HF 2456

as introduced - 87th Legislature (2011 - 2012) Posted on 02/22/2012 02:49pm

A bill for an act
relating to human services; amending continuing care policy provisions; making
changes to disability services and licensing provisions; establishing home and
community-based services standards; establishing payment methodologies;
requiring a report; amending Minnesota Statutes 2010, sections 245A.03,
subdivision 2; 245A.041, by adding subdivisions; 245A.085; 245B.02,
subdivision 10, by adding a subdivision; 245B.04, subdivisions 1, 2, 3; 245B.05,
subdivision 1; 245B.06, subdivision 2; 245B.07, subdivisions 5, 9, 10, by
adding a subdivision; 252.40; 252.41, subdivision 3; 252.42; 252.43; 252.44;
252.45; 252.451, subdivisions 2, 5; 252.46, subdivision 1a; 256B.0916,
subdivision 2; 256B.49, subdivision 17; 256B.4912; 256B.501, subdivision
4b; 256B.5013, subdivision 1; Minnesota Statutes 2011 Supplement, section
256B.49, subdivision 16a; proposing coding for new law in Minnesota Statutes,
chapters 245A; 256B; proposing coding for new law as Minnesota Statutes,
chapter 245D; repealing Minnesota Statutes 2010, sections 252.46, subdivisions
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16, 17, 18, 19, 20, 21; 256B.501, subdivision 8.

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

Section 1.

Minnesota Statutes 2010, section 245A.03, subdivision 2, is amended to
read:

Subd. 2.

Exclusion from licensure.

(a) This chapter does not apply to:

(1) residential or nonresidential programs that are provided to a person by an
individual who is related unless the residential program is a child foster care placement
made by a local social services agency or a licensed child-placing agency, except as
provided in subdivision 2a;

(2) nonresidential programs that are provided by an unrelated individual to persons
from a single related family;

(3) residential or nonresidential programs that are provided to adults who do
not abuse chemicals or who do not have a chemical dependency, a mental illness, a
developmental disability, a functional impairment, or a physical disability;

(4) sheltered workshops or work activity programs that are certified by the
commissioner of employment and economic development;

(5) programs operated by a public school for children 33 months or older;

(6) nonresidential programs primarily for children that provide care or supervision
for periods of less than three hours a day while the child's parent or legal guardian is in
the same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;

(7) nursing homes or hospitals licensed by the commissioner of health except as
specified under section 245A.02;

(8) board and lodge facilities licensed by the commissioner of health that do not
provide children's residential services under Minnesota Rules, chapter 2960, mental health
or chemical dependency treatment;

(9) homes providing programs for persons placed by a county or a licensed agency
for legal adoption, unless the adoption is not completed within two years;

(10) programs licensed by the commissioner of corrections;

(11) recreation programs for children or adults that are operated or approved by a
park and recreation board whose primary purpose is to provide social and recreational
activities;

(12) programs operated by a school as defined in section 120A.22, subdivision 4;
YMCA as defined in section 315.44; YWCA as defined in section 315.44; or JCC as
defined in section 315.51, whose primary purpose is to provide child care or services to
school-age children;

(13) Head Start nonresidential programs which operate for less than 45 days in
each calendar year;

(14) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;

(15) programs for children such as scouting, boys clubs, girls clubs, and sports and
art programs, and nonresidential programs for children provided for a cumulative total of
less than 30 days in any 12-month period;

(16) residential programs for persons with mental illness, that are located in hospitals;

(17) the religious instruction of school-age children; Sabbath or Sunday schools; or
the congregate care of children by a church, congregation, or religious society during the
period used by the church, congregation, or religious society for its regular worship;

(18) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;

(19) mental health outpatient services for adults with mental illness or children
with emotional disturbance;

(20) residential programs serving school-age children whose sole purpose is cultural
or educational exchange, until the commissioner adopts appropriate rules;

(21) unrelated individuals who provide out-of-home respite care services to persons
with developmental disabilities from a single related family for no more than 90 days in a
12-month period and the respite care services are for the temporary relief of the person's
family or legal representative;

(22) respite care services provided as a home and community-based service to a
person with a developmental disability, in the person's primary residence;

(23) community support services programs as defined in section 245.462, subdivision
6, and family community support services as defined in section 245.4871, subdivision 17;

(24) the placement of a child by a birth parent or legal guardian in a preadoptive
home for purposes of adoption as authorized by section 259.47;

(25) settings registered under chapter 144D which provide home care services
licensed by the commissioner of health to fewer than seven adults;

(26) chemical dependency or substance abuse treatment activities of licensed
professionals in private practice as defined in Minnesota Rules, part 9530.6405, subpart
15, when the treatment activities are not paid for by the consolidated chemical dependency
treatment fund;

(27) consumer-directed community support service funded under the Medicaid
waiver for persons with developmental disabilities when the individual who provided
the service is:

(i) the same individual who is the direct payee of these specific waiver funds or paid
by a fiscal agent, fiscal intermediary, or employer of record; and

(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service; or

(28) a program serving only children who are age 33 months or older, that is
operated by a nonpublic school, for no more than four hours per day per child, with no
more than 20 children at any one time, and that is accredited by:

(i) an accrediting agency that is formally recognized by the commissioner of
education as a nonpublic school accrediting organization; or

(ii) an accrediting agency that requires background studies and that receives and
investigates complaints about the services provided.

A program that asserts its exemption from licensure under item (ii) shall, upon
request from the commissioner, provide the commissioner with documentation from the
accrediting agency that verifies: that the accreditation is current; that the accrediting
agency investigates complaints about services; and that the accrediting agency's standards
require background studies on all people providing direct contact services.

(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.

(c) new text begin Except for the home and community-based services identified in section
245D.03, subdivision 1, new text end nothing in this chapter shall be construed to require licensure for
any services provided and funded according to an approved federal waiver plan where
licensure is specifically identified as not being a condition for the services and funding.

Sec. 2.

Minnesota Statutes 2010, section 245A.041, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Record retention; license holder requirements. new text end

new text begin (a) A license holder must
maintain and store records in a manner that will allow for review by the commissioner as
identified in section 245A.04, subdivision 5. The following records must be maintained as
specified and in accordance with applicable state or federal law, regulation, or rule:
new text end

new text begin (1) service recipient records, including verification of service delivery, must be
maintained for a minimum of five years following discharge or termination of service;
new text end

new text begin (2) personnel records must be maintained for a minimum of five years following
termination of employment; and
new text end

new text begin (3) program administration and financial records must be maintained for a minimum
of five years from the date the program closes.
new text end

new text begin (b) A license holder who ceases to provide services must maintain all records related
to the licensed program for five years from the date the program closes. The license holder
must notify the commissioner of the location where the licensing records will be stored
and the name of the person responsible for maintaining the stored records.
new text end

new text begin (c) If the ownership of a licensed program or service changes, the transferor, unless
otherwise provided by law or written agreement with the transferee, is responsible for
maintaining, preserving, and making available to the commissioner on demand the license
records generated before the date of the transfer.
new text end

new text begin (d) In the event of a contested case, the license holder must retain records as required
in paragraph (a) or until the final agency decision is issued and the conclusion of any
related appeal, whichever period is longer.
new text end

Sec. 3.

Minnesota Statutes 2010, section 245A.041, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Electronic records; license holder use. new text end

new text begin A license holder's use of
electronic record keeping or electronic signatures must meet the following requirements:
new text end

new text begin (1) use of electronic record keeping or electronic signatures does not alter the license
holder's obligations under state or federal law, regulation, or rule;
new text end

new text begin (2) the license holder must ensure that the use of electronic record keeping does not
limit the commissioner's access to records as specified under section 245A.04, subdivision
5;
new text end

new text begin (3) upon request, the license holder must assist the commissioner in accessing and
copying all records, including encrypted records and electronic signatures; and
new text end

new text begin (4) the license holder must establish a mechanism or procedure to ensure that:
new text end

new text begin (i) the act of creating the electronic record or signature is attributable to the license
holder, according to section 325L.09;
new text end

new text begin (ii) the electronic records and signatures are maintained in a form capable of being
retained and accurately reproduced;
new text end

new text begin (iii) the commissioner has access to information that establishes the date and time
that data and signatures were entered into the electronic record; and
new text end

new text begin (iv) the license holder's use of electronic record keeping or electronic signatures does
not compromise the security of the records.
new text end

Sec. 4.

Minnesota Statutes 2010, section 245A.085, is amended to read:

245A.085 CONSOLIDATION OF HEARINGS; RECONSIDERATION.

Hearings authorized under this chapter, chapter 245C, and sections 256.045, new text begin
256B.04, new text end 626.556, and 626.557, shall be consolidated if feasible and in accordance with
other applicable statutes and rules. Reconsideration under sections 245C.28; 626.556,
subdivision 10i; and 626.557, subdivision 9d, shall also be consolidated if feasible.

Sec. 5.

new text begin [245A.042] HOME AND COMMUNITY-BASED SERVICES;
ADDITIONAL STANDARDS AND PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Standards governing the provision of home and community-based
services. new text end

new text begin Residential and nonresidential programs for persons with disabilities or
age 65 and older must obtain a license according to this chapter to provide home and
community-based services defined in the federal waiver plans governed by United States
Code, title 42, sections 1396 et seq., or the state's alternative care program according to
section 256B.0913, and identified in section 245D.03, subdivision 1. As a condition
of licensure, an applicant or license holder must demonstrate and maintain verification
of compliance with:
new text end

new text begin (1) licensing requirements under this chapter and chapter 245D;
new text end

new text begin (2) applicable health care program requirements under Minnesota Rules, parts
9505.0170 to 9505.0475 and 9505.2160 to 9505.2245; and
new text end

new text begin (3) provider standards and qualifications identified in the federal waiver plans or the
alternative care program.
new text end

new text begin Subd. 2. new text end

new text begin Applicant and license holder training. new text end

new text begin (a) An applicant or license holder
that is not enrolled as a Minnesota health care program home and community-based
services waiver provider at the time of application must ensure that at least one controlling
individual completes a onetime training on the requirements for providing home services,
as prescribed by the commissioner, before a license is issued.
new text end

new text begin (b) Within 30 days of completing the training, the applicant or license holder
must ensure that the controlling individual provides a copy and an explanation of the
information and materials received from the training to all other controlling individuals.
new text end

new text begin Subd. 3. new text end

new text begin Implementation. new text end

new text begin Implementation of licensure of home and
community-based services according to this section will be phased in upon receipt of an
appropriation to the Department of Human Services sufficient to cover the costs to support
necessary licensing functions.
new text end

Sec. 6.

Minnesota Statutes 2010, section 245B.02, is amended by adding a subdivision
to read:

new text begin Subd. 8a. new text end

new text begin Emergency. new text end

new text begin "Emergency" means any fires, severe weather, natural
disasters, power failures, or other events that threaten the immediate health and safety of a
person receiving services that require emergency evacuation, moving to an emergency
shelter, or temporary closure or relocation of the program to another facility or service site.
new text end

Sec. 7.

Minnesota Statutes 2010, section 245B.02, subdivision 10, is amended to read:

Subd. 10.

Incident.

"Incident" means any of the following:

(1) serious injury as determined by section 245.91, subdivision 6;

(2) a consumer's death;

(3) any medical emergencies, unexpected serious illnesses, or deleted text begin accidents deleted text end new text begin significant
unexpected changes in illnesses or medical conditions of a person new text end that require physician
treatment or hospitalization;

(4) a consumer's unauthorized new text begin or unexplained new text end absence;

deleted text begin (5) any fires or other events that require the relocation of services for more than 24
hours, or circumstances involving a law enforcement agency or fire department related to
the health, safety, or supervision of a consumer;
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end physical aggression by a consumer against another consumer that causes
physical pain, injury, or persistent emotional distress, including, but not limited to, hitting,
slapping, kicking, scratching, pinching, biting, pushing, and spitting;

deleted text begin (7) deleted text end new text begin (6) new text end any sexual activity between consumers involving force or coercion as defined
under section 609.341, subdivisions 3 and 14; or

deleted text begin (8) deleted text end new text begin (7) new text end a report of child or vulnerable adult maltreatment under section 626.556 or
626.557.

Sec. 8.

Minnesota Statutes 2010, section 245B.04, subdivision 1, is amended to read:

Subdivision 1.

License holder's responsibility for consumers' rights.

The license
holder must:

(1) provide the consumer or the consumer's legal representative a copy of the
consumer's rights on the day that services are initiated and an explanation of the rights
in subdivisions 2 and 3 within five working days of service initiation new text begin and annually
thereafter new text end . Reasonable accommodations shall be made by the license holder to provide
this information in other formats as needed to facilitate understanding of the rights by the
consumer and the consumer's legal representative, if any;

(2) document the consumer's or the consumer's legal representative's receipt of a
copy of the rights and an explanation of the rights; and

(3) ensure the exercise and protection of the consumer's rights in the services
provided by the license holder and authorized in the individual service plan.

Sec. 9.

Minnesota Statutes 2010, section 245B.04, subdivision 2, is amended to read:

Subd. 2.

Service-related rights.

A consumer's service-related rights include the
right to:

(1) refuse or terminate services and be informed of the consequences of refusing
or terminating services;

(2) know, in advance, limits to the services available from the license holder;

(3) know conditions and terms governing the provision of services, including deleted text begin those deleted text end new text begin
the license holder's policies and procedures new text end related to initiation and termination;

(4) know what the charges are for services, regardless of who will be paying for the
services, and be notified upon request of changes in those charges;

(5) know, in advance, whether services are covered by insurance, government
funding, or other sources, and be told of any charges the consumer or other private party
may have to pay; and

(6) receive licensed services from individuals who are competent and trained,
who have professional certification or licensure, as required, and who meet additional
qualifications identified in the individual service plan.

