2007 Minnesota Statutes

CHAPTER 245B. SERVICES FOR DEVELOPMENTAL DISABILITIES

245B.001 APPLICATION OF LAWS 2005, CHAPTER 56, TERMINOLOGY CHANGES.
State agencies shall use the terminology changes specified in Laws 2005, chapter 56, section
1, when printed material and signage are replaced and new printed material and signage are
obtained. State agencies do not have to replace existing printed material and signage to comply
with Laws 2005, chapter 56, sections 1 and 2. Language changes made according to Laws 2005,
chapter 56, sections 1 and 2, shall not expand or exclude eligibility to services.
History: 2005 c 56 s 3

245B.01 RULE CONSOLIDATION.
This chapter establishes new methods to ensure the quality of services to persons with
developmental disabilities, and streamlines and simplifies regulation of services and supports for
persons with developmental disabilities. Sections 245B.02 to 245B.07 establish new standards
that eliminate duplication and overlap of regulatory requirements by consolidating and replacing
rule parts from four program rules. Section 245B.08 authorizes the commissioner of human
services to develop and use new regulatory strategies to maintain compliance with the streamlined
requirements.
History: 1997 c 248 s 35; 2005 c 56 s 1

245B.02 DEFINITIONS.
    Subdivision 1. Scope. The terms used in this chapter have the meanings given them.
    Subd. 2. Applicant. "Applicant" has the meaning given in section 245A.02, subdivision 3.
    Subd. 3. Case manager. "Case manager" means the individual designated by the county
board under rules of the commissioner to provide case management services as delineated in
section 256B.092 or successor provisions.
    Subd. 4. Consumer. "Consumer" means a person who has been determined eligible to
receive and is receiving services or support for persons with developmental disabilities.
    Subd. 5. Commissioner. "Commissioner" means the commissioner of the Department of
Human Services or the commissioner's designated representative.
    Subd. 6. Day training and habilitation services; developmental disabilities. "Day training
and habilitation services for adults with developmental disabilities" has the meaning given in
sections 252.40 to 252.46.
    Subd. 7. Department. "Department" means the Department of Human Services.
    Subd. 8. Direct service. "Direct service" means, for a consumer receiving residential-based
services, day training and habilitation services, or respite care services, one or more of the
following: supervision, assistance, or training.
    Subd. 9. Health services. "Health services" means any service or treatment consistent with
the health needs of the consumer, such as medication administration and monitoring, medical,
dental, nutritional, health monitoring, wellness education, and exercise.
    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 accidents that require
physician treatment or hospitalization;
(4) a consumer's unauthorized absence;
(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;
(6) 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;
(7) any sexual activity between consumers involving force or coercion as defined under
section 609.341, subdivisions 3 and 14; or
(8) a report of child or vulnerable adult maltreatment under section 626.556 or 626.557.
    Subd. 11. Individual service plan. "Individual service plan" has the meaning given in
section 256B.092 or successor provisions.
    Subd. 12. Individual who is related. "Individual who is related" has the meaning given
in section 245A.02, subdivision 13.
    Subd. 12a. Interdisciplinary team. "Interdisciplinary team" means a team composed
of the case manager, the person, the person's legal representative and advocate, if any, and
representatives of providers of the service areas relevant to the needs of the person as described in
the individual service plan.
    Subd. 13. Intermediate care facility for persons with developmental disabilities.
"Intermediate care facility for persons with developmental disabilities" or "ICF/MR" means a
residential program licensed to provide services to persons with developmental disabilities under
section 252.28 and chapter 245A and a physical facility licensed as a supervised living facility
under chapter 144, which together are certified by the Department of Health as an intermediate
care facility for persons with developmental disabilities.
    Subd. 14. Least restrictive environment. "Least restrictive environment" means an
environment where services:
(1) are delivered with minimum limitation, intrusion, disruption, or departure from typical
patterns of living available to persons without disabilities;
(2) do not subject the consumer or others to unnecessary risks to health or safety; and
(3) maximize the consumer's level of independence, productivity, and inclusion in the
community.
    Subd. 15. Legal representative. "Legal representative" means the parent or parents of a
consumer who is under 18 years of age or a guardian, conservator, or guardian ad litem authorized
by the court, or other legally authorized representative to make decisions about services for a
consumer.
    Subd. 16. License. "License" has the meaning given in section 245A.02, subdivision 8.
    Subd. 17. License holder. "License holder" has the meaning given in section 245A.02,
subdivision 9 .
