|245D.03||APPLICABILITY AND EFFECT.|
|245D.04||SERVICE RECIPIENT RIGHTS.|
|245D.10||POLICIES AND PROCEDURES.|
This chapter may be cited as the "Home and Community-Based Services Standards" or "HCBS Standards."
The terms used in this chapter have the meanings given them in this section.
"Annual" and "annually" have the meaning given in section 245A.02, subdivision 2b.
"Case manager" means the individual designated to provide waiver case management services, care coordination, or long-term care consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49, or successor provisions.
"Commissioner" means the commissioner of the Department of Human Services or the commissioner's designated representative.
"Department" means the Department of Human Services.
"Direct contact" has the meaning given in section 245C.02, subdivision 11, and is used interchangeably with the term "direct service."
"Emergency" means any event that affects the ordinary daily operation of the program including, but not limited to, fires, severe weather, natural disasters, power failures, or other events that threaten the immediate health and safety of a person receiving services and that require calling 911, emergency evacuation, moving to an emergency shelter, or temporary closure or relocation of the program to another facility or service site.
"Health services" means any service or treatment consistent with the physical and mental health needs of the person, such as medication administration and monitoring, medical, dental, nutritional, health monitoring, wellness education, and exercise.
"Home and community-based services" means the services subject to the provisions of this chapter and defined in the federal waiver plans governed by United States Code, title 42, sections 1396 et seq., or the state's alternative care program according to section 256B.0913, including the brain injury (BI) waiver, the community alternative care (CAC) waiver, the community alternatives for disabled individuals (CADI) waiver, the developmental disability (DD) waiver, the elderly waiver (EW), and the alternative care (AC) program.
"Incident" means an occurrence that affects the ordinary provision of services to a person and includes any of the following:
(1) serious injury as determined by section 245.91, subdivision 6;
(2) a person's death;
(3) any medical emergency, unexpected serious illness, or significant unexpected change in an illness or medical condition, or the mental health status of a person that requires calling 911 or a mental health crisis intervention team, physician treatment, or hospitalization;
(4) a person's unauthorized or unexplained absence from a program;
(5) physical aggression by a person receiving services against another person receiving services that causes physical pain, injury, or persistent emotional distress, including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting, pushing, and spitting;
(6) any sexual activity between persons receiving services involving force or coercion as defined under section 609.341, subdivisions 3 and 14; or
"Legal representative" means the parent of a person who is under 18 years of age, a court-appointed guardian, or other representative with legal authority to make decisions about services for a person.
"Licensed health professional" means a person licensed in Minnesota to practice those professions described in section 214.01, subdivision 2.
"License holder" has the meaning given in section 245A.02, subdivision 9.
"Medication" means a prescription drug or over-the-counter drug. For purposes of this chapter, "medication" includes dietary supplements.
"Medication administration" means performing the following set of tasks to ensure a person takes both prescription and over-the-counter medications and treatments according to orders issued by appropriately licensed professionals, and includes the following:
(1) checking the person's medication record;
(2) preparing the medication for administration;
(3) administering the medication to the person;
(4) documenting the administration of the medication or the reason for not administering the medication; and
(5) reporting to the prescriber or a nurse any concerns about the medication, including side effects, adverse reactions, effectiveness, or the person's refusal to take the medication or the person's self-administration of the medication.
"Medication assistance" means providing verbal or visual reminders to take regularly scheduled medication, which includes either of the following:
(1) bringing to the person and opening a container of previously set up medications and emptying the container into the person's hand or opening and giving the medications in the original container to the person, or bringing to the person liquids or food to accompany the medication; or
(2) providing verbal or visual reminders to perform regularly scheduled treatments and exercises.
"Medication management" means the provision of any of the following:
(1) medication-related services to a person;
(2) medication setup;
(3) medication administration;
(4) medication storage and security;
(5) medication documentation and charting;
(6) verification and monitoring of effectiveness of systems to ensure safe medication handling and administration;
(7) coordination of medication refills;
(8) handling changes to prescriptions and implementation of those changes;
(9) communicating with the pharmacy; or
(10) coordination and communication with prescriber.