Sec. 10.

Minnesota Statutes 2010, section 245B.04, subdivision 3, is amended to read:

Subd. 3.

Protection-related rights.

new text begin (a) new text end The consumer's protection-related rights
include the right to:

(1) have personal, financial, services, and medical information kept private, and
be advised of the license holder's policies and procedures regarding disclosure of such
information;

(2) access records and recorded information;

(3) be free from maltreatment;

(4) be treated with courtesy and respect for the consumer's individuality, mode of
communication, and culture, and receive respectful treatment of the consumer's property;

new text begin (5) reasonable observance of cultural and ethnic practice and religion;
new text end

new text begin (6) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;
new text end

new text begin (7) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;
new text end

new text begin (8) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;
new text end

deleted text begin (5) deleted text end new text begin (9) new text end voice grievances, know the contact persons responsible for addressing
problems and how to contact those persons;

deleted text begin (6) deleted text end new text begin (10) new text end any procedures for grievance or complaint resolution and the right to appeal
under section 256.045;

deleted text begin (7) deleted text end new text begin (11) new text end know the name and address of the state, county, or advocacy agency to
contact for additional information or assistance;

deleted text begin (8) deleted text end new text begin (12) new text end assert these rights personally, or have them asserted by the consumer's
family or legal representative, without retaliation;

deleted text begin (9) deleted text end new text begin (13) new text end give or withhold written informed consent to participate in any research or
experimental treatment;

deleted text begin (10) deleted text end new text begin (14) new text end have daily, private access to and use of a non-coin-operated telephone for
local calls and long-distance calls made collect or paid for by the resident;

deleted text begin (11) deleted text end new text begin (15) new text end receive and send new text begin , without interference, new text end uncensored, unopened mail new text begin or
electronic correspondence or communication new text end ;

deleted text begin (12) deleted text end new text begin (16) new text end marital privacy for visits with the consumer's spouse and, if both are
residents of the site, the right to share a bedroom and bed;

deleted text begin (13) deleted text end new text begin (17) new text end associate with other persons of the consumer's choice;

deleted text begin (14) deleted text end new text begin (18) new text end personal privacy; and

deleted text begin (15) deleted text end new text begin (19) new text end engage in chosen activities.

new text begin (b) Restriction of a person's protection-related rights under paragraph (a), clauses
(13) to (15), is allowed only if determined necessary to ensure the health, safety,
and well-being of the person by the support team, the person or the person's legal
representative, and the case manager. The need for any restriction must be fully
documented in an assessment of the person's vulnerability and risk of maltreatment
related to the exercise of these rights by the person. Written informed consent for the
restriction of a protection-related right must be obtained from the person or the person's
legal representative according to paragraph (c).
new text end

new text begin (c) Written informed consent for the restriction of a protection-related right obtained
from the person or the person's legal representative must:
new text end

new text begin (1) specify the nature of the limitation and the conditions and timelines under which
the limitation will be removed and the right fully restored; and
new text end

new text begin (2) explain that:
new text end

new text begin (i) consent may be withdrawn at any time and the restriction will be discontinued
upon withdrawal of consent;
new text end

new text begin (ii) consent is time-limited and automatically expires annually after the date on
which consent was given; and
new text end

new text begin (iii) upon expiration, written informed consent must be obtained again in order for
the restriction to continue.
new text end

new text begin The person or the person's legal representative must be provided a copy of the
signed informed consent form.
new text end

Sec. 11.

Minnesota Statutes 2010, section 245B.05, subdivision 1, is amended to read:

Subdivision 1.

Environment.

The license holder must:

(1) ensure that services are provided in a safe and hazard-free environment when the
license holder is the owner, lessor, or tenant of the service site. All other license holders
shall inform the consumer or the consumer's legal representative and case manager about
any environmental safety concerns in writing;

(2) lock doors only to protect the safety of consumers and not as a substitute for staff
supervision or interactions with consumers new text begin . new text end new text begin If doors are locked to protect a person's
safety, the license holder must justify and document how this determination was made
in consultation with the person or the person's legal representative and how access will
otherwise be provided to the person and all other affected persons receiving services new text end ;

(3) follow procedures that minimize the consumer's health risk from communicable
diseases; and

(4) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition.

Sec. 12.

Minnesota Statutes 2010, section 245B.06, subdivision 2, is amended to read:

Subd. 2.

Risk management plan.

(a) The license holder must develop, document
deleted text begin in writing deleted text end , and implement a risk management plan that meets the requirements of this
subdivision. License holders licensed under this chapter are exempt from sections
245A.65, subdivision 2, and 626.557, subdivision 14, if the requirements of this
subdivision are met.

(b) The risk management plan must identify areas in which the consumer is
vulnerable, based on an assessment, at a minimum, of the following areas:

(1) an adult consumer's susceptibility to physical, emotional, and sexual abuse as
defined in section 626.5572, subdivision 2, and financial exploitation as defined in section
626.5572, subdivision 9; a minor consumer's susceptibility to sexual and physical abuse as
defined in section 626.556, subdivision 2; and a consumer's susceptibility to self-abuse,
regardless of age;

(2) the consumer's new text begin ability to manage new text end health needs, considering the consumer's new text begin :
new text end

new text begin (i) new text end physical disabilities new text begin or sensory impairments and the ability to obtain and use
assistance, assistive technology, adaptive aids, or equipment new text end ;

deleted text begin allergies; sensory impairments deleted text end new text begin (ii) ability to avoid allergens and manage allergic
reactions new text end ;

new text begin (iii) ability to manage new text end seizures;

new text begin (iv) ability to follow new text end diet new text begin and nutritional guidelines or orders new text end ;

new text begin (v) ability to eat without assistance and swallow without choking;
new text end

deleted text begin need for medications deleted text end new text begin (vi) ability to self-administer and manage medication or
treatment orders new text end ;

deleted text begin and deleted text end new text begin (vii) new text end ability to obtain new text begin routine new text end medical treatment; new text begin and
new text end

new text begin (viii) ability to respond to and report changes in physical and mental well-being;
new text end

(3) the consumer's new text begin personal new text end safety deleted text begin needs deleted text end new text begin skills new text end , considering the consumer's ability to new text begin :
new text end

new text begin (i) new text end take reasonable safety precautions new text begin to prevent accidents that could result in falls,
burns, or injury new text end ;

deleted text begin community survival skills; water survival skills deleted text end new text begin (ii) prevent becoming lost or seeking
help if lost when in the community new text end ;

new text begin (iii) follow street safety rules;
new text end

new text begin (iv) use public transportation;
new text end

new text begin (v) drive or ride in a vehicle;
new text end

new text begin (vi) follow water survival skills sufficient to avoid drowning or near drowning;
new text end

deleted text begin ability to deleted text end new text begin (vii) new text end seek assistance new text begin with new text end or deleted text begin provide medical care deleted text end new text begin self-administer basic
first aid new text end ; and

deleted text begin access to deleted text end new text begin (viii) safely handle or avoid new text end toxic substances or dangerous items;

(4) deleted text begin environmental issues deleted text end new text begin the environments new text end , considering new text begin the consumer's ability to:
new text end

new text begin (i) recognize and respond to hazardous conditions in new text end the deleted text begin program's location in a deleted text end
particular neighborhood or community new text begin where the program is located or where services
are provided new text end ;

deleted text begin the type of deleted text end new text begin (ii) move safely throughout the building or on the new text end grounds and terrain
surrounding the building; deleted text begin and
deleted text end

deleted text begin the consumer's ability to deleted text end new text begin (iii) new text end respond to weather-related conditions, new text begin including
dressing appropriately for the weather or seeking shelter;
new text end

new text begin (iv) new text end open locked doors deleted text begin , deleted text end new text begin to evacuate a room or building in an emergency; new text end and

new text begin (v) new text end remain alone in any environment; and

(5) the consumer's behavior, including new text begin when the license holder knows that the
consumer has committed a violent crime or engages in new text end behaviors that may increase
the likelihood of physical aggression deleted text begin between consumers deleted text end new text begin , new text end or sexual activity deleted text begin between
consumers deleted text end involving force or coercion, as defined under section 245B.02, subdivision 10,
clauses (6) and (7) new text begin , between consumers, or towards others. Under this clause, a license
holder knows of a consumer's history of criminal misconduct, physical aggression, or
sexual activity involving force or coercion, if the license holder receives such information
from a law enforcement authority, through a medical record prepared by a health care
provider, or the license holder's ongoing assessments of the consumer new text end .

(c) When assessing a consumer's vulnerability, the license holder must consider only
the consumer's skills and abilities, independent of staffing patterns, supervision plans, the
environment, or other situational elements. new text begin License holders jointly providing services
to a consumer shall coordinate and use the resulting assessment of risk areas for the
development of each license holder's risk management or the shared risk management plan.
new text end

(d) deleted text begin License holders jointly providing services to a consumer shall coordinate and
use the resulting assessment of risk areas for the development of each license holder's
risk management or the shared risk management plan. deleted text end The license deleted text begin holder's deleted text end new text begin holder must
develop a new text end plan deleted text begin must include deleted text end new text begin that identifies new text end the specific actions deleted text begin a staff person will take deleted text end new text begin and
measures that will be taken new text end to protect the consumer and minimize risks for the identified
vulnerability areas new text begin within the scope of the licensed services new text end . The specific actions must new text begin :
new text end

new text begin (1) new text end include the proactive measures being taken new text begin to reduce or minimize the risk new text end ,
training being provided new text begin to the consumer to develop skills or abilities to avoid or respond
to the risk as independently as possible new text end , or a detailed description of actions a staff person
will take when intervention is needed new text begin ; and
new text end

new text begin (2) be developed according to the requirements of subdivision 1, paragraph (b).
When the assessment indicates that the consumer is vulnerable but does not need specific
risk reduction measures, the risk management plan shall document and justify this
determination. The plan must identify recommendations made to the case manager when
the consumer is vulnerable to risks outside the scope or control of the licensed services new text end .

(e) Prior to or upon initiating services, a license holder must develop an initial risk
management plan that is, at a minimum, verbally approved by the consumer or consumer's
legal representative and case manager. The license holder must document the date the
license holder receives the consumer's or consumer's legal representative's and case
manager's verbal approval of the initial plan.

(f) As part of the meeting held within 45 days of initiating service, as required
under section 245B.06, subdivision 4, the license holder must review the initial risk
management plan for accuracy and revise the plan if necessary. The license holder must
give the consumer or consumer's legal representative and case manager an opportunity to
participate in this plan review. If the license holder revises the plan, or if the consumer or
consumer's legal representative and case manager have not previously signed and dated
the plan, the license holder must obtain dated signatures to document the plan's approval.

(g) After plan approval, the license holder must review the plan at least annually and
update the plan based on the individual consumer's needs and changes to the environment.
The license holder must give the consumer or consumer's legal representative and case
manager an opportunity to participate in the ongoing plan development. The license holder
shall obtain dated signatures from the consumer or consumer's legal representative and
case manager to document completion of the annual review and approval of plan changes.

Sec. 13.

Minnesota Statutes 2010, section 245B.07, subdivision 5, is amended to read:

Subd. 5.

Staff orientation.

(a) Within 60 days of hiring staff who provide direct
service, the license holder must provide 30 hours of staff orientation. Direct care staff
must complete 15 of the 30 hours orientation before providing any unsupervised direct
service to a consumer. If the staff person has received orientation training from a license
holder licensed under this chapter, or provides semi-independent living services only, the
15-hour requirement may be reduced to eight hours. The total orientation of 30 hours may
be reduced to 15 hours if the staff person has previously received orientation training from
a license holder licensed under this chapter.

(b) The 30 hours of orientation must combine supervised on-the-job training with
deleted text begin coverage deleted text end new text begin review new text end of new text begin and instruction on new text end the following material:

(1) review of the consumer's service plans and risk management plan to achieve an
understanding of the consumer as a unique individual new text begin and staff responsibilities related to
implementation of those plans new text end ;

(2) review and instruction on new text begin implementation of new text end the license holder's policies and
procedures, including their location and access;

(3) new text begin staff responsibilities related to new text end emergency procedures;

(4) explanation of specific job functions, including implementing objectives from
the consumer's individual service plan;

(5) explanation of responsibilities related to section 245A.65; sections 626.556
and 626.557, governing maltreatment reporting and service planning for children and
vulnerable adults; and section 245.825, governing use of aversive and deprivation
procedures;

(6) medication administration as it applies to the individual consumer, from a
training curriculum developed by a health services professional described in section
245B.05, subdivision 5, and when the consumer meets the criteria of having overriding
health care needs, then medication administration taught by a health services professional.
Staff may administer medications only after they demonstrate the ability, as defined in the
license holder's medication administration policy and procedures. Once a consumer with
overriding health care needs is admitted, staff will be provided with remedial training as
deemed necessary by the license holder and the health professional to meet the needs of
that consumer.

For purposes of this section, overriding health care needs means a health care
condition that affects the service options available to the consumer because the condition
requires:

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

(ii) nonmedical service providers to adapt their services to accommodate the health
and safety needs of the consumer;

(7) consumer rights new text begin and staff responsibilities related to protecting and ensuring
the exercise of the consumer rights new text end ; and

(8) other topics necessary as determined by the consumer's individual service plan or
other areas identified by the license holder.