    Subd. 18. Person with developmental disability. "Person with developmental disability"
means a person who has been diagnosed under section 256B.092 as having substantial limitations
in present functioning, manifested as significantly subaverage intellectual functioning, existing
concurrently with demonstrated deficits in adaptive behavior, and who manifests these conditions
before the person's 22nd birthday. A person with a related condition means a person who meets
the diagnostic definition under section 252.27, subdivision 1a.
    Subd. 19. Psychotropic medication use checklist. "Psychotropic medication use
checklist" means the psychotropic medication monitoring checklist and manual used to govern
the administration of psychotropic medications. The commissioner may revise or update the
psychotropic medication use checklist to comply with legal requirements or to meet professional
standards or guidelines in the area of developmental disabilities. For purposes of this chapter,
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.
    Subd. 20. Residential-based habilitation. "Residential-based habilitation" means care,
supervision, and training provided primarily in the consumer's own home or place of residence
but also including community-integrated activities following the individual service plan.
Residential habilitation services are provided in coordination with the provision of day training
and habilitation services for those persons receiving day training and habilitation services under
sections 252.40 to 252.46.
    Subd. 21. Respite care. "Respite care" has the meaning given in section 245A.02,
subdivision 15 .
    Subd. 22. Service. "Service" means care, supervision, activities, or training designed to
achieve the outcomes assigned to the license holder.
    Subd. 23. Semi-independent living services or SILS "Semi-independent living services" or
"SILS" has the meaning given in section 252.275.
    Subd. 23a. Supported employment. "Supported employment" services include
individualized counseling, individualized job development and placement that produce an
appropriate job match for the individual and the employer, on-the-job training in work and related
work skills required for job performance, ongoing supervision and monitoring of the person's
performance, long-term support services to assure job retention, training in related skills essential
to obtaining and retaining employment such as the effective use of community resources, use
of break and lunch areas, transportation and mobility training, and transportation between the
individual's place of residence and the work place when other forms of transportation are
unavailable or inaccessible.
    Subd. 24. Volunteer. "Volunteer" means an individual who, under the direction of the license
holder, provides direct services without pay to consumers served by the license holder.
History: 1997 c 248 s 36; 2001 c 203 s 1; 2002 c 289 s 1; 2004 c 288 art 1 s 32; 2005 c 56 s
1; 1Sp2005 c 4 art 1 s 23

245B.03 APPLICABILITY AND EFFECT.
    Subdivision 1. Applicability. The standards in this chapter govern services to persons with
developmental disabilities receiving services from license holders providing residential-based
habilitation; day training and habilitation services for adults; supported employment;
semi-independent living services; residential programs that serve more than four consumers,
including intermediate care facilities for persons with developmental disabilities; and respite
care provided outside the consumer's home for more than four consumers at the same time at a
single site.
    Subd. 2. Relationship to other standards governing services at ICF's/MR. (a) ICF's/MR
are exempt from:
(1) section 245B.04;
(2) section 245B.06, subdivisions 4 and 6; and
(3) section 245B.07, subdivisions 4, paragraphs (b) and (c); 7; and 8, paragraphs (1),
clause (iv), and (2).
(b) License holders also licensed under chapter 144 as a supervised living facility are exempt
from section 245B.04.
(c) Residential service sites controlled by license holders licensed under this chapter
for home and community-based waivered services for four or fewer adults are exempt from
compliance with Minnesota Rules, parts 9543.0040, subpart 2, item C; 9555.5505; 9555.5515,
items B and G; 9555.5605; 9555.5705; 9555.6125, subparts 3, item C, subitem (2), and 4 to
6; 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 9555.6265; and as provided
under section 245B.06, subdivision 2, the license holder is exempt from the program abuse
prevention plans and individual abuse prevention plans otherwise required under sections
245A.65, subdivision 2, and 626.557, subdivision 14. The commissioner may approve alternative
methods of providing overnight supervision using the process and criteria for granting a variance
in section 245A.04, subdivision 9. This chapter does not apply to foster care homes that do not
provide residential habilitation services funded under the home and community-based waiver
programs defined in section 256B.092.
(d) Residential service sites controlled by license holders licensed under this chapter for
home and community-based waivered services for four or fewer children are exempt from
compliance with Minnesota Rules, parts 2960.3060, subpart 3, items B and C; 2960.3070;
2960.3100, subpart 1, items C, F, and I; and 2960.3210.
(e) The commissioner may exempt license holders from applicable standards of this chapter
when the license holder meets the standards under section 245A.09, subdivision 7. License
holders that are accredited by an independent accreditation body shall continue to be licensed
under this chapter.
(f) License holders governed by sections 245B.02 to 245B.07 must also meet the licensure
requirements in chapter 245A.
(g) Nothing in this chapter prohibits license holders from concurrently serving consumers
with and without developmental disabilities provided this chapter's standards are met as well
as other relevant standards.
