each client and are able to demonstrate
the ability to competently follow the procedures and perform the tasks. If an unlicensed
personnel has not regularly performed the delegated home care task for a period of 24
consecutive months, the unlicensed personnel must demonstrate competency in the task
to the registered nurse or appropriate licensed health professional. The registered nurse
or licensed health professional must document instructions for the delegated tasks in
the client's record.
new text end

Sec. 19.

new text begin [144A.4796] ORIENTATION AND ANNUAL TRAINING
REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Orientation of staff and supervisors to home care. new text end

new text begin All staff
providing and supervising direct home care services must complete an orientation to home
care licensing requirements and regulations before providing home care services to clients.
The orientation may be incorporated into the training required under subdivision 6. The
orientation need only be completed once for each staff person and is not transferable
to another home care provider.
new text end

new text begin Subd. 2. new text end

new text begin Content. new text end

new text begin The orientation must contain the following topics:
new text end

new text begin (1) an overview of sections 144A.43 to 144A.4798;
new text end

new text begin (2) introduction and review of all the provider's policies and procedures related to
the provision of home care services;
new text end

new text begin (3) handling of emergencies and use of emergency services;
new text end

new text begin (4) compliance with and reporting of the maltreatment of minors or vulnerable
adults under sections 626.556 and 626.557;
new text end

new text begin (5) home care bill of rights, under section 144A.44;
new text end

new text begin (6) handling of clients' complaints; reporting of complaints and where to report
complaints including information on the Office of Health Facility Complaints and the
Common Entry Point;
new text end

new text begin (7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
Ombudsman at the Department of Human Services, county managed care advocates,
or other relevant advocacy services; and
new text end

new text begin (8) review of the types of home care services the employee will be providing and
the provider's scope of licensure.
new text end

new text begin Subd. 3. new text end

new text begin Verification and documentation of orientation. new text end

new text begin Each home care provider
shall retain evidence in the employee record of each staff person having completed the
orientation required by this section.
new text end

new text begin Subd. 4. new text end

new text begin Orientation to client. new text end

new text begin Staff providing home care services must be oriented
specifically to each individual client and the services to be provided. This orientation may
be provided in person, orally, in writing, or electronically.
new text end

new text begin Subd. 5. new text end

new text begin Training required relating to Alzheimer's disease and related disorders.
new text end

new text begin For home care providers that provide services for persons with Alzheimer's or related
disorders, all direct care staff and supervisors working with those clients must receive
training that includes a current explanation of Alzheimer's disease and related disorders,
effective approaches to use to problem solve when working with a client's challenging
behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
new text end

new text begin Subd. 6. new text end

new text begin Required annual training. new text end

new text begin All staff that perform direct home care
services must complete at least eight hours of annual training for each 12 months of
employment. The training may be obtained from the home care provider or another source
and must include topics relevant to the provision of home care services. The annual
training must include:
new text end

new text begin (1) training on reporting of maltreatment of minors under section 626.556 and
maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
services provided;
new text end

new text begin (2) review of the home care bill of rights in section 144A.44;
new text end

new text begin (3) review of infection control techniques used in the home and implementation of
infection control standards including a review of hand washing techniques; the need for
and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
materials and equipment, such as dressings, needles, syringes, and razor blades;
disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
communicable diseases; and
new text end

new text begin (4) review of the provider's policies and procedures relating to the provision of home
care services and how to implement those policies and procedures.
new text end

new text begin Subd. 7. new text end

new text begin Documentation. new text end

new text begin A home care provider must retain documentation in the
employee records of the staff that have satisfied the orientation and training requirements
of this section.
new text end

Sec. 20.

new text begin [144A.4797] PROVISION OF SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Availability of contact person to staff. new text end

new text begin (a) A home care provider
with a basic home care license must have a person available to staff for consultation on
items relating to the provision of services or about the client.
new text end

new text begin (b) A home care provider with a comprehensive home care license must have a
registered nurse available for consultation to staff performing delegated nursing tasks
and must have an appropriate licensed health professional available if performing other
delegated services such as therapies.
new text end

new text begin (c) The appropriate contact person must be readily available either in person, by
telephone, or by other means to the staff at times when the staff is providing services.
new text end

new text begin Subd. 2. new text end

new text begin Supervision of staff; basic home care services. new text end

new text begin (a) Staff who perform
basic home care services must be supervised periodically where the services are being
provided to verify that the work is being performed competently and to identify problems
and solutions to address issues relating to the staff's ability to provide the services. The
supervision of the unlicensed personnel must be done by staff of the home care provider
having the authority, skills, and ability to provide the supervision of unlicensed personnel
and who can implement changes as needed, and train staff.
new text end

new text begin (b) Supervision includes direct observation of unlicensed personnel while they
are providing the services and may also include indirect methods of gaining input such
as gathering feedback from the client. Supervisory review of staff must be provided at a
frequency based on the staff person's competency and performance.
new text end

new text begin (c) For an individual who is licensed as a home care provider, this section does
not apply.
new text end

new text begin Subd. 3. new text end

new text begin Supervision of staff providing delegated nursing or therapy home
care tasks. new text end

new text begin (a) Staff who perform delegated nursing or therapy home care tasks must be
supervised by an appropriate licensed health professional or a registered nurse periodically
where the services are being provided to verify that the work is being performed
competently and to identify problems and solutions related to the staff person's ability to
perform the tasks. Supervision of staff performing medication or treatment administration
shall be provided by a registered nurse or appropriate licensed health professional and
must include observation of the staff administering the medication or treatment and the
interaction with the client.
new text end

new text begin (b) The direct supervision of staff performing delegated tasks must be provided
within 30 days after the individual begins working for the home care provider and
thereafter as needed based on performance. This requirement also applies to staff who
have not performed delegated tasks for one year or longer.
new text end

new text begin Subd. 4. new text end

new text begin Documentation. new text end

new text begin A home care provider must retain documentation of
supervision activities in the personnel records.
new text end

new text begin Subd. 5. new text end

new text begin Exemption. new text end

new text begin This section does not apply to an individual licensed under
sections 144A.43 to 144A.4799.
new text end

Sec. 21.

new text begin [144A.4798] EMPLOYEE HEALTH STATUS.
new text end

new text begin Subdivision 1. new text end

new text begin Tuberculosis (TB) prevention and control. new text end

new text begin A home care provider
must establish and maintain a TB prevention and control program based on the most
current guidelines issued by the Centers for Disease Control and Prevention (CDC).
Components of a TB prevention and control program include screening all staff providing
home care services, both paid and unpaid, at the time of hire for active TB disease and
latent TB infection, and developing and implementing a written TB infection control plan.
The commissioner shall make the most recent CDC standards available to home care
providers on the department's Web site.
new text end

new text begin Subd. 2. new text end

new text begin Communicable diseases. new text end

new text begin A home care provider must follow
current federal or state guidelines for prevention, control, and reporting of human
immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
communicable diseases as defined in Minnesota Rules, part 4605.7040.
new text end

Sec. 22.

new text begin [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE
PROVIDER ADVISORY COUNCIL.
new text end

new text begin Subdivision 1. new text end

new text begin Membership. new text end

new text begin The commissioner of health shall appoint eight
persons to a home care provider advisory council consisting of the following:
new text end

new text begin (1) three public members as defined in section 214.02 who shall be either persons
who are currently receiving home care services or have family members receiving home
care services, or persons who have family members who have received home care services
within five years of the application date;
new text end

new text begin (2) three Minnesota home care licensees representing basic and comprehensive
levels of licensure who may be a managerial official, an administrator, a supervising
registered nurse, or an unlicensed personnel performing home care tasks;
new text end

new text begin (3) one member representing the Minnesota Board of Nursing; and
new text end

new text begin (4) one member representing the ombudsman for long-term care.
new text end

new text begin Subd. 2. new text end

new text begin Organizations and meetings. new text end

new text begin The advisory council shall be organized
and administered under section 15.059 with per diems and costs paid within the limits of
available appropriations. Meetings will be held quarterly and hosted by the department.
Subcommittees may be developed as necessary by the commissioner. Advisory council
meetings are subject to the Open Meeting Law under chapter 13D.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed home care providers in
this chapter such as:
new text end

new text begin (1) advice to the commissioner regarding community standards for home care
practices;
new text end

new text begin (2) advice to the commissioner on enforcement of licensing standards and whether
certain disciplinary actions are appropriate;
new text end

new text begin (3) advice to the commissioner about ways of distributing information to licensees
and consumers of home care;
new text end

new text begin (4) advice to the commissioner about training standards;
new text end

new text begin (5) identify emerging issues and opportunities in the home care field, including the
use of technology in home and telehealth capabilities; and
new text end

new text begin (6) perform other duties as directed by the commissioner.
new text end

Sec. 23.