For the purposes of this chapter, medication management does not mean "medication therapy management services" as identified in section 256B.0625, subdivision 13h.
"Mental health crisis intervention team" means mental health crisis response providers as identified in section 256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision 1, paragraph (d), for children.
"Over-the-counter drug" means a drug that is not required by federal law to bear the statement "Caution: Federal law prohibits dispensing without prescription."
"Person with a disability" means a person determined to have a disability by the commissioner's state medical review team as identified in section 256B.055, subdivision 7, the Social Security Administration, or the person is determined to have a developmental disability as defined in Minnesota Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section 252.27, subdivision 1a.
"Prescriber" means a licensed practitioner as defined in section 151.01, subdivision 23, who is authorized under section 151.37 to prescribe drugs. For the purposes of this chapter, the term "prescriber" is used interchangeably with "physician."
"Prescription drug" has the meaning given in section 151.01, subdivision 17.
"Program" means either the nonresidential or residential program as defined in section 245A.02, subdivisions 10 and 14.
"Psychotropic medication" means any medication prescribed to treat the symptoms of mental illness that affect thought processes, mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic (neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder. 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.
"Restraint" means physical or mechanical limiting of the free and normal movement of body or limbs.
"Seclusion" means separating a person from others in a way that prevents social contact and prevents the person from leaving the situation if he or she chooses.
"Service" means care, training, supervision, counseling, consultation, or medication assistance assigned to the license holder in the service plan.
"Service plan" means the individual service plan or individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49, or successor provisions, and includes any support plans or service needs identified as a result of long-term care consultation, or a support team meeting that includes the participation of the person, the person's legal representative, and case manager, or assigned to a license holder through an authorized service agreement.
"Service site" means the location where the service is provided to the person, including, but not limited to, a facility licensed according to chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's own home; or a community-based location.
"Staff" means an employee who will have direct contact with a person served by the facility, agency, or program.
"Unit of government" means every city, county, town, school district, other political subdivisions of the state, and any agency of the state or the United States, and includes any instrumentality of a unit of government.
"Volunteer" means an individual who, under the direction of the license holder, provides direct services without pay to a person served by the license holder.
The commissioner shall regulate the provision of home and community-based services to persons with disabilities and persons age 65 and older pursuant to this chapter. The licensing standards in this chapter govern the provision of the following services:
(1) housing access coordination as defined under the current BI, CADI, and DD waiver plans or successor plans;
(2) respite services as defined under the current CADI, BI, CAC, DD, and EW waiver plans or successor plans when the provider is an individual who is not an employee of a residential or nonresidential program licensed by the Department of Human Services or the Department of Health that is otherwise providing the respite service;
(3) behavioral programming as defined under the current BI and CADI waiver plans or successor plans;
(4) specialist services as defined under the current DD waiver plan or successor plans;
(5) companion services as defined under the current BI, CADI, and EW waiver plans or successor plans, excluding companion services provided under the Corporation for National and Community Services Senior Companion Program established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
(6) personal support as defined under the current DD waiver plan or successor plans;
(7) 24-hour emergency assistance, on-call and personal emergency response as defined under the current CADI and DD waiver plans or successor plans;
(8) night supervision services as defined under the current BI waiver plan or successor plans;
(9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW waiver plans or successor plans, excluding providers licensed by the Department of Health under chapter 144A and those providers providing cleaning services only;
(10) independent living skills training as defined under the current BI and CADI waiver plans or successor plans;
(11) prevocational services as defined under the current BI and CADI waiver plans or successor plans;
(12) structured day services as defined under the current BI waiver plan or successor plans; or
(13) supported employment as defined under the current BI and CADI waiver plans or successor plans.
(a) A license holder governed by this chapter is also subject to the licensure requirements under chapter 245A.
(b) A license holder concurrently providing child foster care services licensed according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed under this chapter is exempt from section 245D.04 as it applies to the person.
(c) A license holder concurrently providing home care services registered according to sections 144A.43 to 144A.49 to the same person receiving home management services licensed under this chapter is exempt from section 245D.04 as it applies to the person.