(h) The documentation that sections 245B.02 to 245B.07 require of the license holder meets
the individual program plan required in section 256B.092 or successor provisions.
    Subd. 3. Continuity of care. (a) When a consumer changes service to the same type of
service provided under a different license held by the same license holder and the policies and
procedures under section 245B.07, subdivision 8, are substantially similar, the license holder is
exempt from the requirements in sections 245B.06, subdivisions 2, paragraphs (e) and (f), and 4;
and 245B.07, subdivision 9, clause (2).
(b) When a direct service staff person begins providing direct service under one or more
licenses other than the license for which the staff person initially received the staff orientation
requirements under section 245B.07, subdivision 5, the license holder is exempt from all staff
orientation requirements under section 245B.07, subdivision 5, except that:
(1) if the service provision location changes, the staff person must receive orientation
regarding any policies or procedures under section 245B.07, subdivision 8, that are specific to
the service provision location; and
(2) if the staff person provides direct service to one or more consumers for whom the staff
person has not previously provided direct service, the staff person must review each consumer's:
(i) service plans and risk management plan in accordance with section 245B.07, subdivision 5,
paragraph (b), clause (1); and (ii) medication administration in accordance with section 245B.07,
subdivision 5 , paragraph (b), clause (6).
History: 1997 c 248 s 37; 2001 c 203 s 2; 1Sp2003 c 14 art 6 s 13,14; 2004 c 288 art 1
s 33; 2005 c 56 s 1

245B.04 CONSUMER RIGHTS.
    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. 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.
    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 those 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.
    Subd. 3. Protection-related rights. 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;
(5) voice grievances, know the contact persons responsible for addressing problems and
how to contact those persons;
(6) any procedures for grievance or complaint resolution and the right to appeal under
section 256.045;
(7) know the name and address of the state, county, or advocacy agency to contact for
additional information or assistance;
(8) assert these rights personally, or have them asserted by the consumer's family or legal
representative, without retaliation;
(9) give or withhold written informed consent to participate in any research or experimental
treatment;
(10) 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;
(11) receive and send uncensored, unopened mail;
(12) 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;
(13) associate with other persons of the consumer's choice;
(14) personal privacy; and
(15) engage in chosen activities.
History: 1997 c 248 s 38; 1Sp2003 c 14 art 6 s 15

245B.05 CONSUMER PROTECTION STANDARDS.
    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;
(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.
    Subd. 2. Licensed capacity for facility-based day training and habilitation services. The
licensed capacity of each day training and habilitation service site must be determined by the
amount of primary space available, the scheduling of activities at other service sites, and the space
requirements of consumers receiving services at the site. Primary space does not include hallways,
stairways, closets, utility areas, bathrooms, kitchens, and floor areas beneath stationary equipment.
A facility-based day training and habilitation site must have a minimum of 40 square feet of
primary space available for each consumer who is present at the site at any one time. Licensed
capacity under this subdivision does not apply to: (1) consumers receiving community-based
day training and habilitation services; and (2) the temporary use of a facility-based training
and habilitation service site for the limited purpose of providing transportation to consumers
receiving community-based day training and habilitation services from the license holder. The
license holder must comply at all times with all applicable fire and safety codes under subdivision
4 and adequate supervision requirements under section 245B.055 for all persons receiving day
training and habilitation services.
    Subd. 3. Residential service sites for more than four consumers; four-bed ICF's/MR.
Residential service sites licensed to serve more than four consumers and four-bed ICF's/MR must
meet the fire protection provisions of either the Residential Board and Care Occupancies Chapter
or the Health Care Occupancies Chapter of the Life Safety Code (LSC), National Fire Protection
Association, 1985 edition, or its successors. Sites meeting the definition of a residential board and
care occupancy for 16 or less beds must have the emergency evacuation capability of residents
evaluated in accordance with Appendix F of the LSC or its successors, except for those sites that
meet the LSC Health Care Occupancies Chapter or its successors.
    Subd. 4. Meeting fire and safety codes. An applicant or license holder under sections
245A.01 to 245A.16 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.
    Subd. 5. Consumer health. The license holder is responsible for meeting the health service
needs assigned to the license holder in the individual service plan and for bringing health needs as
discovered by the license holder promptly to the attention of the consumer, the consumer's legal
representative, and the case manager. The license holder is required to maintain documentation on
how the consumer's health needs will be met, including a description of procedures the license
holder will follow for the consumer regarding medication monitoring and administration and
seizure monitoring, if needed. The medication administration procedures are those procedures
necessary to implement medication and treatment orders issued by appropriately licensed
professionals, and must be established in consultation with a registered nurse, nurse practitioner,
physician's assistant, or medical doctor.
