HF 3001

as introduced - 88th Legislature (2013 - 2014) Posted on 03/12/2014 11:34am

A bill for an act
relating to human services; modifying home and community-based services
standards; requiring review of the use of monitoring technology; imposing
sanctions; amending Minnesota Statutes 2012, sections 245A.11, by adding a
subdivision; 245A.155, subdivisions 1, 2, 3; 245A.65, subdivision 2; Minnesota
Statutes 2013 Supplement, sections 245D.02, by adding a subdivision; 245D.05,
subdivisions 1, 1b; 245D.06, subdivision 1; 245D.07, subdivision 2; 245D.071,
subdivisions 1, 3, 4, 5; 245D.09, subdivisions 3, 4, 4a, 5; 245D.095, subdivision
3; 245D.22, subdivision 4; 245D.31, subdivisions 3, 4, 5; repealing Minnesota
Statutes 2013 Supplement, section 245D.071, subdivision 2.

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

Section 1.

Minnesota Statutes 2012, section 245A.11, is amended by adding a
subdivision to read:

new text begin Subd. 7c. new text end

new text begin Review; services through monitoring technology. new text end

new text begin (a) Lead agencies
must submit individual service plans that include residential direct service care provided
remotely through monitoring technology to the Monitoring Technology Review Panel
established in section 256B.4914, subdivision 6, paragraph (d). The panel must verify that:
new text end

new text begin (1) licensing standards have been applied;
new text end

new text begin (2) the person's coordinated service and support plan includes the use of monitoring
technology; and
new text end

new text begin (3) signed informed consent has been obtained from the person or the person's
legal representative.
new text end

new text begin (b) The panel must meet quarterly to review service plans submitted by the lead
agencies.
new text end

new text begin (c) If the panel determines a service plan does not contain the information required
in paragraph (a), clauses (1) to (3), the panel shall provide a written notice of the
deficiencies to the lead agency and license holder. The lead agency and the license holder
must submit to the panel missing or corrected documentation to cure the deficiencies
within 90 calendar days.
new text end

new text begin (d) If the lead agency and license holder contest the findings of the panel, the lead
agency and license holder must submit a written request for reconsideration of the panel's
findings to the commissioner within 60 calendar days. The commissioner's disposition of
a request for reconsideration is final and not subject to appeal under chapter 14.
new text end

new text begin (e) If neither the missing or corrected documentation nor a written request for
reconsideration has been received by the panel within the designated time frames, the panel
may recommend to the licensing authority that direct care staff supervision be placed on
site during the hours remote monitoring had been approved for use, and that the payment
rate to the provider be adjusted until the service plan deficiencies have been resolved.
new text end

Sec. 2.

Minnesota Statutes 2012, section 245A.155, subdivision 1, is amended to read:

Subdivision 1.

Licensed foster care and respite care.

This section applies to
foster care agencies and licensed foster care providers who place, supervise, or care for
individuals who rely on medical deleted text begin monitoring deleted text end equipment new text begin , including but not limited to
ventilators, feeding tubes, or endotracheal tubes, new text end to sustain life deleted text begin or monitor a medical
condition deleted text end in respite care or foster care.

Sec. 3.

Minnesota Statutes 2012, section 245A.155, subdivision 2, is amended to read:

Subd. 2.

Foster care agency requirements.

In order for an agency to place an
individual who relies on medical equipment to sustain life deleted text begin or monitor a medical condition
deleted text end with a foster care provider, the agency must ensure that the foster care provider has
received the training to operate such equipment as observed and confirmed by a qualified
source, and that the provider:

(1) is currently caring for an individual who is using the same equipment in the
foster home; or

(2) has written documentation that the foster care provider has cared for an
individual who relied on such equipment within the past six months; or

(3) has successfully completed training with the individual being placed with the
provider.

Sec. 4.

Minnesota Statutes 2012, section 245A.155, subdivision 3, is amended to read:

Subd. 3.

Foster care provider requirements.

A foster care provider shall not care
for an individual who relies on medical equipment to sustain life deleted text begin or monitor a medical
condition deleted text end unless the provider has received the training to operate such equipment as
observed and confirmed by a qualified source, and:

(1) is currently caring for an individual who is using the same equipment in the
foster home; or

(2) has written documentation that the foster care provider has cared for an
individual who relied on such equipment within the past six months; or

(3) has successfully completed training with the individual being placed with the
provider.

Sec. 5.