(e) Notwithstanding section 245D.06, subdivision 5, a license holder providing structured day, prevocational, or supported employment services under this chapter and day training and habilitation or supported employment services licensed under chapter 245B within the same program is exempt from compliance with this chapter when the license holder notifies the commissioner in writing that the requirements under chapter 245B will be met for all persons receiving these services from the program. For the purposes of this paragraph, if the license holder has obtained approval from the commissioner for an alternative inspection status according to section 245B.031, that approval will apply to all persons receiving services in the program.
If the conditions in section 245A.04, subdivision 9, are met, the commissioner may grant a variance to any of the requirements in this chapter, except sections 245D.04, and 245D.10, subdivision 4, paragraph (b), or provisions governing data practices and information rights of persons.
(a) When a person changes service from one license to a different license held by the same license holder, the license holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
(b) When a staff person begins providing direct service under one or more licenses held by the same license holder, other than the license for which staff orientation was initially provided according to section 245D.09, subdivision 4, the license holder is exempt from those staff orientation requirements, except the staff person must review each person's service plan and medication administration procedures in accordance with section 245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
The license holder must:
(1) provide each person or each person's legal representative with a written notice that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of those rights within five working days of service initiation and annually thereafter;
(2) make reasonable accommodations to provide this information in other formats or languages as needed to facilitate understanding of the rights by the person and the person's legal representative, if any;
(3) maintain documentation of the person's or the person's legal representative's receipt of a copy and an explanation of the rights; and
(4) ensure the exercise and protection of the person's rights in the services provided by the license holder and as authorized in the service plan.
A person's service-related rights include the right to:
(1) participate in the development and evaluation of the services provided to the person;
(2) have services identified in the service plan provided in a manner that respects and takes into consideration the person's preferences;
(3) refuse or terminate services and be informed of the consequences of refusing or terminating services;
(4) know, in advance, limits to the services available from the license holder;
(5) know conditions and terms governing the provision of services, including the license holder's policies and procedures related to temporary service suspension and service termination;
(6) know what the charges are for services, regardless of who will be paying for the services, and be notified of changes in those charges;
(7) know, in advance, whether services are covered by insurance, government funding, or other sources, and be told of any charges the person or other private party may have to pay; and
(8) receive services from an individual who is competent and trained, who has professional certification or licensure, as required, and who meets additional qualifications identified in the person's service plan.
(a) A person's protection-related rights include the right to:
(1) have personal, financial, service, health, and medical information kept private, and be advised of disclosure of this information by the license holder;
(2) access records and recorded information about the person in accordance with applicable state and federal law, regulation, or rule;
(3) be free from maltreatment;
(4) be free from restraint or seclusion used for a purpose other than to protect the person from imminent danger to self or others;
(5) receive services in a clean and safe environment when the license holder is the owner, lessor, or tenant of the service site;
(6) be treated with courtesy and respect and receive respectful treatment of the person's property;
(7) reasonable observance of cultural and ethnic practice and religion;
(8) be free from bias and harassment regarding race, gender, age, disability, spirituality, and sexual orientation;
(9) be informed of and use the license holder's grievance policy and procedures, including knowing how to contact persons responsible for addressing problems and to appeal under section 256.045;
(10) know the name, telephone number, and the Web site, e-mail, and street addresses of protection and advocacy services, including the appropriate state-appointed ombudsman, and a brief description of how to file a complaint with these offices;
(11) assert these rights personally, or have them asserted by the person's family, authorized representative, or legal representative, without retaliation;
(12) give or withhold written informed consent to participate in any research or experimental treatment;
(13) associate with other persons of the person's choice;
(14) personal privacy; and
(15) engage in chosen activities.
(b) For a person residing in a residential site licensed according to chapter 245A, or where the license holder is the owner, lessor, or tenant of the residential service site, protection-related rights also include the right to:
(1) have daily, private access to and use of a non-coin-operated telephone for local calls and long-distance calls made collect or paid for by the person;
(2) receive and send, without interference, uncensored, unopened mail or electronic correspondence or communication; and
(3) privacy for visits with the person's spouse, next of kin, legal counsel, religious advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including privacy in the person's bedroom.