    Subd. 6. First aid. When the license holder is providing direct service and supervision to
a consumer who requires a 24-hour plan of care and receives services at a site licensed under
this chapter, the license holder must have available a staff person trained in first aid, and, if
needed under section 245B.07, subdivision 6, paragraph (d), cardiopulmonary resuscitation from
a qualified source, as determined by the commissioner.
    Subd. 7. Reporting incidents. (a) The license holder must maintain information about and
report incidents under section 245B.02, subdivision 10, clauses (1) to (7), to the consumer's
legal representative, other licensed caregiver, if any, and case manager within 24 hours of the
occurrence, or within 24 hours of receipt of the information unless the incident has been reported
by another license holder. An incident under section 245B.02, subdivision 10, clause (8), must
be reported as required under paragraph (c) unless the incident has been reported by another
license holder.
(b) When the incident involves more than one consumer, the license holder must not disclose
personally identifiable information about any other consumer when making the report to each
consumer's legal representative, other licensed caregiver, if any, and case manager unless the
license holder has the consent of a consumer or a consumer's legal representative.
(c) Within 24 hours of reporting maltreatment as required under section 626.556 or 626.557,
the license holder must inform the consumer's legal representative and case manager of the report
unless there is reason to believe that the legal representative or case manager is involved in the
suspected maltreatment. The information the license holder must disclose is the nature of the
activity or occurrence reported, the agency that receives the report, and the telephone number of
the Department of Human Services Licensing Division.
(d) Death or serious injury of the consumer must also be reported to the Department of
Human Services Licensing Division and the ombudsman, as required under sections 245.91
and 245.94, subdivision 2a.
History: 1997 c 248 s 39; 1999 c 245 art 4 s 11; 2002 c 289 s 2; 2004 c 288 art 1 s 34

245B.055 STAFFING FOR DAY TRAINING AND HABILITATION SERVICES.
    Subdivision 1. Scope. This section applies only to license holders that provide day training
and habilitation services.
    Subd. 2. Factors. (a) The number of direct service staff members that a license holder must
have on duty at a given time to meet the minimum staffing requirements established in this
section varies according to:
(1) the number of persons who are enrolled and receiving direct services at that given time;
(2) the staff ratio requirement established under subdivision 3 for each of the persons who
is present; and
(3) whether the conditions described in subdivision 8 exist and warrant additional staffing
beyond the number determined to be needed under subdivision 7.
(b) The commissioner shall consider the factors in paragraph (a) in determining a license
holder's compliance with the staffing requirements and shall further consider whether the staff
ratio requirement established under subdivision 3 for each person receiving services accurately
reflects the person's need for staff time.
    Subd. 3. Staff ratio requirement for each person receiving services. The case manager, in
consultation with the interdisciplinary team shall determine at least once each year which of the
ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving services on the basis of
the characteristics described in subdivisions 4, 5, and 6. The ratio assigned each person and the
documentation of how the ratio was arrived at must be kept in each person's individual service
plan. Documentation must include an assessment of the person with respect to the characteristics
in subdivisions 4, 5, and 6 recorded on a standard assessment form required by the commissioner.
    Subd. 4. Person requiring staff ratio of one to four. A person who has one or more of the
following characteristics must be assigned a staff ratio requirement of one to four:
(1) on a daily basis the person requires total care and monitoring or constant hand-over-hand
physical guidance to successfully complete at least three of the following activities: toileting,
communicating basic needs, eating, or ambulating; or
(2) the person assaults others, is self-injurious, or manifests severe dysfunctional behaviors
at a documented level of frequency, intensity, or duration requiring frequent daily ongoing
intervention and monitoring as established in an approved behavior management program.
    Subd. 5. Person requiring staff ratio of one to eight. A person who has all of the following
characteristics must be assigned a staff ratio requirement of one to eight:
(1) the person does not meet the requirements in subdivision 4; and
(2) on a daily basis the person requires verbal prompts or spot checks and minimal or no
physical assistance to successfully complete at least three of the following activities: toileting,
communicating basic needs, eating, or ambulating.
    Subd. 6. Person requiring staff ratio of one to six. A person who does not have any of
the characteristics described in subdivision 4 or 5 must be assigned a staff ratio requirement of
one to six.
