Bill Text: MN SF2456 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Home and community-based services standards modification
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-03-10 - Referred to Health, Human Services and Housing [SF2456 Detail]
Download: Minnesota-2013-SF2456-Introduced.html
1.2relating to human services; modifying home and community-based services
1.3standards; requiring review of the use of monitoring technology; imposing
1.4sanctions;amending Minnesota Statutes 2012, sections 245A.11, by adding a
1.5subdivision; 245A.155, subdivisions 1, 2, 3; 245A.65, subdivision 2; Minnesota
1.6Statutes 2013 Supplement, sections 245D.02, by adding a subdivision; 245D.05,
1.7subdivisions 1, 1b; 245D.06, subdivision 1; 245D.07, subdivision 2; 245D.071,
1.8subdivisions 1, 3, 4, 5; 245D.09, subdivisions 3, 4, 4a, 5; 245D.095, subdivision
1.93; 245D.22, subdivision 4; 245D.31, subdivisions 3, 4, 5; repealing Minnesota
1.10Statutes 2013 Supplement, section 245D.071, subdivision 2.
1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.12 Section 1. Minnesota Statutes 2012, section 245A.11, is amended by adding a
1.13subdivision to read:
1.14 Subd. 7c. Review; services through monitoring technology. (a) Lead agencies
1.15must submit individual service plans that include residential direct service care provided
1.16remotely through monitoring technology to the Monitoring Technology Review Panel
1.17established in section 256B.4914, subdivision 6, paragraph (d). The panel must verify that:
1.18(1) licensing standards have been applied;
1.19(2) the person's coordinated service and support plan includes the use of monitoring
1.20technology; and
1.21(3) signed informed consent has been obtained from the person or the person's
1.22legal representative.
1.23(b) The panel must meet quarterly to review service plans submitted by the lead
1.24agencies.
1.25(c) If the panel determines a service plan does not contain the information required
1.26in paragraph (a), clauses (1) to (3), the panel shall provide a written notice of the
1.27deficiencies to the lead agency and license holder. The lead agency and the license holder
2.1must submit to the panel missing or corrected documentation to cure the deficiencies
2.2within 90 calendar days.
2.3(d) If the lead agency and license holder contest the findings of the panel, the lead
2.4agency and license holder must submit a written request for reconsideration of the panel's
2.5findings to the commissioner within 60 calendar days. The commissioner's disposition of
2.6a request for reconsideration is final and not subject to appeal under chapter 14.
2.7(e) If neither the missing or corrected documentation nor a written request for
2.8reconsideration has been received by the panel within the designated time frames, the panel
2.9may recommend to the licensing authority that direct care staff supervision be placed on
2.10site during the hours remote monitoring had been approved for use, and that the payment
2.11rate to the provider be adjusted until the service plan deficiencies have been resolved.
2.12 Sec. 2. Minnesota Statutes 2012, section 245A.155, subdivision 1, is amended to read:
2.13 Subdivision 1. Licensed foster care and respite care. This section applies to
2.14foster care agencies and licensed foster care providers who place, supervise, or care for
2.15individuals who rely on medicalmonitoring equipment, including but not limited to
2.16ventilators, feeding tubes, or endotracheal tubes, to sustain lifeor monitor a medical
2.17condition in respite care or foster care.
2.18 Sec. 3. Minnesota Statutes 2012, section 245A.155, subdivision 2, is amended to read:
2.19 Subd. 2. Foster care agency requirements. In order for an agency to place an
2.20individual who relies on medical equipment to sustain lifeor monitor a medical condition
2.21 with a foster care provider, the agency must ensure that the foster care provider has
2.22received the training to operate such equipment as observed and confirmed by a qualified
2.23source, and that the provider:
2.24(1) is currently caring for an individual who is using the same equipment in the
2.25foster home; or
2.26(2) has written documentation that the foster care provider has cared for an
2.27individual who relied on such equipment within the past six months; or
2.28(3) has successfully completed training with the individual being placed with the
2.29provider.
