SF 1699

1st Engrossment - 87th Legislature (2011 - 2012) Posted on 06/14/2012 02:25pm

A bill for an act
relating to human services; Minnesota supplemental aid shelter needy provisions;
modifying adult foster care homes; amending Minnesota Statutes 2010, sections
245A.03, by adding a subdivision; 245A.11, subdivisions 2a, 7, 7a; 245B.06,
subdivision 2; 245B.07, subdivision 1; 245C.04, subdivision 6; 245C.05,
subdivision 7; 256B.092, subdivision 1b; 256D.44, subdivision 5; Minnesota
Statutes 2011 Supplement, sections 256B.097, subdivision 3; 256B.49,
subdivision 23; proposing coding for new law in Minnesota Statutes, chapter
256B.

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

Section 1.

Minnesota Statutes 2010, section 245A.03, is amended by adding a
subdivision to read:

Subd. 6a.

Adult foster care homes serving people with mental illness;
certification.

(a) The commissioner of human services shall develop an optional
certification process for adult foster care homes licensed under this chapter and Minnesota
Rules, parts 9555.5105 to 9555.6265, that serve people with mental illness where the
home is not the primary residence of the license holder. If an adult foster care license
holder becomes certified, the certification shall be included in the license information.
The certification process shall be developed with input from advocates, mental health
professionals, and adult foster care providers.

(b) As part of the certification process, the commissioner shall require that:

(1) staff working in the adult foster care home receive training on the following
topics:

(i) mental health diagnoses;

(ii) mental health crisis response and de-escalation techniques;

(iii) recovery from mental illness;

(iv) treatment options including evidence-based practices;

(v) medications and their side effects;

(vi) co-occurring substance abuse and health conditions; and

(vii) other topics as determined by the commissioner; and

(2) a mental health professional, as defined in section 245.462, subdivision 18,
provides oversight of the adult foster care home.

(c) The commissioner shall develop certification requirements by January 1, 2013.

Sec. 2.

Minnesota Statutes 2010, section 245A.11, subdivision 2a, is amended to read:

Subd. 2a.

Adult foster care license capacity.

(a) The commissioner shall issue
adult foster care licenses with a maximum licensed capacity of four beds, including
nonstaff roomers and boarders, except that the commissioner may issue a license with a
capacity of five beds, including roomers and boarders, according to paragraphs (b) to (f).

(b) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.

(c) The commissioner may grant variances to paragraph (b) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section 245A.04, subdivision 9, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.

(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed foster care provider is located.

(e) The commissioner may grant a variance to paragraph (b) to allow for the
use of a fifth bed for respite services, as defined in section 245A.02, for persons with
disabilities, regardless of age, if the variance complies with section 245A.03, subdivision
7, and section 245A.04, subdivision 9, and approval of the variance is recommended by
the county in which the licensed foster care provider is licensed. Respite care may be
provided under the following conditions:

(1) staffing ratios cannot be reduced below the approved level for the individuals
being served in the home on a permanent basis;

(2) no more than two different individuals can be accepted for respite services in
any calendar month and the total respite days may not exceed 120 days per program in
any calendar year;

(3) the person receiving respite services must have his or her bedroom, which could
be used for alternative purposes when not used as a respite bedroom, and cannot be the
room of another person who lives in the foster care home; and

(4) individuals living in the foster care home must be notified when the variance
is approved. The provider must give 60 days' notice in writing to the residents and their
legal representatives prior to accepting the first respite placement. Notice must be given to
residents at least two days prior to service initiation, or as soon as the license holder is
able if they receive notice of the need for respite less than two days prior to initiation,
each time a respite client will be served, unless the requirement for this notice is waived
by the resident or legal guardian.

(e) If the 2009 legislature adopts a rate reduction that impacts providers of adult
foster care services, (f) The commissioner may issue an adult foster care license with a
capacity of five adults if the fifth bed does not increase the overall statewide capacity of
licensed adult foster care beds in homes that are not the primary residence of the license
holder, over the licensed capacity in such homes on July 1, 2009, as identified in a plan
submitted to the commissioner by the county, when the capacity is recommended by
the county licensing agency of the county in which the facility is located and if the
recommendation verifies that:

(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;

(2) the five-bed living arrangement is specified for each resident in the resident's:

(i) individualized plan of care;

(ii) individual service plan under section 256B.092, subdivision 1b, if required; or

(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;

(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice
to remain living in the home and that the resident's refusal to consent would not have
resulted in service termination; and

(4) the facility was licensed for adult foster care before March 1, 2009 2011.