    Subd. 7. Determining number of direct service staff required. The minimum number
of direct service staff members required at any one time to meet the combined staff ratio
requirements of the persons present at that time can be determined by following the steps in
clauses (1) through (4):
(1) assign each person in attendance the three-digit decimal below that corresponds to the
staff ratio requirement assigned to that person. A staff ratio requirement of one to four equals
0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio requirement of one to
six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
(2) add all of the three-digit decimals (one three-digit decimal for every person in attendance)
assigned in clause (1);
(3) when the sum in clause (2) falls between two whole numbers, round off the sum to the
larger of the two whole numbers; and
(4) the larger of the two whole numbers in clause (3) equals the number of direct service staff
members needed to meet the staff ratio requirements of the persons in attendance.
    Subd. 8. Conditions requiring additional direct service staff. The license holder shall
increase the number of direct service staff members present at any one time beyond the
number arrived at in subdivision 4 if necessary when any one or combination of the following
circumstances can be documented by the commissioner as existing:
(1) the health and safety needs of the persons receiving services cannot be met by the number
of staff members available under the staffing pattern in effect even though the number has been
accurately calculated under subdivision 7; or
(2) the behavior of a person presents an immediate danger and the person is not eligible for a
special needs rate exception under Minnesota Rules, parts 9510.1020 to 9510.1140.
    Subd. 9. Supervision requirements. At no time shall one direct service staff member be
assigned responsibility for supervision and training of more than ten persons receiving supervision
and training, except as otherwise stated in each person's risk management plan.
History: 2004 c 288 art 1 s 35; 1Sp2005 c 4 art 1 s 24

245B.06 SERVICE STANDARDS.
    Subdivision 1. Outcome-based services. (a) The license holder must provide outcome-based
services in response to the consumer's identified needs as specified in the individual service plan.
(b) Services must be based on the needs and preferences of the consumer and the
consumer's personal goals and be consistent with the principles of least restrictive environment,
self-determination, and consistent with:
(1) the recognition of each consumer's history, dignity, and cultural background;
(2) the affirmation and protection of each consumer's civil and legal rights;
(3) the provision of services and supports for each consumer which:
(i) promote community inclusion and self-sufficiency;
(ii) provide services in the least restrictive environment;
(iii) promote social relationships, natural supports, and participation in community life;
(iv) allow for a balance between safety and opportunities; and
(v) provide opportunities for the development and exercise of age-appropriate skills, decision
making and choice, personal advocacy, and communication; and
(4) the provision of services and supports for families which address the needs of the
consumer in the context of the family and support family self-sufficiency.
(c) The license holder must make available to the consumer opportunities to participate
in the community, functional skill development, reduced dependency on care providers, and
opportunities for development of decision-making skills. "Outcome" means the behavior, action,
or status attained by the consumer that can be observed, measured, and can be determined reliable
and valid. Outcomes are the equivalent of the long-range goals and short-term goals referenced in
section 256B.092, and any rules promulgated under that section.
    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 health needs, considering the consumer's physical disabilities; allergies;
sensory impairments; seizures; diet; need for medications; and ability to obtain medical treatment;
(3) the consumer's safety needs, considering the consumer's ability to take reasonable safety
precautions; community survival skills; water survival skills; ability to seek assistance or provide
medical care; and access to toxic substances or dangerous items;
(4) environmental issues, considering the program's location in a particular neighborhood
or community; the type of grounds and terrain surrounding the building; and the consumer's
ability to respond to weather-related conditions, open locked doors, and remain alone in any
environment; and
(5) the consumer's behavior, including 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).
(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.
(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 plan must include the specific actions a
staff person will take to protect the consumer and minimize risks for the identified vulnerability
areas. The specific actions must include the proactive measures being taken, training being
provided, or a detailed description of actions a staff person will take when intervention is needed.
(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.
    Subd. 3. Assessments. (a) The license holder shall assess and reassess the consumer within
stated time lines and assessment areas specified in the individual service plan or as requested in
writing by the case manager.
(b) For each area of assessment requested, the license holder must provide a written summary,
analysis, and recommendations for use in the development of the individual service plan.
(c) All assessments must include information about the consumer that is descriptive of:
(1) the consumer's strengths and functional skills; and
(2) the level of support and supervision the consumer needs to achieve the outcomes in
subdivision 1.
    Subd. 4. Supports and methods. The license holder, in coordination with other service
providers, shall meet with the consumer, the consumer's legal representative, case manager, and
other members of the interdisciplinary team within 45 days of service initiation. Within ten
working days after the meeting, the license holder shall develop and document in writing:
(1) the methods that will be used to support the individual or accomplish the outcomes in
subdivision 1, including information about physical and social environments, the equipment and
materials required, and techniques that are consistent with the consumer's communication mode
and learning style specified as the license holder's responsibility in the individual service plan;
(2) the projected starting date for service supports and the criteria for identifying when the
desired outcome has been achieved and when the service supports need to be reviewed; and
(3) the names of the staff, staff position, or contractors responsible for implementing each
outcome.
