SF 4064

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/19/2024 09:22am

A bill for an act
relating to health; establishing requirements for hospital behavioral health crisis
intervention teams; establishing a behavioral health crisis intervention grant
program for hospitals; modifying provisions preventing violence against health
care workers; requiring public disclosure of emergency department wait times;
appropriating money; amending Minnesota Statutes 2022, section 144.55, by
adding a subdivision; Minnesota Statutes 2023 Supplement, section 144.566,
subdivisions 10, 15, by adding subdivisions; proposing coding for new law in
Minnesota Statutes, chapter 144.

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

Section 1.

Minnesota Statutes 2022, section 144.55, is amended by adding a subdivision
to read:

new text begin Subd. 3c. new text end

new text begin Standards for emergency rooms. new text end

new text begin (a) A hospital must maintain on its website
and publicly display in its emergency department the approximate wait time for patients
who are not in critical need of emergency care. The approximate wait time must be updated
at least hourly.
new text end

new text begin (b) A hospital must maintain a log of every patient who leaves its emergency department
after checking in but before receiving care. The log must document the reason the patient
left, if known, and the length of time the patient waited before leaving or, if the length of
time the patient waited is unknown, the length of time between the time the patient checked
in and the hospital determined the patient left without receiving care. The patient log required
under this paragraph must be made available to the commissioner of health immediately
upon request. A copy of the patient log with all personally identifiable information removed,
or summary data of the information in the patient log, must be made available to union
representatives within 30 days of a request.
new text end

Sec. 2.

Minnesota Statutes 2023 Supplement, section 144.566, subdivision 10, is amended
to read:

Subd. 10.

new text begin Safety new text end training required.

A hospital must provide training to all health care
workers employed or contracted with the hospital on safety during acts of violence. Each
health care worker must receive safety training during the health care worker's orientation
and before the health care worker completes a shift independently, and annually thereafter.
Training must, at a minimum, include:

(1) safety guidelines for response to deleted text begin and de-escalation of deleted text end an act of violence;

(2) ways to identify potentially violent or abusive situations, including aggression and
violence predicting factors;

(3) the hospital's preparedness and incident response action plans for acts of violence,
including how the health care worker may report concerns about workplace violence within
each hospital's reporting structure without fear of reprisal, how the hospital will address
workplace violence incidents, and how the health care worker can participate in reviewing
and revising the plan; and

(4) any resources available to health care workers for coping with incidents of violence,
including but not limited to critical incident stress debriefing or employee assistance
programs.

Sec. 3.

Minnesota Statutes 2023 Supplement, section 144.566, is amended by adding a
subdivision to read:

new text begin Subd. 10a. new text end

new text begin De-escalation training required. new text end

new text begin A hospital must provide de-escalation
training to all health care workers employed or under contract with the hospital. The
de-escalation training must, at a minimum, include four hours of training covering the
following topics:
new text end

new text begin (1) understanding violence in health care settings and violence-induced stress among
health care workers;
new text end

new text begin (2) recognizing escalating aggression and techniques for de-escalating aggression and
violence;
new text end

new text begin (3) managing post-traumatic stress disorder;
new text end

new text begin (4) minimizing potentially violent situations through effective patient communication;
new text end

new text begin (5) effective whole-person and whole-family interventions;
new text end

new text begin (6) trauma-informed care; and
new text end

new text begin (7) implicit bias and antiracism.
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 144.566, subdivision 15, is amended
to read:

Subd. 15.

Legislative report required.

(a) Beginning January 15, 2026, the commissioner
must compile the information new text begin submitted to the commissioner under subdivision 14 and the
commissioner's evaluation of hospitals' compliance with section 144.567 new text end into a single annual
report and submit the report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care by January 15 of each year.

(b) This subdivision does not expire.

Sec. 5.

Minnesota Statutes 2023 Supplement, section 144.566, is amended by adding a
subdivision to read:

new text begin Subd. 18. new text end

new text begin Reports of acts or threats of violence. new text end

new text begin (a) When implementing the required
reporting procedures under subdivision 7, all hospitals must provide a secure online portal
through which health care workers can submit a report of a violent incident or threat of
violence that occurred in the hospital or on hospital grounds. Hospitals must retain all data
submitted through the online portal for a minimum of seven years from the date on which
the data were submitted.
new text end

new text begin (b) The data submitted through the online portal must be made available to appropriate
hospital personnel and upon request to the commissioner of health. A copy of data submitted
through the online portal with all personally identifiable information removed or, if requested,
summary data of the information submitted, must be made available to union representatives
within 30 days of a request.
new text end