2.30 Sec. 4. Minnesota Statutes 2012, section 245A.155, subdivision 3, is amended to read:
2.31 Subd. 3. Foster care provider requirements. A foster care provider shall not care
2.32for an individual who relies on medical equipment to sustain lifeor monitor a medical
3.1condition unless the provider has received the training to operate such equipment as
3.2observed and confirmed by a qualified source, and:
3.3(1) is currently caring for an individual who is using the same equipment in the
3.4foster home; or
3.5(2) has written documentation that the foster care provider has cared for an
3.6individual who relied on such equipment within the past six months; or
3.7(3) has successfully completed training with the individual being placed with the
3.8provider.
3.9 Sec. 5. Minnesota Statutes 2012, section 245A.65, subdivision 2, is amended to read:
3.10 Subd. 2. Abuse prevention plans. All license holders shall establish and enforce
3.11ongoing written program abuse prevention plans and individual abuse prevention plans as
3.12required under section626.557, subdivision 14 .
3.13(a) The scope of the program abuse prevention plan is limited to the population,
3.14physical plant, and environment within the control of the license holder and the location
3.15where licensed services are provided. In addition to the requirements in section626.557,
3.16subdivision 14 , the program abuse prevention plan shall meet the requirements in clauses
3.17(1) to (5).
3.18(1) The assessment of the population shall include an evaluation of the following
3.19factors: age, gender, mental functioning, physical and emotional health or behavior of the
3.20client; the need for specialized programs of care for clients; the need for training of staff to
3.21meet identified individual needs; and the knowledge a license holder may have regarding
3.22previous abuse that is relevant to minimizing risk of abuse for clients.
3.23(2) The assessment of the physical plant where the licensed services are provided
3.24shall include an evaluation of the following factors: the condition and design of the
3.25building as it relates to the safety of the clients; and the existence of areas in the building
3.26which are difficult to supervise.
3.27(3) The assessment of the environment for each facility and for each site when living
3.28arrangements are provided by the agency shall include an evaluation of the following
3.29factors: the location of the program in a particular neighborhood or community; the type
3.30of grounds and terrain surrounding the building; the type of internal programming; and
3.31the program's staffing patterns.
3.32(4) The license holder shall provide an orientation to the program abuse prevention
3.33plan for clients receiving services. If applicable, the client's legal representative must be
3.34notified of the orientation. The license holder shall provide this orientation for each new
4.1person within 24 hours of admission, or for persons who would benefit more from a later
4.2orientation, the orientation may take place within 72 hours.
4.3(5) The license holder'sgoverning body authorized representative shall review
4.4the plan at least annually using the assessment factors in the plan and any substantiated
4.5maltreatment findings that occurred since the last review. Thegoverning body authorized
4.6representative shall revise the plan, if necessary, to reflect the review results.
4.7(6) A copy of the program abuse prevention plan shall be posted in a prominent
4.8location in the program and be available upon request to mandated reporters, persons
4.9receiving services, and legal representatives.
4.10(b) In addition to the requirements in section626.557, subdivision 14 , the individual
4.11abuse prevention plan shall meet the requirements in clauses (1) and (2).
4.12(1) The plan shall include a statement of measures that will be taken to minimize the
4.13risk of abuse to the vulnerable adult when the individual assessment required in section
4.14626.557, subdivision 14
, paragraph (b), indicates the need for measures in addition to the
4.15specific measures identified in the program abuse prevention plan. The measures shall
4.16include the specific actions the program will take to minimize the risk of abuse within
4.17the scope of the licensed services, and will identify referrals made when the vulnerable
4.18adult is susceptible to abuse outside the scope or control of the licensed services. When
4.19the assessment indicates that the vulnerable adult does not need specific risk reduction
4.20measures in addition to those identified in the program abuse prevention plan, the
4.21individual abuse prevention plan shall document this determination.
