Note: see session law sections for effective dates.
|245F.05||ADMISSION AND DISCHARGE POLICIES.|
|245F.06||SCREENING AND COMPREHENSIVE ASSESSMENT.|
|245F.10||PATIENT RIGHTS AND GRIEVANCE PROCEDURES.|
|245F.11||PATIENT PROPERTY MANAGEMENT.|
|245F.14||STAFFING REQUIREMENTS AND DUTIES.|
|245F.16||PERSONNEL POLICIES AND PROCEDURES.|
|245F.18||POLICY AND PROCEDURES MANUAL.|
|245F.20||DATA COLLECTION REQUIRED.|
It is hereby declared to be the public policy of this state that the public interest is best served by providing efficient and effective withdrawal management services to persons in need of appropriate detoxification, assessment, intervention, and referral services. The services shall vary to address the unique medical needs of each patient and shall be responsive to the language and cultural needs of each patient. Services shall not be denied on the basis of a patient's inability to pay.
The terms used in this chapter have the meanings given them in this section.
"Administration of medications" means performing a task to provide medications to a patient, and includes the following tasks performed in the following order:
(1) checking the patient's medication record;
(2) preparing the medication for administration;
(3) administering the medication to the patient;
(4) documenting administration of the medication or the reason for not administering the medication as prescribed; and
(5) reporting information to a licensed practitioner or a registered nurse regarding problems with the administration of the medication or the patient's refusal to take the medication.
"Alcohol and drug counselor" means an individual qualified under section 245G.11, subdivision 5.
"Applicant" means an individual, partnership, voluntary association, corporation, or other public or private organization that submits an application for licensure under this chapter.
"Care coordination" means activities intended to bring together health services, patient needs, and streams of information to facilitate the aims of care. Care coordination includes an ongoing needs assessment, life skills advocacy, treatment follow-up, disease management, education, and other services as needed.
"Chemical" means alcohol, solvents, controlled substances as defined in section 152.01, subdivision 4, and other mood-altering substances.
"Clinically managed program" means a residential setting with staff comprised of a medical director and a licensed practical nurse. A licensed practical nurse must be on site 24 hours a day, seven days a week. A licensed practitioner must be available by telephone or in person for consultation 24 hours a day. Patients admitted to this level of service receive medical observation, evaluation, and stabilization services during the detoxification process; access to medications administered by trained, licensed staff to manage withdrawal; and a comprehensive assessment pursuant to section 245F.06.
"Commissioner" means the commissioner of human services or the commissioner's designated representative.
"Department" means the Department of Human Services.
"Direct patient contact" has the meaning given for "direct contact" in section 245C.02, subdivision 11.
"Discharge plan" means a written plan that states with specificity the services the program has arranged for the patient to transition back into the community.
"Licensed practitioner" means a practitioner as defined in section 151.01, subdivision 23, who is authorized to prescribe.
"Medical director" means an individual licensed in Minnesota as a doctor of osteopathic medicine or physician, or an individual licensed in Minnesota as an advanced practice registered nurse by the Board of Nursing and certified to practice as a clinical nurse specialist or nurse practitioner by a national nurse organization acceptable to the board. The medical director must be employed by or under contract with the license holder to direct and supervise health care for patients of a program licensed under this chapter.
"Medically monitored program" means a residential setting with staff that includes a registered nurse and a medical director. A registered nurse must be on site 24 hours a day. A licensed practitioner must be available seven days a week, and patients must have the ability to be seen by a licensed practitioner within 24 hours. Patients admitted to this level of service receive medical observation, evaluation, and stabilization services during the detoxification process; medications administered by trained, licensed staff to manage withdrawal; and a comprehensive assessment pursuant to section 245F.06.
"Nurse" means a person licensed and currently registered to practice practical or professional nursing as defined in section 148.171, subdivisions 14 and 15.
"Patient" means an individual who presents or is presented for admission to a withdrawal management program that meets the criteria in section 245F.05.
"Peer recovery support services" means mentoring and education, advocacy, and nonclinical recovery support provided by a recovery peer.
"Program director" means the individual who is designated by the license holder to be responsible for all operations of a withdrawal management program and who meets the qualifications specified in section 245F.15, subdivision 3.
"Protective procedure" means an action taken by a staff member of a withdrawal management program to protect a patient from imminent danger of harming self or others. Protective procedures include the following actions:
(1) seclusion, which means the temporary placement of a patient, without the patient's consent, in an environment to prevent social contact; and
(2) physical restraint, which means the restraint of a patient by use of physical holds intended to limit movement of the body.
"Recovery peer" means a person who has progressed in the person's own recovery from substance use disorder and is willing to serve as a peer to assist others in their recovery.
"Responsible staff person" means the program director, the medical director, or a staff person with current licensure as a nurse in Minnesota. The responsible staff person must be on the premises and is authorized to make immediate decisions concerning patient care and safety.
"Substance" means "chemical" as defined in subdivision 6.
"Substance use disorder" means a pattern of substance use as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.