Minnesota Statutes 2012, section 245A.65, subdivision 2, is amended to read:

Subd. 2.

Abuse prevention plans.

All license holders shall establish and enforce
ongoing written program abuse prevention plans and individual abuse prevention plans as
required under section 626.557, subdivision 14.

(a) The scope of the program abuse prevention plan is limited to the population,
physical plant, and environment within the control of the license holder and the location
where licensed services are provided. In addition to the requirements in section 626.557,
subdivision 14, the program abuse prevention plan shall meet the requirements in clauses
(1) to (5).

(1) The assessment of the population shall include an evaluation of the following
factors: age, gender, mental functioning, physical and emotional health or behavior of the
client; the need for specialized programs of care for clients; the need for training of staff to
meet identified individual needs; and the knowledge a license holder may have regarding
previous abuse that is relevant to minimizing risk of abuse for clients.

(2) The assessment of the physical plant where the licensed services are provided
shall include an evaluation of the following factors: the condition and design of the
building as it relates to the safety of the clients; and the existence of areas in the building
which are difficult to supervise.

(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following
factors: the location of the program in a particular neighborhood or community; the type
of grounds and terrain surrounding the building; the type of internal programming; and
the program's staffing patterns.

(4) The license holder shall provide an orientation to the program abuse prevention
plan for clients receiving services. If applicable, the client's legal representative must be
notified of the orientation. The license holder shall provide this orientation for each new
person within 24 hours of admission, or for persons who would benefit more from a later
orientation, the orientation may take place within 72 hours.

(5) The license holder's deleted text begin governing body deleted text end new text begin authorized representative new text end shall review
the plan at least annually using the assessment factors in the plan and any substantiated
maltreatment findings that occurred since the last review. The deleted text begin governing body deleted text end new text begin authorized
representative new text end shall revise the plan, if necessary, to reflect the review results.

(6) A copy of the program abuse prevention plan shall be posted in a prominent
location in the program and be available upon request to mandated reporters, persons
receiving services, and legal representatives.

(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).

(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within
the scope of the licensed services, and will identify referrals made when the vulnerable
adult is susceptible to abuse outside the scope or control of the licensed services. When
the assessment indicates that the vulnerable adult does not need specific risk reduction
measures in addition to those identified in the program abuse prevention plan, the
individual abuse prevention plan shall document this determination.

(2) An individual abuse prevention plan shall be developed for each new person as
part of the initial individual program plan or service plan required under the applicable
licensing rule. The review and evaluation of the individual abuse prevention plan shall
be done as part of the review of the program plan or service plan. The person receiving
services shall participate in the development of the individual abuse prevention plan to the
full extent of the person's abilities. If applicable, the person's legal representative shall be
given the opportunity to participate with or for the person in the development of the plan.
The interdisciplinary team shall document the review of all abuse prevention plans at least
annually, using the individual assessment and any reports of abuse relating to the person.
The plan shall be revised to reflect the results of this review.

Sec. 6.

Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding a
subdivision to read:

new text begin Subd. 37. new text end

new text begin Working day. new text end

new text begin "Working day" means Monday, Tuesday, Wednesday,
Thursday, or Friday, excluding any legal holiday.
new text end

Sec. 7.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
amended to read:

Subdivision 1.

Health needs.

(a) The license holder is responsible for meeting
health service needs assigned in the coordinated service and support plan or the
coordinated service and support plan addendum, consistent with the person's health needs.
The license holder is responsible for deleted text begin promptly deleted text end notifying the person's legal representative,
if any, and the case manager of changes in a person's physical and mental health needs
affecting health service needs assigned to the license holder in the coordinated service and
support plan or the coordinated service and support plan addendum deleted text begin , when deleted text end new text begin as directed in
the coordinated service and support plan or within 24 hours of being new text end 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) 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, the license holder must 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 assistance or medication administration according to this
chapter;

(2) monitor health conditions according to written instructions from 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 a licensed health professional.

Sec. 8.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b, is
amended to read:

Subd. 1b.

Medication assistance.

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, deleted text begin the license holder must ensure that
the requirements of subdivision 2, paragraph (b), have been met when staff provides
deleted text end medication assistance new text begin must be provided new text end 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:

(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;

(2) bringing to the person liquids or food to accompany the medication; or

(3) providing reminders new text begin , in person, remotely, or through programming devices
such as telephones, alarms, or medication boxes, new text end to take regularly scheduled medication
or perform regularly scheduled treatments and exercises.