4.22(2) An individual abuse prevention plan shall be developed for each new person as
4.23part of the initial individual program plan or service plan required under the applicable
4.24licensing rule. The review and evaluation of the individual abuse prevention plan shall
4.25be done as part of the review of the program plan or service plan. The person receiving
4.26services shall participate in the development of the individual abuse prevention plan to the
4.27full extent of the person's abilities. If applicable, the person's legal representative shall be
4.28given the opportunity to participate with or for the person in the development of the plan.
4.29The interdisciplinary team shall document the review of all abuse prevention plans at least
4.30annually, using the individual assessment and any reports of abuse relating to the person.
4.31The plan shall be revised to reflect the results of this review.
4.32 Sec. 6. Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding a
4.33subdivision to read:
4.34 Subd. 37. Working day. "Working day" means Monday, Tuesday, Wednesday,
4.35Thursday, or Friday, excluding any legal holiday.
5.1 Sec. 7. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
5.2amended to read:
5.3 Subdivision 1. Health needs. (a) The license holder is responsible for meeting
5.4health service needs assigned in the coordinated service and support plan or the
5.5coordinated service and support plan addendum, consistent with the person's health needs.
5.6The license holder is responsible forpromptly notifying the person's legal representative,
5.7if any, and the case manager of changes in a person's physical and mental health needs
5.8affecting health service needs assigned to the license holder in the coordinated service and
5.9support plan or the coordinated service and support plan addendum, when as directed in
5.10the coordinated service and support plan or within 24 hours of being discovered by the
5.11license holder, unless the license holder has reason to know the change has already been
5.12reported. The license holder must document when the notice is provided.
5.13(b) If responsibility for meeting the person's health service needs has been assigned
5.14to the license holder in the coordinated service and support plan or the coordinated service
5.15and support plan addendum, the license holder must maintain documentation on how the
5.16person's health needs will be met, including a description of the procedures the license
5.17holder will follow in order to:
5.18(1) provide medication assistance or medication administration according to this
5.19chapter;
5.20(2) monitor health conditions according to written instructions from a licensed
5.21health professional;
5.22(3) assist with or coordinate medical, dental, and other health service appointments; or
5.23(4) use medical equipment, devices, or adaptive aides or technology safely and
5.24correctly according to written instructions from a licensed health professional.
5.25 Sec. 8. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b, is
5.26amended to read:
5.27 Subd. 1b. Medication assistance. If responsibility for medication assistance
5.28is assigned to the license holder in the coordinated service and support plan or the
5.29coordinated service and support plan addendum,the license holder must ensure that
5.30the requirements of subdivision 2, paragraph (b), have been met when staff provides
5.31 medication assistance must be provided to enable a person to self-administer medication
5.32or treatment when the person is capable of directing the person's own care, or when the
5.33person's legal representative is present and able to direct care for the person. For the
5.34purposes of this subdivision, "medication assistance" means any of the following:
6.1(1) bringing to the person and opening a container of previously set up medications,
6.2emptying the container into the person's hand, or opening and giving the medications in
6.3the original container to the person;
6.4(2) bringing to the person liquids or food to accompany the medication; or
6.5(3) providing reminders, in person, remotely, or through programming devices
6.6such as telephones, alarms, or medication boxes, to take regularly scheduled medication
6.7or perform regularly scheduled treatments and exercises.
6.8 Sec. 9. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
6.9amended to read:
6.10 Subdivision 1. Incident response and reporting. (a) The license holder must
6.11respond to incidents under section245D.02, subdivision 11 , that occur while providing
6.12services to protect the health and safety of and minimize risk of harm to the person.
6.13(b) The license holder must maintain information about and report incidents to the
6.14person's legal representative or designated emergency contact and case manager within
6.1524 hours of an incident occurring while services are being provided, within 24 hours of
6.16discovery or receipt of information that an incident occurred, unless the license holder
6.17has reason to know that the incident has already been reported, or as otherwise directed
6.18in a person's coordinated service and support plan or coordinated service and support
6.19plan addendum. An incident of suspected or alleged maltreatment must be reported as
6.20required under paragraph (d), and an incident of serious injury or death must be reported
6.21as required under paragraph (e).