"Technician" means a person who meets the qualifications in section 245F.15, subdivision 6.
"Withdrawal management program" means a licensed program that provides short-term medical services on a 24-hour basis for the purpose of stabilizing intoxicated patients, managing their withdrawal, and facilitating access to substance use disorder treatment as indicated by a comprehensive assessment.
(a) This chapter establishes minimum standards for withdrawal management programs licensed by the commissioner that serve one or more unrelated persons.
(b) This chapter does not apply to a withdrawal management program licensed as a hospital under sections 144.50 to 144.581. A withdrawal management program located in a hospital licensed under sections 144.50 to 144.581 that chooses to be licensed under this chapter is deemed to be in compliance with section 245F.13.
An applicant for licensure as a clinically managed withdrawal management program or medically monitored withdrawal management program must meet the following requirements, except where otherwise noted. All programs must comply with federal requirements and the general requirements in sections 626.557 and 626.5572 and chapters 245A, 245C, and 260E. A withdrawal management program must be located in a hospital licensed under sections 144.50 to 144.581, or must be a supervised living facility with a class B license from the Department of Health under Minnesota Rules, parts 4665.0100 to 4665.9900.
Prior to the issuance of a license, an applicant must submit, on forms provided by the commissioner, documentation demonstrating the following:
(1) compliance with this section;
(2) compliance with applicable building, fire, and safety codes; health rules; zoning ordinances; and other applicable rules and regulations or documentation that a waiver has been granted. The granting of a waiver does not constitute modification of any requirement of this section;
(3) completion of an assessment of need for a new or expanded program as required by Minnesota Rules, part 9530.6800; and
(4) insurance coverage, including bonding, sufficient to cover all patient funds, property, and interests.
(a) A license holder must notify the commissioner before one of the following occurs and the commissioner must determine the need for a new license:
(1) a change in the Department of Health's licensure of the program;
(2) a change in the medical services provided by the program that affects the program's capacity to provide services required by the program's license designation as a clinically managed program or medically monitored program;
(3) a change in program capacity; or
(4) a change in location.
(b) A license holder must notify the commissioner and apply for a new license when a change in program ownership occurs.
The commissioner may grant variances to the requirements of this chapter under section 245A.04, subdivision 9.
A license holder providing withdrawal management services may admit an individual when the individual meets the admission criteria in section 245F.05, subdivisions 1 and 2. Any assessor providing an additional assessment to an individual must follow the process established in section 245F.06. If an assessor identifies an individual's need for withdrawal management services while the individual is a resident of a substance use disorder treatment facility, the provisions of section 256G.02, subdivision 4, paragraphs (c) and (d), shall apply.
A license holder must have a written admission policy containing specific admission criteria. The policy must describe the admission process and the point at which an individual who is eligible under subdivision 2 is admitted to the program. A license holder must not admit individuals who do not meet the admission criteria. The admission policy must be approved and signed by the medical director of the facility and must designate which staff members are authorized to admit and discharge patients. The admission policy must be posted in the area of the facility where patients are admitted and given to all interested individuals upon request.
For an individual to be admitted to a withdrawal management program, the program must make a determination that the program services are appropriate to the needs of the individual. A program may only admit individuals who, at the time of admission, meet the criteria for admission as determined by current American Society of Addiction Medicine standards for appropriate level of withdrawal management.
(a) A license holder must have a written policy and procedure for addressing the needs of individuals who are denied admission to the program. These individuals include:
(1) individuals whose pregnancy, in combination with their presenting problem, requires services not provided by the program; and
(2) individuals who are in imminent danger of harming self or others if their behavior is beyond the behavior management capabilities of the program and staff.
(b) Programs must document denied admissions, including the date and time of the admission request, reason for the denial of admission, and where the individual was referred. If the individual did not receive a referral, the program must document why a referral was not made. This information must be documented on a form approved by the commissioner and made available to the commissioner upon request.
(a) If a license holder denies an individual admission to the program or terminates services to a patient and the denial or termination poses an immediate threat to the patient's or individual's health or requires immediate medical intervention, the license holder must refer the patient or individual to a medical facility capable of admitting the patient or individual.
(b) A license holder must report to a law enforcement agency with proper jurisdiction all denials of admission and terminations of services that involve the commission of a crime against a staff member of the license holder or on the license holder's property, as provided in Code of Federal Regulations, title 42, section 2.12 (c)(5), and title 45, parts 160 to 164.