new text begin [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
new text end

new text begin Subdivision 1. new text end

new text begin Temporary home care licenses and changes of ownership. new text end

new text begin (a)
Beginning January 1, 2014, all temporary license applicants must apply for either a
temporary basic or comprehensive home care license.
new text end

new text begin (b) Temporary home care licenses issued beginning January 1, 2014, shall be
issued to licensees according to sections 144A.43 to 144A.4799, and the fees in section
144A.472. Licensees must comply with the requirements of this chapter.
new text end

new text begin (c) No temporary licenses will be accepted or issued between October 1, 2013,
and December 31, 2013.
new text end

new text begin (d) Beginning October 1, 2013, changes in ownership applications will require
payment of the new fees listed in section 144A.472.
new text end

new text begin Subd. 2. new text end

new text begin Current home care licensees with licenses prior to July 1, 2013. new text end

new text begin (a)
Beginning July 1, 2014, department licensed home care providers must apply for either
the basic or comprehensive home care license on their regularly scheduled renewal date.
new text end

new text begin (b) By June 30, 2015, all home care providers must either have a basic or
comprehensive home care license or temporary license.
new text end

new text begin Subd. 3. new text end

new text begin Renewal application of home care licensure during transition period.
new text end

new text begin Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
care licensure law in effect on June 30, 2013.
new text end

new text begin The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
new text end

new text begin For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
and no more than $100,000 will be $313 and for providers with revenues no more than
$25,000 the fee will be $125.
new text end

Sec. 24.

new text begin [144A.482] REGISTRATION OF HOME MANAGEMENT
PROVIDERS.
new text end

new text begin (a) For purposes of this section, a home management provider is an individual or
organization that provides at least two of the following services: housekeeping, meal
preparation, and shopping to a person who is unable to perform these activities due to
illness, disability, or physical condition.
new text end

new text begin (b) A person or organization that provides only home management services may not
operate in the state without a current certificate of registration issued by the commissioner
of health. To obtain a certificate of registration, the person or organization must annually
submit to the commissioner the name, mailing and physical addresses, e-mail address, and
telephone number of the person or organization and a signed statement declaring that the
person or organization is aware that the home care bill of rights applies to their clients and
that the person or organization will comply with the home care bill of rights provisions
contained in section 144A.44. A person or organization applying for a certificate must
also provide the name, business address, and telephone number of each of the persons
responsible for the management or direction of the organization.
new text end

new text begin (c) The commissioner shall charge an annual registration fee of $20 for persons and
$50 for organizations. The registration fee shall be deposited in the state treasury and
credited to the state government special revenue fund.
new text end

new text begin (d) A home care provider that provides home management services and other home
care services must be licensed, but licensure requirements other than the home care bill of
rights do not apply to those employees or volunteers who provide only home management
services to clients who do not receive any other home care services from the provider.
A licensed home care provider need not be registered as a home management service
provider but must provide an orientation on the home care bill of rights to its employees
or volunteers who provide home management services.
new text end

new text begin (e) An individual who provides home management services under this section must,
within 120 days after beginning to provide services, attend an orientation session approved
by the commissioner that provides training on the home care bill of rights and an orientation
on the aging process and the needs and concerns of elderly and disabled persons.
new text end

new text begin (f) The commissioner may suspend or revoke a provider's certificate of registration
or assess fines for violation of the home care bill of rights. Any fine assessed for a
violation of the home care bill of rights by a provider registered under this section shall be
in the amount established in the licensure rules for home care providers. As a condition
of registration, a provider must cooperate fully with any investigation conducted by the
commissioner, including providing specific information requested by the commissioner on
clients served and the employees and volunteers who provide services. Fines collected
under this paragraph shall be deposited in the state treasury and credited to the fund
specified in the statute or rule in which the penalty was established.
new text end

new text begin (g) The commissioner may use any of the powers granted in sections 144A.43 to
144A.4799 to administer the registration system and enforce the home care bill of rights
under this section.
new text end

ARTICLE 5

HEALTH DEPARTMENT

Section 1.

new text begin [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS
FACILITY.
new text end

new text begin Subdivision 1. new text end

new text begin License requirement. new text end

new text begin Except as provided in section 149A.01,
subdivision 3, a place or premise shall not be maintained, managed, or operated which
is devoted to or used in the holding and alkaline hydrolysis of a dead human body
without possessing a valid license to operate an alkaline hydrolysis facility issued by the
commissioner of health.
new text end

new text begin Subd. 2. new text end

new text begin Requirements for an alkaline hydrolysis facility. new text end

new text begin (a) An alkaline
hydrolysis facility licensed under this section must consist of:
new text end

new text begin (1) a building or structure that complies with applicable local and state building
codes, zoning laws and ordinances, wastewater management and environmental standards,
containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead
human bodies;
new text end

new text begin (2) a method approved by the commissioner of health to dry the hydrolyzed remains
and which is located within the licensed facility;
new text end

new text begin (3) a means approved by the commissioner of health for refrigeration of dead human
bodies awaiting alkaline hydrolysis;
new text end

new text begin (4) an appropriate means of processing hydrolyzed remains to a granulated
appearance appropriate for final disposition; and
new text end

new text begin (5) an appropriate holding facility for dead human bodies awaiting alkaline
hydrolysis.
new text end

new text begin (b) An alkaline hydrolysis facility licensed under this section may also contain a
display room for funeral goods.
new text end

new text begin Subd. 3. new text end

new text begin Application procedure; documentation; initial inspection. new text end

new text begin An
application to license and operate an alkaline hydrolysis facility shall be submitted to the
commissioner of health. A completed application includes:
new text end

new text begin (1) a completed application form, as provided by the commissioner;
new text end

new text begin (2) proof of business form and ownership;
new text end

new text begin (3) proof of liability insurance coverage or other financial documentation, as
determined by the commissioner, that demonstrates the applicant's ability to respond in
damages for liability arising from the ownership, maintenance management, or operation
of an alkaline hydrolysis facility; and
new text end

new text begin (4) copies of wastewater and other environmental regulatory permits and
environmental regulatory licenses necessary to conduct operations.
new text end

new text begin Upon receipt of the application and appropriate fee, the commissioner shall review and
verify all information. Upon completion of the verification process and resolution of any
deficiencies in the application information, the commissioner shall conduct an initial
inspection of the premises to be licensed. After the inspection and resolution of any
deficiencies found and any reinspections as may be necessary, the commissioner shall
make a determination, based on all the information available, to grant or deny licensure. If
the commissioner's determination is to grant the license, the applicant shall be notified and
the license shall issue and remain valid for a period prescribed on the license, but not to
exceed one calendar year from the date of issuance of the license. If the commissioner's
determination is to deny the license, the commissioner must notify the applicant in writing
of the denial and provide the specific reason for denial.
new text end

new text begin Subd. 4. new text end

new text begin Nontransferability of license. new text end

new text begin A license to operate an alkaline hydrolysis
facility is not assignable or transferable and shall not be valid for any entity other than the
one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the
location identified on the license. A 50 percent or more change in ownership or location of
the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall
be required of two or more persons or other legal entities operating from the same location.
new text end

new text begin Subd. 5. new text end

new text begin Display of license. new text end

new text begin Each license to operate an alkaline hydrolysis
facility must be conspicuously displayed in the alkaline hydrolysis facility at all times.
Conspicuous display means in a location where a member of the general public within the
alkaline hydrolysis facility will be able to observe and read the license.
new text end

new text begin Subd. 6. new text end

new text begin Period of licensure. new text end

new text begin All licenses to operate an alkaline hydrolysis facility
issued by the commissioner are valid for a period of one calendar year beginning on July 1
and ending on June 30, regardless of the date of issuance.
new text end

new text begin Subd. 7. new text end

new text begin Reporting changes in license information. new text end

new text begin Any change of license
information must be reported to the commissioner, on forms provided by the
commissioner, no later than 30 calendar days after the change occurs. Failure to report
changes is grounds for disciplinary action.
new text end

new text begin Subd. 8. new text end

new text begin Notification to the commissioner. new text end

new text begin If the licensee is operating under a
wastewater or an environmental permit or license that is subsequently revoked, denied,
or terminated, the licensee shall notify the commissioner.
new text end

new text begin Subd. 9. new text end

new text begin Application information. new text end

new text begin All information submitted to the commissioner
for a license to operate an alkaline hydrolysis facility is classified as licensing data under
section 13.41, subdivision 5.
new text end

Sec. 2.

new text begin [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE
HYDROLYSIS FACILITY.
new text end

new text begin Subdivision 1. new text end

new text begin Renewal required. new text end

new text begin All licenses to operate an alkaline hydrolysis
facility issued by the commissioner expire on June 30 following the date of issuance of the
license and must be renewed to remain valid.
new text end

new text begin Subd. 2. new text end

new text begin Renewal procedure and documentation. new text end

new text begin Licensees who wish to renew
their licenses must submit to the commissioner a completed renewal application no later
than June 30 following the date the license was issued. A completed renewal application
includes:
new text end

new text begin (1) a completed renewal application form, as provided by the commissioner; and
new text end

new text begin (2) proof of liability insurance coverage or other financial documentation, as
determined by the commissioner, that demonstrates the applicant's ability to respond in
damages for liability arising from the ownership, maintenance, management, or operation
of an alkaline hydrolysis facility.
new text end

new text begin Upon receipt of the completed renewal application, the commissioner shall review and
verify the information. Upon completion of the verification process and resolution of
any deficiencies in the renewal application information, the commissioner shall make a
determination, based on all the information available, to reissue or refuse to reissue the
license. If the commissioner's determination is to reissue the license, the applicant shall
be notified and the license shall issue and remain valid for a period prescribed on the
license, but not to exceed one calendar year from the date of issuance of the license. If
the commissioner's determination is to refuse to reissue the license, section 149A.09,
subdivision 2, applies.
new text end

new text begin Subd. 3. new text end

new text begin Penalty for late filing. new text end

new text begin Renewal applications received after the expiration
date of a license will result in the assessment of a late filing penalty. The late filing penalty
must be paid before the reissuance of the license and received by the commissioner no
later than 31 calendar days after the expiration date of the license.
new text end