(c) Restriction of a person's rights under paragraph (a), clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure the health, safety, and well-being of the person. Any restriction of those rights must be documented in the service plan for the person and must include the following information:
(1) the justification for the restriction based on an assessment of the person's vulnerability related to exercising the right without restriction;
(2) the objective measures set as conditions for ending the restriction;
(3) a schedule for reviewing the need for the restriction based on the conditions for ending the restriction to occur, at a minimum, every three months for persons who do not have a legal representative and annually for persons who do have a legal representative from the date of initial approval; and
(4) signed and dated approval for the restriction from the person, or the person's legal representative, if any. A restriction may be implemented only when the required approval has been obtained. Approval may be withdrawn at any time. If approval is withdrawn, the right must be immediately and fully restored.
(a) The license holder is responsible for providing health services assigned in the service plan and consistent with the person's health needs. The license holder is responsible for promptly notifying the person or the person's legal representative and the case manager of changes in a person's physical and mental health needs affecting assigned health services, when discovered by the license holder, unless the license holder has reason to know the change has already been reported. The license holder must document when the notice is provided.
(b) When assigned in the service plan, the license holder is required to maintain documentation on how the person's health needs will be met, including a description of the procedures the license holder will follow in order to:
(1) provide medication administration, medication assistance, or medication management according to this chapter;
(2) monitor health conditions according to written instructions from the person's physician or a licensed health professional;
(3) assist with or coordinate medical, dental, and other health service appointments; or
(4) use medical equipment, devices, or adaptive aides or technology safely and correctly according to written instructions from the person's physician or a licensed health professional.
(a) The license holder must ensure that the following criteria have been met before staff that is not a licensed health professional administers medication or treatment:
(1) written authorization has been obtained from the person or the person's legal representative to administer medication or treatment orders;
(2) the staff person has completed medication administration training according to section 245D.09, subdivision 4, paragraph (c), clause (2); and
(3) the medication or treatment will be administered under administration procedures established for the person in consultation with a licensed health professional. Written instruction from the person's physician may constitute the medication administration procedures. A prescription label or the prescriber's order for the prescription is sufficient to constitute written instructions from the prescriber. A licensed health professional may delegate medication administration procedures.
(b) The license holder must ensure the following information is documented in the person's medication administration record:
(1) the information on the prescription label or the prescriber's order that includes directions for safely and correctly administering the medication to ensure effectiveness;
(2) information on any discomforts, risks, or other side effects that are reasonable to expect, and any contraindications to its use;
(3) the possible consequences if the medication or treatment is not taken or administered as directed;
(4) instruction from the prescriber on when and to whom to report the following:
(i) if the medication or treatment is not administered as prescribed, whether by error by the staff or the person or by refusal by the person; and
(ii) the occurrence of possible adverse reactions to the medication or treatment;
(5) notation of any occurrence of medication not being administered as prescribed or of adverse reactions, and when and to whom the report was made; and
(6) notation of when a medication or treatment is started, changed, or discontinued.
(c) The license holder must ensure that the information maintained in the medication administration record is current and is regularly reviewed with the person or the person's legal representative and the staff administering the medication to identify medication administration issues or errors. At a minimum, the review must be conducted every three months or more often if requested by the person or the person's legal representative. Based on the review, the license holder must develop and implement a plan to correct medication administration issues or errors. If issues or concerns are identified related to the medication itself, the license holder must report those as required under subdivision 4.
The license holder must ensure that the requirements of subdivision 2, paragraph (a), have been met when staff provides assistance to enable a person to self-administer medication when the person is capable of directing the person's own care, or when the person's legal representative is present and able to direct care for the person.
The following medication administration issues must be reported to the person or the person's legal representative and case manager as they occur or following timelines established in the person's service plan or as requested in writing by the person or the person's legal representative, or the case manager:
(1) any reports made to the person's physician or prescriber required under subdivision 2, paragraph (b), clause (4);
(2) a person's refusal or failure to take medication or treatment as prescribed; or
(3) concerns about a person's self-administration of medication.