A license holder must have a written policy and procedure, approved and signed by the medical director, that specifies conditions under which patients may be discharged or transferred. The policy must include the following:
(1) guidelines for determining when a patient is medically stable and whether a patient is able to be discharged or transferred to a lower level of care;
(2) guidelines for determining when a patient needs a transfer to a higher level of care. Clinically managed program guidelines must include guidelines for transfer to a medically monitored program, hospital, or other acute care facility. Medically monitored program guidelines must include guidelines for transfer to a hospital or other acute care facility;
(3) procedures staff must follow when discharging a patient under each of the following circumstances:
(i) the patient is involved in the commission of a crime against program staff or against a license holder's property. The procedures for a patient discharged under this item must specify how reports must be made to law enforcement agencies with proper jurisdiction as allowed under Code of Federal Regulations, title 42, section 2.12 (c)(5), and title 45, parts 160 to 164;
(ii) the patient is in imminent danger of harming self or others and is beyond the license holder's capacity to ensure safety;
(iii) the patient was admitted under chapter 253B; or
(iv) the patient is leaving against staff or medical advice; and
(4) a requirement that staff must document where the patient was referred after discharge or transfer, and if a referral was not made, the reason the patient was not provided a referral.
A nurse or an alcohol and drug counselor must screen each patient upon admission to determine whether a comprehensive assessment is indicated. The license holder must screen patients at each admission, except that if the patient has already been determined to suffer from a substance use disorder, subdivision 2 applies.
(a) Prior to a medically stable discharge, but not later than 72 hours following admission, a license holder must provide a comprehensive assessment and assessment summary according to sections 245.4863, paragraph (a), and 245G.05, for each patient who has a positive screening for a substance use disorder. If a patient's medical condition prevents a comprehensive assessment from being completed within 72 hours, the license holder must document why the assessment was not completed. The comprehensive assessment must include documentation of the appropriateness of an involuntary referral through the civil commitment process.
(b) If available to the program, a patient's previous comprehensive assessment may be used in the patient record. If a previously completed comprehensive assessment is used, its contents must be reviewed to ensure the assessment is accurate and current and complies with the requirements of this chapter. The review must be completed by a staff person qualified according to section 245G.11, subdivision 5. The license holder must document that the review was completed and that the previously completed assessment is accurate and current, or the license holder must complete an updated or new assessment.
Within 12 hours of admission, a license holder must develop an individualized stabilization plan for each patient accepted for stabilization services. The plan must be based on the patient's initial health assessment and continually updated based on new information gathered about the patient's condition from the comprehensive assessment, medical evaluation and consultation, and ongoing monitoring and observations of the patient. The patient must have an opportunity to have direct involvement in the development of the plan. The stabilization plan must:
(1) identify medical needs and goals to be achieved while the patient is receiving services;
(2) specify stabilization services to address the identified medical needs and goals, including amount and frequency of services;
(3) specify the participation of others in the stabilization planning process and specific services where appropriate; and
(4) document the patient's participation in developing the content of the stabilization plan and any updates.
Progress notes must be entered in the patient's file at least daily and immediately following any significant event, including any change that impacts the medical, behavioral, or legal status of the patient. Progress notes must:
(1) include documentation of the patient's involvement in the stabilization services, including the type and amount of each stabilization service;
(2) include the monitoring and observations of the patient's medical needs;
(3) include documentation of referrals made to other services or agencies;
(4) specify the participation of others; and
(5) be legible, signed, and dated by the staff person completing the documentation.
Before a patient leaves the facility, the license holder must conduct discharge planning for the patient, document discharge planning in the patient's record, and provide the patient with a copy of the discharge plan. The discharge plan must include:
(1) referrals made to other services or agencies at the time of transition;
(2) the patient's plan for follow-up, aftercare, or other poststabilization services;
(3) documentation of the patient's participation in the development of the transition plan;
(4) any service that will continue after discharge under the direction of the license holder; and
(5) a stabilization summary and final evaluation of the patient's progress toward treatment objectives.
The license holder must encourage patients to remain in care for an appropriate duration as determined by the patient's stabilization plan, and must encourage all patients to enter programs for ongoing recovery as clinically indicated. In addition, the license holder must offer services that are patient-centered, trauma-informed, and culturally appropriate. Culturally appropriate services must include translation services and dietary services that meet a patient's dietary needs. All services provided to the patient must be documented in the patient's medical record. The following services must be offered unless clinically inappropriate and the justifying clinical rationale is documented:
(1) individual or group motivational counseling sessions;
(2) individual advocacy and case management services;
(3) medical services as required in section 245F.12;
(4) care coordination provided according to subdivision 2;
(5) peer recovery support services provided according to subdivision 3;
(6) patient education provided according to subdivision 4; and
(7) referrals to mutual aid, self-help, and support groups.
Care coordination services must be initiated for each patient upon admission. The license holder must identify the staff person responsible for the provision of each service. Care coordination services must include:
(1) coordination with significant others to assist in the stabilization planning process whenever possible;
(2) coordination with and follow-up to appropriate medical services as identified by the nurse or licensed practitioner;
(3) referral to substance use disorder services as indicated by the comprehensive assessment;
(4) referral to mental health services as identified in the comprehensive assessment;
(5) referrals to economic assistance, social services, and prenatal care in accordance with the patient's needs;
(6) review and approval of the transition plan prior to discharge, except in an emergency, by a staff member able to provide direct patient contact;
(7) documentation of the provision of care coordination services in the patient's file; and
(8) addressing cultural and socioeconomic factors affecting the patient's access to services.