(f) (g) The commissioner shall not issue a new adult foster care license under
paragraph (e) (f) after June 30, 2011 2016. The commissioner shall allow a facility with
an adult foster care license issued under paragraph (e) (f) before June 30, 2011 2016, to
continue with a capacity of five adults if the license holder continues to comply with the
requirements in paragraph (e) (f).

Sec. 3.

Minnesota Statutes 2010, section 245A.11, subdivision 7, is amended to read:

Subd. 7.

Adult foster care; variance for alternate overnight supervision.

(a) The
commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
requiring a caregiver to be present in an adult foster care home during normal sleeping
hours to allow for alternative methods of overnight supervision. The commissioner may
grant the variance if the local county licensing agency recommends the variance and the
county recommendation includes documentation verifying that:

(1) the county has approved the license holder's plan for alternative methods of
providing overnight supervision and determined the plan protects the residents' health,
safety, and rights;

(2) the license holder has obtained written and signed informed consent from
each resident or each resident's legal representative documenting the resident's or legal
representative's agreement with the alternative method of overnight supervision; and

(3) the alternative method of providing overnight supervision, which may include
the use of technology, is specified for each resident in the resident's: (i) individualized
plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if
required; or (iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required.

(b) To be eligible for a variance under paragraph (a), the adult foster care license
holder must not have had a licensing action conditional license issued under section
245A.06, or any other licensing sanction issued under section 245A.07 during the prior 24
months based on failure to provide adequate supervision, health care services, or resident
safety in the adult foster care home.

(c) A license holder requesting a variance under this subdivision to utilize
technology as a component of a plan for alternative overnight supervision may request
the commissioner's review in the absence of a county recommendation. Upon receipt of
such a request from a license holder, the commissioner shall review the variance request
with the county.

Sec. 4.

Minnesota Statutes 2010, section 245A.11, subdivision 7a, is amended to read:

Subd. 7a.

Alternate overnight supervision technology; adult foster care license.

(a) The commissioner may grant an applicant or license holder an adult foster care license
for a residence that does not have a caregiver in the residence during normal sleeping
hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses
monitoring technology to alert the license holder when an incident occurs that may
jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
to 9555.6265, and the requirements under this subdivision. The license printed by the
commissioner must state in bold and large font:

(1) that the facility is under electronic monitoring; and

(2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.

(b) Applications for a license under this section must be submitted directly to
the Department of Human Services licensing division. The licensing division must
immediately notify the host county and lead county contract agency and the host county
licensing agency. The licensing division must collaborate with the county licensing
agency in the review of the application and the licensing of the program.

(c) Before a license is issued by the commissioner, and for the duration of the
license, the applicant or license holder must establish, maintain, and document the
implementation of written policies and procedures addressing the requirements in
paragraphs (d) through (f).

(d) The applicant or license holder must have policies and procedures that:

(1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;

(2) explain the discharge process when a foster care recipient requires overnight
supervision or other services that cannot be provided by the license holder due to the
limited hours that the license holder is on site;

(3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on site, and
how the license holder's response plan meets the requirements in paragraph (e), clause
(1) or (2);

(4) establish a process for documenting a review of the implementation and
effectiveness of the response protocol for the response required under paragraph (e),
clause (1) or (2). The documentation must include:

(i) a description of the triggering incident;

(ii) the date and time of the triggering incident;

(iii) the time of the response or responses under paragraph (e), clause (1) or (2);

(iv) whether the response met the resident's needs;

(v) whether the existing policies and response protocols were followed; and

(vi) whether the existing policies and protocols are adequate or need modification.

When no physical presence response is completed for a three-month period, the
license holder's written policies and procedures must require a physical presence response
drill to be conducted for which the effectiveness of the response protocol under paragraph
(e), clause (1) or (2), will be reviewed and documented as required under this clause; and

(5) establish that emergency and nonemergency phone numbers are posted in a
prominent location in a common area of the home where they can be easily observed by a
person responding to an incident who is not otherwise affiliated with the home.