new text begin Subd. 4. new text end

new text begin Lapse of license. new text end

new text begin Licenses to operate alkaline hydrolysis facilities
shall automatically lapse when a completed renewal application is not received by the
commissioner within 31 calendar days after the expiration date of a license, or a late
filing penalty assessed under subdivision 3 is not received by the commissioner within 31
calendar days after the expiration of a license.
new text end

new text begin Subd. 5. new text end

new text begin Effect of lapse of license. new text end

new text begin Upon the lapse of a license, the person to whom
the license was issued is no longer licensed to operate an alkaline hydrolysis facility in
Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue
any additional lawful remedies as justified by the case.
new text end

new text begin Subd. 6. new text end

new text begin Restoration of lapsed license. new text end

new text begin The commissioner may restore a lapsed
license upon receipt and review of a completed renewal application, receipt of the late
filing penalty, and reinspection of the premises, provided that the receipt is made within
one calendar year from the expiration date of the lapsed license and the cease and desist
order issued by the commissioner has not been violated. If a lapsed license is not restored
within one calendar year from the expiration date of the lapsed license, the holder of the
lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
new text end

new text begin Subd. 7. new text end

new text begin Reporting changes in license information. new text end

new text begin Any change of license
information must be reported to the commissioner, on forms provided by the
commissioner, no later than 30 calendar days after the change occurs. Failure to report
changes is grounds for disciplinary action.
new text end

new text begin Subd. 8. new text end

new text begin Application information. new text end

new text begin All information submitted to the commissioner
by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is
classified as licensing data under section 13.41, subdivision 5.
new text end

Sec. 3.

new text begin [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE
HYDROLYSIS.
new text end

new text begin Subdivision 1. new text end

new text begin License required. new text end

new text begin A dead human body may only be hydrolyzed in
this state at an alkaline hydrolysis facility licensed by the commissioner of health.
new text end

new text begin Subd. 2. new text end

new text begin General requirements. new text end

new text begin Any building to be used as an alkaline hydrolysis
facility must comply with all applicable local and state building codes, zoning laws and
ordinances, wastewater management regulations, and environmental statutes, rules, and
standards. An alkaline hydrolysis facility must have, on site, a purpose built human
alkaline hydrolysis system approved by the commissioner of health, a system approved by
the commissioner of health for drying the hydrolyzed remains, a motorized mechanical
device approved by the commissioner of health for processing hydrolyzed remains and
must have in the building a holding facility approved by the commissioner of health for
the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility
must be secure from access by anyone except the authorized personnel of the alkaline
hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of
the alkaline hydrolysis facility personnel.
new text end

new text begin Subd. 3. new text end

new text begin Lighting and ventilation. new text end

new text begin The room where the alkaline hydrolysis vessel
is located and the room where the chemical storage takes place shall be properly lit and
ventilated with an exhaust fan that provides at least 12 air changes per hour.
new text end

new text begin Subd. 4. new text end

new text begin Plumbing connections. new text end

new text begin All plumbing fixtures, water supply lines,
plumbing vents, and waste drains shall be properly vented and connected pursuant to the
Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a
functional sink with hot and cold running water.
new text end

new text begin Subd. 5. new text end

new text begin Flooring, walls, ceiling, doors, and windows. new text end

new text begin The room where the
alkaline hydrolysis vessel is located and the room where the chemical storage takes place
shall have nonporous flooring, so that a sanitary condition is provided. The walls and
ceiling of the room where the alkaline hydrolysis vessel is located and the room where
the chemical storage takes place shall run from floor to ceiling and be covered with tile,
or by plaster or sheetrock painted with washable paint or other appropriate material so
that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be
constructed to prevent odors from entering any other part of the building. All windows
or other openings to the outside must be screened and all windows must be treated in a
manner that prevents viewing into the room where the alkaline hydrolysis vessel is located
and the room where the chemical storage takes place. A viewing window for authorized
family members or their designees is not a violation of this subdivision.
new text end

new text begin Subd. 6. new text end

new text begin Equipment and supplies. new text end

new text begin The alkaline hydrolysis facility must have a
functional emergency eye wash and quick drench shower.
new text end

new text begin Subd. 7. new text end

new text begin Access and privacy. new text end

new text begin (a) The room where the alkaline hydrolysis vessel is
located and the room where the chemical storage takes place must be private and have no
general passageway through it. The room shall, at all times, be secure from the entrance of
unauthorized persons. Authorized persons are:
new text end

new text begin (1) licensed morticians;
new text end

new text begin (2) registered interns or students as described in section 149A.91, subdivision 6;
new text end

new text begin (3) public officials or representatives in the discharge of their official duties;
new text end

new text begin (4) trained alkaline hydrolysis facility operators; and
new text end

new text begin (5) the person(s) with the right to control the dead human body as defined in section
149A.80, subdivision 2, and their designees.
new text end

new text begin (b) Each door allowing ingress or egress shall carry a sign that indicates that the
room is private and access is limited. All authorized persons who are present in or enter
the room where the alkaline hydrolysis vessel is located while a body is being prepared for
final disposition must be attired according to all applicable state and federal regulations
regarding the control of infectious disease and occupational and workplace health and
safety.
new text end

new text begin Subd. 8. new text end

new text begin Sanitary conditions and permitted use. new text end

new text begin The room where the alkaline
hydrolysis vessel is located and the room where the chemical storage takes place and all
fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies
stored or used in the room must be maintained in a clean and sanitary condition at all times.
new text end

new text begin Subd. 9. new text end

new text begin Boiler use. new text end

new text begin When a boiler is required by the manufacturer of the alkaline
hydrolysis vessel for its operation, all state and local regulations for that boiler must be
followed.
new text end

new text begin Subd. 10. new text end

new text begin Occupational and workplace safety. new text end

new text begin All applicable provisions of state
and federal regulations regarding exposure to workplace hazards and accidents shall be
followed in order to protect the health and safety of all authorized persons at the alkaline
hydrolysis facility.
new text end

new text begin Subd. 11. new text end

new text begin Licensed personnel. new text end

new text begin A licensed alkaline hydrolysis facility must employ
a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body.
It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for
all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for
compliance with this chapter and other applicable state and federal regulations regarding
occupational and workplace health and safety.
new text end

new text begin Subd. 12. new text end

new text begin Authorization to hydrolyze required. new text end

new text begin No alkaline hydrolysis facility
shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part
without receiving written authorization to do so from the person or persons who have the
legal right to control disposition as described in section 149A.80 or the person's legal
designee. The written authorization must include:
new text end

new text begin (1) the name of the deceased and the date of death of the deceased;
new text end

new text begin (2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
new text end

new text begin (3) the name, address, telephone number, relationship to the deceased, and signature
of the person or persons with legal right to control final disposition or a legal designee;
new text end

new text begin (4) directions for the disposition of any nonhydrolyzed materials or items recovered
from the alkaline hydrolysis vessel;
new text end

new text begin (5) acknowledgment that the hydrolyzed remains will be dried and mechanically
reduced to a granulated appearance and placed in an appropriate container and
authorization to place any hydrolyzed remains that a selected urn or container will not
accommodate into a temporary container;
new text end

new text begin (6) new text end new text begin acknowledgment that, even with the exercise of reasonable care, it is not possible
to recover all particles of the hydrolyzed remains and that some particles may inadvertently
become commingled with particles of other hydrolyzed remains that remain in the alkaline
hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
new text end

new text begin (7) directions for the ultimate disposition of the hydrolyzed remains; and
new text end

new text begin (8) a statement that includes, but is not limited to, the following information:
"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an
alkaline solution is used to chemically break down the human tissue and the hydrolyzable
alkaline hydrolysis container. After the process is complete, the liquid effluent solution
contains the chemical by-products of the alkaline hydrolysis process except for the
deceased's bone fragments. The solution is cooled and released according to local
environmental regulations. A water rinse is applied to the hydrolyzed remains which are
then dried and processed to facilitate inurnment or scattering."
new text end

new text begin Subd. 13. new text end

new text begin Limitation of liability. new text end

new text begin A licensed alkaline hydrolysis facility acting in
good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an
authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from
civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis
facility.
new text end

new text begin Subd. 14. new text end

new text begin Acceptance of delivery of body. new text end

new text begin (a) No dead human body shall be
accepted for final disposition by alkaline hydrolysis unless:
new text end

new text begin (1) encased in an appropriate alkaline hydrolysis container;
new text end

new text begin (2) accompanied by a disposition permit issued pursuant to section 149A.93,
subdivision 3, including a photocopy of the completed death record or a signed release
authorizing alkaline hydrolysis of the body received from the coroner or medical
examiner; and
new text end

new text begin (3) accompanied by an alkaline hydrolysis authorization that complies with
subdivision 12.
new text end

new text begin (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline
hydrolysis container where there is:
new text end

new text begin (1) evidence of leakage of fluids from the alkaline hydrolysis container;
new text end

new text begin (2) a known dispute concerning hydrolysis of the body delivered;
new text end

new text begin (3) a reasonable basis for questioning any of the representations made on the written
authorization to hydrolyze; or
new text end

new text begin (4) any other lawful reason.
new text end

new text begin Subd. 15. new text end

new text begin Bodies awaiting hydrolysis. new text end

new text begin A dead human body must be hydrolyzed
within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of
the body.
new text end

new text begin Subd. 16. new text end

new text begin Handling of alkaline hydrolysis containers for dead human bodies.
new text end