(a) Peers in recovery serve as mentors or recovery-support partners for individuals in recovery, and may provide encouragement, self-disclosure of recovery experiences, transportation to appointments, assistance with finding resources that will help locate housing, job search resources, and assistance finding and participating in support groups.
(b) Peer recovery support services are provided by a recovery peer and must be supervised by the responsible staff person.
A license holder must provide education to each patient on the following:
(1) substance use disorder, including the effects of alcohol and other drugs, specific information about the effects of substance use on unborn children, and the signs and symptoms of fetal alcohol spectrum disorders;
(2) tuberculosis and reporting known cases of tuberculosis disease to health care authorities according to section 144.4804;
(3) Hepatitis C treatment and prevention;
(4) HIV as required in section 245A.19, paragraphs (b) and (c);
(5) nicotine cessation options, if applicable;
(6) opioid tolerance and overdose risks, if applicable; and
(7) long-term withdrawal issues related to use of barbiturates and benzodiazepines, if applicable.
The license holder must refer patients to mutual aid, self-help, and support groups when clinically indicated and to the extent available in the community.
(a) A program must incorporate person-centered planning and trauma-informed care into its protective procedure policies. Protective procedures may be used only in cases where a less restrictive alternative will not protect the patient or others from harm and when the patient is in imminent danger of harming self or others. When a program uses a protective procedure, the program must continuously observe the patient until the patient may safely be left for 15-minute intervals. Use of the procedure must end when the patient is no longer in imminent danger of harming self or others.
(b) Protective procedures may not be used:
(1) for disciplinary purposes;
(2) to enforce program rules;
(3) for the convenience of staff;
(4) as a part of any patient's health monitoring plan; or
(5) for any reason except in response to specific, current behaviors which create an imminent danger of harm to the patient or others.
A license holder must have a written policy and procedure that establishes the protective procedures that program staff must follow when a patient is in imminent danger of harming self or others. The policy must be appropriate to the type of facility and the level of staff training. The protective procedures policy must include:
(1) an approval signed and dated by the program director and medical director prior to implementation. Any changes to the policy must also be approved, signed, and dated by the current program director and the medical director prior to implementation;
(2) which protective procedures the license holder will use to prevent patients from imminent danger of harming self or others;
(3) the emergency conditions under which the protective procedures are permitted to be used, if any;
(4) the patient's health conditions that limit the specific procedures that may be used and alternative means of ensuring safety;
(5) emergency resources the program staff must contact when a patient's behavior cannot be controlled by the procedures established in the policy;
(6) the training that staff must have before using any protective procedure;
(7) documentation of approved therapeutic holds;
(8) the use of law enforcement personnel as described in subdivision 4;
(9) standards governing emergency use of seclusion. Seclusion must be used only when less restrictive measures are ineffective or not feasible. The standards in items (i) to (vii) must be met when seclusion is used with a patient:
(i) seclusion must be employed solely for the purpose of preventing a patient from imminent danger of harming self or others;
(ii) seclusion rooms must be equipped in a manner that prevents patients from self-harm using projections, windows, electrical fixtures, or hard objects, and must allow the patient to be readily observed without being interrupted;
(iii) seclusion must be authorized by the program director, a licensed physician, or a registered nurse. If one of these individuals is not present in the facility, the program director or a licensed physician or registered nurse must be contacted and authorization must be obtained within 30 minutes of initiating seclusion, according to written policies;
(iv) patients must not be placed in seclusion for more than 12 hours at any one time;
(v) once the condition of a patient in seclusion has been determined to be safe enough to end continuous observation, a patient in seclusion must be observed at a minimum of every 15 minutes for the duration of seclusion and must always be within hearing range of program staff;
(vi) a process for program staff to use to remove a patient to other resources available to the facility if seclusion does not sufficiently assure patient safety; and
(vii) a seclusion area may be used for other purposes, such as intensive observation, if the room meets normal standards of care for the purpose and if the room is not locked; and
(10) physical holds may only be used when less restrictive measures are not feasible. The standards in items (i) to (iv) must be met when physical holds are used with a patient:
(i) physical holds must be employed solely for preventing a patient from imminent danger of harming self or others;
(ii) physical holds must be authorized by the program director, a licensed physician, or a registered nurse. If one of these individuals is not present in the facility, the program director or a licensed physician or a registered nurse must be contacted and authorization must be obtained within 30 minutes of initiating a physical hold, according to written policies;
(iii) the patient's health concerns must be considered in deciding whether to use physical holds and which holds are appropriate for the patient; and
(iv) only approved holds may be utilized. Prone holds are not allowed and must not be authorized.
