SF 706

2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 08/24/2015 02:50pm

A bill for an act
relating to human services; establishing requirements for correction orders and
conditional licenses for certain human services programs; providing for settlement
agreements; authorizing a health care delivery pilot program; modifying licensing
requirements for foster care providers; modifying home and community-based
services standards; striking language establishing the Monitoring Technology
Review Panel in the disability waiver rate system; amending Minnesota Statutes
2014, sections 245A.06, by adding a subdivision; 245A.155, subdivisions
1, 2; 245A.65, subdivision 2; 245D.02, by adding a subdivision; 245D.05,
subdivisions 1, 2; 245D.06, subdivisions 1, 2, 7; 245D.07, subdivision 2;
245D.071, subdivision 5; 245D.09, subdivisions 3, 5; 245D.22, subdivision 4;
245D.31, subdivisions 3, 4, 5; 256B.4914, subdivision 6; 256B.492; proposing
coding for new law in Minnesota Statutes, chapters 245A; 256B.

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

Section 1.

Minnesota Statutes 2014, section 245A.06, is amended by adding a
subdivision to read:

new text begin Subd. 1a. new text end

new text begin Correction orders and conditional licenses for programs licensed as
home and community-based services. new text end

new text begin (a) For programs licensed under both this chapter
and chapter 245D, if the license holder operates more than one service site under a single
license governed by chapter 245D, the order issued under this section shall be specific to
the service site or sites at which the violations of applicable law or rules occurred. The
order shall not apply to other service sites governed by chapter 245D and operated by the
same license holder unless the commissioner has included in the order the articulable basis
for applying the order to another service site.
new text end

new text begin (b) If the commissioner has issued more than one license to the license holder under
this chapter, the conditions imposed under this section shall be specific to the license for
the program at which the violations of applicable law or rules occurred and shall not apply
to other licenses held by the same license holder if those programs are being operated in
substantial compliance with applicable law and rules.
new text end

Sec. 2.

new text begin [245A.081] SETTLEMENT AGREEMENT.
new text end

new text begin (a) A license holder who has made a timely appeal pursuant to section 245A.06,
subdivision 4, or 245A.07, subdivision 3, or the commissioner may initiate a discussion
about a possible settlement agreement related to the licensing sanction. For the purposes
of this section, the following conditions apply to a settlement agreement reached by the
parties:
new text end

new text begin (1) if the parties enter into a settlement agreement, the effect of the agreement shall
be that the appeal is withdrawn and the agreement shall constitute the full agreement
between the commissioner and the party who filed the appeal; and
new text end

new text begin (2) the settlement agreement must identify the agreed upon actions the license holder
has taken and will take in order to achieve and maintain compliance with the licensing
requirements that the commissioner determined the license holder had violated.
new text end

new text begin (b) Neither the license holder nor the commissioner is required to initiate a
settlement discussion under this section.
new text end

new text begin (c) If a settlement discussion is initiated by the license holder, the commissioner
shall respond to the license holder within 14 calendar days of receipt of the license
holder's submission.
new text end

new text begin (d) If the commissioner agrees to engage in settlement discussions, the commissioner
may decide at any time not to continue settlement discussions with a license holder.
new text end

Sec. 3.

Minnesota Statutes 2014, 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 monitoring equipment to sustain life or monitor a medical
condition new text begin that could become life-threatening without proper use of the medical equipment
new text end in respite care or foster care.

Sec. 4.

Minnesota Statutes 2014, 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 or monitor a medical condition
new text begin that could become life-threatening without proper use of the medical equipment new 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. 5.

Minnesota Statutes 2014, 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 governing body new text begin or the governing body's delegated
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
governing body new text begin or the governing body's delegated 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 2014, 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, as defined in section 645.44, subdivision
5.
new text end

Sec. 7.

Minnesota Statutes 2014, 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.
new text begin Unless directed otherwise in the coordinated service and support plan or the coordinated
service and support plan addendum, new text end the license holder is responsible for promptly
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, when discovered by the license holder, unless the license
holder has reason to know the change has already been reported. The license holder
must document when the notice is provided.