new text begin All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for
dead human bodies shall use universal precautions and otherwise exercise all reasonable
precautions to minimize the risk of transmitting any communicable disease from the body.
No dead human body shall be removed from the container in which it is delivered.
new text end

new text begin Subd. 17. new text end

new text begin Identification of body. new text end

new text begin All licensed alkaline hydrolysis facilities shall
develop, implement, and maintain an identification procedure whereby dead human
bodes can be identified from the time the alkaline hydrolysis facility accepts delivery
of the remains until the hydrolyzed remains are released to an authorized party. After
hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the
hydrolyzed remains container before the hydrolyzed remains are released from the alkaline
hydrolysis facility. Each identification disk, tab, or label shall have a number that shall
be recorded on all paperwork regarding the decedent. This procedure shall be designed
to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains
are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the
inability to individually identify the hydrolyzed remains is a violation of this subdivision.
new text end

new text begin Subd. 18. new text end

new text begin Alkaline hydrolysis vessel for human remains. new text end

new text begin A licensed alkaline
hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains
in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for
infectious disease control.
new text end

new text begin Subd. 19. new text end

new text begin Alkaline hydrolysis procedures; privacy. new text end

new text begin The final disposition of
dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is
written authorization from the person with the legal right to control the disposition,
only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline
hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting
alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline
hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
new text end

new text begin Subd. 20. new text end

new text begin Alkaline hydrolysis procedures; commingling of hydrolyzed remains
prohibited. new text end

new text begin Except with the express written permission of the person with the legal right
to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one
dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce
a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have
been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze
a dead human body and other human remains at the same time and in the same alkaline
hydrolysis vessel. This section does not apply where commingling of human remains
during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental
and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is
not a violation of this subdivision.
new text end

new text begin Subd. 21. new text end

new text begin Alkaline hydrolysis procedures; removal from alkaline hydrolysis
vessel. new text end

new text begin Upon completion of the alkaline hydrolysis process, reasonable efforts shall be
made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed
remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be
made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed
human remains and dispose of these materials in a lawful manner, by the alkaline
hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate
container to be transported to the processing area.
new text end

new text begin Subd. 22. new text end

new text begin Drying device or mechanical processor procedures; commingling of
hydrolyzed remains prohibited. new text end

new text begin Except with the express written permission of the
person with the legal right to control the final disposition or otherwise provided by
law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed
human remains of more than one body at a time in the same drying device or mechanical
processor, or introduce the hydrolyzed human remains of a second body into a drying
device or mechanical processor until processing of any preceding hydrolyzed human
remains has been terminated and reasonable efforts have been employed to remove all
fragments of the preceding hydrolyzed remains. The fact that there is incidental and
unavoidable residue in the drying device, the mechanical processor, or any container used
in a prior alkaline hydrolysis process, is not a violation of this provision.
new text end

new text begin Subd. 23. new text end

new text begin Alkaline hydrolysis procedures; processing hydrolyzed remains. new text end

new text begin The
hydrolyzed human remains shall be dried and then reduced by a motorized mechanical
device to a granulated appearance appropriate for final disposition and placed in an
alkaline hydrolysis remains container along with the appropriate identifying disk, tab,
or permanent label. Processing must take place within the licensed alkaline hydrolysis
facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they
can be identified, may be removed prior to processing the hydrolyzed remains, only by
staff licensed or registered by the commissioner of health; however, any dental gold and
silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains
container unless otherwise directed by the person or persons having the right to control the
final disposition. Every person who removes or possesses dental gold or silver, jewelry,
or mementos from any hydrolyzed remains without specific written permission of the
person or persons having the right to control those remains is guilty of a misdemeanor.
The fact that residue and any unavoidable dental gold or dental silver, or other precious
metals remain in the alkaline hydrolysis vessel or other equipment or any container used
in a prior hydrolysis is not a violation of this section.
new text end

new text begin Subd. 24. new text end

new text begin Alkaline hydrolysis procedures; container of insufficient capacity.
new text end

new text begin If a hydrolyzed remains container is of insufficient capacity to accommodate all
hydrolyzed remains of a given dead human body, subject to directives provided in the
written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess
hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the
second container, in a manner so as not to be easily detached through incidental contact, to
the primary alkaline hydrolysis remains container. The secondary container shall contain a
duplicate of the identification disk, tab, or permanent label that was placed in the primary
container and all paperwork regarding the given body shall include a notation that the
hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature
hydrolyzed remains containers are not subject to the requirements of this subdivision.
new text end

new text begin Subd. 25. new text end

new text begin Disposition procedures; commingling of hydrolyzed remains
prohibited. new text end

new text begin No hydrolyzed remains shall be disposed of or scattered in a manner or in
a location where the hydrolyzed remains are commingled with those of another person
without the express written permission of the person with the legal right to control
disposition or as otherwise provided by law. This subdivision does not apply to the
scattering or burial of hydrolyzed remains at sea or in a body of water from individual
containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to
the disposal in a dedicated cemetery of accumulated residue removed from an alkaline
hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members
of the same family in a common container designed for the hydrolyzed remains of more
than one body, or to the inurnment in a container or interment in a space that has been
previously designated, at the time of sale or purchase, as being intended for the inurnment
or interment of the hydrolyzed remains of more than one person.
new text end

new text begin Subd. 26. new text end

new text begin Alkaline hydrolysis procedures; disposition of accumulated residue.
new text end

new text begin Every alkaline hydrolysis facility shall provide for the removal and disposition in a
dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel,
drying device, mechanical processor, container, or other equipment used in alkaline
hydrolysis. Disposition of accumulated residue shall be according to the regulations of the
dedicated cemetery and any applicable local ordinances.
new text end

new text begin Subd. 27. new text end

new text begin Alkaline hydrolysis procedures; release of hydrolyzed remains.
new text end

new text begin Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be
released according to the instructions given on the written authorization to hydrolyze. If
the hydrolyzed remains are to be shipped, they must be securely packaged and transported
by a method which has an internal tracing system available and which provides for a
receipt signed by the person accepting delivery. Where there is a dispute over release
or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit
the hydrolyzed remains with a court of competent jurisdiction pending resolution of the
dispute or retain the hydrolyzed remains until the person with the legal right to control
disposition presents satisfactory indication that the dispute is resolved.
new text end

new text begin Subd. 28. new text end

new text begin Unclaimed hydrolyzed remains. new text end

new text begin If, after 30 calendar days following
the inurnment, the hydrolyzed remains are not claimed or disposed of according to the
written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment
may give written notice, by certified mail, to the person with the legal right to control
the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and
requesting further release directions. Should the hydrolyzed remains be unclaimed 120
calendar days following the mailing of the written notification, the alkaline hydrolysis
facility or funeral establishment may dispose of the hydrolyzed remains in any lawful
manner deemed appropriate.
new text end

new text begin Subd. 29. new text end

new text begin Required records. new text end

new text begin Every alkaline hydrolysis facility shall create and
maintain on its premises or other business location in Minnesota an accurate record of
every hydrolyzation provided. The record shall include all of the following information
for each hydrolyzation:
new text end

new text begin (1) the name of the person or funeral establishment delivering the body for alkaline
hydrolysis;
new text end

new text begin (2) the name of the deceased and the identification number assigned to the body;
new text end

new text begin (3) the date of acceptance of delivery;
new text end

new text begin (4) the names of the alkaline hydrolysis vessel, drying device, and mechanical
processor operator;
new text end

new text begin (5) the time and date that the body was placed in and removed from the alkaline
hydrolysis vessel;
new text end

new text begin (6) the time and date that processing and inurnment of the hydrolyzed remains
was completed;
new text end

new text begin (7) the time, date, and manner of release of the hydrolyzed remains;
new text end

new text begin (8) the name and address of the person who signed the authorization to hydrolyze;
new text end

new text begin (9) all supporting documentation, including any transit or disposition permits, a
photocopy of the death record, and the authorization to hydrolyze; and
new text end

new text begin (10) the type of alkaline hydrolysis container.
new text end

new text begin Subd. 30. new text end

new text begin Retention of records. new text end

new text begin Records required under subdivision 29 shall be
maintained for a period of three calendar years after the release of the hydrolyzed remains.
Following this period and subject to any other laws requiring retention of records, the
alkaline hydrolysis facility may then place the records in storage or reduce them to
microfilm, microfiche, laser disc, or any other method that can produce an accurate
reproduction of the original record, for retention for a period of ten calendar years from
the date of release of the hydrolyzed remains. At the end of this period and subject to any
other laws requiring retention of records, the alkaline hydrolysis facility may destroy
the records by shredding, incineration, or any other manner that protects the privacy of
the individuals identified.
new text end