Each use of a protective procedure must be documented in the patient record. The patient record must include:
(1) a description of specific patient behavior precipitating a decision to use a protective procedure, including date, time, and program staff present;
(2) the specific means used to limit the patient's behavior;
(3) the time the protective procedure began, the time the protective procedure ended, and the time of each staff observation of the patient during the procedure;
(4) the names of the program staff authorizing the use of the protective procedure, the time of the authorization, and the program staff directly involved in the protective procedure and the observation process;
(5) a brief description of the purpose for using the protective procedure, including less restrictive interventions used prior to the decision to use the protective procedure and a description of the behavioral results obtained through the use of the procedure. If a less restrictive intervention was not used, the reasons for not using a less restrictive intervention must be documented;
(6) documentation by the responsible staff person on duty of reassessment of the patient at least every 15 minutes to determine if seclusion or the physical hold can be terminated;
(7) a description of the physical holds used in escorting a patient; and
(8) any injury to the patient that occurred during the use of a protective procedure.
The program must maintain a central log documenting each incident involving use of law enforcement, including:
(1) the date and time law enforcement arrived at and left the program;
(2) the reason for the use of law enforcement;
(3) if law enforcement used force or a protective procedure and which protective procedure was used; and
(4) whether any injuries occurred.
(a) The license holder must keep a record of all patient incidents and protective procedures used. An administrative review of each use of protective procedures must be completed within 72 hours by someone other than the person who used the protective procedure. The record of the administrative review of the use of protective procedures must state whether:
(1) the required documentation was recorded for each use of a protective procedure;
(2) the protective procedure was used according to the policy and procedures;
(3) the staff who implemented the protective procedure was properly trained; and
(4) the behavior met the standards for imminent danger of harming self or others.
(b) The license holder must conduct and document a quarterly review of the use of protective procedures with the goal of reducing the use of protective procedures. The review must include:
(1) any patterns or problems indicated by similarities in the time of day, day of the week, duration of the use of a protective procedure, individuals involved, or other factors associated with the use of protective procedures;
(2) any injuries resulting from the use of protective procedures;
(3) whether law enforcement was involved in the use of a protective procedure;
(4) actions needed to correct deficiencies in the program's implementation of protective procedures;
(5) an assessment of opportunities missed to avoid the use of protective procedures; and
(6) proposed actions to be taken to minimize the use of protective procedures.
Patients have the rights in sections 144.651, 148F.165, and 253B.03, as applicable. The license holder must give each patient, upon admission, a written statement of patient rights. Program staff must review the statement with the patient.
Upon admission, the license holder must explain the grievance procedure to the patient or patient's representative and give the patient a written copy of the procedure. The grievance procedure must be posted in a place visible to the patient and must be made available to current and former patients upon request. A license holder's written grievance procedure must include:
(1) staff assistance in developing and processing the grievance;
(2) an initial response to the patient who filed the grievance within 24 hours of the program's receipt of the grievance, and timelines for additional steps to be taken to resolve the grievance, including access to the person with the highest level of authority in the program if the grievance cannot be resolved by other staff members; and
(3) the current addresses and telephone numbers of the Department of Human Services Licensing Division, Department of Health Office of Health Facilities Complaints, Board of Behavioral Health and Therapy, Board of Medical Practice, Board of Nursing, and Office of the Ombudsman for Mental Health and Developmental Disabilities.
A license holder must meet the requirements for handling patient funds and property in section 245A.04, subdivision 13, except:
(1) a license holder must establish policies regarding the use of personal property to assure that program activities and the rights of other patients are not infringed, and may take temporary custody of personal property if these policies are violated;
(2) a license holder must retain the patient's property for a minimum of seven days after discharge if the patient does not reclaim the property after discharge; and
(3) the license holder must return to the patient all of the patient's property held in trust at discharge, regardless of discharge status, except that:
(i) drugs, drug paraphernalia, and drug containers that are subject to forfeiture under section 609.5316 must be given over to the custody of a local law enforcement agency or, if giving the property over to the custody of a local law enforcement agency would violate Code of Federal Regulations, title 42, sections 2.1 to 2.67, and title 45, parts 160 to 164, destroyed by a staff person designated by the program director; and
(ii) weapons, explosives, and other property that may cause serious harm to self or others must be transferred to a local law enforcement agency. The patient must be notified of the transfer and the right to reclaim the property if the patient has a legal right to possess the item.
Withdrawal management programs must have:
(1) a standardized data collection tool for collecting health-related information about each patient. The data collection tool must be developed in collaboration with a registered nurse and approved and signed by the medical director; and
(2) written procedures for a nurse to assess and monitor patient health within the nurse's scope of practice. The procedures must:
(i) be approved by the medical director;
(ii) include a follow-up screening conducted between four and 12 hours after service initiation to collect information relating to acute intoxication, other health complaints, and behavioral risk factors that the patient may not have communicated at service initiation;
(iii) specify the physical signs and symptoms that, when present, require consultation with a registered nurse or a physician and that require transfer to an acute care facility or a higher level of care than that provided by the program;
(iv) specify those staff members responsible for monitoring patient health and provide for hourly observation and for more frequent observation if the initial health assessment or follow-up screening indicates a need for intensive physical or behavioral health monitoring; and
(v) specify the actions to be taken to address specific complicating conditions, including pregnancy or the presence of physical signs or symptoms of any other medical condition.