    Subd. 5. Progress reviews. The license holder must participate in progress review meetings
following stated time lines established in the consumer's individual service plan or as requested in
writing by the consumer, the consumer's legal representative, or the case manager, at a minimum
of once a year. The license holder must summarize the progress toward achieving the desired
outcomes and make recommendations in a written report sent to the consumer or the consumer's
legal representative and case manager prior to the review meeting.
    Subd. 6. Reports. The license holder shall provide written reports regarding the consumer's
status as requested by the consumer, or the consumer's legal representative and case manager.
    Subd. 7. Staffing requirements. The license holder must provide supervision to ensure
the health, safety, and protection of rights of each consumer and to be able to implement each
consumer's individual service plan. Day training and habilitation programs must meet the
minimum staffing requirements as specified in sections 252.40 to 252.46 and rules promulgated
under those sections.
    Subd. 8. Leaving the residence. Each consumer requiring a 24-hour plan of care shall
receive services during the day outside the residence unless otherwise specified in the individual's
service plan. License holders, providing services to consumers living in a licensed site, shall
ensure that they are prepared to care for consumers whenever they are at the residence during
the day because of illness, work schedules, or other reasons.
    Subd. 9. Day training and habilitation service days. Day training and habilitation services
must meet a minimum of 195 available service days.
    Subd. 10. Prohibition. Psychotropic medication and the use of aversive and deprivation
procedures, as referenced in section 245.825 and rules promulgated under that section, cannot be
used as a substitute for adequate staffing, as punishment, or for staff convenience.
History: 1997 c 248 s 40; 1998 c 407 art 6 s 6; 1Sp2003 c 14 art 3 s 2; art 6 s 16,17

245B.07 MANAGEMENT STANDARDS.
    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;
(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.
    Subd. 2. Access to records. The license holder must ensure that the following people have
access to the information in subdivision 1:
(1) the consumer, the consumer's legal representative, and anyone properly authorized by the
consumer or legal representative;
(2) the consumer's case manager;
(3) staff providing direct services to the consumer unless the information is not relevant to
carrying out the individual service plan; and
(4) the county adult foster care licensor, when services are also licensed as an adult foster
home. Adult foster home means a licensed residence operated by an operator who, for financial
gain or otherwise, provides 24-hour foster care to no more than four functionally impaired
residents.
    Subd. 3. Retention of consumer's records. The license holder must retain the records
required for consumers for at least three years following termination of services.
    Subd. 4. Staff qualifications. (a) The license holder must ensure that staff is competent
through training, experience, and education to meet the consumer's needs and additional
requirements as written in the individual service plan. Staff qualifications must be documented.
Staff under 18 years of age may not perform overnight duties or administer medication.
(b) Delivery and evaluation of services provided by the license holder to a consumer must
be coordinated by a designated person. The designated person or coordinator must minimally
have a four-year degree in a field related to service provision, and one year work experience
with consumers with developmental disabilities, a two-year degree in a field related to service
provision, and two years of work experience with consumers with developmental disabilities, or a
diploma in community-based developmental disability services from an accredited postsecondary
institution and two years of work experience with consumers with developmental disabilities. The
coordinator must provide supervision, support, and evaluation of activities that include:
(1) oversight of the license holder's responsibilities designated in the individual service plan;
(2) instruction and assistance to staff implementing the individual service plan areas;
(3) evaluation of the effectiveness of service delivery, methodologies, and progress on
consumer outcomes based on the condition set for objective change; and
(4) review of incident and emergency reports, identification of incident patterns, and
implementation of corrective action as necessary to reduce occurrences.
(c) The coordinator is responsible for taking the action necessary to facilitate the
accomplishment of the outcomes for each consumer as specified in the consumer's individual
service plan.
(d) The license holder must provide for adequate supervision of direct care staff to ensure
implementation of the individual service plan.
    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 coverage
of 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;
(2) review and instruction on the license holder's policies and procedures, including their
location and access;
(3) 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; 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.
    Subd. 6. Staff training. (a) A license holder providing semi-independent living services
shall ensure that direct service staff annually complete hours of training equal to one percent of
the number of hours the staff person worked. All other license holders shall ensure that direct
service staff annually complete hours of training as follows:
(1) if the direct services staff have been employed for one to 24 months and:
(i) the average number of work hours scheduled per week is 30 to 40 hours, the staff must
annually complete 40 training hours;
(ii) the average number of work hours scheduled per week is 20 to 29 hours, the staff must
annually complete 30 training hours; and
(iii) the average number of work hours scheduled per week is one to 19 hours, the staff
must annually complete 20 training hours; or
(2) if the direct services staff have been employed for more than 24 months and:
(i) the average number of work hours scheduled per week is 30 to 40 hours, the staff must
annually complete 20 training hours;
(ii) the average number of work hours scheduled per week is 20 to 29 hours, the staff must
annually complete 15 training hours; and
(iii) the average number of work hours scheduled per week is one to 19 hours, the staff must
annually complete 12 training hours.
