SF 3734

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/16/2024 09:22am

A bill for an act
relating to human services; modifying home and community-based services
standards; amending Minnesota Statutes 2022, sections 245D.071, subdivisions
3, 4; 245D.081, subdivisions 2, 3; 245D.09, subdivisions 3, 4.

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

Section 1.

Minnesota Statutes 2022, section 245D.071, subdivision 3, is amended to read:

Subd. 3.

Assessment and initial service planning.

(a) Within 15 days of service initiation
the license holder must complete a preliminary support plan addendum based on the support
plan.

(b) Within the scope of services, the license holder must, at a minimum, complete
assessments in the following areas before deleted text begin the 45-day planning meeting deleted text end new text begin providing 45 days
of service or within 60 calendar days of service initiation, whichever is shorter new text end :

(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 welfare of the person or others.

Assessments must produce information about the person that describes the person's overall
strengths, functional skills and abilities, and behaviors or symptoms. Assessments must be
based on the person's status within the last 12 months at the time of service initiation.
Assessments based on older information must be documented and justified. Assessments
must be conducted annually at a minimum or within 30 days of a written request from the
person or the person's legal representative or case manager. The results must be reviewed
by the support team or expanded support team as part of a service plan review.

(c) Before providing 45 days of service or within 60 calendar days of service initiation,
whichever is shorter, the license holder must meet with the person, the person's legal
representative, the case manager, other members of the support team or expanded support
team, and other people as identified by the person or the person's legal representative to
determine the following based on information obtained from the assessments identified in
paragraph (b), the person's identified needs in the 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, including how
the provider will support the person to have control of the person's schedule;

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

(5) opportunities to develop and maintain essential and life-enriching skills, abilities,
strengths, interests, and preferences;

(6) opportunities for community access, participation, and inclusion in preferred
community activities;

(7) opportunities to develop and strengthen personal relationships with other persons of
the person's choice in the community;

(8) opportunities to seek competitive employment and work at competitively paying
jobs in the community; and

(9) how services must be coordinated across other providers licensed under this chapter
serving the person and members of the support team or expanded support team to ensure
continuity of care and coordination of services for the person.

(d) A discussion of how technology might be used to meet the person's desired outcomes
must be included in the deleted text begin 45-day deleted text end new text begin initial new text end planning meeting. The support plan or support plan
addendum must include a summary of this discussion. The summary must include a statement
regarding any decision that is made regarding the use of technology and a description of
any further research that needs to be completed before a decision regarding the use of
technology can be made. Nothing in this paragraph requires that the support plan include
the use of technology for the provision of services.

Sec. 2.

Minnesota Statutes 2022, section 245D.071, subdivision 4, is amended to read:

Subd. 4.

Service outcomes and supports.

(a) Within ten working days of the deleted text begin 45-day deleted text end new text begin
initial new text end planning meeting, the license holder must develop a service plan that documents 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 support plan addendum.

(b) The license holder must document the supports and methods to be implemented to
support the person and accomplish outcomes related to acquiring, retaining, or improving
skills and physical, mental, and emotional health and well-being. 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 deleted text begin 45-day deleted text end new text begin initial planning new text end meeting, the license holder
must submit to and obtain dated signatures from the person or the person's legal representative
and case manager to document completion and approval of the assessment and support plan
addendum. If, within ten working days of the submission of the assessment or 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 support plan addendum or has not
proposed written modifications to the license holder's submission, the submission is deemed
approved and the assessment 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 support plan addendum.

Sec. 3.

Minnesota Statutes 2022, section 245D.081, subdivision 2, is amended to read:

Subd. 2.

Coordination and evaluation of individual service delivery.