In addition to the services listed in subdivision 1, clinically managed programs must:
(1) have a licensed practical nurse on site 24 hours a day and a medical director;
(2) provide an initial health assessment conducted by a nurse upon admission;
(3) provide daily on-site medical evaluation by a nurse;
(4) have a registered nurse available by telephone or in person for consultation 24 hours a day;
(5) have a licensed practitioner available by telephone or in person for consultation 24 hours a day; and
(6) have appropriately licensed staff available to administer medications according to prescriber-approved orders.
In addition to the services listed in subdivision 1, medically monitored programs must have a registered nurse on site 24 hours a day and a medical director. Medically monitored programs must provide intensive inpatient withdrawal management services which must include:
(1) an initial health assessment conducted by a registered nurse upon admission;
(2) the availability of a medical evaluation and consultation with a registered nurse 24 hours a day;
(3) the availability of a licensed practitioner by telephone or in person for consultation 24 hours a day;
(4) the ability to be seen within 24 hours or sooner by a licensed practitioner if the initial health assessment indicates the need to be seen;
(5) the availability of on-site monitoring of patient care seven days a week by a licensed practitioner; and
(6) appropriately licensed staff available to administer medications according to prescriber-approved orders.
A license holder must employ or contract with a registered nurse to develop the policies and procedures for medication administration. A registered nurse must provide supervision as defined in section 148.171, subdivision 23, for the administration of medications. For clinically managed programs, the registered nurse supervision must include on-site supervision at least monthly or more often as warranted by the health needs of the patient. The medication administration policies and procedures must include:
(1) a provision that patients may carry emergency medication such as nitroglycerin as instructed by their prescriber;
(2) requirements for recording the patient's use of medication, including staff signatures with date and time;
(3) guidelines regarding when to inform a licensed practitioner or a registered nurse of problems with medication administration, including failure to administer, patient refusal of a medication, adverse reactions, or errors; and
(4) procedures for acceptance, documentation, and implementation of prescriptions, whether written, oral, telephonic, or electronic.
A license holder must have in place and implement written policies and procedures relating to control of drugs. The policies and procedures must be developed by a registered nurse and must contain the following provisions:
(1) a requirement that all drugs must be stored in a locked compartment. Schedule II drugs, as defined in section 152.02, subdivision 3, must be stored in a separately locked compartment that is permanently affixed to the physical plant or a medication cart;
(2) a system for accounting for all scheduled drugs each shift;
(3) a procedure for recording a patient's use of medication, including staff signatures with time and date;
(4) a procedure for destruction of discontinued, outdated, or deteriorated medications;
(5) a statement that only authorized personnel are permitted to have access to the keys to the locked drug compartments; and
(6) a statement that no legend drug supply for one patient may be given to another patient.
A license holder must employ or contract with a person, on a full-time basis, to serve as program director. The program director must be responsible for all aspects of the facility and the services delivered to the license holder's patients. An individual may serve as program director for more than one program owned by the same license holder.
During all hours of operation, a license holder must designate a staff member as the responsible staff person to be present and awake in the facility and be responsible for the program. The responsible staff person must have decision-making authority over the day-to-day operation of the program as well as the authority to direct the activity of or terminate the shift of any staff member who has direct patient contact.
A license holder must have one technician awake and on duty at all times for every ten patients in the program. A license holder may assign technicians according to the need for care of the patients, except that the same technician must not be responsible for more than 15 patients at one time. For purposes of establishing this ratio, all staff whose qualifications meet or exceed those for technicians under section 245F.15, subdivision 6, and who are performing the duties of a technician may be counted as technicians. The same individual may not be counted as both a technician and an alcohol and drug counselor.
A license holder must employ or contract with a registered nurse, who must be available 24 hours a day by telephone or in person for consultation. The registered nurse is responsible for:
(1) establishing and implementing procedures for the provision of nursing care and delegated medical care, including:
(i) a health monitoring plan;
(ii) a medication control plan;
(iii) training and competency evaluations for staff performing delegated medical and nursing functions;
(iv) handling serious illness, accident, or injury to patients;
(v) an infection control program; and
(vi) a first aid kit;
(2) delegating nursing functions to other staff consistent with their education, competence, and legal authorization;
(3) assigning, supervising, and evaluating the performance of nursing tasks; and
(4) implementing condition-specific protocols in compliance with section 151.37, subdivision 2.
A license holder must have a medical director available for medical supervision. The medical director is responsible for ensuring the accurate and safe provision of all health-related services and procedures. A license holder must obtain and document the medical director's annual approval of the following procedures before the procedures may be used:
(1) admission, discharge, and transfer criteria and procedures;
(2) a health services plan;
(3) physical indicators for a referral to a physician, registered nurse, or hospital, and procedures for referral;
(4) procedures to follow in case of accident, injury, or death of a patient;
(5) formulation of condition-specific protocols regarding the medications that require a withdrawal regimen that will be administered to patients;
(6) an infection control program;
(7) protective procedures; and
(8) a medication control plan.