Injectable medications may be administered according to a prescriber's order and written instructions when one of the following conditions has been met:
(1) a registered nurse or licensed practical nurse will administer the subcutaneous or intramuscular injection;
(2) a supervising registered nurse with a physician's order has delegated the administration of subcutaneous injectable medication to an unlicensed staff member and has provided the necessary training; or
(3) there is an agreement signed by the license holder, the prescriber, and the person or the person's legal representative specifying what subcutaneous injections may be given, when, how, and that the prescriber must retain responsibility for the license holder's giving the injections. A copy of the agreement must be placed in the person's service recipient record.
Only licensed health professionals are allowed to administer psychotropic medications by injection.
(a) The license holder must respond to all incidents under section 245D.02, subdivision 11, that occur while providing services to protect the health and safety of and minimize risk of harm to the person.
(b) The license holder must maintain information about and report incidents to the person's legal representative or designated emergency contact and case manager within 24 hours of an incident occurring while services are being provided, or within 24 hours of discovery or receipt of information that an incident occurred, unless the license holder has reason to know that the incident has already been reported. An incident of suspected or alleged maltreatment must be reported as required under paragraph (d), and an incident of serious injury or death must be reported as required under paragraph (e).
(c) When the incident involves more than one person, the license holder must not disclose personally identifiable information about any other person when making the report to each person and case manager unless the license holder has the consent of the person.
(d) Within 24 hours of reporting maltreatment as required under section 626.556 or 626.557, the license holder must inform the case manager of the report unless there is reason to believe that the case manager is involved in the suspected maltreatment. The license holder must disclose the nature of the activity or occurrence reported and the agency that received the report.
(e) The license holder must report the death or serious injury of the person to the legal representative, if any, and case manager, the Department of Human Services Licensing Division, and the Office of Ombudsman for Mental Health and Developmental Disabilities as required under section 245.94, subdivision 2a, within 24 hours of the death, or receipt of information that the death occurred, unless the license holder has reason to know that the death has already been reported.
(f) The license holder must conduct a review of incident reports, for identification of incident patterns, and implementation of corrective action as necessary to reduce occurrences.
The license holder must:
(1) ensure the following when the license holder is the owner, lessor, or tenant of the service site:
(i) the service site is a safe and hazard-free environment;
(ii) doors are locked or toxic substances or dangerous items normally accessible to persons served by the program are stored in locked cabinets, drawers, or containers only to protect the safety of a person receiving services and not as a substitute for staff supervision or interactions with a person who is receiving services. If doors are locked or toxic substances or dangerous items normally accessible to persons served by the program are stored in locked cabinets, drawers, or containers, the license holder must justify and document how this determination was made in consultation with the person or person's legal representative, and how access will otherwise be provided to the person and all other affected persons receiving services; and
(iii) a staff person is available on site who is trained in basic first aid whenever persons are present and staff are required to be at the site to provide direct service;
(2) maintain equipment, vehicles, supplies, and materials owned or leased by the license holder in good condition when used to provide services;
(3) follow procedures to ensure safe transportation, handling, and transfers of the person and any equipment used by the person, when the license holder is responsible for transportation of a person or a person's equipment;
(4) be prepared for emergencies and follow emergency response procedures to ensure the person's safety in an emergency; and
(5) follow sanitary practices for infection control and to prevent communicable diseases.
When services are provided at a service site licensed according to chapter 245A or where the license holder is the owner, lessor, or tenant of the service site, the license holder must document compliance with applicable building codes, fire and safety codes, health rules, and zoning ordinances, or document that an appropriate waiver has been granted.
(a) Whenever the license holder assists a person with the safekeeping of funds or other property according to section 245A.04, subdivision 13, the license holder must have written authorization to do so from the person and the case manager.
(b) A license holder or staff person may not accept powers-of-attorney from a person receiving services from the license holder for any purpose, and may not accept an appointment as guardian or conservator of a person receiving services from the license holder. This does not apply to license holders that are Minnesota counties or other units of government or to staff persons employed by license holders who were acting as power-of-attorney, guardian, or conservator for specific individuals prior to April 23, 2012. The license holder must maintain documentation of the power-of-attorney, guardianship, or conservatorship in the service recipient record.