(c) The license holder must document each employee's orientation received.

Sec. 14.

Minnesota Statutes 2010, section 245B.07, is amended by adding a
subdivision to read:

new text begin Subd. 7a. new text end

new text begin Subcontractors. new text end

new text begin If the license holder uses a subcontractor to perform
services licensed under this chapter on the license holder's behalf, the license holder must
ensure that the subcontractor meets and maintains compliance with all requirements under
this chapter that apply to the services to be provided.
new text end

Sec. 15.

Minnesota Statutes 2010, section 245B.07, subdivision 9, is amended to read:

Subd. 9.

Availability of current written policies and procedures.

The license
holder shall:

(1) review and update, as needed, the written policies and procedures in this chapter;

(2) inform consumers or the consumer's legal representatives of the written policies
and procedures in this chapter upon service initiation. Copies new text begin of policies and procedures
affecting a consumer's rights under section 245D.04 must be provided upon service
initiation. Copies of all other policies and procedures new text end must be available to consumers
or the consumer's legal representatives, case managers, the county where services are
located, and the commissioner upon request;

(3) provide all consumers or the consumers' legal representatives and case managers
a copy new text begin of the revised policies and procedures new text end and explanation of new text begin the new text end revisions deleted text begin to policies
and procedures deleted text end that affect consumers' service-related or protection-related rights under
section 245B.04 new text begin and maltreatment reporting policies and procedures new text end . Unless there is
reasonable cause, the license holder must provide this notice at least 30 days before
implementing the revised policy and procedure. The license holder must document the
reason for not providing the notice at least 30 days before implementing the revisions;

(4) annually notify all consumers or the consumers' legal representatives and case
managers of any revised policies and procedures under this chapter, other than those in
clause (3). Upon request, the license holder must provide the consumer or consumer's
legal representative and case manager copies of the revised policies and procedures;

(5) before implementing revisions to policies and procedures under this chapter,
inform all employees of the new text begin revisions and provide training on implementation of the new text end
revised policies and procedures; and

(6) document and maintain relevant information related to the policies and
procedures in this chapter.

Sec. 16.

Minnesota Statutes 2010, section 245B.07, subdivision 10, is amended to read:

Subd. 10.

Consumer funds.

(a) The license holder must ensure that consumers
retain the use and availability of personal funds or property unless restrictions are justified
in the consumer's individual service plan.

(b) The license holder must ensure separation of consumer funds from funds of the
license holder, the program, or program staff.

(c) Whenever the license holder assists a consumer with the safekeeping of funds
or other property, the license holder must have written authorization to do so by the
consumer or the consumer's legal representative, and the case manager. In addition, the
license holder must:

(1) document receipt and disbursement of the consumer's funds or the property;

(2) annually survey, document, and implement the preferences of the consumer,
consumer's legal representative, and the case manager for frequency of receiving a
statement that itemizes receipts and disbursements of consumer funds or other property;
and

(3) return to the consumer upon the consumer's request, funds and property in the
license holder's possession subject to restrictions in the consumer's individual service plan,
as soon as possible, but no later than three working days after the date of the request.

(d) License holders and program staff must not:

(1) borrow money from a consumer;

(2) purchase personal items from a consumer;

(3) sell merchandise or personal services to a consumer;

(4) require a consumer to purchase items for which the license holder is eligible for
reimbursement; deleted text begin or
deleted text end

(5) use consumer funds in a manner that would violate section 256B.04, or any
rules promulgated under that section deleted text begin . deleted text end new text begin ; or
new text end

new text begin (6) accept powers-of-attorney from a person receiving services from the license
holder for any purpose, and may not accept an appointment as guardian or conservator of
a person receiving services from the license holder. This does not apply to license holders
that are Minnesota counties or other units of government.
new text end

Sec. 17.

new text begin [245D.01] CITATION.
new text end

new text begin This chapter may be cited as the "Home and Community-Based Services Standards"
or "HCBS Standards."
new text end

Sec. 18.

new text begin [245D.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin The terms used in this chapter have the meanings given
them in this section.
new text end

new text begin Subd. 2. new text end

new text begin Annual and annually. new text end

new text begin "Annual" and "annually" have the meaning given
in section 245A.02, subdivision 2b.
new text end

new text begin Subd. 3. new text end

new text begin Case manager. new text end

new text begin "Case manager" means the individual designated to provide
case management services, care coordination, or long-term care consultation, as specified
in sections 256B.0913, 256B.0915, 256B.092, and 256B.49, or successor provisions.
new text end

new text begin Subd. 4. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of the
Department of Human Services or the commissioner's designated representative.
new text end

new text begin Subd. 5. new text end

new text begin Department. new text end

new text begin "Department" means the Department of Human Services.
new text end

new text begin Subd. 6. new text end

new text begin Direct contact. new text end

new text begin "Direct contact" has the meaning given in section 245C.02,
subdivision 11, and is used interchangeably with the term "direct service."
new text end

new text begin Subd. 7. new text end

new text begin Drug. new text end

new text begin "Drug" has the meaning given in section 151.01, subdivision 5.
new text end

new text begin Subd. 8. new text end

new text begin Emergency. new text end

new text begin "Emergency" means any fires, severe weather, natural
disasters, power failures, or other events that threaten the immediate health and safety of a
person receiving services, that require emergency evacuation, moving to an emergency
shelter, or temporary closure or relocation of the program to another facility or service site.
new text end

new text begin Subd. 9. new text end

new text begin Health services. new text end

new text begin "Health services" means any service or treatment
consistent with the health needs of the person, such as medication administration and
monitoring, medical, dental, nutritional, health monitoring, wellness education, and
exercise.
new text end

new text begin Subd. 10. new text end

new text begin Home and community-based services. new text end

new text begin "Home and community-based
services" means the services subject to the provisions of this chapter and defined in the
federal waiver plans governed by United States Code, title 42, sections 1396 et seq., or the
state's alternative care program according to section 256B.0913, including the brain injury
(BI) waiver, the community alternative care (CAC) waiver, the community alternatives
for disabled individuals (CADI) waiver, the developmental disability (DD) waiver, the
elderly waiver (EW), and the alternative care (AC) program.
new text end

new text begin Subd. 11. new text end

new text begin Incident. new text end

new text begin "Incident" means any of the following:
new text end

new text begin (1) serious injury as determined by section 245.91, subdivision 6;
new text end

new text begin (2) a person's death;
new text end

new text begin (3) any medical emergencies, unexpected serious illnesses, or significant unexpected
changes in illnesses or medical conditions of a person that require physician treatment
or hospitalization;
new text end

new text begin (4) a person's unauthorized or unexplained absence from a program;
new text end

new text begin (5) physical aggression by a person receiving services against another person
receiving services that causes physical pain, injury, or persistent emotional distress,
including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
pushing, and spitting;
new text end

new text begin (6) any sexual activity between persons receiving services involving force or
coercion as defined under section 609.341, subdivisions 3 and 14; or
new text end

new text begin (7) a report of alleged or suspected child or vulnerable adult maltreatment under
section 626.556 or 626.557.
new text end

new text begin Subd. 12. new text end

new text begin Legal representative. new text end

new text begin "Legal representative" means the parent of a
person who is under 18 years of age, a court-appointed guardian, or other representative
with legal authority to make decisions about services for a person.
new text end

new text begin Subd. 13. new text end

new text begin License. new text end

new text begin "License" has the meaning given in section 245A.02,
subdivision 8.
new text end

new text begin Subd. 14. new text end

new text begin Licensed health professional. new text end

new text begin "Licensed health professional" means a
person licensed in Minnesota to practice those professions described in section 214.01,
subdivision 2.
new text end

new text begin Subd. 15. new text end

new text begin License holder. new text end

new text begin "License holder" has the meaning given in section
245A.02, subdivision 9.
new text end

new text begin Subd. 16. new text end

new text begin Medication. new text end

new text begin "Medication" means a prescription drug or over-the-counter
drug. For purposes of this chapter, "medication" includes dietary supplements.
new text end

new text begin Subd. 17. new text end

new text begin Medication administration. new text end

new text begin "Medication administration" means
performing the following set of tasks to ensure a person takes both prescription and
over-the-counter medications and treatments according to orders issued by appropriately
licensed professionals, and includes the following:
new text end

new text begin (1) checking the person's medication record;
new text end

new text begin (2) preparing the medication for administration or setting up medications for
self-administration by the person;
new text end

new text begin (3) administering the medication to the person or providing assistance to the person
for self-administration;
new text end

new text begin (4) completing medication documentation and charting, including documenting the
administration of the medication or the reason for not administering the medication; and
new text end

new text begin (5) reporting to the prescriber or a nurse any concerns about the medication,
including side effects, adverse reactions, effectiveness, or the person's refusal to take the
medication or the person's self-administration of the medication.
new text end

new text begin Subd. 18. new text end

new text begin Medication assistance. new text end

new text begin "Medication assistance" means providing verbal
or visual reminders to take regularly scheduled medication, which includes either of
the following:
new text end

new text begin (1) bringing to the person and opening a container of previously set up medications
and emptying the container into the person's hand or opening and giving the medications
in the original container to the person, or bringing to the person liquids or food to
accompany the medication; or
new text end

new text begin (2) providing verbal or visual reminders to perform regularly scheduled treatments
and exercises.
new text end

new text begin Subd. 19. new text end

new text begin Medication management. new text end

new text begin "Medication management" means the
provision of any of the following:
new text end

new text begin (1) medication-related services to a person;
new text end

new text begin (2) medication setup;
new text end

new text begin (3) medication administration;
new text end

new text begin (4) medication storage and security;
new text end

new text begin (5) medication documentation and charting;
new text end

new text begin (6) verification and monitoring of effectiveness of systems to ensure safety;
new text end

new text begin (7) medication handling and administration;
new text end

new text begin (8) coordination of medication refills;
new text end

new text begin (9) handling changes to prescriptions and implementation of those changes;
new text end

new text begin (10) communicating with the pharmacy; or
new text end

new text begin (11) coordination and communication with prescriber.
new text end

new text begin Subd. 20. new text end

new text begin Over-the-counter drug. new text end

new text begin "Over-the-counter drug" means a drug that
is not required by federal law to bear the statement "Caution: Federal law prohibits
dispensing without prescription."
new text end

new text begin Subd. 21. new text end

new text begin Person. new text end

new text begin "Person" has the meaning given in section 245A.02, subdivision
11.
new text end

new text begin Subd. 22. new text end

new text begin Person with a disability. new text end

new text begin "Person with a disability" means a person
determined to have a disability by the commissioner's state medical review team as
identified in section 256B.055, subdivision 7, the Social Security Administration, or
the person is determined to have a developmental disability as defined in Minnesota
Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
252.27, subdivision 1a.
new text end

new text begin Subd. 23. new text end

new text begin Prescriber. new text end

new text begin "Prescriber" means a licensed practitioner as defined in
section 151.01, subdivision 23, who is authorized under section 151.37 to prescribe
drugs. For the purposes of this chapter, the term "prescriber" is used interchangeably
with "physician."
new text end

new text begin Subd. 24. new text end

new text begin Prescription drug. new text end

new text begin "Prescription drug" has the meaning given in section
151.01, subdivision 17.
new text end

new text begin Subd. 25. new text end

new text begin Program. new text end

new text begin "Program" means either the nonresidential or residential
program as defined in section 245A.02, subdivisions 10 and 14.
new text end

new text begin Subd. 26. new text end

new text begin Psychotropic medication. new text end

new text begin "Psychotropic medication" means any
medication prescribed to treat mental illness and associated behaviors or to control or alter
behavior. The major classes of psychotropic medication are antipsychotic (neuroleptic),
antidepressant, antianxiety, antimania, stimulant, and sedative or hypnotic. Other
miscellaneous medications are considered to be a psychotropic medication when they are
specifically prescribed to treat a mental illness or to control or alter behavior.
new text end

new text begin Subd. 27. new text end

new text begin Restraint. new text end

new text begin "Restraint" means manual restraint as defined in Minnesota
Rules, part 9525.2710, subpart 22, and mechanical restraint as defined in Minnesota
Rules, part 9525.2710, subpart 23.
new text end

new text begin Subd. 28. new text end

new text begin Seclusion. new text end

new text begin "Seclusion" has the meaning given in Minnesota Rules, part
9525.2710, subpart 32.
new text end

new text begin Subd. 29. new text end

new text begin Service. new text end

new text begin "Service" means care, training, supervision, counseling,
consultation, or medication assistance assigned to the license holder in the service plan.
new text end

new text begin Subd. 30. new text end

new text begin Service plan. new text end

new text begin "Service plan" means the individual service plan or
individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions, and includes any support plans or service needs identified as a
result of long-term care consultation, or a support team meeting, or assigned to a license
holder through an authorized service agreement.
new text end

new text begin Subd. 31. new text end

new text begin Service site. new text end

new text begin "Service site" means the location where the service is
provided to the person, including but not limited to, a facility licensed according to chapter
245A; a location where the license holder is the owner, lessor, or tenant; a person's own
home; or a community-based location.
new text end

new text begin Subd. 32. new text end

new text begin Staff. new text end

new text begin "Staff" means an employee who will have direct contact with a
person served by the facility, agency, or program.
new text end

new text begin Subd. 33. new text end

new text begin Support team. new text end

new text begin "Support team" means the service planning team
identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
Minnesota Rules, part 9525.0004, subpart 14.
new text end

new text begin Subd. 34. new text end

new text begin Unit of government. new text end

new text begin "Unit of government" means every city, county,
town, school district, other political subdivisions of the state, and any agency of the state
or the United States, and includes any instrumentality of a unit of government.
new text end

new text begin Subd. 35. new text end

new text begin Volunteer. new text end

new text begin "Volunteer" means an individual who, under the direction of
the license holder, provides direct services without pay to a person served by the license
holder.
new text end