new text begin (c) The online portal must include data fields allowing a health care worker to submit:
new text end

new text begin (1) the date, time, and location of the act of violence or threat of violence;
new text end

new text begin (2) the names and job titles of all health care workers known by the submitting health
care worker to have been victims and witnesses of the act or threat of violence;
new text end

new text begin (3) the names and job titles of all health care workers known by the submitting health
care worker to have responded to the act or threat of violence;
new text end

new text begin (4) a classification of the perpetrator;
new text end

new text begin (5) a description of the act or threat of violence;
new text end

new text begin (6) a description of the incident response;
new text end

new text begin (7) the nature and extent of any injuries known by the submitting health care worker to
have been suffered by health care workers; and
new text end

new text begin (8) a description of the staffing levels at the time of the act or threat of violence and the
submitting health care worker's opinion concerning whether staffing levels contributed to
the incident.
new text end

Sec. 6.

new text begin [144.567] BEHAVIORAL HEALTH CRISIS INTERVENTION TEAMS.
new text end

new text begin Subdivision 1. new text end

new text begin Behavioral health crisis intervention teams required. new text end

new text begin All hospitals
must establish and maintain behavioral health crisis intervention teams according to the
requirements of this section. At least one member of the behavioral health crisis intervention
team listed in subdivision 3 who is a licensed medical professional and authorized to
administer all medications that may be required during a behavioral health crisis intervention
must be available on site at all times to respond promptly to any behavioral health crisis
that occurs in the hospital.
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 and section 144.568, the
following terms have the meanings given.
new text end

new text begin (b) "Behavioral health crisis" means physical aggression toward self or others or
destruction of property that requires the immediate response of another person.
new text end

new text begin (c) "Crisis intervention" means face-to-face, short-term intensive mental health services
initiated during a behavioral health crisis to help a patient cope with immediate stressors,
identify and utilize available resources and patient strengths, and begin to return to the
patient's baseline level of functioning. Crisis intervention does not include the use of violence,
physical holds, mechanical restraints, or chemical restraints to immobilize a patient unless
the physical hold, mechanical restraint, or chemical restraint is necessary to conduct a
medical examination or treatment.
new text end

new text begin (c) "Hospital" means a general acute care hospital licensed under sections 144.50 to
144.58.
new text end

new text begin (d) "Licensed medical professional" means one of the following, licensed by the
profession's licensing board: (1) a doctor of medicine or osteopathy; (2) a registered nurse;
or (3) a practical nurse.
new text end

new text begin (e) "Licensed mental health professional" means a psychologist or clinical social worker
licensed by the profession's licensing board.
new text end

new text begin Subd. 3. new text end

new text begin Behavioral health crisis intervention team. new text end

new text begin (a) Each behavioral health crisis
intervention team must include at least four members and all members must have completed
the training required under subdivision 10.
new text end

new text begin (b) Each behavioral health crisis intervention team must include at least:
new text end

new text begin (1) three licensed medical professionals who have experience and competency in
providing psychiatric care, of whom at least one must be a registered nurse and of whom
at least one must be either an additional registered nurse or a licensed practical nurse;
new text end

new text begin (2) one licensed mental health professional who has experience and competency in
responding to the psychosocial needs of patients; and
new text end

new text begin (3) any additional health care staff necessary to ensure the care needs of a patient
experiencing a behavioral health crisis can be met.
new text end

new text begin (c) Health care staff who are not members of the behavioral crisis intervention team are
not permitted to perform behavioral health crisis interventions but may support the behavioral
health crisis intervention team during a behavioral health crisis.
new text end

new text begin (d) When scheduled to serve on the behavioral health crisis intervention team, hospitals
must not assign team members any duties or tasks that would prevent the team member
from promptly responding to a behavioral health crisis and immediately participating in an
intervention until the resolution of the crisis.
new text end

new text begin (e) A hospital must treat a response by behavioral health crisis intervention team members
as a supplemental emergency service and must not regard the presence of team members
on a unit as a replacement for health care staff who would otherwise be assigned to the unit
to provide care for the patient experiencing a behavioral health crisis or any other patient
on the unit.
new text end

new text begin Subd. 4. new text end

new text begin Behavioral health crisis intervention. new text end

new text begin (a) Hospital staff must seek assistance
from the behavioral health crisis intervention team when hospital staff believe that a patient
is experiencing a behavioral health crisis or that a patient is at risk of an imminent behavioral
health crisis.
new text end

new text begin (b) A member of the behavioral health crisis intervention team must respond promptly
and in person to all requests for assistance from the team.
new text end