(b) 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 setup, assistance, or administration according to this chapter.
Unlicensed staff responsible for medication setup or medication administration under this
section must complete training according to section 245D.09, subdivision 4a, paragraph (d);

(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 2014, section 245D.05, subdivision 2, is amended to read:

Subd. 2.

Medication administration.

(a) For purposes of this subdivision,
"medication administration" means:

(1) checking the person's medication record;

(2) preparing the medication as necessary;

(3) administering the medication or treatment to the person;

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

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

(b)(1) If responsibility for medication administration is assigned to the license holder
in the coordinated service and support plan or the coordinated service and support plan
addendum, the license holder must implement medication administration procedures to
ensure a person takes medications and treatments as prescribed. The license holder must
ensure that the requirements in clauses (2) and (3) have been met before administering
medication or treatment.

(2) The license holder must obtain written authorization from the person or the
person's legal representative to administer medication or treatment deleted text begin and must obtain
reauthorization annually as needed deleted text end . This authorization shall remain in effect unless it is
withdrawn in writing and may be withdrawn at any time. If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.

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

(c) The license holder must ensure the following information is documented in the
person's medication administration record:

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

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

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

(4) instruction on when and to whom to report the following:

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

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

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

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

Sec. 9.

Minnesota Statutes 2014, 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 or successor provisions.

Sec. 10.

Minnesota Statutes 2014, section 245D.06, subdivision 2, is amended to read:

Subd. 2.

Environment and safety.

The license holder must:

(1) ensure the following when the license holder is the owner, lessor, or tenant
of the service site:

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

(ii) that toxic substances or dangerous items are inaccessible to persons served by
the program only to protect the safety of a person receiving services when a known safety
threat exists and not as a substitute for staff supervision or interactions with a person who
is receiving services. If toxic substances or dangerous items are made inaccessible, the
license holder must document an assessment of the physical plant, its environment, and its
population identifying the risk factors which require toxic substances or dangerous items
to be inaccessible and a statement of specific measures to be taken to minimize the safety
risk to persons receiving services and to restore accessibility to all persons receiving
services at the service site;

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

(iv) a staff person is available at the service site who is trained in basic first aid and,
when required in a person's coordinated service and support plan or coordinated service
and support plan addendum, cardiopulmonary resuscitation (CPR) whenever persons are
present and staff are required to be at the site to provide direct support 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;

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

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

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

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

Sec. 11.

Minnesota Statutes 2014, section 245D.06, subdivision 7, is amended to read:

Subd. 7.

Permitted actions and procedures.

(a) Use of the instructional techniques
and intervention procedures as identified in paragraphs (b) and (c) is permitted when used
on an intermittent or continuous basis. When used on a continuous basis, it must be
addressed in a person's coordinated service and support plan addendum as identified in
sections 245D.07 and 245D.071. For purposes of this chapter, the requirements of this
subdivision supersede the requirements identified in Minnesota Rules, part 9525.2720.

(b) Physical contact or instructional techniques must use the least restrictive
alternative possible to meet the needs of the person and may be used:

(1) to calm or comfort a person by holding that person with no resistance from
that person;

(2) to protect a person known to be at risk of injury due to frequent falls as a result
of a medical condition;

(3) to facilitate the person's completion of a task or response when the person does
not resist or the person's resistance is minimal in intensity and duration;

(4) to block or redirect a person's limbs or body without holding the person or
limiting the person's movement to interrupt the person's behavior that may result in injury
to self or others with less than 60 seconds of physical contact by staff; or

(5) to redirect a person's behavior when the behavior does not pose a serious threat
to the person or others and the behavior is effectively redirected with less than 60 seconds
of physical contact by staff.

(c) Restraint may be used as an intervention procedure to:

(1) allow a licensed health care professional to safely conduct a medical examination
or to provide medical treatment ordered by a licensed health care professional deleted text begin to a person
necessary to promote healing or recovery from an acute, meaning short-term, medical
condition deleted text end ;

(2) assist in the safe evacuation or redirection of a person in the event of an
emergency and the person is at imminent risk of harm; or

(3) position a person with physical disabilities in a manner specified in the person's
coordinated service and support plan addendum.

Any use of manual restraint as allowed in this paragraph must comply with the restrictions
identified in subdivision 6, paragraph (b).

