HF 908

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; expanding a quality assurance system to include
additional service recipients; establishing a statewide quality assurance and
improvement system; establishing a State Quality Commission; removing
sunset dates; appropriating money; amending Minnesota Statutes 2006, sections
256B.095; 256B.0951, subdivision 1; proposing coding for new law in Minnesota
Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2006, section 256B.095, is amended to read:

256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.

(a) Effective July 1, 1998, a quality assurance system for persons with developmental
disabilities, which includes an alternative quality assurance licensing system for programs,
is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice,
Steele, Wabasha, and Winona Counties for the purpose of improving the quality of
services provided to persons with developmental disabilities. A county, at its option, may
choose to have all programs for persons with developmental disabilities located within
the county licensed under chapter 245A using standards determined under the alternative
quality assurance licensing system or may continue regulation of these programs under the
licensing system operated by the commissioner. deleted text begin The project expires on June 30, 2009.
deleted text end

(b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to
participate in the quality assurance system established under paragraph (a). The
commission established under section 256B.0951 may, at its option, allow additional
counties to participate in the system.

(c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a)
may establish a quality assurance system under this section. A new system established
under this section shall have the same rights and duties as the system established
under paragraph (a). A new system shall be governed by a commission under section
256B.0951. The commissioner shall appoint the initial commission members based
on recommendations from advocates, families, service providers, and counties in the
geographic area included in the new system. Counties that choose to participate in a
new system shall have the duties assigned under section 256B.0952. The new system
shall establish a quality assurance process under section 256B.0953. The provisions of
section 256B.0954 shall apply to a new system established under this paragraph. The
commissioner shall delegate authority to a new system established under this paragraph
according to section 256B.0955.

new text begin (d) Effective July 1, 2007, the quality assurance system may be expanded to include
programs for persons with disabilities and older adults.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.0951, subdivision 1, is amended to read:

Subdivision 1.

Membership.

The Quality Assurance Commission is established.
The commission consists of at least 14 but not more than 21 members as follows: at
least three but not more than five members representing advocacy organizations; at
least three but not more than five members representing consumers, families, and their
legal representatives; at least three but not more than five members representing service
providers; at least three but not more than five members representing counties; and the
commissioner of human services or the commissioner's designee. The first commission
shall establish membership guidelines for the transition and recruitment of membership for
the commission's ongoing existence. Members of the commission who do not receive a
salary or wages from an employer for time spent on commission duties may receive a per
diem payment when performing commission duties and functions. All members may be
reimbursed for expenses related to commission activities. deleted text begin Notwithstanding the provisions
of section 15.059, subdivision 5, the commission expires on June 30, 2009.
deleted text end

Sec. 3.

new text begin [256B.096] STATE AND REGIONAL QUALITY ASSURANCE AND
IMPROVEMENT SYSTEM FOR MINNESOTANS RECEIVING DISABILITY
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin In order to improve the quality of services provided to
Minnesotans with disabilities, a statewide quality assurance and improvement system
for Minnesotans receiving disability services is established. The disability services
included are the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, traumatic brain injury,
and for those who qualify for nursing facility or hospital levels of care under section
256B.49; home care services under section 256B.0651; family support grant under section
252.32; consumer support grant under section 256.476; and semi-independent living
services under section 252.275. The statewide quality assurance and improvement system
shall include a state quality commission, six regional quality councils, an outcome based
quality review component, and a comprehensive system for effective incident reporting,
investigation, analysis, and follow-up.
new text end

new text begin Subd. 2. new text end

new text begin State Quality Commission. new text end

new text begin (a) The commissioner shall appoint the
members of the State Quality Commission, including representatives from the following
groups: disability service recipients; at least one member from each regional quality
council; disability service providers; disability advocacy groups; county human service
agencies; and state agency staff from the Departments of Human Services, Health, and the
Office of the Ombudsman for Mental Health and Developmental Disabilities.
new text end

new text begin (b) The State Quality Commission shall assist the Departments of Human Services
and Health in fulfilling federally mandated obligations by monitoring disability service
quality and quality assurance and improvement practices in Minnesota, establishing state
quality improvement priorities with methods for achieving results, and providing an
annual report to the legislative committees with jurisdiction over policy and funding of
disability services on the outcomes, improvement priorities, and activities undertaken by
the commission during the previous state fiscal year.
new text end

new text begin Subd. 3. new text end

new text begin Regional quality councils. new text end

new text begin (a) The commissioner shall establish six
regional quality councils of key stakeholders including regional representatives of
disability service recipients, disability service providers, disability advocacy groups,
county government, and state agency regional staff from the Departments of Human
Services, Health, and the Office of the Ombudsman for Mental Health and Developmental
Disabilities who are appointed by the State Quality Commission.
new text end

new text begin (b) The regional councils shall:
new text end

new text begin (1) direct and monitor outcome-based quality assurance programs;
new text end

new text begin (2) analyze and review quality outcomes and critical incident data;
new text end

new text begin (3) provide information and training programs for persons with disabilities, including
service recipients and their caregivers, on service options and quality expectations;
new text end