6.22(c) When the incident involves more than one person, the license holder must not
6.23disclose personally identifiable information about any other person when making the report
6.24to each person and case manager unless the license holder has the consent of the person.
6.25(d) Within 24 hours of reporting maltreatment as required under section626.556
6.26or
626.557 , the license holder must inform the case manager of the report unless there is
6.27reason to believe that the case manager is involved in the suspected maltreatment. The
6.28license holder must disclose the nature of the activity or occurrence reported and the
6.29agency that received the report.
6.30(e) The license holder must report the death or serious injury of the person as
6.31required in paragraph (b) and to the Department of Human Services Licensing Division,
6.32and the Office of Ombudsman for Mental Health and Developmental Disabilities as
6.33required under section245.94, subdivision 2a , within 24 hours of the death or serious
6.34injury, or receipt of information that the death or serious injury occurred, unless the license
6.35holder has reason to know that the death or serious injury has already been reported.
7.1(f) When a death or serious injury occurs in a facility certified as an intermediate
7.2care facility for persons with developmental disabilities, the death or serious injury must
7.3be reported to the Department of Health, Office of Health Facility Complaints, and the
7.4Office of Ombudsman for Mental Health and Developmental Disabilities, as required
7.5under sections245.91 and
245.94, subdivision 2a , unless the license holder has reason to
7.6know that the death or serious injury has already been reported.
7.7(g) The license holder must conduct an internal review of incident reports of deaths
7.8and serious injuries that occurred while services were being provided and that were not
7.9reported by the program as alleged or suspected maltreatment, for identification of incident
7.10patterns, and implementation of corrective action as necessary to reduce occurrences.
7.11The review must include an evaluation of whether related policies and procedures were
7.12followed, whether the policies and procedures were adequate, whether there is a need for
7.13additional staff training, whether the reported event is similar to past events with the
7.14persons or the services involved, and whether there is a need for corrective action by the
7.15license holder to protect the health and safety of persons receiving services. Based on
7.16the results of this review, the license holder must develop, document, and implement a
7.17corrective action plan designed to correct current lapses and prevent future lapses in
7.18performance by staff or the license holder, if any.
7.19(h) The license holder must verbally report the emergency use of manual restraint of
7.20a person as required in paragraph (b) within 24 hours of the occurrence. The license holder
7.21must ensure the written report and internal review of all incident reports of the emergency
7.22use of manual restraints are completed according to the requirements in section245D.061 .
7.23 Sec. 10. Minnesota Statutes 2013 Supplement, section 245D.07, subdivision 2, is
7.24amended to read:
7.25 Subd. 2. Service planning requirements for basic support services and certain
7.26intensive support services. (a) License holders providing basic support services or
7.27intensive support services identified in section 245D.03, subdivision 1, paragraph (c),
7.28clauses (1) and (2), must meet the requirements of this subdivision.
7.29(b) Within 15 calendar days of service initiation the license holder must complete
7.30a preliminary coordinated service and support plan addendum based on the coordinated
7.31service and support plan.
7.32(c) Within 60 calendar days of service initiation the license holder must review
7.33and revise as needed the preliminary coordinated service and support plan addendum to
7.34document the services that will be provided including how, when, and by whom services
8.1will be provided, and the person responsible for overseeing the delivery and coordination
8.2of services.
8.3(d) The license holder must participate in service planning and support team
8.4meetings for the person following stated timelines established in the person's coordinated
8.5service and support plan or as requested by the person or the person's legal representative,
8.6the support team or the expanded support team.
8.7 Sec. 11. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 1,
8.8is amended to read:
8.9 Subdivision 1. Requirements for certain intensive support services. A license
8.10holder providing intensive support services identified in section245D.03, subdivision 1 ,
8.11paragraph (c), clauses (3) to (5), must comply with the requirements in this section and
8.12section245D.07, subdivisions 1 and 3.