new text begin (c) For each behavioral health crisis intervention, one crisis intervention team member
must be designated the team lead. The team lead must determine what intervention method
is most appropriate and promptly organize an intervention plan.
new text end

new text begin Subd. 5. new text end

new text begin Behavioral health crisis intervention follow-up; crisis intervention team
responsibilities. new text end

new text begin After a behavioral health crisis intervention, the behavioral health crisis
intervention team must conduct an informal debriefing to determine if: (1) policies and
procedures were followed prior to and during the intervention; (2) the best outcome for the
patient was achieved; and (3) improvement to the intervention process is needed to better
serve the needs of patients experiencing a behavioral health crisis. The behavioral health
crisis intervention team may make recommendations to the hospital administration for
improving crisis interventions in the future.
new text end

new text begin Subd. 6. new text end

new text begin Behavioral health crisis intervention follow-up; care team
responsibilities. new text end

new text begin (a) After a behavioral health crisis intervention, the care team of the patient
who experienced the behavioral health crisis must review the patient's care plan and
implement an updated person-centered care plan to minimize the chances of a recurrence
of a behavioral health crisis. When preparing the updated care plan, the care team must
consult the patient's physician to determine if the patient's treatment plan needs to be adjusted.
new text end

new text begin (b) The patient's updated care plan must:
new text end

new text begin (1) address in observable and measurable terms where, when, and with whom the
behavioral health crisis occurred and determine if adjustments to the patient's care, care
team, or environment are necessary to minimize known antecedents and triggers of the
patient's prior behavioral health crises;
new text end

new text begin (2) include what interventions and strategies were previously implemented to prevent
the patient from experiencing a behavioral health crisis and the efficacy of those interventions
and strategies;
new text end

new text begin (3) provide recommendations on the best de-escalation strategies for the patient; and
new text end

new text begin (4) set a staffing level and patient status observation schedule for the patient to ensure
the care plan is followed and the patient's needs are met in a timely manner.
new text end

new text begin (c) The care team of the patient who experienced the behavioral health crisis must ensure
all care plans are appropriately transferred if the patient's care is transferred to other health
care staff or to a different unit or facility.
new text end

new text begin Subd. 7. new text end

new text begin Behavioral health crisis intervention follow-up; hospital
responsibilities. new text end

new text begin After a behavioral health crisis intervention, the hospital administration
must:
new text end

new text begin (1) provide options for affected staff to leave their shift and return to work when they
are fit to do so;
new text end

new text begin (2) ensure the patient's electronic health record is modified to display a conspicuous
notice alerting members of the patient's care team that the patient recently experienced a
behavioral health crisis requiring a response from the behavioral health crisis intervention
team;
new text end

new text begin (3) contact affected staff to provide support and referrals to employee assistance plans,
mental health programs, and other available resources;
new text end

new text begin (4) conduct a thorough investigation of the circumstances precipitating the behavioral
health crisis, including staffing levels at the time of the behavioral health crisis, and
documenting direct care staff concerns about staffing levels;
new text end

new text begin (5) provide recommendations to the workplace violence prevention action plan team
under section 144.566 for remedial action and remedies around staffing levels;
new text end

new text begin (6) review incidents, staffing levels, and documentation to ensure behavioral health crisis
prevention strategies are implemented and added to the workplace violence prevention
action plan under section 144.566;
new text end

new text begin (7) submit a violence incident report to the workplace violence prevention action plan
team under section 144.566; and
new text end

new text begin (8) submit to the workplace violence prevention action plan team any recommendations
for improving crisis interventions in the future that the behavioral health crisis intervention
team may have submitted to the hospital administration under subdivision 5.
new text end

new text begin Subd. 8. new text end

new text begin Required behavioral health crisis intervention policies. new text end

new text begin All hospitals must
adopt and implement policies governing a behavioral health crisis intervention team's
response when hospital staff believe a patient is experiencing a behavioral health crisis or
believe a patient is at risk of an imminent behavioral health crisis. The behavioral health
crisis intervention policies must include the names or job titles of the hospital staff responsible
for implementing the behavioral health crisis intervention policies. The behavioral health
crisis intervention policies must include procedures for:
new text end

new text begin (1) creating a behavioral health crisis intervention team that meets the requirements of
subdivision 3;
new text end

new text begin (2) identifying and assessing a patient's condition to determine the need for response or
intervention by a behavioral health crisis intervention team member;
new text end

new text begin (3) ambulance personnel to request that a behavioral health crisis intervention team be
available to assist when the ambulance arrives at the hospital;
new text end