(d) Use of adaptive aids or equipment, orthotic devices, or other medical equipment
ordered by a licensed health professional to treat a diagnosed medical condition do not in
and of themselves constitute the use of mechanical restraint.

Sec. 12.

Minnesota Statutes 2014, section 245D.07, subdivision 2, is amended to read:

Subd. 2.

Service planning requirements for basic support services.

(a) License
holders providing basic support services 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. 13.

Minnesota Statutes 2014, section 245D.071, subdivision 5, is amended to read:

Subd. 5.

Service plan review and evaluation.

(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 service plan and 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 service plan 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. The purpose of the service plan review
is to determine whether changes are needed to the service plan based on the assessment
information, the license holder's evaluation of progress towards accomplishing outcomes,
or other information provided by the support team or expanded support team.

(b) The license holder must summarize the person's status and 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 in a deleted text begin written deleted text end report deleted text begin 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 report
deleted text end 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 at least
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) new text begin The license holder must send the coordinated service and support plan addendum
to the person, the person's legal representative, and the case manager by mail within ten
working days of the progress review meeting. new text end Within ten working days of the deleted text begin progress
review meeting deleted text end new text begin mailing of the coordinated service and support plan addendum new text end , 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 submitting changes to the coordinated service
and support plan and 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 or 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 addendum.
new text end

Sec. 14.

Minnesota Statutes 2014, 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
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 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
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 or observed
skill assessment conducted by the trainer or instructor new text begin or by an individual who has been
previously deemed competent by the trainer or instructor in the area being assessed 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. 15.

Minnesota Statutes 2014, 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 (10). new text begin If the direct
support staff has a first aid certification, annual training under subdivision 4, clause (9), is
not required as long as the certification remains current. new text end A license holder must provide a
minimum of 24 hours of annual training to direct service staff providing intensive services
and having fewer than five years of documented experience and 12 hours of annual
training to direct service staff providing intensive services and having five or more years
of documented experience in topics described in subdivisions 4 and 4a, paragraphs (a) to
(f). Training on relevant topics received from sources other than the license holder may
count toward training requirements. 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.

Sec. 16.

Minnesota Statutes 2014, 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. 17.

Minnesota Statutes 2014, 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. 18.

Minnesota Statutes 2014, 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, new text begin or new text end ambulating; deleted text begin or is not capable
of taking appropriate action for self-preservation under emergency conditions; deleted text end or

(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. 19.

Minnesota Statutes 2014, 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. 20.

new text begin [256B.0758] HEALTH CARE DELIVERY PILOT PROGRAM.
new text end

new text begin (a) The commissioner may establish a health care delivery pilot program to test
alternative and innovative integrated health care delivery networks, including accountable
care organizations or a community-based collaborative care network created by or
including North Memorial Health Care. If required, the commissioner shall seek federal
approval of a new waiver request or amend an existing demonstration pilot project waiver.
new text end

new text begin (b) Individuals eligible for the pilot program shall be individuals who are eligible for
medical assistance under section 256B.055. The commissioner may identify individuals
to be enrolled in the pilot program based on zip code or whether the individuals would
benefit from an integrated health care delivery network.
new text end

new text begin (c) In developing a payment system for the pilot programs, the commissioner shall
establish a total cost of care for the individuals enrolled in the pilot program that equals
the cost of care that would otherwise be spent for these enrollees in the prepaid medical
assistance program.
new text end

Sec. 21.

Minnesota Statutes 2014, section 256B.4914, subdivision 6, is amended to read:

Subd. 6.

Payments for residential support services.

(a) Payments for residential
support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
subdivision 22, must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet
a recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the appropriate staff wages in
subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the product of the supervision
span of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (16);

(6) combine the results of clauses (4) and (5), excluding any shared and individual
direct staff hours provided through monitoring technology, and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(b), clause (2). This is defined as the direct staffing cost;

(7) for employee-related expenses, multiply the direct staffing cost, excluding any
shared and individual direct staff hours provided through monitoring technology, by one
plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (3);

(8) for client programming and supports, the commissioner shall add $2,179; and

(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(b) The total rate must be calculated using the following steps:

(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any
shared and individual direct staff hours provided through monitoring technology that
was excluded in clause (7);

(2) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is
the total payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.