Sec. 4. new text begin STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
new text end

new text begin (a) The commissioners of health, human services, and commerce, and the board of
MNsure, shall study whether Minnesota-based risk adjustment of the individual and small
group insurance market, using either the federal risk adjustment model or a state-based
alternative, can be more cost-effective and perform better than risk adjustment conducted
by federal agencies. The study shall assess the policies, infrastructure, and resources
necessary to satisfy the requirements of Code of Federal Regulations, title 45, section
153, subpart D. The study shall also evaluate the extent to which Minnesota-based risk
adjustment could meet requirements established in Code of Federal Regulations, title
45, section 153.330, including:
new text end

new text begin (1) explaining the variation in health care costs of a given population;
new text end

new text begin (2) linking risk factors to daily clinical practices and that which is clinically
meaningful to providers;
new text end

new text begin (3) encouraging favorable behavior among health care market participants and
discouraging unfavorable behavior;
new text end

new text begin (4) whether risk adjustment factors are relatively easy for stakeholders to understand
and participate in;
new text end

new text begin (5) providing stable risk scores over time and across health plan products;
new text end

new text begin (6) minimizing administrative costs;
new text end

new text begin (7) accounting for risk selection across metal levels;
new text end

new text begin (8) aligning each of the elements of the methodology; and
new text end

new text begin (9) having a per-member cost equal to or lower than the projected cost of the federal
risk adjustment model.
new text end

new text begin (b) In conducting the study, and notwithstanding Minnesota Rules, chapter 4653,
and as part of responsibilities under Minnesota Statutes, section 62U.04, subdivision
4, paragraph (b), the commissioner of health shall collect from health carriers in the
individual and small group health insurance market, beginning on January 1, 2014, and for
service dates in calendar year 2014, all data required for conducting risk adjustment with
standard risk adjusters such as the Adjusted Clinical Groups or the Hierarchical Condition
Category System, including but not limited to:
new text end

new text begin (1) an indicator identifying the health plan product under which an enrollee is covered;
new text end

new text begin (2) an indicator identifying whether an enrollee's policy is an individual or small
group market policy;
new text end

new text begin (3) an indicator identifying, if applicable, the metal level of an enrollee's health plan
product, and whether the policy is a catastrophic policy; and
new text end

new text begin (4) additional identified demographic data necessary to link individuals' data across
carriers and insurance affordability programs with 95 percent accuracy. The commissioner
shall not collect more than the last four digits of an individual's Social Security number.
new text end

new text begin (c) The commissioner of health shall also assess the extent to which data collected
under paragraph (b) and under Minnesota Statutes, section 62U.04, subdivision 4,
paragraph (a), are sufficient for developing and operating a state alternative risk adjustment
methodology consistent with applicable federal rules by evaluating:
new text end

new text begin (1) if the data submitted are adequately complete, accurate, and timely;
new text end

new text begin (2) if the data should be further enriched by nontraditional risk adjusters that help
in better explaining variation in health care costs of a given population and account for
risk selection across metal levels;
new text end

new text begin (3) whether additional data or identifiers have the potential to strengthen a
Minnesota-based risk adjustment approach; and
new text end

new text begin (4) what, if any, changes to the technical infrastructure will be necessary to
effectively perform state-based risk adjustment.
new text end

new text begin For purposes of this paragraph, the commissioner of health shall have the authority to
use identified data to validate and audit a statistically valid sample of data for each
health carrier in the individual and small group market. In conducting the study, the
commissioners shall contract with entities that do not have an economic interest in the
outcome of Minnesota-based risk adjustment but do have demonstrated expertise in
actuarial science or health economics and demonstrated experience with designing and
implementing risk adjustment models.
new text end

new text begin (d) The commissioner of human services shall evaluate opportunities to maximize
federal funding under section 1331 of the federal Patient Protection and Affordable
Care Act, Public Law 111-148, and further defined through amendments to the act and
regulations issued under the act. The commissioner of human services shall make
recommendations on risk adjustment strategies to maximize federal funding to the state
of Minnesota.
new text end

new text begin (e) The commissioners and board of MNsure shall submit to the legislature by March
15, 2014, an interim report with preliminary findings from the assessment conducted in
paragraphs (c) and (d). The interim report shall include legislative recommendations
for any necessary changes to Minnesota Statutes, section 62Q.03. A final report shall
be submitted by the commissioners and board of MNsure to the legislature by October
1, 2015. The final report must include findings from the overall assessment and a
recommendation whether to conduct state-based risk adjustment.
new text end

new text begin (f) For purposes of this section, "board of MNsure" means the board established
under Minnesota Statutes, section 62V.03.
new text end

ARTICLE 6

CONTINUING CARE

Section 1.

Minnesota Statutes 2012, section 256.01, is amended by adding a
subdivision to read:

new text begin Subd. 35. new text end

new text begin Commissioner must annually report certain prepaid medical
assistance plan data. new text end

new text begin (a) The commissioners of human services and education may share
private or nonpublic data to allow the commissioners to analyze the screening, diagnosis,
and treatment of children with autism spectrum disorder and other developmental
conditions. The commissioners may share the individual-level data necessary to:
new text end

new text begin (1) measure the prevalence of autism spectrum disorder and other developmental
conditions;
new text end

new text begin (2) analyze the effectiveness of existing policies and procedures in the early
identification of children with autism spectrum disorder and other developmental
conditions;
new text end

new text begin (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
with autism spectrum disorder and other developmental conditions to meet developmental
and social-emotional milestones;
new text end

new text begin (4) identify and address disparities in screening, diagnosis, and treatment related
to the native language or race and ethnicity of the child;
new text end

new text begin (5) measure the effectiveness of public health care programs in addressing the medical
needs of children with autism spectrum disorder and other developmental conditions; and
new text end

new text begin (6) determine the capacity of educational and health care systems to meet the needs
of children with autism spectrum disorder and other developmental conditions.
new text end

new text begin (b) The commissioner of human services shall use the data shared with the
commissioner of education under this subdivision to improve public health care program
performance in early screening, diagnosis, and treatment for children once data are
available and shall report on the results and any summary data, as defined in section 13.02,
subdivision 19, on the department's Web site by September 30 of each year.
new text end

Sec. 2.

new text begin [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin This section creates a new benefit available under the
medical assistance state plan when federal approval consistent with the provisions in
subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section
2402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to
provide early intensive intervention to a child with an autism spectrum disorder diagnosis.
This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing
progress evaluation, and medically necessary treatment of autism spectrum disorder.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in
this subdivision have the meanings given.
new text end

new text begin (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
new text end

new text begin (c) "Child" means a person under the age of seven, or for two years at any age under
age 18 if the person was not diagnosed with autism spectrum disorder before age five, or a
person under age 18 pursuant to subdivision 12.
new text end

new text begin (d) "Commissioner" means the commissioner of human services, unless otherwise
specified.
new text end

new text begin (e) "Early intensive intervention benefit" means autism treatment options based in
behavioral and developmental science, which may include modalities such as applied
behavior analysis, developmental treatment approaches, and naturalistic and parent
training models.
new text end

new text begin (f) "Generalizable goals" means results or gains that are observed during a variety
of activities with different people, such as providers, family members, other adults,
and children, and in different environments including but not limited to clinics, homes,
schools, and the community.
new text end

new text begin Subd. 3. new text end

new text begin Initial eligibility. new text end

new text begin This benefit is available to a child enrolled in medical
assistance who:
new text end

new text begin (1) has an autism spectrum disorder diagnosis;
new text end

new text begin (2) has had a diagnostic assessment described in subdivision 5 that recommends
early intensive intervention services;
new text end

new text begin (3) meets the criteria for medically necessary autism early intensive intervention
services; and
new text end

new text begin (4) declines to enroll in the state services described in section 252.27.
new text end

new text begin Subd. 4. new text end

new text begin Diagnosis. new text end

new text begin (a) A diagnosis must:
new text end

new text begin (1) be based on current DSM criteria including direct observations of the child and
reports from parents or primary caregivers;
new text end

new text begin (2) be completed by a professional who has expertise and training in autism spectrum
disorder and child development and who is a licensed physician, nurse practitioner, or
licensed mental health professional until the commissioner's assessment required in
subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
or delays in diagnosis for young children if two professionals are required for a diagnosis
pursuant to clause (3); and
new text end

new text begin (3) be completed by both a medical and mental health professional who have expertise
and training in autism spectrum disorder and child development when the assessment in
subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
new text end

new text begin (b) Additional diagnostic assessment information including from special education
evaluations and licensed school personnel, and from professionals licensed in the fields of
medicine, speech and language, psychology, occupational therapy, and physical therapy
may be considered.
new text end

new text begin Subd. 5. new text end

new text begin Diagnostic assessment. new text end

new text begin The following information and assessments must
be performed, reviewed, and relied upon for the eligibility determination, treatment and
services recommendations, and treatment plan development for the child:
new text end

new text begin (1) an assessment of the child's developmental skills, functional behavior, needs, and
capacities based on direct observation of the child that must be administered by a licensed
mental health professional and may also include observations from family members,
licensed school personnel, child care providers, or other caregivers, as well as any medical
or assessment information from other licensed professionals such as the child's physician,
rehabilitation therapists, or mental health professionals; and
new text end

new text begin (2) an assessment of parental or caregiver capacity to participate in therapy including
the type and level of parental or caregiver involvement and training recommended.
new text end

new text begin Subd. 6. new text end

new text begin Treatment plan. new text end

new text begin (a) Each child's treatment plan must be:
new text end

new text begin (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
new text end

new text begin (2) coordinated with medically necessary occupational, physical, and speech and
language therapies, special education, and other services the child and family are receiving;
new text end

new text begin (3) family-centered;
new text end

new text begin (4) culturally sensitive; and
new text end

new text begin (5) individualized based on the child's developmental status and the child's and
family's identified needs.
new text end

new text begin (b) The treatment plan must specify the:
new text end

new text begin (1) child's goals, that are developmentally appropriate, functional, and generalizable;
new text end

new text begin (2) treatment modality;
new text end

new text begin (3) treatment intensity;
new text end

new text begin (4) setting; and
new text end

new text begin (5) level and type of parental or caregiver involvement.
new text end