(e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of people receiving foster care services
in the home:

(1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on site to respond to the situation; or

(2) response alternative (2) requires the electronic notification and alert system
under alternative (1), but more than ten minutes may pass before the license holder is
present on site to respond to the situation. Under alternative (2), all of the following
conditions are met:

(i) the license holder has a written description of the interactive technological
applications that will assist the license holder in communicating with and assessing the
needs related to the care, health, and safety of the foster care recipients. This interactive
technology must permit the license holder to remotely assess the well being of the foster
care recipient without requiring the initiation of the foster care recipient. Requiring the
foster care recipient to initiate a telephone call does not meet this requirement;

(ii) the license holder documents how the remote license holder is qualified and
capable of meeting the needs of the foster care recipients and assessing foster care
recipients' needs under item (i) during the absence of the license holder on site;

(iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and

(iv) each foster care recipient's individualized plan of care, individual service plan
under section 256B.092, subdivision 1b, if required, or individual resident placement
agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the
maximum response time, which may be greater than ten minutes, for the license holder
to be on site for that foster care recipient.

(f) All Each foster care recipient's placement agreements agreement, individual
service agreements, and plans applicable to the foster care recipient agreement, and plan
must clearly state that the adult foster care license category is a program without the
presence of a caregiver in the residence during normal sleeping hours; the protocols in
place for responding to situations that present a serious risk to the health, safety, or rights
of foster care recipients under paragraph (e), clause (1) or (2); and a signed informed
consent from each foster care recipient or the person's legal representative documenting
the person's or legal representative's agreement with placement in the program. If
electronic monitoring technology is used in the home, the informed consent form must
also explain the following:

(1) how any electronic monitoring is incorporated into the alternative supervision
system;

(2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;

(3) how the license holder is caregivers are trained on the use of the technology;

(4) the event types and license holder response times established under paragraph (e);

(5) how the license holder protects the foster care recipient's privacy related to
electronic monitoring and related to any electronically recorded data generated by the
monitoring system. A foster care recipient may not be removed from a program under
this subdivision for failure to consent to electronic monitoring. The consent form must
explain where and how the electronically recorded data is stored, with whom it will be
shared, and how long it is retained; and

(6) the risks and benefits of the alternative overnight supervision system.

The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the
person giving consent, and the person giving consent is offered a copy.

(g) Nothing in this section requires the applicant or license holder to develop or
maintain separate or duplicative policies, procedures, documentation, consent forms, or
individual plans that may be required for other licensing standards, if the requirements of
this section are incorporated into those documents.

(h) The commissioner may grant variances to the requirements of this section
according to section 245A.04, subdivision 9.

(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.

(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
remotely determine what action the license holder needs to take to protect the well-being
of the foster care recipient.

(k) The commissioner shall evaluate license applications using the requirements
in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
including a checklist of criteria needed for approval.

(l) To be eligible for a license under paragraph (a), the adult foster care license holder
must not have had a conditional license issued under section 245A.06 or any licensing
sanction under section 245A.07 during the prior 24 months based on failure to provide
adequate supervision, health care services, or resident safety in the adult foster care home.

(m) The commissioner shall review an application for an alternative overnight
supervision license within 60 days of receipt of the application. When the commissioner
receives an application that is incomplete because the applicant failed to submit required
documents or that is substantially deficient because the documents submitted do not meet
licensing requirements, the commissioner shall provide the applicant written notice
that the application is incomplete or substantially deficient. In the written notice to the
applicant, the commissioner shall identify documents that are missing or deficient and
give the applicant 45 days to resubmit a second application that is substantially complete.
An applicant's failure to submit a substantially complete application after receiving
notice from the commissioner is a basis for license denial under section 245A.05. The
commissioner shall complete subsequent review within 30 days.

(n) Once the application is considered complete under paragraph (m), the
commissioner will approve or deny an application for an alternative overnight supervision
license within 60 days.

(o) For the purposes of this subdivision, "supervision" means:

(1) oversight by a caregiver as specified in the individual resident's place agreement
and awareness of the resident's needs and activities; and

(2) the presence of a caregiver in a residence during normal sleeping hours, unless a
determination has been made and documented in the individual's support plan that the
individual does not require the presence of a caregiver during normal sleeping hours.

Sec. 5.

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

Subd. 2.

Risk management plan.