new text begin (4) training all hospital staff to seek assistance from the behavioral health intervention
team when appropriate or to call emergency services;
new text end

new text begin (5) training of behavioral health crisis intervention team members that meet the
requirements of subdivision 10;
new text end

new text begin (6) ensuring at least one member of the behavioral health crisis intervention team listed
in subdivision 3, who is a licensed medical professional and authorized to administer all
medications that may be required during a behavioral health crisis intervention, is available
on site at all times to respond promptly to any behavioral health crisis that occurs in the
hospital, including a requirement that a behavioral health crisis intervention team member
is not considered available if the team member has been assigned any duties or tasks that
would prevent the team member from promptly responding to a behavioral health crisis and
immediately participating in an intervention until the resolution of the crisis;
new text end

new text begin (7) a behavioral health crisis intervention team's timely response to a request for
assistance;
new text end

new text begin (8) evaluating a patient experiencing a behavioral health crisis for substance use treatment
and counseling and to provide guidance on that treatment and counseling;
new text end

new text begin (9) ensuring the provision of linguistically and culturally competent behavioral health
crisis intervention services to patients;
new text end

new text begin (10) reporting concerns by hospital staff regarding the availability of behavioral health
crisis intervention team members and concerns regarding the availability, condition, storage,
and maintenance of equipment; and
new text end

new text begin (11) coordinating implementation of the requirements of this section with the workplace
violence prevention plan adopted by a hospital under section 144.566, including methods
of reporting and investigating any incidents of workplace violence that result from a patient's
behavioral health crisis.
new text end

new text begin Subd. 9. new text end

new text begin Required safety procedures. new text end

new text begin All hospitals must adopt and implement safety
procedures for situations in which the risk posed by a behavioral health crisis exceeds the
ability of the behavioral health crisis intervention team to safely intervene. The safety
procedures must be created by the behavioral health crisis intervention team with input from
direct patient care staff. The safety procedures must include:
new text end

new text begin (1) mechanisms to provide appropriate intervention when health care staff are concerned
about confronting a suspected perpetrator of abuse or concerned for their own safety, such
as when a perpetrator is wielding a deadly weapon;
new text end

new text begin (2) standards for determining when and how to inform all impacted health care staff of
potential life-threatening circumstances in the hospital; and
new text end

new text begin (3) standards for determining when to call security or law enforcement to respond to an
incident.
new text end

new text begin Subd. 10. new text end

new text begin Required training for behavioral health crisis intervention team
members. new text end

new text begin (a) All hospitals must ensure that all members of a behavioral health crisis
intervention team receive training and education on a continuing annual basis to ensure
competency in existing and new skills in psychiatric care, behavioral health crisis
intervention, substance use treatment services, providing trauma-informed care, and ensuring
access to linguistically and culturally competent care.
new text end

new text begin (b) The training and education required under this subdivision must include opportunities
for interactive questions and answers between behavioral health crisis intervention team
members and a person knowledgeable about the hospital's behavioral health crisis intervention
policies.
new text end

new text begin (c) The training and education required under this subdivision must be conducted during
the normal working hours of the participating team member unless the team member receives
at least the normal hourly wage for any additional time spent in the training and education
sessions. Training must be conducted only when participating team members are not
scheduled to provide patient care.
new text end

new text begin Subd. 11. new text end

new text begin Behavioral health crisis intervention program implementation
requirements. new text end

new text begin (a) All hospitals must designate a licensed medical professional who: (1)
has experience and competence in psychiatric services as a behavioral health crisis
intervention director; (2) is either a registered nurse or a physician; and (3) is responsible
for the implementation of the requirements of this section.
new text end

new text begin (b) The behavioral health crisis intervention director must ensure that the policies adopted
under subdivisions 8 and 9 are developed, implemented, and annually reviewed with
meaningful input and active involvement of the following hospital staff, including hospital
staff with a recognized collective bargaining agent or agents:
new text end

new text begin (1) registered nurses who provide emergency medical services;
new text end

new text begin (2) registered nurses who provide psychiatric nursing care or provide care in a psychiatric
unit, if any;
new text end

new text begin (3) psychiatrists and other physicians who provide inpatient psychiatric services or
provide care in a psychiatric unit, if any;
new text end

new text begin (4) ancillary health care staff who provide inpatient psychiatric services or provide care
in a psychiatric unit, including psychiatric technicians, if any;
new text end

new text begin (5) emergency medical technicians who serve the hospital;
new text end

new text begin (6) behavioral health crisis intervention team members; and
new text end