If direct service staff has received training from a license holder licensed under a program
rule identified in this chapter or completed course work regarding disability-related issues from a
postsecondary educational institute, that training may also count toward training requirements for
other services and for other license holders.
(b) The license holder must document the training completed by each employee.
(c) Training shall address staff competencies necessary to address the consumer needs as
identified in the consumer's individual service plan and ensure consumer health, safety, and
protection of rights. Training may also include other areas identified by the license holder.
(d) For consumers requiring a 24-hour plan of care, the license holder shall provide training
in cardiopulmonary resuscitation, from a qualified source determined by the commissioner, if
the consumer's health needs as determined by the consumer's physician indicate trained staff
would be necessary to the consumer.
    Subd. 7. Volunteers. The license holder must ensure that volunteers who provide direct
services to consumers receive the training and orientation necessary to fulfill their responsibilities.
    Subd. 8. Policies and procedures. The license holder must develop and implement the
policies and procedures in paragraphs (1) to (3).
(1) Policies and procedures that promote consumer health and safety by ensuring:
(i) consumer safety in emergency situations;
(ii) consumer health through sanitary practices;
(iii) safe transportation, when the license holder is responsible for transportation of
consumers, with provisions for handling emergency situations;
(iv) a system of record keeping for both individuals and the organization, for review of
incidents and emergencies, and corrective action if needed;
(v) a plan for responding to all incidents, as defined in section 245B.02, subdivision 10, and
reporting all incidents required to be reported under section 245B.05, subdivision 7;
(vi) safe medication administration as identified in section 245B.05, subdivision 5,
incorporating an observed skill assessment to ensure that staff demonstrate the ability to
administer medications consistent with the license holder's policy and procedures;
(vii) psychotropic medication monitoring when the consumer is prescribed a psychotropic
medication, including the use of the psychotropic medication use checklist. If the responsibility
for implementing the psychotropic medication use checklist has not been assigned in the
individual service plan and the consumer lives in a licensed site, the residential license holder
shall be designated; and
(viii) criteria for admission or service initiation developed by the license holder.
(2) Policies and procedures that protect consumer rights and privacy by ensuring:
(i) consumer data privacy, in compliance with the Minnesota Data Practices Act, chapter
13; and
(ii) that complaint procedures provide consumers with a simple process to bring grievances
and consumers receive a response to the grievance within a reasonable time period. The license
holder must provide a copy of the program's grievance procedure and time lines for addressing
grievances. The program's grievance procedure must permit consumers served by the program and
the authorized representatives to bring a grievance to the highest level of authority in the program.
(3) Policies and procedures that promote continuity and quality of consumer supports by
ensuring:
(i) continuity of care and service coordination, including provisions for service termination,
temporary service suspension, and efforts made by the license holder to coordinate services with
other vendors who also provide support to the consumer. The policy must include the following
requirements:
(A) the license holder must notify the consumer or consumer's legal representative and the
consumer's case manager in writing of the intended termination or temporary service suspension
and the consumer's right to seek a temporary order staying the termination or suspension of service
according to the procedures in section 256.045, subdivision 4a or subdivision 6, paragraph (c);
(B) 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;
(C) the license holder must provide information requested by the consumer or consumer's
legal representative or case manager when services are temporarily suspended or upon notice
of termination;
(D) use of temporary service suspension procedures are restricted to situations in which
the consumer's behavior causes immediate and serious danger to the health and safety of the
individual or others;
(E) 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 termination or
temporary service suspension; and
(F) during the period of temporary service suspension, the license holder will work with
the appropriate county agency to develop reasonable alternatives to protect the individual and
others; and
(ii) quality services measured through a program evaluation process including regular
evaluations of consumer satisfaction and sharing the results of the evaluations with the consumers
and legal representatives.
    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 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
and explanation of revisions to policies and procedures that affect consumers' service-related or
protection-related rights under section 245B.04. 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 revised policies and procedures; and
(6) document and maintain relevant information related to the policies and procedures
in this chapter.
    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; or
(5) use consumer funds in a manner that would violate section 256B.04, or any rules
promulgated under that section.