A withdrawal management program must provide one full-time equivalent alcohol and drug counselor for every 16 patients served by the program.
The responsible staff person under subdivision 2 must ensure that the program does not exceed the staff-to-patient ratios in subdivisions 3 and 6 and must inform admitting staff of the current staffed capacity of the program for that shift. A license holder must have a written policy for documenting staff-to-patient ratios for each shift and actions to take when staffed capacity is reached.
(a) All staff who have direct patient contact must be at least 18 years of age and must, at the time of hiring, document that they meet the requirements in paragraph (b), (c), or (d).
(b) Program directors, supervisors, nurses, and alcohol and drug counselors must be free of substance use problems for at least two years immediately preceding their hiring and must sign a statement attesting to that fact.
(c) Recovery peers must be free of substance use problems for at least one year immediately preceding their hiring and must sign a statement attesting to that fact.
(d) Technicians and other support staff must be free of substance use problems for at least six months immediately preceding their hiring and must sign a statement attesting to that fact.
License holders must require staff to be free from substance use problems as a condition of continuing employment. Staff are not required to sign statements attesting to their freedom from substance use problems after the initial statement required by subdivision 1. Staff with substance use problems must be immediately removed from any responsibilities that include direct patient contact.
A program director must:
(1) have at least one year of work experience in direct service to individuals with substance use disorders or one year of work experience in the management or administration of direct service to individuals with substance use disorders;
(2) have a baccalaureate degree or three years of work experience in administration or personnel supervision in human services; and
An alcohol and drug counselor must meet the requirements in section 245G.11, subdivision 5.
Each responsible staff person must know and understand the requirements of this chapter, sections 245A.65, 253B.04, 253B.051, 626.557, and 626.5572, and chapter 260E. In a clinically managed program, the responsible staff person must be a licensed practical nurse employed by or under contract with the license holder. In a medically monitored program, the responsible staff person must be a registered nurse, program director, or physician.
A technician employed by a program must demonstrate competency, prior to direct patient contact, in the following areas:
(2) knowledge of and the ability to perform basic health screening procedures with intoxicated patients that consist of:
(i) blood pressure, pulse, temperature, and respiration readings;
(ii) interviewing to obtain relevant medical history and current health complaints; and
(iii) visual observation of a patient's health status, including monitoring a patient's behavior as it relates to health status;
(3) a current first aid certificate from the American Red Cross or an equivalent organization; a current cardiopulmonary resuscitation certificate from the American Red Cross, the American Heart Association, a community organization, or an equivalent organization; and knowledge of first aid for seizures, trauma, and loss of consciousness; and
(4) knowledge of and ability to perform basic activities of daily living and personal hygiene.
Recovery peers must:
(1) be at least 21 years of age and have a high school diploma or its equivalent;
(2) have a minimum of one year in recovery from substance use disorder;
(3) have completed a curriculum designated by the commissioner that teaches specific skills and training in the domains of ethics and boundaries, advocacy, mentoring and education, and recovery and wellness support; and
(4) receive supervision in areas specific to the domains of their role by qualified supervisory staff.
A license holder must have a written policy addressing personal relationships between patients and staff who have direct patient contact. The policy must:
(1) prohibit direct patient contact between a patient and a staff member if the staff member has had a personal relationship with the patient within two years prior to the patient's admission to the program;
(2) prohibit access to a patient's clinical records by a staff member who has had a personal relationship with the patient within two years prior to the patient's admission, unless the patient consents in writing; and
(3) prohibit a clinical relationship between a staff member and a patient if the staff member has had a personal relationship with the patient within two years prior to the patient's admission. If a personal relationship exists, the staff member must report the relationship to the staff member's supervisor and recuse the staff member from a clinical relationship with that patient.
A license holder must have written personnel policies and must make them available to staff members at all times. The personnel policies must:
(1) ensure that a staff member's retention, promotion, job assignment, or pay are not affected by a good-faith communication between the staff member and the Department of Human Services, Department of Health, Ombudsman for Mental Health and Developmental Disabilities, law enforcement, or local agencies that investigate complaints regarding patient rights, health, or safety;
(2) include a job description for each position that specifies job responsibilities, degree of authority to execute job responsibilities, standards of job performance related to specified job responsibilities, and qualifications;
(3) provide for written job performance evaluations for staff members of the license holder at least annually;
(4) describe behavior that constitutes grounds for disciplinary action, suspension, or dismissal, including policies that address substance use problems and meet the requirements of section 245F.15, subdivisions 1 and 2. The policies and procedures must list behaviors or incidents that are considered substance use problems. The list must include:
(i) receiving treatment for substance use disorder within the period specified for the position in the staff qualification requirements;
(ii) substance use that has a negative impact on the staff member's job performance;
(iii) substance use that affects the credibility of treatment services with patients, referral sources, or other members of the community; and
(iv) symptoms of intoxication or withdrawal on the job;
(6) include a chart or description of organizational structure indicating the lines of authority and responsibilities;
(7) include a written plan for new staff member orientation that, at a minimum, includes training related to the specific job functions for which the staff member was hired, program policies and procedures, patient needs, and the areas identified in subdivision 2, paragraphs (b) to (e); and
(8) include a policy on the confidentiality of patient information.