Sec. 9.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
amended to read:

Subdivision 1.

Incident response and reporting.

(a) The license holder must
respond to 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, 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, or as otherwise directed
in a person's coordinated service and support plan or coordinated service and support
plan addendum. 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 as
required in paragraph (b) and to 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 new text begin or serious
injury new text end , or receipt of information that the death new text begin or serious injury new text end occurred, unless the license
holder has reason to know that the death new text begin or serious injury new text end has already been reported.

(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 new text begin or serious injury new text end has already been reported.

(g) The license holder must conduct an internal review of incident reports 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, for identification of incident
patterns, and implementation of corrective action as necessary to reduce occurrences.
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.

(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.

Sec. 10.

Minnesota Statutes 2013 Supplement, section 245D.07, subdivision 2, is
amended to read:

Subd. 2.

Service planning requirements for basic support services new text begin and certain
intensive support services new text end .

(a) License holders providing basic support services new text begin or
intensive support services identified in section 245D.03, subdivision 1, paragraph (c),
clauses (1) and (2), new text end must meet the requirements of this subdivision.

(b) Within 15 new text begin calendar new text end days of service initiation the license holder must complete
a preliminary coordinated service and support plan addendum based on the coordinated
service and support plan.

(c) Within 60 new text begin calendar new text end days of service initiation the license holder must review
and revise as needed the preliminary coordinated service and support plan addendum to
document the services that will be provided including how, when, and by whom services
will be provided, and the person responsible for overseeing the delivery and coordination
of services.

(d) The license holder must participate in service planning and support team
meetings for the person following stated timelines established in the person's coordinated
service and support plan or as requested by the person or the person's legal representative,
the support team or the expanded support team.

Sec. 11.

Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 1,
is amended to read:

Subdivision 1.

Requirements for new text begin certain new text end intensive support services.

A license
holder providing intensive support services identified in section 245D.03, subdivision 1,
paragraph (c), new text begin clauses (3) to (5), new text end must comply with the requirements in this section and
section 245D.07, subdivisions 1 and 3.

Sec. 12.

Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
is amended to read:

Subd. 3.

Assessment and initial service planning.

(a) Within 15 new text begin calendar new text end days of
service initiation the license holder must complete a preliminary coordinated service and
support plan addendum based on the coordinated service and support plan.

(b) Within 45 new text begin calendar new text end days of service initiation the license holder must meet with
the person, the person's legal representative, the case manager, and other members of the
support team or expanded support team to assess and determine the following based on the
person's coordinated service and support plan and the requirements in subdivision 4 and
section 245D.07, subdivision 1a:

(1) the scope of the services to be provided to support the person's daily needs
and activities;

(2) the person's desired outcomes and the supports necessary to accomplish the
person's desired outcomes;

(3) the person's preferences for how services and supports are provided;

(4) whether the current service setting is the most integrated setting available and
appropriate for the person; and

(5) how services must be coordinated across other providers licensed under this
chapter serving the same person to ensure continuity of care for the person.

(c) Within the scope of services, the license holder must, at a minimum, assess
the following areas:

(1) the person's ability to self-manage health and medical needs to maintain or
improve physical, mental, and emotional well-being, including, when applicable, allergies,
seizures, choking, special dietary needs, chronic medical conditions, self-administration
of medication or treatment orders, preventative screening, and medical and dental
appointments;

(2) the person's ability to self-manage personal safety to avoid injury or accident in
the service setting, including, when applicable, risk of falling, mobility, regulating water
temperature, community survival skills, water safety skills, and sensory disabilities; and

(3) the person's ability to self-manage symptoms or behavior that may otherwise
result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7),
suspension or termination of services by the license holder, or other symptoms or
behaviors that may jeopardize the health and safety of the person or others.

The assessments must produce information about the person that is descriptive of the
person's overall strengths, functional skills and abilities, and behaviors or symptoms.

Sec. 13.

Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 4,
is amended to read:

Subd. 4.

Service outcomes and supports.

(a) Within ten working days of the
45-day meeting, the license holder must develop and document the service outcomes and
supports based on the assessments completed under subdivision 3 and the requirements
in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
coordinated service and support plan addendum.