    Subd. 11. Travel time to and from a day training and habilitation site. Except in unusual
circumstances, the license holder must not transport a consumer receiving services for longer than
90 minutes per one-way trip. Nothing in this subdivision relieves the provider of the obligation to
provide the number of program hours as identified in the individualized service plan.
    Subd. 12. Separate license required for separate sites. The license holder shall apply
for separate licenses for each day training and habilitation service site owned or leased by the
license holder at which persons receiving services and the provider's employees who provide
training and habilitation services are present for a cumulative total of more than 30 days within
any 12-month period, and for each residential service site. Notwithstanding this subdivision, a
separate license is not required for a day training and habilitation service site used only for the
limited purpose of providing transportation to consumers receiving community-based day training
and habilitation services from a license holder.
    Subd. 13. Variance. The commissioner may grant a variance to any of the requirements
in sections 245B.02 to 245B.07 except section 245B.07, subdivision 8(1)(vii), or provisions
governing data practices and information rights of consumers if the conditions in section 245A.04,
subdivision 9 are met. Upon the request of the license holder, the commissioner shall continue
variances from the standards in this chapter previously granted under Minnesota Rules that are
repealed as a result of this chapter. The commissioner may approve variances for a license holder
on a program, geographic, or organizational basis.
History: 1997 c 248 s 41; 3Sp1997 c 3 s 7,8; 1999 c 245 art 4 s 12-14; 2002 c 289 s 3;
1Sp2003 c 14 art 3 s 3; art 6 s 18,19; 2004 c 288 art 1 s 36,37; 2005 c 56 s 1; 1Sp2005 c 4
art 1 s 25

245B.08 COMPLIANCE STRATEGIES.
    Subdivision 1. Alternative methods of determining compliance. (a) In addition to
methods specified in chapters 245A and 245C, the commissioner may use alternative methods
and new regulatory strategies to determine compliance with this section. The commissioner
may use sampling techniques to ensure compliance with this section. Notwithstanding section
245A.09, subdivision 7, paragraph (e), the commissioner may also extend periods of licensure,
not to exceed five years, for license holders who have demonstrated substantial and consistent
compliance with sections 245B.02 to 245B.07 and have consistently maintained the health and
safety of consumers and have demonstrated by alternative methods in paragraph (b) that they
meet or exceed the requirements of this section. For purposes of this section, "substantial and
consistent compliance" means that during the current licensing period:
(1) the license holder's license has not been made conditional, suspended, or revoked;
(2) there have been no substantiated allegations of maltreatment against the license holder;
(3) there have been no program deficiencies that have been identified that would jeopardize
the health or safety of consumers being served; and
(4) the license holder is in substantial compliance with the other requirements of chapters
245A and 245C and other applicable laws and rules.
(b) To determine the length of a license, the commissioner shall consider:
(1) information from affected consumers, and the license holder's responsiveness to
consumers' concerns and recommendations;
(2) self assessments and peer reviews of the standards of this section, corrective actions taken
by the license holder, and sharing the results of the inspections with consumers, the consumers'
families, and others, as requested;
(3) length of accreditation by an independent accreditation body, if applicable;
(4) information from the county where the license holder is located; and
(5) information from the license holder demonstrating performance that meets or exceeds the
minimum standards of this chapter.
(c) The commissioner may reduce the length of the license if the license holder fails to meet
the criteria in paragraph (a) and the conditions specified in paragraph (b).
    Subd. 2. Additional measures. The commissioner may require the license holder to
implement additional measures on a time-limited basis to ensure the health and safety of
consumers when the health and safety of consumers has been determined to be at risk as
determined by substantiated incidents of maltreatment under sections 626.556 and 626.557.
The license holder may request reconsideration of the actions taken by the commissioner under
this subdivision according to section 245A.06.
    Subd. 3. Sanctions available. Nothing in this subdivision shall be construed to limit the
commissioner's authority to suspend or revoke a license or issue a fine at any time under section
245A.07; make correction orders and make a license conditional for failure to comply with
applicable laws or rules under section 245A.06; or deny an application for license under section
245A.05.
    Subd. 4. Efficient application. The commissioner shall establish application procedures for
license holders licensed under this chapter to reduce the need to submit duplicative material.
    Subd. 5. Information. The commissioner shall make information available to consumers
and interested others regarding the licensing status of a license holder.
    Subd. 6. Implementation. The commissioner shall seek advice from parties affected by
the implementation of this chapter.
    Subd. 7. Deem status. The commissioner may exempt a license holder from duplicative
standards if the license holder is already licensed under chapter 245A.
History: 1997 c 248 s 42; 1Sp2001 c 9 art 14 s 25; 2002 c 379 art 1 s 113; 2003 c 15
art 1 s 33; 1Sp2003 c 14 art 6 s 20