Sec. 19.

new text begin [245D.03] APPLICABILITY AND EFFECT.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of the following services:
new text end

new text begin (1) housing access coordination as defined under the current DD waiver plan or
successor plans;
new text end

new text begin (2) respite services as defined under the current CADI waiver plan or successor plans
excluding providers serving only one family;
new text end

new text begin (3) behavioral programming as defined under the current BI waiver plan or successor
plans;
new text end

new text begin (4) specialist services as defined under the current DD waiver plan or successor
plans;
new text end

new text begin (5) companion services as defined under the current BI and EW waiver plans or
successor plans, except companion services provided under the Corporation for National
and Community Services Senior Companion Program established under the Domestic
Volunteer Service Act of 1973, Public Law 98-288 and excluding providers serving only
one family;
new text end

new text begin (6) personal support as defined under the current DD waiver plan or successor plans
excluding providers serving only one family;
new text end

new text begin (7) 24-hour emergency assistance, on-call and personal emergency response as
defined under the current CADI and DD waiver plans or successor plans;
new text end

new text begin (8) night supervision services as defined under the current BI waiver;
new text end

new text begin (9) homemaker services as defined under the current CADI waiver plan or successor
plans, excluding providers licensed by the Department of Health under chapter 144A,
those providers providing cleaning services only, and providers serving only one family;
new text end

new text begin (10) independent living skills training as defined under the current BI and CADI
waiver plans or successor plans;
new text end

new text begin (11) prevocational services as defined under the current BI and CADI waiver plans
or successor plans;
new text end

new text begin (12) structured day services as defined under the current BI waiver plan or successor
plans; or
new text end

new text begin (13) supported employment as defined under the current BI and CADI waiver plans
or successor plans.
new text end

new text begin Subd. 2. new text end

new text begin Relationship to other standards governing home and community-based
services. new text end

new text begin (a) A license holder governed by this chapter is also subject to the licensure
requirements under chapter 245A.
new text end

new text begin (b) A license holder concurrently providing child foster care services licensed
according to Minnesota Rules, chapter 2960, to the same person receiving a service
licensed under this chapter is exempt from section 245D.04, as it applies to the person.
new text end

new text begin (c) A license holder concurrently providing home care services registered according
to sections 144A.43 to 144A.49 to the same person receiving home management services
licensed under this chapter is exempt from section 245D.04, as it applies to the person.
new text end

new text begin (d) A license holder identified in subdivision 1, clauses (1), (2), (5), and (9), is
exempt from compliance with sections 245A.65, subdivision 2, paragraph (a), and
626.557, subdivision 14, paragraph (b).
new text end

new text begin (e) A license holder providing structured day, prevocational, or supported
employment services under this chapter and day training and habilitation or supported
employment services licensed under chapter 245B within the same program is exempt
from compliance with this chapter, when the license holder notifies the commissioner in
writing that the requirements under chapter 245B will be met for all persons receiving
services from the program. For the purposes of this paragraph, if the license holder has
obtained approval from the commissioner for an alternative inspection status according to
section 245B.031, that approval will apply to all persons receiving services in the program.
new text end

new text begin Subd. 3. new text end

new text begin Variance. new text end

new text begin If the conditions in section 245A.04, subdivision 9, are met,
the commissioner may grant a variance to any of the requirements in this chapter, except
sections 245D.04, and 245D.10, subdivision 4, paragraph (b), or provisions governing
data practices and information rights of persons.
new text end

new text begin Subd. 4. new text end

new text begin License holders with multiple 245D licenses. new text end

new text begin (a) When a person changes
service from one license to a different license held by the same license holder, the license
holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
new text end

new text begin (b) When a staff person begins providing direct service under one or more licenses
held by the same license holder, other than the license for which staff orientation was
initially provided according to section 245D.09, subdivision 4, the license holder is
exempt from those staff orientation requirements; except the staff person must review each
person's service plan and medication administration procedures in accordance with section
245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
new text end

Sec. 20.

new text begin [245D.04] SERVICE RECIPIENT RIGHTS.
new text end

new text begin Subdivision 1. new text end

new text begin License holder responsibility for individual rights of persons
served by the program. new text end

new text begin The license holder must:
new text end

new text begin (1) provide each person or each person's legal representative with a written notice
that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
those rights within five working days of service initiation and annually thereafter;
new text end

new text begin (2) make reasonable accommodations to provide this information in other formats
or languages as needed to facilitate understanding of the rights by the person and the
person's legal representative, if any;
new text end

new text begin (3) maintain documentation of the person's or the person's legal representative's
receipt of a copy and an explanation of the rights; and
new text end

new text begin (4) ensure the exercise and protection of the person's rights in the services provided
by the license holder and as authorized in the service plan.
new text end

new text begin Subd. 2. new text end

new text begin Service-related rights. new text end

new text begin A person's service-related rights include the right
to:
new text end

new text begin (1) participate in the development and evaluation of the services provided to the
person;
new text end

new text begin (2) have services identified in the service plan provided in a manner that respects
and takes into consideration the person's preferences;
new text end

new text begin (3) refuse or terminate services and be informed of the consequences of refusing
or terminating services;
new text end

new text begin (4) know, in advance, limits to the services available from the license holder;
new text end

new text begin (5) know conditions and terms governing the provision of services, including the
license holder's policies and procedures related to temporary service suspension and
service termination;
new text end

new text begin (6) know what the charges are for services, regardless of who will be paying for the
services, and be notified of changes in those charges;
new text end

new text begin (7) know, in advance, whether services are covered by insurance, government
funding, or other sources, and be told of any charges the person or other private party
may have to pay; and
new text end

new text begin (8) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the person's service plan.
new text end

new text begin Subd. 3. new text end

new text begin Protection-related rights. new text end

new text begin (a) A person's protection-related rights include
the right to:
new text end

new text begin (1) have personal, financial, service, health, and medical information kept private,
and be advised of disclosure of this information by the license holder;
new text end

new text begin (2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;
new text end

new text begin (3) be free from maltreatment;
new text end

new text begin (4) be free from restraint or seclusion used for a purpose other than to protect the
person from imminent danger to self or others;
new text end

new text begin (5) receive services in a clean and safe environment when the license holder is the
owner, lessor, or tenant of the service site;
new text end

new text begin (6) be treated with courtesy and respect and receive respectful treatment of the
person's property;
new text end

new text begin (7) reasonable observance of cultural and ethnic practice and religion;
new text end

new text begin (8) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;
new text end

new text begin (9) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;
new text end

new text begin (10) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;
new text end

new text begin (11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;
new text end

new text begin (12) give or withhold written informed consent to participate in any research or
experimental treatment;
new text end

new text begin (13) associate with other persons of the person's choice;
new text end

new text begin (14) personal privacy; and
new text end

new text begin (15) engage in chosen activities.
new text end

new text begin (b) For a person residing in a residential site licensed according to chapter 245A,
or where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:
new text end

new text begin (1) have daily, private access to and use of a non-coin-operated telephone for local
calls and long-distance calls made collect or paid for by the person;
new text end

new text begin (2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication; and
new text end

new text begin (3) privacy for visits with the person's spouse, next of kin, legal counsel, religious
advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
privacy in the person's bedroom.
new text end

new text begin (c) Restriction of a person's protection-related rights under paragraphs (a), clauses
(13) and (14), and (b) is allowed only if determined necessary to ensure the health,
safety, and well-being of the person by the support team, the person or the person's
legal representative, and the case manager. The need for any restriction must be fully
documented in an assessment of the person's vulnerability and risk of maltreatment
related to the exercise of these rights by the person. Written informed consent for the
restriction of a protection-related right must be obtained from the person or the person's
legal representative according to paragraph (d).
new text end

new text begin (d) Written informed consent for the restriction of a protection-related right obtained
from the person or the person's legal representative must:
new text end

new text begin (1) specify the nature of the limitation and the conditions and timelines under which
the limitation will be removed and the right fully restored; and
new text end

new text begin (2) explain that:
new text end

new text begin (i) consent may be withdrawn at any time and the restriction will be discontinued
upon withdrawal of consent;
new text end

new text begin (ii) consent is time-limited and automatically expires annually after the date on
which consent was given; and
new text end

new text begin (iii) upon expiration, written informed consent must be obtained again in order for
the restriction to continue.
new text end

new text begin The person or the person's legal representative must be provided a copy of the signed
informed consent form.
new text end

Sec. 21.

new text begin [245D.05] HEALTH SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Health needs. new text end

new text begin The license holder is responsible for providing health
services assigned in the service plan and consistent with the person's health needs. The
license holder is responsible for promptly notifying the person or the person's legal
representative and the case manager of changes in a person's health needs affecting
assigned health services, 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. When assigned in the service plan, the license
holder is required to 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:
new text end

new text begin (1) provide medication administration, medication assistance, or medication
management according to the requirements of this section;
new text end

new text begin (2) monitor health conditions according to written instructions from the person's
physician or a licensed health professional;
new text end

new text begin (3) assist with or coordinate medical, dental, and other health service appointments;
or
new text end

new text begin (4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from the person's physician or a licensed
health professional.
new text end

new text begin Subd. 2. new text end

new text begin Medication administration. new text end

new text begin (a) The license holder must ensure that the
following criteria have been met before staff that is not a licensed health professional
administers medication or treatment:
new text end

new text begin (1) new text end new text begin written authorization has been obtained from the person or the person's legal
representative to administer medication or treatment orders;
new text end

new text begin (2) the staff person has completed medication administration training according to
section 245D.09, subdivision 4, paragraph (c), clause (2); and
new text end

new text begin (3) the medication or treatment will be administered under administration procedures
established for the person in consultation with a licensed health professional. Written
instruction from the person's physician may constitute the medication administration
procedures. A prescription label or the prescriber's order for the prescription is sufficient
to constitute written instructions from the prescriber. A licensed health professional may
delegate medication administration procedures.
new text end

new text begin (b) The license holder must ensure the following information is documented in the
person's medication administration record:
new text end

new text begin (1) the information on the prescription label or the prescriber's order;
new text end

new text begin (2) information on any discomforts, risks, or other side effects that are reasonable
to expect;
new text end

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

new text begin (4) instruction from the prescriber on when and to whom to report the following:
new text end

new text begin (i) if the medication or treatment is not administered as prescribed, whether by error
by the staff or the person or by refusal by the person; and
new text end

new text begin (ii) the occurrence of possible adverse reactions to the medication or treatment;
new text end

new text begin (5) notation of any occurrence of medication not being administered as prescribed or
of adverse reactions, and when and to whom the report was made; and
new text end

new text begin (6) notation of when a medication or treatment is started, changed, or discontinued.
new text end

new text begin (c) The license holder must ensure that the information maintained in the medication
administration record is current and is regularly reviewed with the person or the person's
legal representative and the staff administering the medication to identify medication
administration issues or errors. At a minimum, the review must be conducted every three
months or more often if requested by the person or the person's legal representative.
Based on the review, the license holder must develop and implement a plan to correct
medication administration issues or errors. If issues or concerns are identified related to
the medication itself, the license holder must report those as required under subdivision 4.
new text end

new text begin Subd. 3. new text end

new text begin Medication assistance. new text end

new text begin The license holder must ensure that the
requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
to enable a person to self-administer medication when the person is capable of directing
the person's own care, or when the person's legal representative is present and able to
direct care for the person.
new text end

new text begin Subd. 4. new text end

new text begin Reporting medication and treatment issues. new text end

new text begin The following medication
administration issues must be reported to the person or the person's legal representative
and case manager as they occur or following timelines established in the person's service
plan or as requested in writing by the person or the person's legal representative, or the
case manager:
new text end

new text begin (1) any reports made to the person's physician or prescriber required under
subdivision 2, paragraph (b), clause (4);
new text end

new text begin (2) a person's refusal or failure to take medication or treatment as prescribed; or
new text end

new text begin (3) concerns about a person's self-administration of medication.
new text end

new text begin Subd. 5. new text end

new text begin Injectable medications. new text end

new text begin Injectable medications may be administered
according to a prescriber's order and written instructions when one of the following
conditions has been met:
new text end

new text begin (1) a registered nurse or licensed practical nurse will administer the subcutaneous or
intramuscular injection;
new text end

new text begin (2) a supervising registered nurse with a physician's order has delegated the
administration of subcutaneous injectable medication to an unlicensed staff member
and has provided the necessary training; or
new text end

new text begin (3) there is an agreement signed by the license holder, the prescriber, and the person
or the person's legal representative, specifying what injections may be given, when,
how, and that the prescriber must retain responsibility for the license holder's giving the
injections. A copy of the agreement must be placed in the person's service recipient record.
new text end

Sec. 22.