new text begin (c) The treatment must be supervised by a professional with expertise and training in
autism and child development who is a licensed physician, nurse practitioner, or mental
health professional.
new text end

new text begin (d) The treatment plan must be submitted to the commissioner for approval in a
manner determined by the commissioner.
new text end

new text begin (e) Services authorized must be consistent with the child's approved treatment plan.
new text end

new text begin Subd. 7. new text end

new text begin Ongoing eligibility. new text end

new text begin (a) An independent progress evaluation conducted
by a licensed mental health professional with expertise and training in autism spectrum
disorder and child development must be completed after each six months of treatment,
or more frequently as determined by the commissioner, to determine if progress is being
made toward achieving generalizable gains and meeting functional goals contained in
the treatment plan.
new text end

new text begin (b) The progress evaluation must include:
new text end

new text begin (1) the treating provider's report;
new text end

new text begin (2) parental or caregiver input;
new text end

new text begin (3) an independent observation of the child, that can be performed by the child's
licensed special education staff;
new text end

new text begin (4) any treatment plan modifications; and
new text end

new text begin (5) recommendations for continued treatment services.
new text end

new text begin (c) Progress evaluations must be submitted to the commissioner in a manner
determined by the commissioner.
new text end

new text begin (d) A child who continues to achieve generalizable gains and treatment goals as
specified in the treatment plan is eligible to continue receiving this benefit.
new text end

new text begin (e) A child's treatment shall continue during the progress evaluation and during an
appeal if continuation of services pending appeal has been requested pursuant to section
256.045, subdivision 10.
new text end

new text begin Subd. 8. new text end

new text begin Refining benefit with stakeholders. new text end

new text begin The commissioner must develop
the implementation details of the benefit in consultation with stakeholders and consider
recommendations from the Health Services Advisory Council, the Department of Human
Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
Disorder Task Force, and the Interagency Task Force of the Departments of Health,
Education, and Human Services. The commissioner must release these details for a 30-day
public comment period prior to submission to the federal government for approval. The
implementation details include, but are not limited to, the following components:
new text end

new text begin (1) a definition of the qualifications, standards, and roles of the treatment team,
including recommendations after stakeholder consultation on whether board-certified
behavior analysts and other types of professionals trained in autism spectrum disorder and
child development should be added as mental health or other professionals for treatment
supervision or other function under medical assistance;
new text end

new text begin (2) development of initial, uniform parameters for comprehensive multidisciplinary
diagnostic assessment information and progress evaluation standards;
new text end

new text begin (3) the design of an effective and consistent process for assessing parent and
caregiver capacity to participate in the child's early intervention treatment and methods of
involving the parents in the treatment of the child;
new text end

new text begin (4) formulation of a collaborative process in which professionals have opportunities
to collectively inform the comprehensive, multidisciplinary diagnostic assessment and
progress evaluation processes and standards to support quality improvement of early
intensive intervention services;
new text end

new text begin (5) coordination of this benefit and its interaction with other services provided by the
Departments of Human Services, Health, and Education;
new text end

new text begin (6) evaluation, on an ongoing basis, of research regarding the program and treatment
modalities provided to children under this benefit; and
new text end

new text begin (7) determination of the availability of licensed medical and mental health
professionals with expertise and training in autism spectrum disorder throughout the state
in order to assess whether there are sufficient professionals to require involvement of
both a medical and mental health professional to provide access and prevent delay in the
diagnosis and treatment of young children so as to implement subdivision 4, paragraph
(a), and to ensure treatment is effective, timely, and accessible.
new text end

new text begin Subd. 9. new text end

new text begin Revision of treatment options. new text end

new text begin (a) The commissioner may revise covered
treatment options as needed based on outcome data and other evidence.
new text end

new text begin (b) Before the changes become effective, the commissioner must provide public
notice of the changes, the reasons for the changes, and a 30-day public comment period
to those who request notice through an electronic list accessible to the public on the
department's Web site.
new text end

new text begin Subd. 10. new text end

new text begin Coordination between agencies. new text end

new text begin The commissioners of human services
and education must develop the capacity to coordinate services and information including
diagnostic, functional, developmental, medical, and educational assessments; service
delivery; and progress evaluations across health and education sectors.
new text end

new text begin Subd. 11. new text end

new text begin Federal approval of autism benefit. new text end

new text begin The provisions of subdivision 9
shall apply to state plan services under title XIX of the Social Security Act when federal
approval is granted under a 1915(i) waiver or other authority that allows children eligible
for medical assistance through the TEFRA option under section 256B.055, subdivision
12, to qualify and includes children eligible for medical assistance in families over 150
percent of the federal poverty guidelines.
new text end

new text begin Subd. 12. new text end

new text begin Local school districts option to continue treatment. new text end

new text begin (a) A local school
district may contract with the commissioner of human services to pay the state share of
the benefits described under this section to continue the treatment as part of the special
education services offered to all students in the district diagnosed with autism spectrum
disorder.
new text end

new text begin (b) A local school district may utilize third-party billing to seek reimbursement
for the district for any services paid by the district under this section for which private
insurance coverage was available to the child.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2012, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 32a. new text end

new text begin Initiatives to improve early screening, diagnosis, and treatment of
children with autism spectrum disorder and other developmental conditions. new text end

new text begin (a) The
commissioner shall require managed care plans and county-based purchasing plans, as
a condition of contract, to implement strategies that facilitate access for young children
between the ages of one and three years to periodic developmental and social-emotional
screenings, as recommended by the Minnesota Interagency Developmental Screening
Task Force, and that those children who do not meet milestones are provided access to
appropriate evaluation and assessment, including treatment recommendations, expected to
improve the child's functioning, with the goal of meeting milestones by age five.
new text end

new text begin (b) The managed care plans must report the following data annually:
new text end

new text begin (1) the number of children who received a diagnostic assessment;
new text end

new text begin (2) the total number of children ages one to six with a diagnosis of autism spectrum
disorder who received treatments;
new text end

new text begin (3) the number of children identified under clause (2) reported by each 12-month
age group beginning with age one and ending with age six;
new text end

new text begin (4) the types of treatments provided to children identified under clause (2), listed by
billing code, including the number of units billed for each child;
new text end

new text begin (5) barriers to providing screening, diagnosis, and treatment of young children
between the ages of one and three years and any strategies implemented to address
those barriers; and
new text end

new text begin (6) recommendations on how to measure and report on the effectiveness of the
strategies implemented to facilitate access for young children to provide developmental
and social-emotional screening, diagnosis, and treatment.
new text end

Sec. 4. new text begin NURSING HOME LEVEL OF CARE REPORT.
new text end

new text begin (a) The commissioner of human services shall report on the impact of the nursing
home level of care implementation including the following:
new text end

new text begin (1) the number of individuals who lost waivered services and medical assistance;
new text end

new text begin (2) the result of the loss of services;
new text end

new text begin (3) information on where individuals were living before and after the nursing home
level of care changes took effect, to show the impact on an individual's ability to maintain
independence in the community; and
new text end

new text begin (4) utilization data before and after nursing home level of care implementation for
those who retained medical assistance, including which essential community support
and personal care assistant services were used and to what extent the $400 essential
community support grant was sufficient to meet needs.
new text end

new text begin (b) The commissioner of human services shall report to the chairs of the legislative
committees with jurisdiction over health and human services policy and finance with the
information required under paragraph (a) on October 1, 2014, and annually thereafter.
new text end

ARTICLE 7

HOME AND COMMUNITY-BASED SERVICES DISABILITY RATE SETTING

Section 1.

new text begin [256B.4914] HOME AND COMMUNITY-BASED SERVICES
WAIVERS; RATE SETTING.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The payment methodologies in this section apply to
home and community-based services waivers under sections 256B.092 and 256B.49. This
section does not change existing waiver policies and procedures.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
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new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
new text end

new text begin (d) "Customized living tool" means a methodology for setting service rates which
delineates and documents the amount of each component service included in a recipient's
customized living service plan.
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new text begin (e) "Disability waiver rates system" means a statewide system which establishes
rates that are based on uniform processes and captures the individualized nature of waiver
services and recipient needs.
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new text begin (f) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.
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new text begin (g) "Median" means the amount that divides distribution into two equal groups,
one-half above the median and one-half below the median.
new text end

new text begin (h) "Payment or rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
new text end

new text begin (i) "Rates management system" means a Web-based software application that uses
a framework and component values, as determined by the commissioner, to establish
service rates.
new text end

new text begin (j) "Recipient" means a person receiving home and community-based services
funded under any of the disability waivers.
new text end

new text begin Subd. 3. new text end

new text begin Applicable services. new text end

new text begin Applicable services are those authorized under the
state's home and community-based services waivers under sections 256B.092 and 256B.49
including, as defined in the federally approved home and community-based services plan:
new text end

new text begin (1) 24-hour customized living;
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new text begin (2) adult day care;
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new text begin (3) adult day care bath;
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new text begin (4) behavioral programming;
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new text begin (5) companion services;
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new text begin (6) customized living;
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new text begin (7) day training and habilitation;
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new text begin (8) housing access coordination;
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new text begin (9) independent living skills;
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new text begin (10) in-home family support;
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new text begin (11) night supervision;
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new text begin (12) personal support;
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new text begin (13) prevocational services;
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new text begin (14) residential care services;
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new text begin (15) residential support services;
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new text begin (16) respite services;
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new text begin (17) structured day services;
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new text begin (18) supported employment services;
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new text begin (19) supported living services;
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new text begin (20) transportation services; and
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new text begin (21) other services as approved by the federal government in the state home and
community-based services plan.
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new text begin Subd. 4. new text end