8.13 Sec. 12. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
8.14is amended to read:
8.15 Subd. 3. Assessment and initial service planning. (a) Within 15 calendar days of
8.16service initiation the license holder must complete a preliminary coordinated service and
8.17support plan addendum based on the coordinated service and support plan.
8.18(b) Within 45 calendar days of service initiation the license holder must meet with
8.19the person, the person's legal representative, the case manager, and other members of the
8.20support team or expanded support team to assess and determine the following based on the
8.21person's coordinated service and support plan and the requirements in subdivision 4 and
8.22section245D.07, subdivision 1a :
8.23(1) the scope of the services to be provided to support the person's daily needs
8.24and activities;
8.25(2) the person's desired outcomes and the supports necessary to accomplish the
8.26person's desired outcomes;
8.27(3) the person's preferences for how services and supports are provided;
8.28(4) whether the current service setting is the most integrated setting available and
8.29appropriate for the person; and
8.30(5) how services must be coordinated across other providers licensed under this
8.31chapter serving the same person to ensure continuity of care for the person.
8.32(c) Within the scope of services, the license holder must, at a minimum, assess
8.33the following areas:
9.1(1) the person's ability to self-manage health and medical needs to maintain or
9.2improve physical, mental, and emotional well-being, including, when applicable, allergies,
9.3seizures, choking, special dietary needs, chronic medical conditions, self-administration
9.4of medication or treatment orders, preventative screening, and medical and dental
9.5appointments;
9.6(2) the person's ability to self-manage personal safety to avoid injury or accident in
9.7the service setting, including, when applicable, risk of falling, mobility, regulating water
9.8temperature, community survival skills, water safety skills, and sensory disabilities; and
9.9(3) the person's ability to self-manage symptoms or behavior that may otherwise
9.10result in an incident as defined in section245D.02, subdivision 11 , clauses (4) to (7),
9.11suspension or termination of services by the license holder, or other symptoms or
9.12behaviors that may jeopardize the health and safety of the person or others.
9.13The assessments must produce information about the person that is descriptive of the
9.14person's overall strengths, functional skills and abilities, and behaviors or symptoms.
9.15 Sec. 13. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 4,
9.16is amended to read:
9.17 Subd. 4. Service outcomes and supports. (a) Within ten working days of the
9.1845-day meeting, the license holder must develop and document the service outcomes and
9.19supports based on the assessments completed under subdivision 3 and the requirements
9.20in section245D.07, subdivision 1a . The outcomes and supports must be included in the
9.21coordinated service and support plan addendum.
9.22(b) The license holder must document the supports and methods to be implemented
9.23to support the accomplishment of outcomes related to acquiring, retaining, or improving
9.24skills. The documentation must include:
9.25(1) the methods or actions that will be used to support the person and to accomplish
9.26the service outcomes, including information about:
9.27(i) any changes or modifications to the physical and social environments necessary
9.28when the service supports are provided;
9.29(ii) any equipment and materials required; and
9.30(iii) techniques that are consistent with the person's communication mode and
9.31learning style;
9.32(2) the measurable and observable criteria for identifying when the desired outcome
9.33has been achieved and how data will be collected;
10.1(3) the projected starting date for implementing the supports and methods and
10.2the date by which progress towards accomplishing the outcomes will be reviewed and
10.3evaluated; and
10.4(4) the names of the staff or position responsible for implementing the supports
10.5and methods.
10.6(c) Within 20 working days of the 45-day meeting, the license holder must submit
10.7to and obtain dated signatures from the person or the person's legal representative and
10.8case manager to document completion and approval of the assessment and coordinated
10.9service and support plan addendum. If, within ten working days of the submission of the
10.10assessment or coordinated service and support plan addendum, the person or the person's
10.11legal representative or case manager has not signed and returned to the license holder the
10.12assessment and coordinated service and support plan addendum or has not proposed
10.13written modifications to the license holder's submission, the submission is deemed
10.14approved and the assessment and coordinated service and support plan addendum become
10.15effective and remain in effect until the legal representative or case manager submits a
10.16written request to revise the assessment or coordinated service and support plan addendum.