(a) The license holder is prohibited from using psychotropic medication as a substitute for adequate staffing, as punishment, for staff convenience, or for any reason other than as prescribed.
(b) The license holder is prohibited from using restraints or seclusion under any circumstance, unless the commissioner has approved a variance request from the license holder that allows for the emergency use of restraints and seclusion according to terms and conditions approved in the variance. Applicants and license holders who have reason to believe they may be serving an individual who will need emergency use of restraints or seclusion may request a variance on the application or reapplication, and the commissioner shall automatically review the request for a variance as part of the application or reapplication process. License holders may also request the variance any time after issuance of a license. In the event a license holder uses restraint or seclusion for any reason without first obtaining a variance as required, the license holder must report the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the occurrence and request the required variance.
The license holder must provide services as specified in the service plan and assigned to the license holder. The provision of services must comply with the requirements of this chapter and the federal waiver plans.
The license holder must participate in support team meetings related to the person following stated timelines established in the person's service plan or as requested by the support team, the person, or the person's legal representative.
The license holder must provide written reports regarding the person's progress or status as requested by the person, the person's legal representative, the case manager, or the team.
The license holder must ensure that the content and format of service recipient, personnel, and program records are uniform, legible, and in compliance with the requirements of this chapter.
(a) The license holder must:
(1) maintain a record of current services provided to each person on the premises where the services are provided or coordinated; and
(b) The license holder must maintain the following information for each person:
(1) identifying information, including the person's name, date of birth, address, and telephone number;
(2) the name, address, and telephone number of the person's legal representative, if any, an emergency contact, the case manager, and family members or others as identified by the person or case manager;
(3) service information, including service initiation information, verification of the person's eligibility for services, and documentation verifying that services have been provided as identified in the service plan according to paragraph (a);
(4) health information, including medical history and allergies, and when the license holder is assigned responsibility for meeting the person's health needs according to section 245D.05:
(i) current orders for medication, treatments, or medical equipment;
(ii) medication administration procedures;
(iii) a medication administration record documenting the implementation of the medication administration procedures, including any agreements for administration of injectable medications by the license holder; and
(iv) a medical appointment schedule;
(5) the person's current service plan or that portion of the plan assigned to the license holder. When a person's case manager does not provide a current service plan, the license holder must make a written request to the case manager to provide a copy of the service plan and inform the person of the right to a current service plan and the right to appeal under section 256.045;
(6) a record of other service providers serving the person when the person's service plan identifies the need for coordination between the service providers that includes a contact person and telephone numbers, services being provided, and names of staff responsible for coordination;
(7) documentation of orientation to the service recipient rights according to section 245D.04, subdivision 1, and maltreatment reporting policies and procedures according to section 245A.65, subdivision 1, paragraph (c);
(8) copies of authorizations to handle a person's funds according to section 245D.06, subdivision 4, paragraph (a);
(9) documentation of complaints received and grievance resolution;
(10) incident reports required under section 245D.06, subdivision 1;
(11) copies of written reports regarding the person's status when requested according to section 245D.07, subdivision 3; and
(12) discharge summary, including service termination notice and related documentation, when applicable.
The license holder must ensure that the following people have access to the information in subdivision 1 in accordance with applicable state and federal law, regulation, or rule:
(1) the person, the person's legal representative, and anyone properly authorized by the person;
(2) the person's case manager;
(3) staff providing services to the person unless the information is not relevant to carrying out the service plan; and
(4) the county adult foster care licensor, when services are also licensed as adult foster care.
The license holder must maintain a personnel record of each employee, direct service volunteer, and subcontractor to document and verify staff qualifications, orientation, and training. For the purposes of this subdivision, the terms "staff" and "staff person" mean paid employee, direct service volunteer, or subcontractor. The personnel record must include:
(1) the staff person's date of hire, completed application, a position description signed by the staff person, documentation that the staff person meets the position requirements as determined by the license holder, the date of first supervised direct contact with a person served by the program, and the date of first unsupervised direct contact with a person served by the program;
(2) documentation of staff qualifications, orientation, training, and performance evaluations as required under section 245D.09, subdivisions 3, 4, and 5, including the date the training was completed, the number of hours per subject area, and the name and qualifications of the trainer or instructor; and
(3) a completed background study as required under chapter 245C.