deleted text begin (d) The commissioner shall establish a Monitoring Technology Review Panel to
annually review and approve the plans, safeguards, and rates that include residential
direct care provided remotely through monitoring technology. Lead agencies shall submit
individual service plans that include supervision using monitoring technology to the
Monitoring Technology Review Panel for approval. Individual service plans that include
supervision using monitoring technology as of December 31, 2013, shall be submitted to
the Monitoring Technology Review Panel, but the plans are not subject to approval.
deleted text end

deleted text begin (e) deleted text end new text begin (d) new text end For individuals enrolled prior to January 1, 2014, the days of service
authorized must meet or exceed the days of service used to convert service agreements
in effect on December 1, 2013, and must not result in a reduction in spending or service
utilization due to conversion during the implementation period under section 256B.4913,
subdivision 4a. If during the implementation period, an individual's historical rate,
including adjustments required under section 256B.4913, subdivision 4a, paragraph (c),
is equal to or greater than the rate determined in this subdivision, the number of days
authorized for the individual is 365.

deleted text begin (f) deleted text end new text begin (e) new text end The number of days authorized for all individuals enrolling after January 1,
2014, in residential services must include every day that services start and end.

Sec. 22.

Minnesota Statutes 2014, section 256B.492, is amended to read:

256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
WITH DISABILITIES.

(a) Individuals receiving services under a home and community-based waiver under
section 256B.092 or 256B.49 may receive services in the following settings:

(1) deleted text begin an individual's own home or family deleted text end home new text begin and community-based settings that
comply with all requirements identified by the federal Centers for Medicare and Medicaid
Services in the Code of Federal Regulations, title 42, section 441.301(c), and with the
requirements of the federally approved transition plan and waiver plans for each home
and community-based services waiver new text end ; new text begin and
new text end

(2) deleted text begin a licensed adult foster care or child foster care setting of up to five people or
community residential setting of up to five people; and deleted text end new text begin settings required by the Housing
Opportunities for Persons with AIDS Program.
new text end

deleted text begin (3) community living settings as defined in section 256B.49, subdivision 23, where
individuals with disabilities may reside in all of the units in a building of four or fewer units,
and who receive services under a home and community-based waiver occupy no more
than the greater of four or 25 percent of the units in a multifamily building of more than
four units, unless required by the Housing Opportunities for Persons with AIDS Program.
deleted text end

(b) The settings in paragraph (a) must not deleted text begin :
deleted text end

deleted text begin (1) be located in a building that is a publicly or privately operated facility that
provides institutional treatment or custodial care;
deleted text end

deleted text begin (2) be located in a building on the grounds of or adjacent to a public or private
institution;
deleted text end

deleted text begin (3) be a housing complex designed expressly around an individual's diagnosis or
disability, unless required by the Housing Opportunities for Persons with AIDS Program;
deleted text end

deleted text begin (4) be segregated based on a disability, either physically or because of setting
characteristics, from the larger community; and
deleted text end

deleted text begin (5) deleted text end have the qualities of an institution which include, but are not limited to:
regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
agreed to and documented in the person's individual service plan shall not result in a
residence having the qualities of an institution as long as the restrictions for the person are
not imposed upon others in the same residence and are the least restrictive alternative,
imposed for the shortest possible time to meet the person's needs.

deleted text begin (c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
individuals receive services under a home and community-based waiver as of July 1,
2012, and the setting does not meet the criteria of this section.
deleted text end

deleted text begin (d) Notwithstanding paragraph (c), a program in Hennepin County established as
part of a Hennepin County demonstration project is qualified for the exception allowed
under paragraph (c).
deleted text end

deleted text begin (e) Notwithstanding paragraphs (a) and (b), a program in Hennepin County, located
in the city of Golden Valley, within the city of Golden Valley's Highway 55 West
redevelopment area, that is not a provider-owned or controlled home and community-based
setting, and is scheduled to open by July 1, 2016, is exempt from the restrictions in
paragraphs (a) and (b). If the program fails to comply with the Centers for Medicare and
Medicaid Services rules for home and community-based settings, the exemption is void.
deleted text end

deleted text begin (f) The commissioner shall submit an amendment to the waiver plan no later than
December 31, 2012.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2016.
new text end