(a) The license holder must develop, document
in writing, 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 ability to manage mental and physical health needs, considering
the consumer's physical:

(i) mental health diagnosis and disabilities or sensory impairments and the ability
to seek and use assistance, assistive technology, adaptive aids, or equipment; allergies;
sensory impairments

(ii) ability to recognize and avoid allergens and manage allergic reactions;

(iii) ability to manage seizures;

(iv) ability to meet diet and nutritional needs, including eating without assistance
and swallowing without choking; need for

(v) ability to self-administer and manage medications or treatment orders; and
ability to

(vi) ability to obtain routine medical treatment; and

(vii) ability to recognize, respond appropriately to, and report changes in physical
and mental well-being;

(3) the consumer's safety needs skills in environments where the license holder
serves the consumer, considering the consumer's ability to:

(i) take reasonable safety precautions to prevent falls, burns, or avoid hazards;

(ii) identify and use community survival skills to prevent becoming lost or seeking
help when lost;

(iii) follow street safety rules;

(iv) use public transportation;

(v) drive or ride in a vehicle;

(vi) identify and follow water survival skills sufficient to avoid drowning or near
drowning; ability to

(vii) seek assistance with or provide medical care self-administer basic first aid;
and access to

(viii) recognize and handle or avoid toxic substances or dangerous items;

(4) environmental issues the consumer's ability to recognize and respond
appropriately to unsafe or hazardous situations or conditions in the physical and social
environment, considering the program's location in a particular consumer's ability to:

(i) access and participate in the neighborhood or community resources where the
program is located; the type of

(ii) maneuver around areas in the building where services are provided or on the
grounds and terrain surrounding the building; and the consumer's ability to

(iii) respond to weather-related conditions, including dressing appropriately for
the weather or seeking shelter;

(iv) open locked doors, to safely evacuate a room or building in an emergency; and

(v) remain alone in any environment; and

(5) the consumer's behavior, including when the license holder knows that the
consumer has committed a violent crime or the consumer engages in behaviors that may
increase the likelihood of physical aggression between consumers or sexual activity
between consumers involving force or coercion, as defined under section 245B.02,
subdivision 10, clauses (6) and (7), between consumers, or towards others. Under this
clause, a license holder knows of a consumer's history of criminal misconduct or physical
aggression if it 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.

(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. 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.

(d) 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. The license holder's license holder
must develop a plan must include that identifies the specific actions a staff person will
take and measures that will be taken to protect the consumer and minimize risks for the
identified vulnerability areas within the scope of the licensed services. The plan must
identify referrals made when the consumer is vulnerable to risks outside the scope or
control of the licensed services.

(e) The specific actions must include the proactive measures being taken to reduce
or minimize the risk, training being provided to the consumer to develop skills or abilities
to avoid or respond to the risk as independently as possible, or a detailed description of
actions a staff person will take when intervention is needed.

(e) (f) The specific actions must be developed according to the requirements
of subdivision 1, paragraph (a). When the assessment indicates that the consumer is
vulnerable but does not need specific risk reduction measures, the risk management
plan shall document this determination and why, at a minimum, proactive measures or
consumer training are not needed.

(g) 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 (h) 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) (i) 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. 6.

Minnesota Statutes 2010, section 245B.07, subdivision 1, is amended to read:

Subdivision 1.

Consumer data file.

The license holder must maintain the following
information for each consumer:

(1) identifying information that includes date of birth, medications, legal
representative, history, medical, and other individual-specific information, and names and
telephone numbers of contacts;

(2) consumer health information, including individual medication administration
and monitoring information;

(3) the consumer's individual service plan. When a consumer's case manager does
not provide a current individual service plan, the license holder shall make a written
request to the case manager to provide a copy of the individual service plan and inform
the consumer or the consumer's legal representative of the right to an individual service
plan and the right to appeal under section 256.045;. In the event the case manager fails
to provide an individual service plan after a written request from the license holder, the
license holder shall not be sanctioned or penalized financially for not having a current
individual service plan in the consumer's data file;

(4) copies of assessments, analyses, summaries, and recommendations;

(5) progress review reports;

(6) incidents involving the consumer;

(7) reports required under section 245B.05, subdivision 7;

(8) discharge summary, when applicable;

(9) record of other license holders serving the consumer that includes a contact
person and telephone numbers, services being provided, services that require coordination
between two license holders, and name of staff responsible for coordination;

(10) information about verbal aggression directed at the consumer by another
consumer; and

(11) information about self-abuse.