new text begin (4) disseminate information and resources developed to other regional quality
councils;
new text end

new text begin (5) respond to state level priorities;
new text end

new text begin (6) establish regional priorities for quality improvement;
new text end

new text begin (7) submit an annual report to the State Quality Commission on the status, outcomes,
and improvement priorities and activities in the region;
new text end

new text begin (8) choose a representative to participate on the State Quality Commission; and
new text end

new text begin (9) assume other responsibilities consistent with the priorities of the State Quality
Commission.
new text end

new text begin (c) The regional councils shall maintain staff and manage resources needed,
consistent with funding and direction from the commissioner in consultation with the
State Quality Commission.
new text end

new text begin Subd. 4. new text end

new text begin Annual survey of service recipients. new text end

new text begin The commissioner, in consultation
with the State Quality Commission, shall conduct an annual independent statewide survey
of at least five to ten percent of service recipients, randomly selected, to determine the
effectiveness and quality of disability services. The survey shall be consistent with the
system performance expectations of the Centers for Medicare and Medicaid Services
(CMS) Quality Framework and analyze whether desired outcomes for persons with
different demographic, diagnostic, health, and functional needs, receiving different types
of services, in different settings, with different costs, have been achieved. Annual
statewide and regional reports of the results will be published for use by regions, counties,
and providers to plan and measure the impact of quality improvement activities.
new text end

new text begin Subd. 5. new text end

new text begin Outcome-based quality review. new text end

new text begin The state commission shall designate an
outcome-based quality review program to assure that quality assessment and licensing
practices are founded on valid, reliable assessments in areas consistent with the CMS
Quality Framework. The outcome-based quality review process shall:
new text end

new text begin (1) be designed and implemented based on the work of the State Quality Commission
and Regional Councils, information from the statewide service user survey, and the
incident reporting data;
new text end

new text begin (2) cover both licensed and unlicensed services;
new text end

new text begin (3) include outcome-based interviews of a sufficient sample of individuals and
caregivers served by an agency to provide reliable information which can be used to
determine the level of service quality, issue program licenses as needed, recommend
remedial activities, and determine the need for general and specific training, technical
assistance, consumer education, and other service improvement activities; and
new text end

new text begin (4) be available for use by regional councils for an alternative quality assurance
program should counties in a region seek to develop an alternative to the state licensure
system pursuant to the process established under sections 256B.095 to 256B.0955.
new text end

new text begin Subd. 6. new text end

new text begin Incident reporting, investigation, analysis, and follow-up
improvements. new text end

new text begin (a) The commissioner shall improve the system of incident reporting,
including reports made under the Maltreatment of Minors and Vulnerable Adults Acts,
investigation, analysis, and follow-up for disability services to assure that incidents
that may have jeopardized safety, health, civil and human rights, service-related
assurances, and other protections to prevent abuse, neglect, and exploitation are reviewed,
investigated, and acted upon in a timely manner.
new text end

new text begin (b) Information, data, and analysis from the reporting system shall be used at the
provider, county, and regional levels to improve services for recipients and shall be
provided in a standardized format on a regular basis to regional quality councils, the State
Quality Commission, and appropriate state and county agencies.
new text end

new text begin Subd. 7. new text end

new text begin Effective date. new text end

new text begin (a) Subdivisions 1 to 4 and 6 are effective July 1, 2007,
subject to the following phased implementation:
new text end

new text begin (1) the State Quality Commission and at least two regional quality councils, one
in southeastern Minnesota and the other to be designated by the commissioner, shall
begin July 1, 2008;
new text end

new text begin (2) two additional regional councils must be established by January 1, 2010;
new text end

new text begin (3) the remaining two regional councils must be established by July 1, 2011;
new text end

new text begin (4) the statewide survey of service recipients shall be developed beginning July
1, 2007, and field-tested during calendar year 2008 with implementation beginning on
or before January 31, 2009; and
new text end

new text begin (5) beginning July 1, 2007, in consultation with a stakeholder workgroup, the
commissioner shall develop, design, and make recommendations for improvements in the
incident reporting, analysis, and data systems.
new text end

new text begin (b) Subdivision 5 is effective July 1, 2009. The outcome-based quality review
process shall be designed and implemented based on the work of the State Quality
Commission and regional councils, information from the statewide service user survey,
and the incident reporting data, as funding allows after July 1, 2009.
new text end

Sec. 4. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the general fund to the commissioner of human
services for the biennium beginning July 1, 2007, for the purposes of section 1.
new text end

new text begin (b) $....... is appropriated from the general fund to the commissioner of human
services for fiscal year 2008 to develop and establish the quality assurance and
improvement system according to the schedule set forth under Minnesota Statutes, section
256B.096, subdivision 7. Federal Medicaid match obtained for this purpose shall be
dedicated to the commissioner for this purpose.
new text end

new text begin (c) $....... in fiscal year 2008 and $....... in fiscal year 2009 are appropriated from
the general fund to the commissioner of human services for the implementation of the
quality assurance and improvement system. Federal Medicaid match obtained for this
purpose shall be dedicated to the commissioner for this purpose. This appropriation is
added to the agency's base.
new text end