new text begin [245D.06] PROTECTION STANDARDS.
new text end

new text begin Subdivision 1. new text end

new text begin Incident response and reporting. new text end

new text begin (a) The license holder must
respond to all 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.
new text end

new text begin (b) The license holder must maintain information about and report incidents to
the person's legal representative and case manager within 24 hours of an incident
occurring while services are being provided, or 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. 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).
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (e) Within 24 hours of the occurrence, or within 24 hours of receipt of the
information, the license holder must report the death or serious injury of the person to
the legal representative, if any, and case manager, 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.
new text end

new text begin (f) The license holder must conduct a review of incident reports, for identification
of incident patterns, and implementation of corrective action as necessary to reduce
occurrences.
new text end

new text begin Subd. 2. new text end

new text begin Environment and safety. new text end

new text begin The license holder must:
new text end

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

new text begin (i) the service site is a safe and hazard-free environment;
new text end

new text begin (ii) doors are locked only to protect the safety of a person receiving services and
not as a substitute for staff supervision or interactions with a person who is receiving
services. If doors are locked to protect a person's safety, the license holder must justify and
document how this determination was made in consultation with the person or person's
legal representative, and how access will otherwise be provided to the person and all other
affected persons receiving services; and
new text end

new text begin (iii) a staff person is available on site who is trained in basic first aid whenever
persons are present and staff are required to be at the site to provide direct service;
new text end

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

new text begin (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;
new text end

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

new text begin (5) follow sanitary practices for infection control and to prevent communicable
diseases.
new text end

new text begin Subd. 3. new text end

new text begin Compliance with fire and safety codes. new text end

new text begin When services are provided at a
service site licensed according to chapter 245A or where the license holder is the owner,
lessor, or tenant of the service site, the license holder must document compliance with
applicable building codes, fire and safety codes, health rules, and zoning ordinances, or
document that an appropriate waiver has been granted.
new text end

new text begin Subd. 4. new text end

new text begin Funds and property. new text end

new text begin (a) Whenever the license holder assists a person
with the safekeeping of funds or other property according to section 245A.04, subdivision
13, the license holder must have written authorization to do so from the person and the
case manager.
new text end

new text begin (b) A license holder or staff person may not accept powers-of-attorney from a
person receiving services from the license holder for any purpose, and may not accept an
appointment as guardian or conservator of a person receiving services from the license
holder. This does not apply to license holders that are Minnesota counties or other units
of government.
new text end

new text begin Subd. 5. new text end

new text begin Prohibitions. new text end

new text begin The license holder is prohibited from using psychotropic
medication, restraints, or seclusion as a substitute for adequate staffing, as punishment,
or for staff convenience.
new text end

Sec. 23.

new text begin [245D.07] SERVICE NEEDS.
new text end

new text begin Subdivision 1. new text end

new text begin Provision of services. new text end

new text begin The license holder must provide services as
specified in the service plan and assigned to the license holder. The provision of services
must comply with the requirements of this chapter and the federal waiver plans.
new text end

new text begin Subd. 2. new text end

new text begin Service planning. new text end

new text begin The license holder must participate in support team
meetings related to the person following stated timelines established in the person's service
plan or as requested by the support team, the person, or the person's legal representative.
new text end

new text begin Subd. 3. new text end

new text begin Reports. new text end

new text begin The license holder must provide written reports regarding the
person's progress or status as requested by the person, the person's legal representative, the
case manager, or the team.
new text end

Sec. 24.

new text begin [245D.08] RECORD REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Record-keeping systems. new text end

new text begin The license holder must ensure that the
content and format of service recipient, personnel, and program records are uniform,
legible, and in compliance with the requirements of this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Service recipient record. new text end

new text begin (a) The license holder must:
new text end

new text begin (1) maintain a record of current services provided to each person on the premises
where the services are provided or coordinated; and
new text end

new text begin (2) protect service recipient records against loss, tampering, or unauthorized
disclosure in compliance with sections 13.01 to 13.10 and 13.46.
new text end

new text begin (b) The license holder must maintain the following information for each person:
new text end

new text begin (1) identifying information, including the person's name, date of birth, address, and
telephone number;
new text end

new text begin (2) the name, address, telephone number of an emergency contact, the case manager,
and family members or others as identified by the person or case manager;
new text end

new text begin (3) service information, including service initiation information, verification of the
person's eligibility for services, and documentation verifying that services have been
provided as identified in the service plan according to paragraph (a);
new text end

new text begin (4) health information, including medical history and allergies; and when the license
holder is assigned responsibility for meeting the person's health needs according to section
245D.05:
new text end

new text begin (i) current orders for medication, treatments, or medical equipment;
new text end

new text begin (ii) medication administration procedures;
new text end

new text begin (iii) a medication administration record documenting the implementation of the
medication administration procedures, including any agreements for administration of
injectable medications by the license holder; and
new text end

new text begin (iv) a medical appointment schedule;
new text end

new text begin (5) the person's current service plan or that portion of the plan assigned to the
license holder. When a person's case manager does not provide a current service plan,
the license holder must make a written request to the case manager to provide a copy of
the service plan and inform the person of the right to a current service plan and the right
to appeal under section 256.045;
new text end

new text begin (6) a record of other license holders serving the person when the person's service
plan identifies the need for coordination between the license holders, that includes a
contact person and telephone numbers, services being provided, and names of staff
responsible for coordination;
new text end

new text begin (7) documentation of orientation to the service recipient rights according to section
245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
section 245A.65, subdivision 1, paragraph (c);
new text end

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

new text begin (9) documentation of complaints received and grievance resolution;
new text end

new text begin (10) incident reports required under section 245D.06, subdivision 1;
new text end

new text begin (11) copies of written reports regarding the person's status when requested according
to section 245D.07, subdivision 3; and
new text end

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

new text begin Subd. 3. new text end

new text begin Access to service recipient records. new text end

new text begin The license holder must ensure that
the following people have access to the information in subdivision 1 in accordance with
applicable state and federal law, regulation, or rule:
new text end

new text begin (1) the person, the person's legal representative, and anyone properly authorized
by the person;
new text end

new text begin (2) the person's case manager;
new text end

new text begin (3) staff providing services to the person unless the information is not relevant to
carrying out the service plan; and
new text end

new text begin (4) the county adult foster care licensor, when services are also licensed as adult
foster care.
new text end

new text begin Subd. 4. new text end

new text begin Personnel records. new text end

new text begin The license holder must maintain a personnel record
of each employee, direct service volunteer, and subcontractor to document and verify staff
qualifications, orientation, and training. For the purposes of this subdivision, the terms
"staff" or "staff person" mean paid employee, direct service volunteer, or subcontractor.
The personnel record must include:
new text end

new text begin (1) the staff person's date of hire, completed application, a position description
signed by the staff person, documentation that the staff person meets the position
requirements as determined by the license holder, the date of first supervised direct contact
with a person served by the program, and the date of first unsupervised direct contact with
a person served by the program;
new text end

new text begin (2) documentation of staff qualifications, orientation, training, and performance
evaluations as required under section 245D.09, subdivisions 3, 4, and 5, including the
date the training was completed, the number of hours per subject area, and the name and
qualifications of the trainer or instructor; and
new text end

new text begin (3) a completed background study as required under chapter 245C.
new text end

Sec. 25.

new text begin [245D.09] STAFFING STANDARDS.
new text end

new text begin Subdivision 1. new text end

new text begin Staffing requirements. new text end

new text begin The license holder must provide direct
service staff sufficient to ensure the health, safety, and protection of rights of each person
and to be able to implement the responsibilities assigned to the license holder in each
person's service plan.
new text end

new text begin Subd. 2. new text end

new text begin Supervision of staff having direct contact. new text end

new text begin Except for a license holder
who are the sole direct service staff, the license holder must provide adequate supervision
of staff providing direct service to ensure the health, safety, and protection of rights of
each person and implementation of the responsibilities assigned to the license holder in
each person's service plan.
new text end

new text begin Subd. 3. new text end

new text begin Staff qualifications. new text end

new text begin (a) The license holder must ensure that staff is
competent through training, experience, and education to meet the person's needs and
additional requirements as written in the service plan, 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:
new text end

new text begin (1) education and experience qualifications, including a valid degree and transcript,
or a current license, registration, or certification, when a degree or licensure, registration,
or certification is required;
new text end

new text begin (2) completion of required orientation and training, including completion of
continuing education required to maintain professional licensure, registration, or
certification requirements; and
new text end

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

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

new text begin Subd. 4. new text end

new text begin Orientation. new text end

new text begin (a) Except for a license holder who does not supervise any
direct service staff, within 90 days of hiring direct service staff, the license holder must
provide and ensure completion of orientation that combines supervised on-the-job training
with review of and instruction on the following:
new text end

new text begin (1) the job description and how to complete specific job functions, including:
new text end

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

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

new text begin (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;
new text end

new text begin (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;
new text end

new text begin (4) the service recipient rights under section 245D.04, and staff responsibilities
related to ensuring the exercise and protection of those rights;
new text end

new text begin (5) sections 245A.65; 245A.66, 626.556, and 626.557, governing maltreatment
reporting and service planning for children and vulnerable adults, and staff responsibilities
related to protecting persons from maltreatment and reporting maltreatment;
new text end

new text begin (6) what constitutes use of restraints, seclusion, and psychotropic medications, and
staff responsibilities related to the prohibitions of their use; and
new text end

new text begin (7) other topics as determined necessary in the person's service plan by the case
manager or other areas identified by the license holder.
new text end

new text begin (b) License holders who provide direct service themselves must complete the
orientation required in paragraph (a), clauses (3) to (7).
new text end

new text begin (c) Before providing unsupervised direct service to a person served by the program,
or for whom the staff person has not previously provided direct service, or any time the
plans or procedures identified in clauses (1) and (2) are revised, the staff person must
review and receive instruction on the following as it relates to the staff person's job
functions for that person:
new text end

new text begin (1) the person's service plan as it relates to the responsibilities assigned to the license
holder, and when applicable, the person's individual abuse prevention plan according to
section 245A.65, to achieve an understanding of the person as a unique individual, and
how to implement those plans; and
new text end

new text begin (2) medication administration procedures established for the person when assigned
to the license holder according to section 245D.05, subdivision 1, paragraph (b).
Unlicensed staff may administer medications only after successful completion of a
medication administration training, from a training curriculum developed by a registered
nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
practitioner, physician's assistant, or physician incorporating an observed skill assessment
conducted by the trainer to ensure staff demonstrate the ability to safely and correctly
follow medication procedures. Medication administration must be taught by a registered
nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
practitioner, physician's assistant, or physician, if at the time of service initiation or any
time thereafter, the person has or develops a health care condition that affects the service
options available to the person because the condition requires:
new text end

new text begin (i) specialized or intensive medical or nursing supervision;
new text end

new text begin (ii) nonmedical service providers to adapt their services to accommodate the health
and safety needs of the person; and
new text end

new text begin (iii) necessary training in order to meet the health service needs of the person as
determined by the person's physician.
new text end

new text begin Subd. 5. new text end

new text begin Training. new text end

new text begin (a) A license holder must provide annual training to direct
service staff on the topics identified in subdivision 4, paragraph (a), clauses (3) to (5).
new text end

new text begin (b) A license holder providing behavioral programming, specialist services, personal
support, 24-hour emergency assistance, night supervision, independent living skills,
structured day, prevocational, or supported employment services must provide a minimum
of eight hours of annual training to direct service staff that addresses:
new text end

new text begin (1) topics related to the general health, safety, and service needs of the population
served by the license holder; and
new text end

new text begin (2) other areas identified by the license holder or in the person's current service plan.
new text end

new text begin Training on relevant topics received from sources other than the license holder
may count toward training requirements.
new text end

new text begin (c) When the license holder is the owner, lessor, or tenant of the service site and
whenever a person receiving services is present at the site, the license holder must have
a staff person available on site who is trained in basic first aid and, when required in a
person's service plan, cardiopulmonary resuscitation.
new text end

new text begin Subd. 6. new text end

new text begin Subcontractors. new text end

new text begin If the license holder uses a subcontractor to perform
services licensed under this chapter on their behalf, the license holder must ensure that the
subcontractor meets and maintains compliance with all requirements under this chapter
that apply to the services to be provided.
new text end

new text begin Subd. 7. new text end

new text begin Volunteers. new text end

new text begin The license holder must ensure that volunteers who provide
direct services to persons served by the program receive the training, orientation, and
supervision necessary to fulfill their responsibilities.
new text end

Sec. 26.