Sec. 7.

Minnesota Statutes 2010, section 245C.04, subdivision 6, is amended to read:

Subd. 6.

Unlicensed home and community-based waiver providers of service to
seniors and individuals with disabilities.

(a) Providers required to initiate background
studies under section 256B.4912 must initiate a study before the individual begins in a
position allowing direct contact with persons served by the provider.

(b) The commissioner shall conduct Except as provided in paragraph (c), the
providers must initiate a background study annually of an individual required to be studied
under section 245C.03, subdivision 6.

(c) After an initial background study under this subdivision is initiated on an
individual by a provider of both services licensed by the commissioner and the unlicensed
services under this subdivision, a repeat annual background study is not required if:

(1) the provider maintains compliance with the requirements of section 245C.07,
paragraph (a), regarding one individual with one address and telephone number as the
person to receive sensitive background study information for the multiple programs that
depend on the same background study, and that the individual who is designated to receive
the sensitive background information is capable of determining, upon the request of the
commissioner, whether a background study subject is providing direct contact services
in one or more of the provider's programs or services and, if so, at which location or
locations; and

(2) the individual who is the subject of the background study provides direct
contact services under the provider's licensed program for at least 40 hours per year so
the individual will be recognized by a probation officer or corrections agent to prompt
a report to the commissioner regarding criminal convictions as required under section
245C.05, subdivision 7.

Sec. 8.

Minnesota Statutes 2010, section 245C.05, subdivision 7, is amended to read:

Subd. 7.

Probation officer and corrections agent.

(a) A probation officer or
corrections agent shall notify the commissioner of an individual's conviction if the
individual is:

(1) has been affiliated with a program or facility regulated by the Department of
Human Services or Department of Health, a facility serving children or youth licensed by
the Department of Corrections, or any type of home care agency or provider of personal
care assistance services within the preceding year; and

(2) has been convicted of a crime constituting a disqualification under section
245C.14.

(b) For the purpose of this subdivision, "conviction" has the meaning given it
in section 609.02, subdivision 5.

(c) The commissioner, in consultation with the commissioner of corrections, shall
develop forms and information necessary to implement this subdivision and shall provide
the forms and information to the commissioner of corrections for distribution to local
probation officers and corrections agents.

(d) The commissioner shall inform individuals subject to a background study that
criminal convictions for disqualifying crimes will be reported to the commissioner by the
corrections system.

(e) A probation officer, corrections agent, or corrections agency is not civilly or
criminally liable for disclosing or failing to disclose the information required by this
subdivision.

(f) Upon receipt of disqualifying information, the commissioner shall provide the
notice required under section 245C.17, as appropriate, to agencies on record as having
initiated a background study or making a request for documentation of the background
study status of the individual.

(g) This subdivision does not apply to family child care programs.

Sec. 9.

Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to read:

Subd. 1b.

Individual service plan.

(a) The individual service plan must:

(1) include the results of the assessment information on the person's need for service,
including identification of service needs that will be or that are met by the person's
relatives, friends, and others, as well as community services used by the general public;

(2) identify the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor;

(3) identify long- and short-range goals for the person;

(4) identify specific services and the amount and frequency of the services to be
provided to the person based on assessed needs, preferences, and available resources.
The individual service plan shall also specify other services the person needs that are
not available;

(5) identify the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;

(6) identify provider responsibilities to implement and make recommendations for
modification to the individual service plan;

(7) include notice of the right to request a conciliation conference or a hearing
under section 256.045;

(8) be agreed upon and signed by the person, the person's legal guardian
or conservator, or the parent if the person is a minor, and the authorized county
representative; and

(9) be reviewed by a health professional if the person has overriding medical needs
that impact the delivery of services.

(b) Service planning formats developed for interagency planning such as transition,
vocational, and individual family service plans may be substituted for service planning
formats developed by county agencies.

(c) Approved, written, and signed changes to a consumer's services that meet the
criteria in this subdivision shall be an addendum to that consumer's individual service plan.

Sec. 10.

Minnesota Statutes 2011 Supplement, section 256B.097, subdivision 3,
is amended to read:

Subd. 3.

State Quality Council.