(a) A license holder must ensure that each staff member receives orientation training before providing direct patient care and at least 30 hours of continuing education every two years. A written record must be kept to demonstrate completion of training requirements.
(b) Within 72 hours of beginning employment, all staff having direct patient contact must be provided orientation on the following:
(1) specific license holder and staff responsibilities for patient confidentiality;
(2) standards governing the use of protective procedures;
(3) patient ethical boundaries and patient rights, including the rights of patients admitted under chapter 253B;
(4) infection control procedures;
(6) HIV minimum standards as required in section 245A.19;
(7) motivational counseling techniques and identifying stages of change; and
(8) eight hours of training on the program's protective procedures policy required in section 245F.09, including:
(i) approved therapeutic holds;
(ii) protective procedures used to prevent patients from imminent danger of harming self or others;
(iii) the emergency conditions under which the protective procedures may be used, if any;
(iv) documentation standards for using protective procedures;
(v) how to monitor and respond to patient distress; and
(vi) person-centered planning and trauma-informed care.
(c) All staff having direct patient contact must be provided annual training on the following:
(1) infection control procedures;
(3) HIV minimum standards as required in section 245A.19; and
(4) motivational counseling techniques and identifying stages of change.
(d) All staff having direct patient contact must be provided training every two years on the following:
(1) specific license holder and staff responsibilities for patient confidentiality;
(2) standards governing use of protective procedures, including:
(i) approved therapeutic holds;
(ii) protective procedures used to prevent patients from imminent danger of harming self or others;
(iii) the emergency conditions under which the protective procedures may be used, if any;
(iv) documentation standards for using protective procedures;
(v) how to monitor and respond to patient distress; and
(vi) person-centered planning and trauma-informed care; and
(3) patient ethical boundaries and patient rights, including the rights of patients admitted under chapter 253B.
(e) Continuing education that is completed in areas outside of the required topics must provide information to the staff person that is useful to the performance of the individual staff person's duties.
A license holder must maintain a separate personnel file for each staff member. At a minimum, the file must contain:
(1) a completed application for employment signed by the staff member that contains the staff member's qualifications for employment and documentation related to the applicant's background study data, as defined in chapter 245C;
(2) documentation of the staff member's current professional license or registration, if relevant;
(3) documentation of orientation and subsequent training;
(4) documentation of a statement of freedom from substance use problems; and
(5) an annual job performance evaluation.
A license holder must develop a written policy and procedures manual that is alphabetically indexed and has a table of contents, so that staff have immediate access to all policies and procedures, and that consumers of the services and other authorized parties have access to all policies and procedures. The manual must contain the following materials:
(1) a description of patient education services as required in section 245F.06;
(2) personnel policies that comply with section 245F.16;
(3) admission information and referral and discharge policies that comply with section 245F.05;
(4) a health monitoring plan that complies with section 245F.12;
(5) a protective procedures policy that complies with section 245F.09, if the program elects to use protective procedures;
(6) policies and procedures for assuring appropriate patient-to-staff ratios that comply with section 245F.14;
(7) policies and procedures for assessing and documenting the susceptibility for risk of abuse to the patient as the basis for the individual abuse prevention plan required by section 245A.65;
(9) a medication control plan that complies with section 245F.13; and
(10) policies and procedures regarding HIV that meet the minimum standards under section 245A.19.
A license holder must maintain a file of current patient records on the program premises where the treatment is provided. Each entry in each patient record must be signed and dated by the staff member making the entry. Patient records must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and section 254A.09; Code of Federal Regulations, title 42, sections 2.1 to 2.67; and title 45, parts 160 to 164.
A license holder must retain and store records as required by section 245A.041, subdivisions 3 and 4.
Patient records must include the following:
(1) documentation of the patient's presenting problem, any substance use screening, the most recent assessment, and any updates;
(2) a stabilization plan and progress notes as required by section 245F.07, subdivisions 1 and 2;
(3) a discharge summary as required by section 245F.07, subdivision 3;
(4) an individual abuse prevention plan that complies with section 245A.65 and related rules;
(5) documentation of referrals made; and
(6) documentation of the monitoring and observations of the patient's medical needs.
The license holder must participate in the drug and alcohol abuse normative evaluation system (DAANES) by submitting, in a format provided by the commissioner, information concerning each patient admitted to the program. Staff submitting data must be trained by the license holder with the DAANES web manual.
The commissioner shall develop a payment methodology for services provided under this chapter or by an Indian Health Services facility or a facility owned and operated by a tribe or tribal organization operating under Public Law 93-638 as a 638 facility. The commissioner shall seek federal approval for the methodology. Upon federal approval, the commissioner must seek and obtain legislative approval of the funding methodology to support the service.
Official Publication of the State of Minnesota
Revisor of Statutes