The license holder must provide direct service staff sufficient to ensure the health, safety, and protection of rights of each person and to be able to implement the responsibilities assigned to the license holder in each person's service plan.
Except for a license holder who is the sole direct service staff, the license holder must provide adequate supervision of staff providing direct service to ensure the health, safety, and protection of rights of each person and implementation of the responsibilities assigned to the license holder in each person's service plan.
(a) The license holder must ensure that staff is competent through training, experience, and education to meet the person's needs and additional requirements as written in the service plan, or when otherwise required by the case manager or the federal waiver plan. The license holder must verify and maintain evidence of staff competency, including documentation of:
(1) education and experience qualifications, including a valid degree and transcript, or a current license, registration, or certification, when a degree or licensure, registration, or certification is required;
(2) completion of required orientation and training, including completion of continuing education required to maintain professional licensure, registration, or certification requirements; and
(3) except for a license holder who is the sole direct service staff, performance evaluations completed by the license holder of the direct service staff person's ability to perform the job functions based on direct observation.
(b) Staff under 18 years of age may not perform overnight duties or administer medication.
(a) Except for a license holder who does not supervise any direct service staff, within 90 days of hiring direct service staff, the license holder must provide and ensure completion of orientation that combines supervised on-the-job training with review of and instruction on the following:
(1) the job description and how to complete specific job functions, including:
(i) responding to and reporting incidents as required under section 245D.06, subdivision 1; and
(ii) following safety practices established by the license holder and as required in section 245D.06, subdivision 2;
(2) the license holder's current policies and procedures required under this chapter, including their location and access, and staff responsibilities related to implementation of those policies and procedures;
(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices;
(4) the service recipient rights under section 245D.04, and staff responsibilities related to ensuring the exercise and protection of those rights;
(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment;
(6) what constitutes use of restraints, seclusion, and psychotropic medications, and staff responsibilities related to the prohibitions of their use; and
(7) other topics as determined necessary in the person's service plan by the case manager or other areas identified by the license holder.
(b) License holders who provide direct service themselves must complete the orientation required in paragraph (a), clauses (3) to (7).
(c) Before providing unsupervised direct service to a person served by the program, or for whom the staff person has not previously provided direct service, or any time the plans or procedures identified in clauses (1) and (2) are revised, the staff person must review and receive instruction on the following as it relates to the staff person's job functions for that person:
(1) the person's service plan as it relates to the responsibilities assigned to the license holder, and when applicable, the person's individual abuse prevention plan according to section 245A.65, to achieve an understanding of the person as a unique individual, and how to implement those plans; and
(2) medication administration procedures established for the person when assigned to the license holder according to section 245D.05, subdivision 1, paragraph (b). Unlicensed staff may administer medications only after successful completion of a medication administration training, from a training curriculum developed by a registered nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse practitioner, physician's assistant, or physician incorporating an observed skill assessment conducted by the trainer to ensure staff demonstrate the ability to safely and correctly follow medication procedures. Medication administration must be taught by a registered nurse, clinical nurse specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of service initiation or any time thereafter, the person has or develops a health care condition that affects the service options available to the person because the condition requires:
(i) specialized or intensive medical or nursing supervision;
(ii) nonmedical service providers to adapt their services to accommodate the health and safety needs of the person; and
(iii) necessary training in order to meet the health service needs of the person as determined by the person's physician.
(a) A license holder must provide annual training to direct service staff on the topics identified in subdivision 4, paragraph (a), clauses (3) to (6).
(b) A license holder providing behavioral programming, specialist services, personal support, 24-hour emergency assistance, night supervision, independent living skills, structured day, prevocational, or supported employment services must provide a minimum of eight hours of annual training to direct service staff that addresses:
(1) topics related to the general health, safety, and service needs of the population served by the license holder; and
(2) other areas identified by the license holder or in the person's current service plan.
Training on relevant topics received from sources other than the license holder may count toward training requirements.