(a) There is hereby created a State Quality
Council which must define regional quality councils, and carry out a community-based,
person-directed quality review component, and a comprehensive system for effective
incident reporting, investigation, analysis, and follow-up.

(b) By August 1, 2011, the commissioner of human services shall appoint the
members of the initial State Quality Council. Members shall include representatives
from the following groups:

(1) disability service recipients and their family members;

(2) during the first two years of the State Quality Council, there must be at least three
members from the Region 10 stakeholders. As regional quality councils are formed under
subdivision 4, each regional quality council shall appoint one member;

(3) disability service providers;

(4) disability advocacy groups; and

(5) county human services agencies and staff from the Department of Human
Services and Ombudsman for Mental Health and Developmental Disabilities.

(c) Members of the council who do not receive a salary or wages from an employer
for time spent on council duties may receive a per diem payment when performing council
duties and functions.

(d) The State Quality Council shall:

(1) assist the Department of Human Services in fulfilling federally mandated
obligations by monitoring disability service quality and quality assurance and
improvement practices in Minnesota; and

(2) establish state quality improvement priorities with methods for achieving results
and provide an annual report to the legislative committees with jurisdiction over policy
and funding of disability services on the outcomes, improvement priorities, and activities
undertaken by the commission during the previous state fiscal year;

(3) identify issues pertaining to financial and personal risk that impede Minnesotans
with disabilities from optimizing choice of community-based services; and

(4) recommend to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services and civil law by January 15, 2013,
statutory and rule changes related to the findings under clause (3) that promote
individualized service and housing choices balanced with appropriate individualized
protection.

(e) The State Quality Council, in partnership with the commissioner, shall:

(1) approve and direct implementation of the community-based, person-directed
system established in this section;

(2) recommend an appropriate method of funding this system, and determine the
feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;

(3) approve measurable outcomes in the areas of health and safety, consumer
evaluation, education and training, providers, and systems;

(4) establish variable licensure periods not to exceed three years based on outcomes
achieved; and

(5) in cooperation with the Quality Assurance Commission, design a transition plan
for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.

(f) The State Quality Council shall notify the commissioner of human services that a
facility, program, or service has been reviewed by quality assurance team members under
subdivision 4, paragraph (b), clause (13), and qualifies for a license.

(g) The State Quality Council, in partnership with the commissioner, shall establish
an ongoing review process for the system. The review shall take into account the
comprehensive nature of the system which is designed to evaluate the broad spectrum of
licensed and unlicensed entities that provide services to persons with disabilities. The
review shall address efficiencies and effectiveness of the system.

(h) The State Quality Council may recommend to the commissioner certain
variances from the standards governing licensure of programs for persons with disabilities
in order to improve the quality of services so long as the recommended variances do
not adversely affect the health or safety of persons being served or compromise the
qualifications of staff to provide services.

(i) The safety standards, rights, or procedural protections referenced under
subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
recommendations to the commissioner or to the legislature in the report required under
paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
procedural protections referenced under subdivision 2, paragraph (c).

(j) The State Quality Council may hire staff to perform the duties assigned in this
subdivision.

Sec. 11.

Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 23,
is amended to read:

Subd. 23.

Community-living settings.

"Community-living settings" means a
single-family home or apartment where the service recipient or their family owns or rents,
as demonstrated by a lease agreement, and maintains control over the individual unit as
demonstrated by the lease agreement, or has a plan for transition of a lease from a service
provider to the individual. Within two years of signing the initial lease, the service provider
shall transfer the lease to the individual. In the event the landlord denies the transfer, the
commissioner may approve an exception within sufficient time to ensure the continued
occupancy by the individual. Community-living settings are subject to the following:

(1) individuals are not required to receive services;

(2) individuals are not required to have a disability or specific diagnosis to live
in the community-living setting;

(3) individuals may hire service providers of their choice;

(4) individuals may choose whether to share their household and with whom;

(5) the home or apartment must include living, sleeping, bathing, and cooking areas;

(6) individuals must have lockable access and egress;

(7) individuals must be free to receive visitors and leave the settings at times and for
durations of their own choosing;

(8) leases must not reserve the right to assign units or change unit assignments; and

(9) access to the greater community must be easily facilitated based on the
individual's needs and preferences.

Sec. 12.

[256B.492] ADULT FOSTER CARE VOLUNTARY CLOSURE.