10.17 Sec. 14. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 5,
10.18is amended to read:
10.19 Subd. 5. Progress reviews. (a) The license holder must give the person or the
10.20person's legal representative and case manager an opportunity to participate in the ongoing
10.21review and development of the methods used to support the person and accomplish
10.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
10.23the person's support team or expanded support team, must meet with the person, the
10.24person's legal representative, and the case manager, and participate in progress review
10.25meetings following stated timelines established in the person's coordinated service and
10.26support plan or coordinated service and support plan addendum or within 30 days of a
10.27written request by the person, the person's legal representative, or the case manager,
10.28at a minimum of once per year.
10.29(b) The license holder must summarize the person's progress toward achieving the
10.30identified outcomes and make recommendations and identify the rationale for changing,
10.31continuing, or discontinuing implementation of supports and methods identified in
10.32subdivision 4in a written report sent to the person or the person's legal representative
10.33and case manager five working days prior to the review meeting, unless the person, the
10.34person's legal representative, or the case manager requests to receive the in a report
10.35 available at the time of the progress review meeting. The report must be sent five working
11.1days prior to the progress review meeting if requested by the team in the coordinated
11.2service and support plan or coordinated service and support plan addendum.
11.3(c) Within ten working days of the progress review meeting, the license holder
11.4must obtain dated signatures from the person or the person's legal representative and
11.5the case manager to document approval of any changes to the coordinated service and
11.6support plan addendum.
11.7(d) If, within ten working days of the submission of the changes to the coordinated
11.8service and support plan addendum, the person or the person's legal representative or case
11.9manager has not signed and returned to the license holder the coordinated service and
11.10support plan addendum or has not proposed written modifications to the license holder's
11.11submission, the submission is deemed approved and the coordinated service and support
11.12plan addendum becomes effective and remains in effect until the legal representative or
11.13case manager submits a written request to revise the coordinated service and support plan.
11.14 Sec. 15. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 3, is
11.15amended to read:
11.16 Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
11.17direct support, or staff who have responsibilities related to supervising or managing the
11.18provision of direct support service, are competent as demonstrated through skills and
11.19knowledge training, experience, and education to meet the person's needs and additional
11.20requirements as written in the coordinated service and support plan or coordinated
11.21service and support plan addendum, or when otherwise required by the case manager or
11.22the federal waiver plan. The license holder must verify and maintain evidence of staff
11.23competency, including documentation of:
11.24(1) education and experience qualifications relevant to the job responsibilities
11.25assigned to the staff and the needs of the general population of persons served by the
11.26program, including a valid degree and transcript, or a current license, registration, or
11.27certification, when a degree or licensure, registration, or certification is required by this
11.28chapter or in the coordinated service and support plan or coordinated service and support
11.29plan addendum;
11.30(2) demonstrated competency in the orientation and training areas required under
11.31this chapter, and when applicable, completion of continuing education required to
11.32maintain professional licensure, registration, or certification requirements. Competency in
11.33these areas is determined by the license holder through knowledge testingand or observed
11.34skill assessment conducted by the trainer or instructor, the person served if the person is
11.35self-directing services, or another person already deemed competent; and
12.1(3) except for a license holder who is the sole direct support staff, periodic
12.2performance evaluations completed by the license holder of the direct support staff
12.3person's ability to perform the job functions based on direct observation.
12.4(b) Staff under 18 years of age may not perform overnight duties or administer
12.5medication.