(c) When the license holder is the owner, lessor, or tenant of the service site and whenever a person receiving services is present at the site, the license holder must have a staff person available on site who is trained in basic first aid and, when required in a person's service plan, cardiopulmonary resuscitation.
If the license holder uses a subcontractor to perform services licensed under this chapter on the license holder's behalf, the license holder must ensure that the subcontractor meets and maintains compliance with all requirements under this chapter that apply to the services to be provided.
The license holder must ensure that volunteers who provide direct services to persons served by the program receive the training, orientation, and supervision necessary to fulfill their responsibilities.
The license holder must establish, enforce, and maintain policies and procedures as required in this chapter.
The license holder must establish policies and procedures that provide a simple complaint process for persons served by the program and their authorized representatives to bring a grievance that:
(1) provides staff assistance with the complaint process when requested, and the addresses and telephone numbers of outside agencies to assist the person;
(2) allows the person to bring the complaint to the highest level of authority in the program if the grievance cannot be resolved by other staff members, and that provides the name, address, and telephone number of that person;
(3) requires the license holder to promptly respond to all complaints affecting a person's health and safety. For all other complaints, the license holder must provide an initial response within 14 calendar days of receipt of the complaint. All complaints must be resolved within 30 calendar days of receipt or the license holder must document the reason for the delay and a plan for resolution;
(4) requires a complaint review that includes an evaluation of whether:
(i) related policies and procedures were followed and adequate;
(ii) there is a need for additional staff training;
(iii) the complaint is similar to past complaints with the persons, staff, or services involved; and
(iv) there is a need for corrective action by the license holder to protect the health and safety of persons receiving services;
(5) based on the review in clause (4), requires the license holder to develop, document, and implement a corrective action plan designed to correct current lapses and prevent future lapses in performance by staff or the license holder, if any;
(6) provides a written summary of the complaint and a notice of the complaint resolution to the person and case manager that:
(i) identifies the nature of the complaint and the date it was received;
(ii) includes the results of the complaint review;
(iii) identifies the complaint resolution, including any corrective action; and
(7) requires that the complaint summary and resolution notice be maintained in the service recipient record.
(a) The license holder must establish policies and procedures for temporary service suspension and service termination that promote continuity of care and service coordination with the person and the case manager and with other licensed caregivers, if any, who also provide support to the person.
(b) The policy must include the following requirements:
(1) the license holder must notify the person and case manager in writing of the intended termination or temporary service suspension, and the person's right to seek a temporary order staying the termination of service according to the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
(2) notice of the proposed termination of services, including those situations that began with a temporary service suspension, must be given at least 60 days before the proposed termination is to become effective when a license holder is providing independent living skills training, structured day, prevocational or supported employment services to the person, and 30 days prior to termination for all other services licensed under this chapter;
(3) the license holder must provide information requested by the person or case manager when services are temporarily suspended or upon notice of termination;
(4) prior to giving notice of service termination or temporary service suspension, the license holder must document actions taken to minimize or eliminate the need for service suspension or termination;
(5) during the temporary service suspension or service termination notice period, the license holder will work with the appropriate county agency to develop reasonable alternatives to protect the person and others;
(6) the license holder must maintain information about the service suspension or termination, including the written termination notice, in the service recipient record; and
(7) the license holder must restrict temporary service suspension to situations in which the person's behavior causes immediate and serious danger to the health and safety of the person or others.
(a) The license holder must review and update, as needed, the written policies and procedures required under this chapter.
(b) The license holder must inform the person and case manager of the policies and procedures affecting a person's rights under section 245D.04, and provide copies of those policies and procedures, within five working days of service initiation.
(c) The license holder must provide a written notice at least 30 days before implementing any revised policies and procedures affecting a person's rights under section 245D.04. The notice must explain the revision that was made and include a copy of the revised policy and procedure. The license holder must document the reason for not providing the notice at least 30 days before implementing the revisions.
(d) Before implementing revisions to required policies and procedures, the license holder must inform all employees of the revisions and provide training on implementation of the revised policies and procedures.
Official Publication of the State of Minnesota
Revisor of Statutes