Subdivision 1.

Commissioner's duties; report.

The commissioner of human
services shall ask providers of adult foster care services to present proposals for the
conversion of services provided for persons with developmental disabilities in settings
licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, to services to other
community settings in conjunction with the cessation of operations and closure of
identified facilities.

Subd. 2.

Inventory of foster care capacity.

The commissioner of human services
shall submit to the legislature by February 15, 2013, a report that includes:

(1) an inventory of the assessed needs of all individuals with disabilities receiving
foster care services under section 256B.092;

(2) an inventory of total licensed foster care capacity for adults and children
available in Minnesota as of January 1, 2013; and

(3) a comparison of the needs of individuals receiving services in foster care settings
and nonfoster care settings.

The report will also contain recommendations on developing a profile of individuals
requiring foster care services and the projected level of foster care capacity needed
to serve that population.

Subd. 3.

Applications for planned closure of adult foster care facilities.

(a) If
the report required in subdivision 2 determines the existing supply of foster care capacity
is higher than needed to meet the needs of individuals requiring that level of care, the
commissioner shall, within the limits of available appropriations, announce and implement
a program for closure of adult foster care homes. Names and identifying information
provided in response to the announcement shall remain private unless approved, according
to the timelines established in the plan.

(b) To be considered for approval, an application must include:

(1) a description of the proposed closure plan, which must include identification of
the home or homes to receive a planned closure rate adjustment;

(2) the proposed timetable for any proposed closure, including the proposed dates
for announcement to residents, commencement of closure, and completion of closure;

(3) the proposed relocation plan jointly developed by the county of financial
responsibility and the provider for current residents of any facility designated for closure;
and

(4) documentation in a format approved by the commissioner that all the adult foster
care homes receiving a planned closure rate adjustment under the plan have accepted joint
and several liability for recovery of overpayments under section 256B.0641, subdivision
2, for the facilities designated for closure under the plan.

Subd. 4.

Criteria for review of application.

(a) In reviewing and approving
closure proposals that the commissioner shall consider, the commissioner shall give first
priority to proposals that:

(1) result in the closing of a facility;

(2) demonstrate savings of medical assistance expenditures; and

(3) demonstrate that alternative placements will be developed based on individual
resident needs and applicable federal and state rules.

(b) The commissioner shall select proposals that best meet the criteria established
in this subdivision within the appropriations made available for planned closure of adult
foster care facilities. The commissioner shall notify providers of the selections made and
approved by the commissioner.

(c) For each proposal approved by the commissioner, a contract must be established
between the commissioner, the county of financial responsibility, and the participating
provider.

Subd. 5.

Adjustment to rates.

(a) For purposes of this section, the commissioner
shall establish an enhanced payment rate under section 256B.4913 to facilitate an orderly
transition for persons with developmental disabilities from adult foster care to other
community-based settings.

(b) The maximum length the commissioner may establish an enhanced rate is six
months.

(c) The commissioner shall analyze the fiscal impact of the closure of each facility
on medical assistance expenditures. Any savings is allocated to the medical assistance
program.

Sec. 13.

Minnesota Statutes 2010, section 256D.44, subdivision 5, is amended to read:

Subd. 5.

Special needs.

In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential housing facility.

(a) The county agency shall pay a monthly allowance for medically prescribed
diets if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for special diets or dietary items must be prescribed by
a licensed physician. Costs for special diets shall be determined as percentages of the
allotment for a one-person household under the thrifty food plan as defined by the United
States Department of Agriculture. The types of diets and the percentages of the thrifty
food plan that are covered are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
of thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using
the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent
of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
guardian or conservator is a member of the county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
1990, and who eats two or more meals in a restaurant daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full calendar month
or until the person's living arrangement changes and the person no longer meets the criteria
for the restaurant meal allowance, whichever occurs first.

(e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets the
requirements under SSI regulations to charge a fee for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid regardless of
their living arrangement.

(f)(1) Notwithstanding the language in this subdivision, an amount equal to the
maximum allotment authorized by the federal Food Stamp Program for a single individual
which is in effect on the first day of July of each year will be added to the standards of
assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
as shelter needy and are: (i) relocating from an institution, or an adult mental health
residential treatment program under section 256B.0622; (ii) eligible for the self-directed
supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
community-based waiver recipients living in their own home or rented or leased apartment
which is not owned, operated, or controlled by a provider of service not related by blood
or marriage, unless allowed under paragraph (g).