new text begin Data collection for rate determination. new text end

new text begin (a) Rates for all applicable home
and community-based waivered services, including rate exceptions under subdivision 12,
are set via the rates management system.
new text end

new text begin (b) Only data and information in the rates management system may be used to
calculate an individual's rate.
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new text begin (c) Service providers, with information from the community support plan, shall enter
values and information needed to calculate an individual's rate into the rates management
system. These values and information include:
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new text begin (1) shared staffing hours;
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new text begin (2) individual staffing hours;
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new text begin (3) staffing ratios;
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new text begin (4) information to document variable levels of service qualification for variable
levels of reimbursement in each framework;
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new text begin (5) shared or individualized arrangements for unit-based services, including the
staffing ratio; and
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new text begin (6) number of trips and miles for transportation services.
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new text begin (d) Updates to individual data shall include:
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new text begin (1) data for each individual that is updated annually when renewing service plans; and
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new text begin (2) requests by individuals or lead agencies to update a rate whenever there is a
change in an individual's service needs, with accompanying documentation.
new text end

new text begin (e) Lead agencies shall review and approve values to calculate the final payment rate
for each individual. Lead agencies must notify the individual and the service provider
of the final agreed upon values and rate. If a value used was mistakenly or erroneously
entered and used to calculate a rate, a provider may petition lead agencies to correct it.
Lead agencies must respond to these requests.
new text end

new text begin Subd. 5. new text end

new text begin Base wage index and standard component values. new text end

new text begin (a) The base wage
index is established to determine staffing costs associated with providing services to
individuals receiving home and community-based services. For purposes of developing
and calculating the proposed base wage, Minnesota-specific wages taken from job
descriptions and standard occupational classification (SOC) codes from the Bureau of
Labor Statistics, as defined in the most recent edition of the Occupational Handbook, shall
be used. The base wage index shall be calculated as follows:
new text end

new text begin (1) for residential direct care basic staff, 50 percent of the median wage for personal
and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
aide (SOC code 31-1012); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093);
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new text begin (2) for residential direct care intensive staff, 20 percent of the median wage for home
health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
21-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
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new text begin (3) for day services, 20 percent of the median wage for nursing aide (SOC code
31-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 60 percent of the median wage for social and human services code (SOC code 21-1093);
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new text begin (4) for residential asleep overnight staff, the wage shall be $7.66 per hour, except
in a family foster care setting the wage is $2.80 per hour;
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new text begin (5) for behavior program analyst staff, 100 percent of the median wage for mental
health counselors (SOC code 21-1014);
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new text begin (6) for behavior program professional staff, 100 percent of the median wage for
clinical counseling and school psychologist (SOC code 19-3031);
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new text begin (7) for behavior program specialist staff, 100 percent of the median wage for
psychiatric technicians (SOC code 29-2053);
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new text begin (8) for supportive living services staff, 20 percent of the median wage for nursing
aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
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new text begin (9) for housing access coordination staff, 50 percent of the median wage for
community and social services specialist (SOC code 21-1099); and 50 percent of the
median wage for social and human services aide (SOC code 21-1093);
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new text begin (10) for in-home family support staff, 20 percent of the median wage for nursing
aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
21-1099); 40 percent of the median wage for social and human services aide (SOC code
21-1093); and 10 percent of the median wage for psychiatric technician (SOC code
29-2053);
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new text begin (11) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social
and human services aide (SOC code 21-1093); and 10 percent of the median wage for
psychiatric technician (SOC code 29-2053);
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new text begin (12) for supported employment staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
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new text begin (13) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012);
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new text begin (14) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
percent of the median wage for social and human services aide (SOC code 21-1093);
new text end

new text begin (15) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
attendants (SOC code 31-1012);
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new text begin (16) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012); and
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new text begin (17) for supervisory staff, the basic wage is $17.43 per hour with exception of the
supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
new text end

new text begin (b) Component values for residential support services, excluding family foster
care, are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) general administrative support ratio, 13.25 percent;
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new text begin (5) program-related expense ratio, 1.3 percent; and
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new text begin (6) absence and utilization factor ratio, 3.9 percent.
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new text begin (c) Component values for family foster care are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) general administrative support ratio, 3.3 percent; and
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new text begin (5) program-related expense ratio, 1.3 percent.
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new text begin (d) Component values for day services for all services are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) program plan support ratio, 5.6 percent;
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new text begin (5) client programming and support ratio, 10 percent;
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new text begin (6) general administrative support ratio, 13.25 percent;
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new text begin (7) program-related expense ratio, 1.8 percent; and
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new text begin (8) absence and utilization factor ratio, 3.9 percent.
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new text begin (e) Component values for unit-based services with program services are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) program plan supports ratio, 3.1 percent;
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new text begin (5) client programming and support ratio, 8.6 percent;
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new text begin (6) general administrative support ratio, 13.25 percent;
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new text begin (7) program-related expense ratio, 6.1 percent; and
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new text begin (8) absence and utilization factor ratio, 3.9 percent.
new text end

new text begin (f) Component values for unit-based services without programming except respite
are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) program plan support ratio, 3.1 percent;
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new text begin (5) client programming and support ratio, 8.6 percent;
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new text begin (6) general administrative support ratio, 13.25 percent;
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new text begin (7) program-related expense ratio, 6.1 percent; and
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new text begin (8) absence and utilization factor ratio, 3.9 percent.
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new text begin (g) Component values for unit-based services without programming for respite are:
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new text begin (1) supervisory span of control ratio, 11 percent;
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new text begin (2) employee vacation, sick, and training allowance ratio, 8.71 percent;
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new text begin (3) employee-related cost ratio, 23.6 percent;
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new text begin (4) general administrative support ratio, 13.25 percent;
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new text begin (5) program-related expense ratio, 6.1 percent; and
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new text begin (6) absence and utilization factor ratio, 3.9 percent.
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new text begin (h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by SOC from the Bureau of Labor Statistics available on
December 31, 2016. The commissioner shall publish these updated values and load them
into the rates management system. This adjustment shall occur every five years. For
adjustments in 2021 and later, the commissioner shall use the data available on December
31 of the calendar year five years prior.
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new text begin (i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust
these values higher or lower by the percentage change in the Consumer Price Index-All
Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The
commissioner shall publish these updated values and load them into the rates management
system. This adjustment shall occur every five years. For adjustments in 2021 and later,
the commissioner shall use the data available on January 1 of the calendar year four years
prior and January 1 of the current calendar year.
new text end

new text begin Subd. 6. new text end

new text begin Payments for residential support services. new text end

new text begin (a) Payments for residential
support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
subdivision 22, must be calculated as follows:
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new text begin (1) determine the number of units of service to meet a recipient's needs;
new text end

new text begin (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
national and Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5. This is defined as the direct care rate;
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new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
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new text begin (4) multiply the number of residential services direct staff hours by the appropriate
staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
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new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
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new text begin (6) combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;
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new text begin (7) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
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new text begin (8) for client programming and supports, the commissioner shall add $2,179; and
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new text begin (9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport per year.
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new text begin (b) The total rate shall be calculated using the following steps:
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new text begin (1) subtotal paragraph (a), clauses (7) to (9);
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new text begin (2) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio; and
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new text begin (3) divide the result of clause (1) by one minus the result of clause (2). This is
the total payment amount.
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new text begin Subd. 7. new text end

new text begin Payments for day programs. new text end

new text begin Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and
structured day services must be calculated as follows:
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new text begin (1) determine the number of units of service to meet a recipient's needs;
new text end

new text begin (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
new text end

new text begin (4) multiply the number of day program direct staff hours by the appropriate staff
wage in subdivision 5, paragraph (a), or the customized direct care rate;
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new text begin (5) multiply the number of day program direct staff hours by the product of the
supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the
appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
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new text begin (6) combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
clause (2). This is defined as the direct staffing rate;
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new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (d), clause (4);
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new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
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new text begin (9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
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new text begin (10) for program facility costs, add $8.30 per week with consideration of staffing
ratios to meet individual needs;
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new text begin (11) for adult day bath services, add $7.01 per 15-minute unit;
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new text begin (12) this is the subtotal rate;
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new text begin (13) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
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new text begin (14) divide the result of clause (12) by one minus the result of clause (13). This is
the total payment amount;
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new text begin (15) for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:
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new text begin (i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
ride in a vehicle with a lift;
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new text begin (ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
ride in a vehicle with a lift;
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new text begin (iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
ride in a vehicle with a lift; or
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new text begin (iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
vehicle with a lift;
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new text begin (16) for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:
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new text begin (i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
a lift, and $15.05 for a shared ride in a vehicle with a lift;
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new text begin (ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
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new text begin (iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
a lift, and $58.76 for a shared ride in a vehicle with a lift; or
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new text begin (iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
lift, and $80.93 for a shared ride in a vehicle with a lift.
new text end

new text begin Subd. 8. new text end

new text begin Payments for unit-based services with programming. new text end

new text begin Payments for
unit-based services with programming, including behavior programming, housing access
coordination, in-home family support, independent living skills training, hourly supported
living services, and supported employment provided to an individual outside of any day or
residential service plan, must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:
new text end

new text begin (1) determine the number of units of service to meet a recipient's needs;
new text end

new text begin (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
new text end