new text begin [245D.10] POLICIES AND PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Policy and procedure requirements. new text end

new text begin The license holder must
establish, enforce, and maintain policies and procedures as required in this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Grievances. new text end

new text begin The license holder must establish policies and procedures that
provide a simple complaint process for persons served by the program and their authorized
representatives to bring a grievance that:
new text end

new text begin (1) provides staff assistance with the complaint process when requested, and the
addresses and telephone numbers of outside agencies to assist the person;
new text end

new text begin (2) allows the person to bring the complaint to the highest level of authority in the
program if the grievance cannot be resolved by other staff members, and that provides
the name, address, and telephone number of that person;
new text end

new text begin (3) requires the license holder to promptly respond to all complaints affecting a
person's health and safety. For all other complaints the license holder must provide an
initial response within 14 calendar days of receipt of the complaint. All complaints must
be resolved within 30 calendar days of receipt or the license holder must document the
reason for the delay and a plan for resolution;
new text end

new text begin (4) requires a complaint review that includes an evaluation of whether:
new text end

new text begin (i) related policies and procedures were followed and adequate;
new text end

new text begin (ii) there is a need for additional staff training;
new text end

new text begin (iii) the complaint is similar to past complaints with the persons, staff, or services
involved; and
new text end

new text begin (iv) there is a need for corrective action by the license holder to protect the health
and safety of persons receiving services;
new text end

new text begin (5) based on the review in clause (4), requires the license holder to 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;
new text end

new text begin (6) provides a written summary of the complaint and a notice of the complaint
resolution to the person and case manager, that:
new text end

new text begin (i) identifies the nature of the complaint and the date it was received;
new text end

new text begin (ii) includes the results of the complaint review;
new text end

new text begin (iii) identifies the complaint resolution, including any corrective action; and
new text end

new text begin (7) requires that the complaint summary and resolution notice be maintained in the
service recipient record.
new text end

new text begin Subd. 3. new text end

new text begin Service suspension and service termination. new text end

new text begin (a) The license holder must
establish policies and procedures for temporary service suspension and service termination
that promote continuity of care and service coordination with the person and the case
manager, and with other licensed caregivers, if any, who also provide support to the person.
new text end

new text begin (b) The policy must include the following requirements:
new text end

new text begin (1) the license holder must notify the person and case manager in writing of the
intended termination or temporary service suspension, and the person's right to seek a
temporary order staying the termination of service according to the procedures in section
256.045, subdivision 4a, or 6, paragraph (c);
new text end

new text begin (2) notice of the proposed termination of services, including those situations
that began with a temporary service suspension, must be given at least 60 days before
the proposed termination is to become effective when a license holder is providing
independent living skills training, structured day, prevocational or supported employment
services to the person, and 30 days prior to termination for all other services licensed
under this chapter;
new text end

new text begin (3) the license holder must provide information requested by the person or case
manager when services are temporarily suspended or upon notice of termination;
new text end

new text begin (4) prior to giving notice of service termination or temporary service suspension,
the license holder must document actions taken to minimize or eliminate the need for
service suspension or termination;
new text end

new text begin (5) during the temporary service suspension or service termination notice period,
the license holder will work with the appropriate county agency to develop reasonable
alternatives to protect the person and others;
new text end

new text begin (6) the license holder must maintain information about the service suspension or
termination, including the written termination notice, in the service recipient record; and
new text end

new text begin (7) the license holder must restrict temporary service suspension to situations in
which the person's behavior causes immediate and serious danger to the health and safety
of the person or others.
new text end

new text begin Subd. 4. new text end

new text begin Availability of current written policies and procedures. new text end

new text begin (a) The license
holder must review and update, as needed, the written policies and procedures required
under this chapter.
new text end

new text begin (b) The license holder must inform the person and case manager of the policies and
procedures affecting a person's rights under section 245D.04, and provide copies of those
policies and procedures, within 24 hours of service initiation, or if requested by the person,
the orientation may take place within 72 hours.
new text end

new text begin (c) The license holder must provide a written notice at least 30 days before
implementing any revised policies and procedures affecting a person's rights under section
245D.04. The notice must explain the revision that was made and include a copy of
the revised policy and procedure. The license holder must document the reason for not
providing the notice at least 30 days before implementing the revisions.
new text end

new text begin (d) Before implementing revisions to required policies and procedures the license
holder must inform all employees of the revisions and provide training on implementation
of the revised policies and procedures.
new text end

Sec. 27.

Minnesota Statutes 2010, section 252.40, is amended to read:

252.40 SERVICE PRINCIPLES AND RATE-SETTING PROCEDURES.

new text begin (a) new text end Sections 252.40 to 252.46 apply to day training and habilitation services for
adults with developmental disabilities when the services are authorized to be funded by a
county and provided under a contract between a county board and a vendor as defined
in section 252.41. Nothing in sections 252.40 to 252.46 absolves intermediate care
facilities for persons with developmental disabilities of the responsibility for providing
active treatment and habilitation under federal regulations with which those facilities must
comply to be certified by the Minnesota Department of Health.

new text begin (b) This section expires January 1, 2013.
new text end

Sec. 28.

Minnesota Statutes 2010, section 252.41, subdivision 3, is amended to read:

Subd. 3.

Day training and habilitation services for adults with developmental
disabilities.

"Day training and habilitation services for adults with developmental
disabilities" means services that:

(1) include supervision, training, assistance, and supported employment,
work-related activities, or other community-integrated activities designed and
implemented in accordance with the individual service and individual habilitation plans
required under Minnesota Rules, parts 9525.0015 to 9525.0165, to help an adult reach
and maintain the highest possible level of independence, productivity, and integration
into the community; and

(2) are provided deleted text begin under contract with the county where the services are delivered deleted text end
by a vendor licensed under sections 245A.01 to 245A.16 and 252.28, subdivision 2, to
provide day training and habilitation services.

Day training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and
(17), or vocational services funded under section 110 of the Rehabilitation Act of 1973,
United States Code, title 29, section 720, as amended.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 29.

Minnesota Statutes 2010, section 252.42, is amended to read:

252.42 SERVICE PRINCIPLES.

The design and delivery of services eligible for reimbursement deleted text begin under the rates
established in section 252.46 deleted text end should reflect the following principles:

(1) services must suit a person's chronological age and be provided in the least
restrictive environment possible, consistent with the needs identified in the person's
individual service and individual habilitation plans under Minnesota Rules, parts
9525.0015 to 9525.0165;

(2) a person with a developmental disability whose individual service and individual
habilitation plans authorize employment or employment-related activities shall be given
the opportunity to participate in employment and employment-related activities in which
nondisabled persons participate;

(3) a person with a developmental disability participating in work shall be paid
wages commensurate with the rate for comparable work and productivity except as
regional centers are governed by section 246.151;

(4) a person with a developmental disability shall receive services which include
services offered in settings used by the general public and designed to increase the person's
active participation in ordinary community activities;

(5) a person with a developmental disability shall participate in the patterns,
conditions, and rhythms of everyday living and working that are consistent with the norms
of the mainstream of society.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 30.

Minnesota Statutes 2010, section 252.43, is amended to read:

252.43 COMMISSIONER'S DUTIES.

The commissioner shall supervise county boards' provision of day training and
habilitation services to adults with developmental disabilities. The commissioner shall:

(1) determine the need for day training and habilitation services under section 252.28;

(2) deleted text begin approve payment rates established by a county under section 252.46, subdivision
1 deleted text end new text begin implement the payment rates under section 256B.4913. The payment rates will
supersede rates established in county contracts for recipients receiving day training and
habilitation funded through Medicaid new text end ;

(3) adopt rules for the administration and provision of day training and habilitation
services under sections deleted text begin 252.40 to 252.46 deleted text end new text begin 252.41 to 252.46 new text end and sections 245A.01 to
245A.16 and 252.28, subdivision 2;

(4) enter into interagency agreements necessary to ensure effective coordination and
provision of day training and habilitation services;

(5) monitor and evaluate the costs and effectiveness of day training and habilitation
services; and

(6) provide information and technical help to county boards and vendors in their
administration and provision of day training and habilitation services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 31.

Minnesota Statutes 2010, section 252.44, is amended to read:

252.44 COUNTY BOARD RESPONSIBILITIES.

(a) When the need for day training and habilitation services in a county has been
determined under section 252.28, the board of commissioners for that county shall:

(1) authorize the delivery of services according to the individual service and
habilitation plans required as part of the county's provision of case management services
under Minnesota Rules, parts 9525.0015 to 9525.0165. For calendar years for which
section 252.46, subdivisions 2 to 10, apply, the county board shall not authorize a change
in service days from the number of days authorized for the previous calendar year unless
there is documentation for the change in the individual service plan. An increase in service
days must also be supported by documentation that the goals and objectives assigned to the
vendor cannot be met more economically and effectively by other available community
services and that without the additional days of service the individual service plan could
not be implemented in a manner consistent with the service principles in section 252.42;

(2) contract with licensed vendors, as specified in paragraph (b), under sections
256E.12 and 256B.092 and rules adopted under those sections;

(3) ensure that transportation is provided or arranged by the vendor in the most
efficient and reasonable way possible; new text begin and
new text end

(4) deleted text begin set deleted text end new text begin apply new text end payment rates under section deleted text begin 252.46 deleted text end new text begin 256B.4913 new text end ;

(5) monitor and evaluate the cost and effectiveness of the services; and

(6) reimburse vendors for the provision of authorized services according to the rates,
procedures, and regulations governing reimbursement.

(b) With all vendors deleted text begin except regional centers deleted text end , the contract must include the approved
payment rates new text begin under section 256B.4913 new text end , the projected budget for the contract period,
and any actual expenditures of previous and current contract periods. deleted text begin With all vendors,
including regional centers, deleted text end The contract must also include the amount, availability, and
components of day training and habilitation services to be provided, the performance
standards governing service provision and evaluation, and the time period in which the
contract is effective.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 32.

Minnesota Statutes 2010, section 252.45, is amended to read:

252.45 VENDOR'S DUTIES.

A deleted text begin vendor's responsibility deleted text end new text begin vendor enrolled through the process established by the
commissioner is responsible new text end under clauses (1) deleted text begin , (2), and (3) deleted text end new text begin to (4). This responsibility new text end
extends only to the provision of services that are reimbursable under state and federal
law. A vendor deleted text begin under contract with a county board to provide deleted text end new text begin providing new text end day training and
habilitation services shall:

(1) provide the amount and type of services authorized in the individual service plan
under Minnesota Rules, parts 9525.0015 to 9525.0165;

(2) design the services to achieve the outcomes assigned to the vendor in the
individual service plan;

(3) provide or arrange for transportation of persons receiving services to and from
service sites; new text begin and
new text end

(4) enter into agreements with community-based intermediate care facilities for
persons with developmental disabilities to ensure compliance with applicable federal
regulations deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (5) comply with state and federal law.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 33.

Minnesota Statutes 2010, section 252.451, subdivision 2, is amended to read:

Subd. 2.

Vendor participation and reimbursement.

Notwithstanding requirements
in chapter 245A, and sections 252.28, deleted text begin 252.40 to 252.46 deleted text end new text begin 252.41 to 252.46 new text end , and 256B.501,
vendors of day training and habilitation services may enter into written agreements with
qualified businesses to provide additional training and supervision needed by individuals
to maintain their employment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 34.

Minnesota Statutes 2010, section 252.451, subdivision 5, is amended to read:

Subd. 5.

Vendor payment.

(a) For purposes of this section, deleted text begin the vendor shall bill and
the commissioner shall reimburse the vendor for full-day or partial-day services to a client
that would otherwise have been paid to the vendor for providing direct services, provided
that both of the following criteria are met:
deleted text end

deleted text begin (1) the vendor provides services and payments to the qualified business that enable
the business to perform support and supervision services for the client that the vendor
would otherwise need to perform; and
deleted text end

deleted text begin (2) the client for whom a rate will be billed will receive full-day or partial-day
services from the vendor and the rate to be paid the vendor will allow the client to work
with this support and supervision at the qualified business instead of receiving these
services from the vendor. deleted text end new text begin vendors of day training and habilitation services that enter into
agreements with qualified businesses shall reimburse the qualified business according to
the terms of their written agreement as defined in subdivision 3, clause (5), items (i)
and (ii).
new text end

(b) Medical assistance reimbursement of services provided to persons receiving
day training and habilitation services under this section is subject to the limitations on
reimbursement for vocational services under federal law and regulation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 35.

Minnesota Statutes 2010, section 252.46, subdivision 1a, is amended to read:

Subd. 1a.

Day training and habilitation rates.

The commissioner shall establish a
statewide rate-setting methodology for all day training and habilitation services new text begin as defined
in section 256B.4913 new text end . The deleted text begin rate-setting deleted text end new text begin payment new text end methodology must abide by the principles
of transparency and equitability across the state. The methodology must involve a uniform
process of structuring rates for each service and must promote quality and participant
choice new text begin under section 256B.4913 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 36.

Minnesota Statutes 2010, section 256B.0916, subdivision 2, is amended to
read:

Subd. 2.

Distribution of funds; partnerships.

(a) Beginning with fiscal year 2000,
the commissioner shall distribute all funding available for home and community-based
waiver services for persons with developmental disabilities to individual counties or to
groups of counties that form partnerships to jointly plan, administer, and authorize funding
for eligible individuals. The commissioner shall encourage counties to form partnerships
that have a sufficient number of recipients and funding to adequately manage the risk
and maximize use of available resources.

(b) Counties must submit a request for funds and a plan for administering the
program as required by the commissioner. The plan must identify the number of clients to
be served, their ages, and their priority listing based on:

(1) requirements in Minnesota Rules, part 9525.1880; and

(2) statewide priorities identified in section 256B.092, subdivision 12.

The plan must also identify changes made to improve services to eligible persons and to
improve program management.

(c) In allocating resources to counties, priority must be given to groups of counties
that form partnerships to jointly plan, administer, and authorize funding for eligible
individuals and to counties determined by the commissioner to have sufficient waiver
capacity to maximize resource use.

(d) Within 30 days after receiving the county request for funds and plans, the
commissioner shall provide a written response to the plan that includes the level of
resources available to serve additional persons.

(e) Counties are eligible to receive medical assistance administrative reimbursement
for administrative costs under criteria established by the commissioner.

new text begin (f) Beginning January 1, 2013, the commissioner shall implement, within the
allocation methodologies for each home and community-based waiver under this section,
a procedure to adjust for the impact on waiver allocations of changes in payment and
waiver service usage under section 256B.4913. In the aggregate, the procedure may not
increase or decrease the amount of waiver funds available for allocation to counties or
tribes under this section.
new text end

Sec. 37.

Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 16a,
is amended to read:

Subd. 16a.