12.6 Sec. 16. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4, is
12.7amended to read:
12.8 Subd. 4. Orientation to program requirements. Except for a license holder
12.9who does not supervise any direct support staff, within 60 calendar days of hire, unless
12.10stated otherwise, the license holder must provide and ensure completion of ten hours of
12.11orientation for direct support staff providing basic services and 30 hours of orientation
12.12for direct support staff providing intensive services that combines supervised on-the-job
12.13training with review of and instruction in the following areas:
12.14(1) the job description and how to complete specific job functions, including:
12.15(i) responding to and reporting incidents as required under section245D.06 ,
12.16subdivision 1; and
12.17(ii) following safety practices established by the license holder and as required in
12.18section245D.06, subdivision 2 ;
12.19(2) the license holder's current policies and procedures required under this chapter,
12.20including their location and access, and staff responsibilities related to implementation
12.21of those policies and procedures;
12.22(3) data privacy requirements according to sections13.01 to
13.10 and
13.46 , the
12.23federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
12.24responsibilities related to complying with data privacy practices;
12.25(4) the service recipient rights and staff responsibilities related to ensuring the
12.26exercise and protection of those rights according to the requirements in section245D.04 ;
12.27(5) sections245A.65 ,
245A.66 ,
626.556 , and
626.557 , governing maltreatment
12.28reporting and service planning for children and vulnerable adults, and staff responsibilities
12.29related to protecting persons from maltreatment and reporting maltreatment. This
12.30orientation must be provided within 72 hours of first providing direct contact services and
12.31annually thereafter according to section245A.65, subdivision 3 ;
12.32(6) the principles of person-centered service planning and delivery as identified in
12.33section245D.07, subdivision 1a, and how they apply to direct support service provided
12.34by the staff person;and
13.1(7) the safe and correct use of manual restraint on an emergency basis according to
13.2the requirements in section 245D.061 and what constitutes the use of restraints, time out,
13.3and seclusion, including chemical restraint;
13.4(8) staff responsibilities related to prohibited procedures under section 245D.06,
13.5subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
13.6or undesired behavior, and why such procedures are not safe;
13.7(9) competence in providing basic first aid; and
13.8(10) other topics as determined necessary in the person's coordinated service and
13.9support plan by the case manager or other areas identified by the license holder.
13.10 Sec. 17. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4a,
13.11is amended to read:
13.12 Subd. 4a. Orientation to individual service recipient needs. (a) Before having
13.13unsupervised direct contact with a person served by the program, or for whom the staff
13.14person has not previously provided direct support, or any time the plans or procedures
13.15identified in paragraphs (b) to(f) (e) are revised, the staff person must review and receive
13.16instruction on the requirements in paragraphs (b) to(f) (e) as they relate to the staff
13.17person's job functions for that person.
13.18(b) For community residential services, training and competency evaluations must
13.19include the following, if identified in the coordinated service and support plan:
13.20(1) appropriate and safe techniques in personal hygiene and grooming, including
13.21hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
13.22daily living (ADLs) as defined under section256B.0659, subdivision 1 ;
13.23(2) an understanding of what constitutes a healthy diet according to data from the
13.24Centers for Disease Control and Prevention and the skills necessary to prepare that diet; and
13.25(3) skills necessary to provide appropriate support in instrumental activities of daily
13.26living (IADLs) as defined under section256B.0659, subdivision 1 ; and.
13.27(4) demonstrated competence in providing first aid.
13.28(c) The staff person must review and receive instruction on the person's coordinated
13.29service and support plan or coordinated service and support plan addendum as it relates
13.30to the responsibilities assigned to the license holder, and when applicable, the person's
13.31individual abuse prevention plan, to achieve and demonstrate an understanding of the
13.32person as a unique individual, and how to implement those plans.
13.33(d) The staff person must review and receive instruction on medication
13.34administration procedures established for the person when medication administration is
13.35assigned to the license holder according to section245D.05, subdivision 1 , paragraph
14.1(b). Unlicensed staff may administer medications only after successful completion of a
14.2medication administration training, from a training curriculum developed by a registered
14.3nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
14.4practitioner, physician's assistant, or physician. The training curriculum must incorporate
14.5an observed skill assessment conducted by the trainer to ensure staff demonstrate the
14.6ability to safely and correctly follow medication procedures.