(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
shelter needy benefit under this paragraph is considered a household of one. An eligible
individual who receives this benefit prior to age 65 may continue to receive the benefit
after the age of 65.

(3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
exceed 40 percent of the assistance unit's gross income before the application of this
special needs standard. "Gross income" for the purposes of this section is the applicant's or
recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
considered shelter needy for purposes of this paragraph.

(g) Notwithstanding this subdivision, to access housing and services as provided
in paragraph (f), the recipient may choose housing that may be owned, operated, or
controlled by the recipient's service provider. In a multifamily building of four or more
units, the maximum number of apartments that may be used by recipients of this program
shall be 50 percent of the units in a building. This paragraph expires on June 30, 2012.
the service provider shall implement a plan with the recipient to transition the lease to
the recipient's name. Within two years of signing the initial lease, the service provider
shall transfer the lease entered into under this subdivision to the recipient. In the event the
landlord denies this transfer, the commissioner may approve an exception within sufficient
time to ensure the continued occupancy by the recipient.

Sec. 14. INNOVATION TASK FORCE.

(a) The commissioner of human services shall appoint members to the Innovation
Task Force to review and make recommendations on provider or lead agency initiated
pilot projects in home and community-based services for people with disabilities that
otherwise would be limited by state-imposed regulatory or funding restrictions.

(b) The task force membership shall include: two providers of disability services;
one person receiving disability services or a family member; one advocate for people with
disabilities; one representative from the Disability Law Center; one county representative;
one representative from the National Alliance on Mental Illness-Minnesota; and three
representatives from the Department of Human Services, one from the mental health
division, one from the disability services division, and one from the licensing division.
Members of the task force shall serve three-year terms and shall not be reimbursed for
task force work or meetings.

(c) On January 1 and July 1 of each year, the commissioner shall issue a request for
proposals in the State Register for service providers or lead agencies to develop and
implement new models for residential services that support people with disabilities. The
task force shall review and recommend to the commissioner projects for implementation
twice per year.

(d) Each proposed pilot project must:

(1) spend no more in state and federal funding than is spent in total funding for the
affected service recipients;

(2) be two years in duration;

(3) have the informed consent of all affected recipients or their guardians;

(4) be based on recipients' individual needs and designed for specific quality
outcomes; and

(5) be evaluated by the task force after two years with recommendations to the
commissioner to either discontinue the pilot project or continue the pilot project with
no time limitation.

(e) The commissioner shall review the task force's recommendations for start-up or
continuation of pilot projects and may approve new and continued pilot projects twice
per year.

(f) If a pilot project is discontinued, the affected recipients may return to services
provided prior to the pilot project and shall have funding for services restored to prepilot
project levels.

(g) Providers or lead agencies whose pilot projects are not continued shall not be
penalized due to a pilot project's performance but remain accountable to state and federal
Medicaid, vulnerable adult, and maltreatment of minors laws.

Sec. 15. HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE WITH
DISABILITIES.

Individuals receiving services under a home and community-based waiver may
receive services in the following settings:

(1) an individual's own home or family home;

(2) a licensed adult foster care setting of up to five people; and

(3) community living settings as defined in Minnesota Statutes, section 256B.49,
subdivision 23, regardless of the number of people living in the setting receiving services
under the home and community-based waiver.

The above settings must not:

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

(2) be located in a building on the grounds of or adjacent to a public institution;

(3) be a housing complex designed expressly around an individual's diagnosis or
disability unless state or federal funding for housing requires it;

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

(5) have the qualities of an institution, unless specifically required in the individual's
plan developed with the lead agency case manager and legal guardian. The qualities of an
institution include, but are not limited to:

(i) regimented meal and sleep times;

(ii) limitations on visitors; and

(iii) lack of privacy.

The commissioner shall submit an amendment to the waiver plan no later than
December 31, 2012.

Sec. 16. INDEPENDENT LIVING SERVICES BILLING.

The commissioner shall allow for daily rate and 15-minute increment billing for
independent living services under the brain injury (BI) and CADI waivers. If necessary to
comply with this requirement, the commissioner shall submit a waiver amendment to the
state plan no later than December 31, 2012.