Medical assistance reimbursement.

deleted text begin (a) The commissioner shall
seek federal approval for medical assistance reimbursement of independent living skills
services, foster care waiver service, supported employment, prevocational service, and
structured day service under the home and community-based waiver for persons with a
traumatic brain injury, the community alternatives for disabled individuals waivers, and
the community alternative care waivers.
deleted text end

deleted text begin (b) Medical reimbursement shall be made only when the provider demonstrates
evidence of its capacity to meet basic health, safety, and protection standards through
the following methods:
deleted text end

deleted text begin (1) for independent living skills services, supported employment, prevocational
service, and structured day service through one of the methods in paragraphs (c) and
(d); and
deleted text end

deleted text begin (2) for foster care waiver services through the method in paragraph (e).
deleted text end

deleted text begin (c) The provider is licensed to provide services under chapter 245B and agrees
to apply these standards to services funded through the traumatic brain injury,
community alternatives for disabled persons, or community alternative care home and
community-based waivers.
deleted text end

deleted text begin (d) The commissioner shall certify that the provider has policies and procedures
governing the following:
deleted text end

deleted text begin (1) protection of the consumer's rights and privacy;
deleted text end

deleted text begin (2) risk assessment and planning;
deleted text end

deleted text begin (3) record keeping and reporting of incidents and emergencies with documentation
of corrective action if needed;
deleted text end

deleted text begin (4) service outcomes, regular reviews of progress, and periodic reports;
deleted text end

deleted text begin (5) complaint and grievance procedures;
deleted text end

deleted text begin (6) service termination or suspension;
deleted text end

deleted text begin (7) necessary training and supervision of direct care staff that includes:
deleted text end

deleted text begin (i) documentation in personnel files of 20 hours of orientation training in providing
training related to service provision;
deleted text end

deleted text begin (ii) training in recognizing the symptoms and effects of certain disabilities, health
conditions, and positive behavioral supports and interventions;
deleted text end

deleted text begin (iii) a minimum of five hours of related training annually; and
deleted text end

deleted text begin (iv) when applicable:
deleted text end

deleted text begin (A) safe medication administration;
deleted text end

deleted text begin (B) proper handling of consumer funds; and
deleted text end

deleted text begin (C) compliance with prohibitions and standards developed by the commissioner to
satisfy federal requirements regarding the use of restraints and restrictive interventions.
The commissioner shall review at least biennially that each service provider's policies
and procedures governing basic health, safety, and protection of rights continue to meet
minimum standards.
deleted text end

deleted text begin (e) The commissioner shall seek federal approval for Medicaid reimbursement
of foster care services under the home and community-based waiver for persons with
a traumatic brain injury, the community alternatives for disabled individuals waiver,
and community alternative care waiver when the provider demonstrates evidence of
its capacity to meet basic health, safety, and protection standards. The commissioner
shall verify that the adult foster care provider is licensed under Minnesota Rules, parts
9555.5105 to 9555.6265; that the child foster care provider is licensed as a family foster
care or a foster care residence under Minnesota Rules, parts 2960.3000 to 2960.3340, and
certify that the provider has policies and procedures that govern:
deleted text end

deleted text begin (1) compliance with prohibitions and standards developed by the commissioner to
meet federal requirements regarding the use of restraints and restrictive interventions;
deleted text end

deleted text begin (2) documentation of service needs and outcomes, regular reviews of progress,
and periodic reports; and
deleted text end

deleted text begin (3) safe medication management and administration.
deleted text end

deleted text begin The commissioner shall review at least biennially that each service provider's policies and
procedures governing basic health, safety, and protection of rights standards continue to
meet minimum standards.
deleted text end

deleted text begin (f) deleted text end The commissioner shall seek federal waiver approval for Medicaid reimbursement
of family adult day services under all disability waivers. After the waiver is granted, the
commissioner shall include family adult day services in the common services menu that
is currently under development.

Sec. 38.

Minnesota Statutes 2010, section 256B.49, subdivision 17, is amended to read:

Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.

(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:

(1) an incentive-based payment process for achieving outcomes;

(2) the need for a state-level risk pool;

(3) the need for retention of management responsibility at the state agency level; and

(4) a phase-in strategy as appropriate.

(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:

(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or

(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.

(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
to 256B.0656 and 256B.0659. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.

(e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
services, the county must negotiate a revised per diem rate for room and board and waiver
services that reflects the legislated rate reduction and results in an overall average per
diem reduction for all foster care recipients in that home. The revised per diem must allow
the provider to maintain, as much as possible, the level of services or enhanced services
provided in the residence, while mitigating the losses of the legislated rate reduction.

new text begin (f) Beginning January 1, 2013, the commissioner shall implement, within the
allocation methodologies for each home and community-based waiver under this section,
a procedure to adjust for the impact on waiver allocations of changes in payment and
waiver service usage under section 256B.4913. In the aggregate, the procedure may not
increase or decrease the amount of waiver funds available for allocation to counties or
tribes under this section.
new text end

Sec. 39.

Minnesota Statutes 2010, section 256B.4912, is amended to read:

256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS
AND PAYMENT.

Subdivision 1.

Provider qualifications.

For the home and community-based
waivers providing services to seniors and individuals with disabilities, the commissioner
shall establish:

(1) agreements with enrolled waiver service providers to ensure providers meet
deleted text begin qualifications defined in the waiver plans deleted text end new text begin Minnesota health care program requirements new text end ;

(2) regular reviews of provider qualifications new text begin , and including requests of proof of
documentation new text end ; and

(3) processes to gather the necessary information to determine provider
qualifications.

deleted text begin By July 2010, deleted text end new text begin Beginning July 2012, new text end staff that provide direct contact, as defined
in section 245C.02, subdivision 11, deleted text begin that are employees of waiver service providers deleted text end new text begin for
services specified in the federally approved waiver plans new text end must meet the requirements
of chapter 245C prior to providing waiver services and as part of ongoing enrollment.
Upon federal approval, this requirement must also apply to consumer-directed community
supports.

Subd. 2.

deleted text begin Rate-setting deleted text end new text begin Payment new text end methodologies.

The commissioner shall establish
statewide deleted text begin rate-setting deleted text end new text begin payment new text end methodologies that meet federal waiver requirements
for home and community-based waiver services for individuals with disabilities. The
deleted text begin rate-setting deleted text end new text begin payment new text end methodologies must abide by the principles of transparency and
equitability across the state. The methodologies must involve a uniform process of
structuring rates for each service and must promote quality and participant choice.

new text begin Subd. 3. new text end

new text begin Payment requirements. new text end

new text begin The payment-setting methodologies established
under this section shall accommodate:
new text end

new text begin (1) direct care staffing wages;
new text end

new text begin (2) staffing patterns;
new text end

new text begin (3) program-related expenses;
new text end

new text begin (4) general and administrative expenses; and
new text end

new text begin (5) consideration of recipient intensity.
new text end

new text begin Subd. 4. new text end

new text begin Payment rate criteria. new text end

new text begin (a) The payment structures and methodologies
under this section shall reflect the payment rate criteria in paragraphs (b) and (c).
new text end

new text begin (b) Payment rates must be based on reasonable costs that are ordinary, necessary,
and related to delivery of authorized client services.
new text end

new text begin (c) The commissioner must not reimburse:
new text end

new text begin (1) unauthorized service delivery;
new text end

new text begin (2) services provided under a receipt of a special grant;
new text end

new text begin (3) services provided under contract to a local school district;
new text end

new text begin (4) extended employment services under Minnesota Rules, parts 3300.2005 to
3300.3100, or vocational rehabilitation services provided under the federal Rehabilitation
Act, as amended, Title I, section 110, or Title VI-C, and not through use of medical
assistance or county social service funds; or
new text end

new text begin (5) services provided to a client by a licensed medical, therapeutic, or rehabilitation
practitioner or any other vendor of medical care which are billed separately on a
fee-for-service basis.
new text end

new text begin Subd. 5. new text end

new text begin County and tribal provider contract elimination. new text end

new text begin County and tribal
contracts with providers of home and community-based waiver services provided under
sections 256B.0913, 256B.0915, 256B.092, and 256B.49 are eliminated effective January
1, 2013, or when the commissioner receives authority for the collection of fees for home
and community-based waiver services under section 245A.10, subdivisions 3, paragraph
(b), and 4, paragraph (g), whichever is later.
new text end

new text begin Subd. 6. new text end

new text begin Program standards. new text end

new text begin The commissioner of human services must establish
uniform program standards for services identified in chapter 245D for persons with
disabilities and people age 65 and older. The commissioner must grant licenses according
to the provisions of chapter 245A.
new text end

new text begin Subd. 7. new text end

new text begin Applicant and license holder training. new text end

new text begin An applicant or license holder
that is not enrolled as a Minnesota health care program home and community-based
services waiver provider at the time of application must ensure that at least one controlling
individual completes a onetime training on the requirements for providing home and
community-based services from a qualified source as determined by the commissioner,
before a license is issued.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2012, except that subdivision
6 is effective January 1, 2013, or when the commissioner receives an appropriation or
authorization for the collection of fees under section 245A.10, subdivisions 3, paragraph
(b), and 4, paragraph (g), whichever is later.
new text end

Sec. 40.

new text begin [256B.4913] PAYMENT METHODOLOGIES.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The payment methodologies in this section apply to
home and community-based services waivers under sections 256B.092 and 256B.49,
except that where the particular waiver limits the type, scope, or extent of service
provided, the commissioner may not provide that service to an individual subject to that
service restriction under this methodology.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Payment" means reimbursement to an eligible provider for services provided to
a qualified individual based on an approved service authorization.
new text end

new text begin Subd. 3. new text end

new text begin Applicable services. new text end

new text begin Applicable services are those authorized under the
state's home and community-based services waivers under sections 256B.092 and 256B.49
including as defined in the federally approved home and community-based services plan:
new text end

new text begin (1) adult day care or family adult day services;
new text end

new text begin (2) behavioral programming;
new text end

new text begin (3) customized living;
new text end

new text begin (4) day treatment and habilitation;
new text end

new text begin (5) housing access coordination;
new text end

new text begin (6) independent living services;
new text end

new text begin (7) in-home family supports;
new text end

new text begin (8) night supervision;
new text end

new text begin (9) personal support;
new text end

new text begin (10) prevocational services;
new text end

new text begin (11) residential care services;
new text end

new text begin (12) respite services;
new text end

new text begin (13) structured day services;
new text end

new text begin (14) supported employment services;
new text end

new text begin (15) supported living services;
new text end

new text begin (16) transportation services; and
new text end

new text begin (17) other services as approved by the federal government in the state home and
community-based services plan.
new text end

new text begin Subd. 4. new text end

new text begin Uniform payment methodology. new text end

new text begin The commissioner shall determine
representative personnel and program-related components to meet the individualized
service plan for individuals with disabilities as funded under the state plan for home and
community-based services under sections 256B.092 and 256B.49. The commissioner shall
use those representative components, along with individualized assessment information,
to determine the amount payable to a provider under this section.
new text end

new text begin Subd. 5. new text end

new text begin Payments for individualized unit-based services. new text end

new text begin (a) Payments for
services priced on a partial hour or hourly unit basis and provided to an individual outside
of any day or residential service plan must be calculated as follows unless the services are
authorized separately under subdivisions 6 and 7:
new text end

new text begin (1) Determine the number of units of service used.
new text end

new text begin (2) Determine the direct staff wages. The 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 paragraph (b). This is the direct care rate except
for customizations for certain individuals.
new text end

new text begin (3) For an individual requiring customization under subdivision 8, add the
customization rate provided in subdivision 8 to the result of step (2). This is the
customized direct care rate.
new text end

new text begin (4) Take the direct care rate under step (2) or step (3) and increase this amount by the
employee and program-related expense factor of 102.7 percent.
new text end

new text begin (5) Take the rate under step (4) and add $20 per day for daily respite room and board
as authorized and provided. This is the payment rate.
new text end

new text begin (6) Multiply the result of step (5) by step (1) to establish the payment amount.
new text end

new text begin (b) If the commissioner derives rates for personnel hourly wages under this
paragraph, the commissioner must use the following Direct Care Job Classifications with
the Bureau of Labor Statistics job classes. These classes must be aligned with services
provided under the home and community-based waiver:
new text end

new text begin (1) adult companion;
new text end

new text begin (2) behavior program analyst;
new text end

new text begin (3) behavior program professional;
new text end

new text begin (4) behavior program specialist;
new text end

new text begin (5) housing access coordinator;
new text end

new text begin (6) in-home family support;
new text end

new text begin (7) independent living skills direct service;
new text end

new text begin (8) independent living skills professional;
new text end

new text begin (9) night supervision;
new text end

new text begin (10) personal support;
new text end

new text begin (11) respite hourly;
new text end

new text begin (12) supported employment job coach;
new text end

new text begin (13) supported employment job developer;
new text end

new text begin (14) supportive living services;
new text end

new text begin (15) extra transportation attendant;
new text end

new text begin (16) registered nurse;
new text end

new text begin (17) licensed practical nurse;
new text end

new text begin (18) direct primary care;
new text end

new text begin (19) asleep overnight; and
new text end

new text begin (20) supervisor.
new text end

new text begin (c) The commissioner shall revise the wage rates under paragraph (a), clause (2),
in the manner provided in subdivision 10.
new text end

new text begin Subd. 6. new text end

new text begin Payments for day programs. new text end

new text begin (a) Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and
structured day services must be calculated as follows unless the services are authorized
separately under subdivisions 5 and 7:
new text end

new text begin (1) Determine the number of units of service used.
new text end

new text begin (2) Determine the direct staff wages. The 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 paragraph (b). This is the direct care rate except
for customizations for certain individuals.
new text end

new text begin (3) For an individual requiring customization under subdivision 8, add the
customization rate provided in subdivision 8 to the result of step (2). This is the
customized direct care rate.
new text end