(a) Delivery
and evaluation of services provided by the license holder must be coordinated by a designated
staff person. Except as provided in clause (3), the designated coordinator must provide
supervision, support, and evaluation of activities that include:

(1) oversight of the license holder's responsibilities assigned in the person's support plan
and the support plan addendum;

(2) taking the action necessary to facilitate the accomplishment of the outcomes according
to the requirements in section 245D.07;

(3) instruction and assistance to direct support staff implementing the support plan and
the service outcomes, including direct observation of service delivery sufficient to assess
staff competency. The designated coordinator may delegate the direct observation and
competency assessment of the service delivery activities of direct support staff to an
individual whom the designated coordinator has previously deemed competent in those
activities; and

(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
the person's outcomes based on the measurable and observable criteria for identifying when
the desired outcome has been achieved according to the requirements in section 245D.07.

(b) The license holder must ensure that the designated coordinator is competent to
perform the required duties identified in paragraph (a) through education, training, and work
experience relevant to the primary disability of persons served by the license holder and
the individual persons for whom the designated coordinator is responsible. The designated
coordinator must have the skills and ability necessary to develop effective plans and to
design and use data systems to measure effectiveness of services and supports. The license
holder must verify and document competence according to the requirements in section
245D.09, subdivision 3. The designated coordinator must minimally have:

(1) a baccalaureate degree deleted text begin in a field related to human services, deleted text end and one year of full-time
work experience providing direct care services to persons with disabilities or persons age
65 and older;

(2) an associate degree deleted text begin in a field related to human services, deleted text end and two years of full-time
work experience providing direct care services to persons with disabilities or persons age
65 and older;

(3) a diploma deleted text begin in a field related to human services deleted text end from an accredited postsecondary
institution and three years of full-time work experience providing direct care services to
persons with disabilities or persons age 65 and older; or

(4) a minimum of 50 hours of education and training related to human services and
disabilities; and

(5) four years of deleted text begin full-time work deleted text end experience providing direct care services to persons
with disabilities or persons age 65 and older deleted text begin under the supervision of a staff person who
meets the qualifications identified in clauses (1) to (3) deleted text end .

Sec. 4.

Minnesota Statutes 2022, section 245D.081, subdivision 3, is amended to read:

Subd. 3.

Program management and oversight.

(a) The license holder must designate
a managerial staff person or persons to provide program management and oversight of the
services provided by the license holder. The designated manager is responsible for the
following:

(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g);

(2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;

(3) ensuring the program implements corrective action identified as necessary by the
program following review of incident and emergency reports according to the requirements
in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of
alleged or suspected maltreatment must be conducted according to the requirements in
section 245A.65, subdivision 1, paragraph (b);

(4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress toward
accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring and
protecting each person's rights as identified in section 245D.04;

(5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;

(6) ensuring corrective action is taken when ordered by the commissioner and that the
terms and conditions of the license and any variances are met; and

(7) evaluating the information identified in clauses (1) to (6) to develop, document, and
implement ongoing program improvements.

(b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision 2,
paragraph (b), and have a minimum of three years of supervisory level experience deleted text begin in a
program providing direct support services to persons with disabilities or persons age 65 and
older deleted text end .

Sec. 5.

Minnesota Statutes 2022, 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 relevant to the primary disability of the
person and to meet the person's needs and additional requirements as written in the support
plan or 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 to the primary disability 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 support plan or
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 or observed skill assessment
conducted by the trainer or instructor or by an individual who has been previously deemed
competent by the trainer or instructor in the area being assessed; 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 deleted text begin or administer
medication deleted text end .

Sec. 6.

Minnesota Statutes 2022, 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 calendar days of hire, unless stated otherwise,
the license holder must provide and ensure completion of orientation sufficient to create
staff competency for direct support staff 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, and 626.557 and chapter 260E 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 (7) the safe and correct use of manual restraint on an emergency basis according to the
requirements in section 245D.061 or successor provisions, and what constitutes the use of
restraints, time out, and seclusion, including chemical restraint;
deleted text end

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

deleted text begin (9) deleted text end new text begin (7) new text end basic first aid;

deleted text begin (10) deleted text end new text begin (8) new text end strategies to minimize the risk of sexual violence, including concepts of healthy
relationships, consent, and bodily autonomy of people with disabilities; and

deleted text begin (11) deleted text end new text begin (9) new text end other topics as determined necessary in the person's support plan by the case
manager or other areas identified by the license holder.