(b) The license holder must document the supports and methods to be implemented
to support the accomplishment of outcomes related to acquiring, retaining, or improving
skills. The documentation must include:

(1) the methods or actions that will be used to support the person and to accomplish
the service outcomes, including information about:

(i) any changes or modifications to the physical and social environments necessary
when the service supports are provided;

(ii) any equipment and materials required; and

(iii) techniques that are consistent with the person's communication mode and
learning style;

(2) the measurable and observable criteria for identifying when the desired outcome
has been achieved and how data will be collected;

(3) the projected starting date for implementing the supports and methods and
the date by which progress towards accomplishing the outcomes will be reviewed and
evaluated; and

(4) the names of the staff or position responsible for implementing the supports
and methods.

(c) Within 20 working days of the 45-day meeting, the license holder must new text begin submit
to and new text end obtain dated signatures from the person or the person's legal representative and
case manager to document completion and approval of the assessment and coordinated
service and support plan addendum. new text begin If, within ten working days of the submission of the
assessment or coordinated service and support plan addendum, the person or the person's
legal representative or case manager has not signed and returned to the license holder the
assessment and coordinated service and support plan addendum or has not proposed
written modifications to the license holder's submission, the submission is deemed
approved and the assessment and coordinated service and support plan addendum become
effective and remain in effect until the legal representative or case manager submits a
written request to revise the assessment or coordinated service and support plan addendum.
new text end

Sec. 14.

Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 5,
is amended to read:

Subd. 5.

Progress reviews.

(a) The license holder must give the person or the
person's legal representative and case manager an opportunity to participate in the ongoing
review and development of the methods used to support the person and accomplish
outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
the person's support team or expanded support team, must meet with the person, the
person's legal representative, and the case manager, and participate in progress review
meetings following stated timelines established in the person's coordinated service and
support plan or coordinated service and support plan addendum or within 30 days of a
written request by the person, the person's legal representative, or the case manager,
at a minimum of once per year.

(b) The license holder must summarize the person's progress toward achieving the
identified outcomes and make recommendations and identify the rationale for changing,
continuing, or discontinuing implementation of supports and methods identified in
subdivision 4 deleted text begin in a written report sent to the person or the person's legal representative
and case manager five working days prior to the review meeting, unless the person, the
person's legal representative, or the case manager requests to receive the deleted text end new text begin in a new text end report
new text begin available new text end at the time of the new text begin progress review new text end meeting. new text begin The report must be sent five working
days prior to the progress review meeting if requested by the team in the coordinated
service and support plan or coordinated service and support plan addendum.
new text end

(c) Within ten working days of the progress review meeting, the license holder
must obtain dated signatures from the person or the person's legal representative and
the case manager to document approval of any changes to the coordinated service and
support plan addendum.

new text begin (d) If, within ten working days of the submission of the changes to the coordinated
service and support plan addendum, the person or the person's legal representative or case
manager has not signed and returned to the license holder the coordinated service and
support plan addendum or has not proposed written modifications to the license holder's
submission, the submission is deemed approved and the coordinated service and support
plan addendum becomes effective and remains in effect until the legal representative or
case manager submits a written request to revise the coordinated service and support plan.
new text end

Sec. 15.

Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 3, is
amended to read:

Subd. 3.

Staff qualifications.

(a) The license holder must ensure that staff providing
direct support, or staff who have responsibilities related to supervising or managing the
provision of direct support service, are competent as demonstrated through skills and
knowledge training, experience, and education to meet the person's needs and additional
requirements as written in the coordinated service and support plan or coordinated
service and support plan addendum, or when otherwise required by the case manager or
the federal waiver plan. The license holder must verify and maintain evidence of staff
competency, including documentation of:

(1) education and experience qualifications relevant to the job responsibilities
assigned to the staff and the needs of the general population of persons served by the
program, including a valid degree and transcript, or a current license, registration, or
certification, when a degree or licensure, registration, or certification is required by this
chapter or in the coordinated service and support plan or coordinated service and support
plan addendum;

(2) demonstrated competency in the orientation and training areas required under
this chapter, and when applicable, completion of continuing education required to
maintain professional licensure, registration, or certification requirements. Competency in
these areas is determined by the license holder through knowledge testing deleted text begin and deleted text end new text begin or new text end observed
skill assessment conducted by the trainer or instructor new text begin , the person served if the person is
self-directing services, or another person already deemed competent new text end ; and

(3) except for a license holder who is the sole direct support staff, periodic
performance evaluations completed by the license holder of the direct support staff
person's ability to perform the job functions based on direct observation.

(b) Staff under 18 years of age may not perform overnight duties or administer
medication.

Sec. 16.

Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4, is
amended to read:

Subd. 4.

Orientation to program requirements.