new text begin (7) any other hospital staff required to be present in a patient care area who are reasonably
anticipated to require a response by a behavioral health crisis intervention team.
new text end

new text begin (c) The behavioral health crisis intervention director must ensure that the programs
implementing the training and education requirements under subdivisions 8 to 10 are
developed, implemented, and annually reviewed and revised with meaningful input and
active involvement of the hospital staff listed in paragraph (b), including the development
of curricula and training materials.
new text end

new text begin (d) The behavioral health crisis intervention director must ensure that the hospital's
behavioral health crisis intervention program is evaluated annually for effectiveness in
providing timely access to behavioral health crisis intervention services and reducing rates
of workplace violence. The behavioral health crisis intervention director must ensure that
the program evaluation is conducted with meaningful input and active involvement of the
hospital staff listed in paragraph (b).
new text end

new text begin Subd. 12. new text end

new text begin Enforcement. new text end

new text begin (a) Notwithstanding section 144.55, the commissioner of health
shall inspect hospitals for compliance with this section according to the schedule in section
144.653, subdivision 2. The commissioner shall issue a correction order to the hospital if,
upon inspection, the commissioner finds that the hospital was not in compliance with this
section for three or more days. The correction order shall state the deficiency, cite the specific
rule violated, and specify the time allowed for correction.
new text end

new text begin (b) If, upon reinspection, the commissioner finds that the hospital has not corrected
deficiencies specified in the correction order, the commissioner shall issue a notice of
noncompliance with a correction order stating all deficiencies not corrected and the provisions
of section 144.653, subdivisions 6 to 9, apply.
new text end

new text begin Subd. 13. new text end

new text begin Limited immunity. new text end

new text begin (a) No individual employed to work in a hospital shall
be subject to civil or criminal liability for engaging in conduct in good faith compliance
with the hospital's procedures governing the hospital's behavioral health crisis intervention
program.
new text end

new text begin (b) No licensed medical professional or licensed mental health professional employed
to work in a hospital shall be subject to professional disciplinary action, including censure,
suspension, loss of license, loss of privileges, loss of membership, or any other penalty for
engaging in conduct in good faith compliance with the hospital's procedures governing the
hospital's behavioral health crisis intervention program.
new text end

Sec. 7.

new text begin [144.568] BEHAVIORAL HEALTH CRISIS INTERVENTION GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Grant program established. new text end

new text begin The commissioner of health shall create
and implement an annual behavioral health crisis intervention grant program to assist
hospitals to implement and maintain a behavioral health crisis intervention program and
comply with the requirements of section 144.567.
new text end

new text begin Subd. 2. new text end

new text begin Creation of account. new text end

new text begin (a) A behavioral health crisis intervention grant program
account is established in the health care access fund. The commissioner of health shall use
money from the account to implement a behavioral health crisis intervention grant program.
new text end

new text begin (b) Deposits to the behavioral health crisis intervention grant program account do not
cancel and are available until expended.
new text end

new text begin Subd. 3. new text end

new text begin Allowable uses. new text end

new text begin (a) Allowable uses of behavioral health crisis intervention
grant program funds under this section include:
new text end

new text begin (1) behavioral health crisis intervention training programs;
new text end

new text begin (2) hiring or retaining behavioral health crisis intervention team members;
new text end

new text begin (3) implementing policies and procedures adopted by a hospital to meet the requirements
of section 144.567; and
new text end

new text begin (4) providing employee assistance plan services, mental health services, and other
resources to hospital staff impacted by a patient's behavioral health crisis.
new text end

new text begin (b) The commissioner of health may use up to six percent of the money appropriated
for the behavioral health crisis intervention grant program to administer the grant program.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for an annual grant under this section, a hospital
must submit an annual application to the commissioner of health by a date to be determined
by the commissioner and must not be out of compliance with reporting requirements under
section 144.566, subdivision 14, at the time the grant application is under consideration.
new text end

new text begin (b) The commissioner shall give preference to applicants that are rural hospitals, public
hospitals, and hospitals in designated underserved areas.
new text end

new text begin (c) The commissioner shall make decisions regarding successful grant applications and
grant amounts after consideration of all applications and all relevant factors, such as the
applicants' requested grant amount and the availability of funds.
new text end

Sec. 8. new text begin APPROPRIATION; BEHAVIORAL HEALTH CRISIS INTERVENTION
GRANTS.
new text end

new text begin $....... is appropriated in fiscal year 2025 from the general fund to the commissioner of
health for the behavioral health crisis intervention grant program under Minnesota Statutes,
section 144.568.
new text end