new text begin (4) Take the direct care rate under step (2) or step (3) and increase this amount by
the employee and program-related expense factor of 108.8 percent, with consideration of
staffing to meet individual needs and utilization.
new text end

new text begin (5) To the result of step (4) add the facility reasonable use rate of $8.30 per week,
with consideration of staffing ratios to meet individual needs and utilization.
new text end

new text begin (6) To the result of step (5) add reimbursement for meals authorized and provided in
conjunction with adult day care services. This is the payment rate.
new text end

new text begin (7) Multiply the result of step (6) by step (1) to establish the payment amount.
new text end

new text begin (b) If the commissioner derives rates for personnel hourly wages under this
paragraph, the commissioner must use the following Direct Care Job Classification with
Bureau of Labor Standards job classes. These classes must be aligned with services
provided under the home and community-based services waiver:
new text end

new text begin (1) registered nurse;
new text end

new text begin (2) licensed practical nurse; and
new text end

new text begin (3) direct primary care.
new text end

new text begin (c) The commissioner shall revise the wage rates under paragraph (a), clause (2),
in the manner provided in subdivision 10.
new text end

new text begin Subd. 7. new text end

new text begin Payments for residential services. new text end

new text begin (a) Payments for services in residential
settings including supported living services, foster care, residential care, customized
living, and 24-hour customized living subject to limitation to settings registered or
licensed for five or fewer individuals must be calculated as follows unless the services are
authorized separately under subdivisions 5 and 6:
new text end

new text begin (1) Determine the number of units of service used.
new text end

new text begin (2) Determine the direct staff wages. The 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 paragraph (b). This is the direct care rate except
for customizations for certain individuals.
new text end

new text begin (3) For an individual requiring customization under subdivision 8, add the
customization rate provided in subdivision 8 to the result of step (2). This is the
customized direct care rate.
new text end

new text begin (4) Except for a family foster care setting subject to step (5), take the direct care cost
under step (2) or step (3) and increase this amount by the employee and program-related
expense factor of 61.8 percent.
new text end

new text begin (5) For family foster care settings, take the direct care cost under step (2) or step
(3) and increase this amount by the employee and program-related expense factor of
38.3 percent.
new text end

new text begin (6) To the result of step (4) or step (5) add a value of $2,179 per year adjusted to
a weekly unit.
new text end

new text begin (7) To the result of step (6) add individual waiver transportation, if provided, at
$1,680 or $4,290 annually if customized for full size adapted transportation. This is the
payment rate.
new text end

new text begin (8) Multiply the result of step (7) by step (1) to establish the payment amount.
new text end

new text begin (b) If the commissioner derives rates for personnel hourly wages under this
paragraph, the commissioner must use the following Direct Care Job Classifications with
the Bureau of Labor Statistics job classes. These classes must be aligned with services
provided under the home and community-based waiver:
new text end

new text begin (1) licensed practical nurse;
new text end

new text begin (2) registered nurse;
new text end

new text begin (3) direct primary care;
new text end

new text begin (4) asleep overnight; and
new text end

new text begin (5) supervisor.
new text end

new text begin (c) The commissioner shall revise the wage rates under paragraph (a), clause (2),
in the manner provided in subdivision 10.
new text end

new text begin (d) For customized living settings registered for six or more, the commissioner
shall use results from the customized living tool to determine the customized living
payment to be used beginning January 1, 2013. The commissioner shall provide notice
of that payment rate under subdivision 10. By January 15, 2014, the commissioner shall
provide an evaluation of the implications of the rate on service provision to the legislative
committees with jurisdiction over human services.
new text end

new text begin Subd. 8. new text end

new text begin Customization of rates for individuals. new text end

new text begin (a) For persons determined to
have higher needs based on assessment of medical, mental health, or behavior issues, or as
being deaf/hard-of-hearing, the direct care costs in subdivisions 5 to 7 must be increased
by an adjustment factor prior to calculating the price under the respective subdivision.
new text end

new text begin (b) The customization rate with respect to medical, mental health, and behavior
issues shall be $2.38 per authorized hour for clients who meet the respective criteria as
determined by the commissioner.
new text end

new text begin (c) The customization rate with respect to deaf/hard-of-hearing persons shall be $9.70
per hour for clients who meet the respective criteria as determined by the commissioner.
new text end

new text begin Subd. 9. new text end

new text begin Payments for transportation. new text end

new text begin (a) Transportation payments must be
calculated according to clauses (1) to (5).
new text end

new text begin (1) Determine the number of individual and shared trips authorized.
new text end

new text begin (2) Determine the distance and whether the individual requires a lift.
new text end

new text begin (3) For a shared trip payment take the constant trip value of $2.52 and add a distance
rate amount of payment of:
new text end

new text begin (i) 50 cents per mile for five miles for distances within ten miles;
new text end

new text begin (ii) 50 cents per mile for 15.5 miles for distances more than ten and up to 20 miles;
new text end

new text begin (iii) 50 cents per mile for 35.5 miles for distances more than 20 and up to 50 miles;
and
new text end

new text begin (iv) 50 cents per mile for 51 miles for distances more than 50 miles.
new text end

new text begin (4) For individual trip payments, take the constant trip value of $2.52 and add
one-sixth of the distance rate payment amounts provided for in paragraph (a), clause (3).
new text end

new text begin (5) For a trip payment requiring a lift, add 93 cents per mile to the distance rate
calculation in paragraph (a), clauses (3) and (4).
new text end

new text begin (b) The commissioner shall require that the purchase of transportation services be
cost-effective and be limited to market rates where the transportation mode is generally
available and accessible.
new text end

new text begin Subd. 10. new text end

new text begin Updating or changing payment values. new text end

new text begin (a) The commissioner shall
develop and implement uniform procedures to refine terms and update or adjust values
used to calculate payment rates in this section. For calendar year 2013, the commissioner
shall use the values, terms, and procedures provided in this section.
new text end

new text begin (b) The commissioner must update the factors and values described in this section
on January 1 of every second year subsequent to January 1, 2013, and provide notice
of the update by October 1 of that year.
new text end

new text begin (c) A commissioner's notice must be made available October 1 of each year starting
October 1, 2012, and shall contain information detailing: calculation values including
derived wage rates and related employee and administrative factors; service utilization;
county and tribal allocation changes and, in even-numbered years, information on
adjustments to be made to calculation values and the timing of those adjustments.
new text end

new text begin (d) By November 1, 2012, the commissioner shall report to the legislative
committees with jurisdiction over disability waiver policy and budget on the operation
and management of the disability waiver rates-setting system, the results of the service
utilization research under subdivision 11, paragraph (a), and the implications of those
results for providers, provider types and applicable services, counties and tribes, and
individuals with disabilities. With respect to the procedure developed under subdivision
11, paragraph (b), the report shall include a description of the procedure and the expected
impact of the procedure on payments to providers individually and grouped by the
applicable services listed in subdivision 3.
new text end

new text begin Subd. 11. new text end

new text begin Waiver rates management system. new text end

new text begin (a) The rates management system
tool shall be used to determine the rate for an individual eligible under section 256B.092 or
256B.49. Beginning February 2012, the system shall be used as a guide for research into
service utilization in calendar year 2012. Effective January 1, 2013, the system must be
used to determine payment rates for home and community-based services and shall be the
basis for authorizing services except as provided under paragraphs (b) to (e). Paragraphs
(b) to (e) apply to payments made in calendar years 2013 and 2014.
new text end

new text begin (b) By October 1, 2012, the commissioner shall develop a procedure for uniformly
adjusting individualized payment rates, subject to accommodation under this section, to
allow for higher or lower reimbursements for providers when equivalent individualized
rates in effect as of October 1, 2012, with respect to the service, are more than five percent
higher or lower than the payments provided under section 256B.4913.
new text end

new text begin (c) For payment rates in effect for 2013 and 2014, if the payment rates established
under section 256B.4913 are within five percent of the historic individual rate for
calendar year 2013 and subsequently calendar year 2014, the payment rate shall be the
authorization rate.
new text end

new text begin (d) For payment rates in effect for 2013 and 2014, when a historic rate is above the
five percent range of the payment rates established under section 256B.4913, the county
or tribe shall reduce the payment to providers as follows:
new text end

new text begin (1) if a provider's individualized rate in 2013 exceeds the historic rate by ten percent
or more, the payment must be reduced by five percentage points; or
new text end

new text begin (2) if a provider's individualized rate in 2013 exceeds the historic rate by at least five
percent but not more than ten percent, the payment must be reduced so that the difference
equals five percent.
new text end

new text begin (e) For payment rates in effect for 2013 and 2014, when a historic rate is below the
five percent range of the payment rates established under section 256B.4913, the county or
tribe shall increase the payment to providers as follows:
new text end

new text begin (1) if a provider's individualized rate in 2013 is lower than the historic rate by ten
percent or more, the payment must be increased by five percentage points; or
new text end

new text begin (2) if a provider's individualized rate in 2013 is lower than the historic rate by at
least five points but not more than ten points, the payment must be increased so that
the difference equals five percent.
new text end

new text begin (f) For calendar year 2015, all payment rates established under section 256B.4913
shall be the authorization rates.
new text end

new text begin Subd. 12. new text end

new text begin Exceptions. new text end

new text begin In a format prescribed by the commissioner, lead agencies
must identify individuals with exceptional needs that cannot be met under the disability
waiver rate system. The commissioner shall use that information to evaluate and, if
necessary, design an alternative payment structure for those individuals.
new text end

new text begin Subd. 13. new text end

new text begin Shared service limits. new text end

new text begin The commissioner retains authority to limit the
number of people that share waiver and day services. Individualized payment structures
and methodologies established by the commissioner under section 256B.4912 must reflect
the option to share services within the limits established by the commissioner.
new text end

new text begin Subd. 14. new text end

new text begin Payment implementation. new text end

new text begin Upon implementation of the payment
methodologies under this section, those payment rates supersede rates established in
county contracts for recipients receiving waiver services under sections 256B.092 and
256B.49.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 41.

Minnesota Statutes 2010, section 256B.501, subdivision 4b, is amended to
read:

Subd. 4b.

Waiver rates and group residential housing rates.

new text begin (a) new text end The average
daily reimbursement rates established by the commissioner for waivered services shall
be adjusted to include the additional costs of services eligible for waiver funding under
title XIX of the Social Security Act and for which there is no group residential housing
payment available as a result of the payment limitations set forth in section 256I.05,
subdivision 10. The adjustment to the waiver rates shall be based on county reports of
service costs that are no longer eligible for group residential housing payments. No
adjustment shall be made for any amount of reported payments that prior to July 1, 1992,
exceeded the group residential housing rate limits established in section 256I.05 and were
reimbursed through county funds.

new text begin (b) This subdivision expires January 1, 2013.
new text end

Sec. 42.

Minnesota Statutes 2010, section 256B.5013, subdivision 1, is amended to
read:

Subdivision 1.

Variable rate adjustments.

(a) For rate years beginning on or after
October 1, 2000, when there is a documented increase in the needs of a current ICF/MR
recipient, the county of financial responsibility may recommend a variable rate to enable
the facility to meet the individual's increased needs. deleted text begin Variable rate adjustments made under
this subdivision replace payments for persons with special needs under section 256B.501,
subdivision 8, and payments for persons with special needs for crisis intervention services
under section 256B.501, subdivision 8a. deleted text end Effective July 1, 2003, facilities with a base rate
above the 50th percentile of the statewide average reimbursement rate for a Class A
facility or Class B facility, whichever matches the facility licensure, are not eligible for a
variable rate adjustment. Variable rate adjustments may not exceed a 12-month period,
except when approved for purposes established in paragraph (b), clause (1). Variable rate
adjustments approved solely on the basis of changes on a developmental disabilities
screening document will end June 30, 2002.

(b) A variable rate may be recommended by the county of financial responsibility
for increased needs in the following situations:

(1) a need for resources due to an individual's full or partial retirement from
participation in a day training and habilitation service when the individual: (i) has reached
the age of 65 or has a change in health condition that makes it difficult for the person
to participate in day training and habilitation services over an extended period of time
because it is medically contraindicated; and (ii) has expressed a desire for change through
the developmental disability screening process under section 256B.092;

(2) a need for additional resources for intensive short-term programming which is
necessary prior to an individual's discharge to a less restrictive, more integrated setting;

(3) a demonstrated medical need that significantly impacts the type or amount of
services needed by the individual; or

(4) a demonstrated behavioral need that significantly impacts the type or amount of
services needed by the individual.

(c) The county of financial responsibility must justify the purpose, the projected
length of time, and the additional funding needed for the facility to meet the needs of
the individual.

(d) The facility shall provide an annual report to the county case manager on
the use of the variable rate funds and the status of the individual on whose behalf the
funds were approved. The county case manager will forward the facility's report with a
recommendation to the commissioner to approve or disapprove a continuation of the
variable rate.

(e) Funds made available through the variable rate process that are not used by
the facility to meet the needs of the individual for whom they were approved shall be
returned to the state.

Sec. 43. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin In Minnesota Statutes, sections 245B.02, 245B.06, 252.40, 252.41, 256B.038,
256B.0918, 256B.5015, 256B.765, and 604A.33, the revisor of statutes shall delete
"sections 252.40 to 252.46" and replace it with "sections 252.41 to 252.46."
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end

Sec. 44. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2010, sections 252.46, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,
11, 16, 17, 18, 19, 20, and 21; and 256B.501, subdivision 8, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013.
new text end