Except for a license holder
who does not supervise any direct support staff, within 60 new text begin calendar new text end days of hire, unless
stated otherwise, the license holder must provide and ensure completion of new text begin ten hours of
orientation for direct support staff providing basic services and new text end 30 hours of orientation
for direct support staff new text begin providing intensive services new text end that combines supervised on-the-job
training with review of and instruction in the following areas:

(1) the job description and how to complete specific job functions, including:

(i) responding to and reporting incidents as required under section 245D.06,
subdivision 1; and

(ii) following safety practices established by the license holder and as required in
section 245D.06, subdivision 2;

(2) the license holder's current policies and procedures required under this chapter,
including their location and access, and staff responsibilities related to implementation
of those policies and procedures;

(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
responsibilities related to complying with data privacy practices;

(4) the service recipient rights and staff responsibilities related to ensuring the
exercise and protection of those rights according to the requirements in section 245D.04;

(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
reporting and service planning for children and vulnerable adults, and staff responsibilities
related to protecting persons from maltreatment and reporting maltreatment. This
orientation must be provided within 72 hours of first providing direct contact services and
annually thereafter according to section 245A.65, subdivision 3;

(6) the principles of person-centered service planning and delivery as identified in
section 245D.07, subdivision 1a, and how they apply to direct support service provided
by the staff person; deleted text begin and
deleted text end

(7) new text begin the safe and correct use of manual restraint on an emergency basis according to
the requirements in section 245D.061 and what constitutes the use of restraints, time out,
and seclusion, including chemical restraint;
new text end

new text begin (8) staff responsibilities related to prohibited procedures under section 245D.06,
subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
or undesired behavior, and why such procedures are not safe;
new text end

new text begin (9) competence in providing basic first aid; and
new text end

new text begin (10) new text end other topics as determined necessary in the person's coordinated service and
support plan by the case manager or other areas identified by the license holder.

Sec. 17.

Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4a,
is amended to read:

Subd. 4a.

Orientation to individual service recipient needs.

(a) Before having
unsupervised direct contact with a person served by the program, or for whom the staff
person has not previously provided direct support, or any time the plans or procedures
identified in paragraphs (b) to deleted text begin (f) deleted text end new text begin (e) new text end are revised, the staff person must review and receive
instruction on the requirements in paragraphs (b) to deleted text begin (f) deleted text end new text begin (e) new text end as they relate to the staff
person's job functions for that person.

(b) new text begin For community residential services, new text end training and competency evaluations must
include the following new text begin , if identified in the coordinated service and support plan new text end :

(1) appropriate and safe techniques in personal hygiene and grooming, including
hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
daily living (ADLs) as defined under section 256B.0659, subdivision 1;

(2) an understanding of what constitutes a healthy diet according to data from the
Centers for Disease Control and Prevention and the skills necessary to prepare that diet; new text begin and
new text end

(3) skills necessary to provide appropriate support in instrumental activities of daily
living (IADLs) as defined under section 256B.0659, subdivision 1 deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (4) demonstrated competence in providing first aid.
deleted text end

(c) The staff person must review and receive instruction on the person's coordinated
service and support plan or coordinated service and support plan addendum as it relates
to the responsibilities assigned to the license holder, and when applicable, the person's
individual abuse prevention plan, to achieve and demonstrate an understanding of the
person as a unique individual, and how to implement those plans.

(d) The staff person must review and receive instruction on medication
administration procedures established for the person when medication administration is
assigned to the license holder according to section 245D.05, subdivision 1, paragraph
(b). Unlicensed staff may administer medications only after successful completion of a
medication administration training, from a training curriculum developed by a registered
nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
practitioner, physician's assistant, or physician. The training curriculum must incorporate
an observed skill assessment conducted by the trainer to ensure staff demonstrate the
ability to safely and correctly follow medication procedures.

Medication administration must be taught by a registered nurse, clinical nurse
specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
service initiation or any time thereafter, the person has or develops a health care condition
that affects the service options available to the person because the condition requires:

(1) specialized or intensive medical or nursing supervision; and

(2) nonmedical service providers to adapt their services to accommodate the health
and safety needs of the person.

(e) The staff person must review and receive instruction on the safe and correct
operation of medical equipment used by the person to sustain life, including but not
limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
by a licensed health care professional or a manufacturer's representative and incorporate
an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
operate the equipment according to the treatment orders and the manufacturer's instructions.