new text begin (4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a), or the customized direct care rate;
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new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
new text end

new text begin (6) combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
clause (2). This is defined as the direct staffing rate;
new text end

new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan supports ratio in subdivision 5, paragraph (e), clause (4);
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new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
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new text begin (9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
new text end

new text begin (10) this is the subtotal rate;
new text end

new text begin (11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio; and
new text end

new text begin (12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount.
new text end

new text begin Subd. 9. new text end

new text begin Payments for unit-based services without programming. new text end

new text begin Payments for
unit-based services without programming including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:
new text end

new text begin (1) for all services except respite, determine the number of units of service to meet
a recipient's needs;
new text end

new text begin (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
new text end

new text begin (4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5 or the customized direct care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
new text end

new text begin (6) combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f),
clause (2). This is defined as the direct staffing rate;
new text end

new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (f), clause (4);
new text end

new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
new text end

new text begin (10) this is the subtotal rate;
new text end

new text begin (11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
new text end

new text begin (12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount;
new text end

new text begin (13) for respite services, determine the number of daily units of service to meet an
individual's needs;
new text end

new text begin (14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
new text end

new text begin (15) for a recipient requiring deaf or hard-of-hearing customization under
subdivision 12, add the customization rate provided in subdivision 12 to the result of
clause (14). This is defined as the customized direct care rate;
new text end

new text begin (16) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a);
new text end

new text begin (17) multiply the number of direct staff hours by the product of the supervisory span
of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
new text end

new text begin (18) combine the results of clauses (16) and (17) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;
new text end

new text begin (19) for employee-related expenses, multiply the result of clause (18) by one plus
the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
new text end

new text begin (20) this is the subtotal rate;
new text end

new text begin (21) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio; and
new text end

new text begin (22) divide the result of clause (20) by one minus the result of clause (21). This is
the total payment amount.
new text end

new text begin Subd. 10. new text end

new text begin Updating payment values and additional information. new text end

new text begin (a) The
commissioner shall develop and implement uniform procedures to refine terms and update
or adjust values used to calculate payment rates in this section. For calendar year 2014,
the commissioner shall use the values, terms, and procedures provided in this section.
new text end

new text begin (b) The commissioner shall work with stakeholders to assess efficacy of values
and payment rates. The commissioner shall report back to the legislature with proposed
changes for component values and recommendations for revisions on the schedule
provided in paragraphs (c) and (d).
new text end

new text begin (c) The commissioner shall work with stakeholders to continue refining a
subset of component values, which are to be referred to as interim values, and report
recommendations to the legislature by February 15, 2014. Interim component values are:
transportation rates for day training and habilitation; transportation for adult day, structured
day, and prevocational services; geographic difference factor; day program facility rate;
services where monitoring technology replaces staff time; shared services for independent
living skills training; and supported employment and billing for indirect services.
new text end

new text begin (d) The commissioner shall report and make recommendations to the legislature on:
February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
2021, reports shall be provided on a four-year cycle.
new text end

new text begin (e) The commissioner shall provide a public notice via list serve in October of each
year beginning October 1, 2014. The notice shall contain information detailing legislatively
approved changes in: calculation values including derived wage rates and related employee
and administrative factors; services utilization; county and tribal allocation changes;
and information on adjustments to be made to calculation values and timing of those
adjustments. Information in this notice shall be effective January 1 of the following year.
new text end

new text begin Subd. 11. new text end

new text begin Payment implementation. new text end

new text begin Upon implementation of the payment
methodologies under this section, those payment rates supersede rates established in county
contracts for recipients receiving waiver services under section 256B.092 or 256B.49.
new text end

new text begin Subd. 12. new text end

new text begin Customization of rates for individuals. new text end

new text begin (a) For persons determined to
have higher needs based on being deaf or hard-of-hearing, the direct care costs must be
increased by an adjustment factor prior to calculating the rate under subdivisions 6 to 9. The
customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour
for waiver recipients who meet the respective criteria as determined by the commissioner.
new text end

new text begin (b) For the purposes of this section, "deaf or hard-of-hearing" means:
new text end

new text begin (1)(i) the person has a developmental disability and an assessment score that
indicates a hearing impairment that is severe or that the person has no useful hearing;
new text end

new text begin (ii) the person has a developmental disability and an expressive communications
score that indicates the person uses single signs or gestures, uses an augmentative
communication aid, or does not have functional communication, or the person's expressive
communications are unknown; and
new text end

new text begin (iii) the person has a developmental disability and a communication score that
indicates the person comprehends signs, gestures, and modeling prompts or does not
comprehend verbal, visual, or gestural communication or that the person's receptive
communications score is unknown; or
new text end

new text begin (2)(i) the person receives long-term care services and has an assessment score that
indicates they hear only very loud sounds, have no useful hearing, or a determination
cannot be made; and
new text end

new text begin (ii) the person receives long-term care services and has an assessment score that
indicates the person communicates needs with sign language, symbol board, written
messages, gestures, or an interpreter; communicates with inappropriate content; makes
garbled sounds or displays echolalia; or does not communicate needs.
new text end

new text begin Subd. 13. new text end

new text begin Transportation. new text end

new text begin The commissioner shall require that the purchase
of transportation services be cost-effective and be limited to market rates where the
transportation mode is generally available and accessible.
new text end

new text begin Subd. 14. new text end

new text begin Exceptions. new text end

new text begin (a) In a format prescribed by the commissioner, lead
agencies must identify individuals with exceptional needs that cannot be met under the
disability waiver rate system. The commissioner shall use that information to evaluate
and, if necessary, approve an alternative payment rate for those individuals.
new text end

new text begin (b) Lead agencies must submit exception requests to the state.
new text end

new text begin (c) An application for a rate exception may be submitted for the following criteria:
new text end

new text begin (1) an individual has service needs that cannot be met through additional units
of service; or
new text end

new text begin (2) an individual's rate determined under subdivisions 6 to 9 results in an individual
being discharged.
new text end

new text begin (d) Exception requests must include the following information:
new text end

new text begin (1) the service needs required by each individual that are not accounted for in
subdivisions 6 to 9;
new text end

new text begin (2) the service rate requested and the difference from the rate determined in
subdivisions 6 to 9;
new text end

new text begin (3) a basis for the underlying costs used for the rate exception and any accompanying
documentation;
new text end

new text begin (4) the duration of the rate exception; and
new text end

new text begin (5) any contingencies for approval.
new text end

new text begin (e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.
new text end

new text begin (f) Individual disability waiver recipients may request that a lead agency submit an
exception request. A lead agency that denies such a request shall notify the individual
waiver recipient of its decision and the reasons for denying the request in writing no later
than 30 days after the individual's request has been made.
new text end

new text begin (g) The commissioner shall determine whether to approve or deny an exception
request no more than 30 days after receiving the request. If the commissioner denies the
request, the commissioner shall notify the lead agency and the individual disability waiver
recipient in writing of the reasons for the denial.
new text end

new text begin (h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. If the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall
issue a temporary stay of demission, when requested by the disability waiver recipient,
consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
The temporary stay shall remain in effect until the lead agency can provide an informed
choice of appropriate, alternative services to the disability waiver.
new text end

new text begin (i) Providers may petition lead agencies to update values that were entered
incorrectly or erroneously into the rate management system, based on past service level
discussions and determination in subdivision 4, without applying for a rate exception.
new text end

new text begin Subd. 15. new text end

new text begin County or tribal allocations. new text end

new text begin (a) Upon implementation of the disability
waiver rates management system on January 1, 2014, the commissioner shall establish
a method of tracking and reporting the fiscal impact of the disability waiver rates
management system on individual lead agencies.
new text end

new text begin (b) Beginning on January 1, 2014, and continuing through full implementation on
December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
home and community-based waivered service budget allocations to adjust for rate
differences and the resulting impact on county allocations upon implementation of the
disability waiver rates system.
new text end

new text begin Subd. 16. new text end

new text begin Budget neutrality adjustment. new text end

new text begin The commissioner shall calculate the
total spending for all home and community-based waiver services under the payments
as defined in subdivisions 6 to 9 for all recipients as of July 1, 2013, and compare it
to spending for services defined for subdivisions 6 to 9 under current law. If spending
for services in one particular subdivision differs, there will be a percentage adjustment
to increase or decrease individual rates for the services defined in each subdivision so
aggregate spending matches projections under current law.
new text end

new text begin Subd. 17. new text end

new text begin Implementation. new text end

new text begin (a) On January 1, 2014, the commissioner shall fully
implement the calculation of rates for waivered services under sections 256B.092 and
256B.49, without additional legislative approval.
new text end

new text begin (b) The commissioner shall phase in the application of rates determined in
subdivisions 6 to 9 for two years.
new text end

new text begin (c) The commissioner shall preserve rates in effect on December 31, 2013, for
the two-year period.
new text end

new text begin (d) The commissioner shall calculate and measure the difference in cost per
individual using the historical rate and the rates under subdivisions 6 to 9 for all
individuals enrolled as of December 31, 2013. This measurement shall occur statewide
and for individuals in every county. The commissioner shall provide the results of this
analysis, by county for calendar year 2014, to the legislative committees with jurisdiction
over health and human services finance by February 15, 2015.
new text end

new text begin (e) The commissioner shall calculate the average rate per unit for each service by
county. For individuals enrolled after January 1, 2014, individuals will receive the higher
of the rate produced under subdivisions 6 to 9, or the by-county average rate.
new text end

new text begin (f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.
new text end