(f) deleted text begin The staff person must review and receive instruction on what constitutes use of
restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
related to the prohibitions of their use according to the requirements in section 245D.06,
subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
or undesired behavior and why they are not safe, and the safe and correct use of manual
restraint on an emergency basis according to the requirements in section 245D.061.
deleted text end

deleted text begin (g) deleted text end In the event of an emergency service initiation, the license holder must ensure
the training required in this subdivision occurs within 72 hours of the direct support staff
person first having unsupervised contact with the person receiving services. The license
holder must document the reason for the unplanned or emergency service initiation and
maintain the documentation in the person's service recipient record.

deleted text begin (h) deleted text end new text begin (g) new text end License holders who provide direct support services themselves must
complete the orientation required in subdivision 4, clauses (3) to deleted text begin (7) deleted text end new text begin (10) new text end .

Sec. 18.

Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 5, is
amended to read:

Subd. 5.

Annual training.

A license holder must provide annual training to direct
support staff on the topics identified in subdivision 4, clauses (3) to deleted text begin (7), and subdivision
4a deleted text end new text begin (10) new text end . A license holder must provide a minimum of 24 hours of annual training to
direct service staff deleted text begin with deleted text end new text begin providing intensive services and having new text end fewer than five years
of documented experience and 12 hours of annual training to direct service staff deleted text begin with
deleted text end new text begin providing intensive services and having new text end five or more years of documented experience in
topics described in subdivisions 4 and 4a, paragraphs (a) to deleted text begin (h) deleted text end new text begin (g) new text end . Training on relevant
topics received from sources other than the license holder may count toward training
requirements. new text begin A license holder must provide a minimum of 12 hours of annual training
to direct service staff providing basic services and having fewer than five years of
documented experience and six hours of annual training to direct service staff providing
basic services and having five or more years of documented experience.
new text end

Sec. 19.

Minnesota Statutes 2013 Supplement, section 245D.095, subdivision 3,
is amended to read:

Subd. 3.

Service recipient record.

(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. 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.

(b) The license holder must maintain the following information for each person:

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

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

(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;

(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;

(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:

(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;

(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;

(iii) medication administration procedures;

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

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

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

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

(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;

(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);

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

(9) documentation of complaints received and grievance resolution;

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

(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

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

Sec. 20.

Minnesota Statutes 2013 Supplement, section 245D.22, subdivision 4, is
amended to read:

Subd. 4.

First aid must be available on site.

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

(b) A facility must have first aid kits readily available for use by, and that meet
the needs of, persons receiving services and staff. At a minimum, the first aid kit must
be equipped with accessible first aid supplies including bandages, sterile compresses,
scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
adhesive tape, and first aid manual.

Sec. 21.

Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 3, is
amended to read:

Subd. 3.

Staff ratio requirement for each person receiving services.

The case
manager, in consultation with the interdisciplinary team, must determine at least once each
year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
assigned each person and the documentation of how the ratio was arrived at must be kept
in each person's individual service plan. Documentation must include an assessment of the
person with respect to the characteristics in subdivisions 4, 5, and 6 deleted text begin recorded on a standard
assessment form required by the commissioner deleted text end .

Sec. 22.

Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 4, is
amended to read:

Subd. 4.

Person requiring staff ratio of one to four.

A person must be assigned a
staff ratio requirement of one to four if:

(1) on a daily basis the person requires total care and monitoring or constant
hand-over-hand physical guidance to successfully complete at least three of the following
activities: toileting, communicating basic needs, eating, ambulating; or deleted text begin is not capable of
taking appropriate action for self-preservation under emergency conditions; or
deleted text end

(2) the person engages in conduct that poses an imminent risk of physical harm to
self or others at a documented level of frequency, intensity, or duration requiring frequent
daily ongoing intervention and monitoring as established in the person's coordinated
service and support plan or coordinated service and support plan addendum.

Sec. 23.

Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 5, is
amended to read:

Subd. 5.

Person requiring staff ratio of one to eight.

A person must be assigned a
staff ratio requirement of one to eight if:

(1) the person does not meet the requirements in subdivision 4; and

(2) on a daily basis the person requires verbal prompts or spot checks and minimal
or no physical assistance to successfully complete at least deleted text begin four deleted text end new text begin three new text end of the following
activities: toileting, communicating basic needs, eating, new text begin or new text end ambulating deleted text begin , or taking
appropriate action for self-preservation under emergency conditions deleted text end .

Sec. 24. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 2, new text end new text begin is repealed.
new text end