14.7Medication administration must be taught by a registered nurse, clinical nurse
14.8specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
14.9service initiation or any time thereafter, the person has or develops a health care condition
14.10that affects the service options available to the person because the condition requires:
14.11(1) specialized or intensive medical or nursing supervision; and
14.12(2) nonmedical service providers to adapt their services to accommodate the health
14.13and safety needs of the person.
14.14(e) The staff person must review and receive instruction on the safe and correct
14.15operation of medical equipment used by the person to sustain life, including but not
14.16limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
14.17by a licensed health care professional or a manufacturer's representative and incorporate
14.18an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
14.19operate the equipment according to the treatment orders and the manufacturer's instructions.
14.20(f)The staff person must review and receive instruction on what constitutes use of
14.21restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
14.22related to the prohibitions of their use according to the requirements in section
245D.06,
14.23subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
14.24or undesired behavior and why they are not safe, and the safe and correct use of manual
14.25restraint on an emergency basis according to the requirements in section
245D.061.
14.26(g) In the event of an emergency service initiation, the license holder must ensure
14.27the training required in this subdivision occurs within 72 hours of the direct support staff
14.28person first having unsupervised contact with the person receiving services. The license
14.29holder must document the reason for the unplanned or emergency service initiation and
14.30maintain the documentation in the person's service recipient record.
14.31(h) (g) License holders who provide direct support services themselves must
14.32complete the orientation required in subdivision 4, clauses (3) to(7) (10).
14.33 Sec. 18. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 5, is
14.34amended to read:
15.1 Subd. 5. Annual training. A license holder must provide annual training to direct
15.2support staff on the topics identified in subdivision 4, clauses (3) to(7), and subdivision
15.34a (10). A license holder must provide a minimum of 24 hours of annual training to
15.4direct service staffwith providing intensive services and having fewer than five years
15.5of documented experience and 12 hours of annual training to direct service staffwith
15.6 providing intensive services and having five or more years of documented experience in
15.7topics described in subdivisions 4 and 4a, paragraphs (a) to(h) (g). Training on relevant
15.8topics received from sources other than the license holder may count toward training
15.9requirements. A license holder must provide a minimum of 12 hours of annual training
15.10to direct service staff providing basic services and having fewer than five years of
15.11documented experience and six hours of annual training to direct service staff providing
15.12basic services and having five or more years of documented experience.
15.13 Sec. 19. Minnesota Statutes 2013 Supplement, section 245D.095, subdivision 3,
15.14is amended to read:
15.15 Subd. 3. Service recipient record. (a) The license holder must maintain a record of
15.16current services provided to each person on the premises where the services are provided
15.17or coordinated. When the services are provided in a licensed facility, the records must
15.18be maintained at the facility, otherwise the records must be maintained at the license
15.19holder's program office. The license holder must protect service recipient records against
15.20loss, tampering, or unauthorized disclosure according to the requirements in sections
15.2113.01
to
13.10 and
13.46 .
15.22(b) The license holder must maintain the following information for each person:
15.23(1) an admission form signed by the person or the person's legal representative
15.24that includes:
15.25(i) identifying information, including the person's name, date of birth, address,
15.26and telephone number; and
15.27(ii) the name, address, and telephone number of the person's legal representative, if
15.28any, and a primary emergency contact, the case manager, and family members or others as
15.29identified by the person or case manager;
15.30(2) service information, including service initiation information, verification of the
15.31person's eligibility for services, documentation verifying that services have been provided
15.32as identified in the coordinated service and support plan or coordinated service and support
15.33plan addendum according to paragraph (a), and date of admission or readmission;
16.1(3) health information, including medical history, special dietary needs, and
16.2allergies, and when the license holder is assigned responsibility for meeting the person's
16.3health service needs according to section245D.05 :
16.4(i) current orders for medication, treatments, or medical equipment and a signed
16.5authorization from the person or the person's legal representative to administer or assist in
16.6administering the medication or treatments, if applicable;
16.7(ii) a signed statement authorizing the license holder to act in a medical emergency
16.8when the person's legal representative, if any, cannot be reached or is delayed in arriving;
16.9(iii) medication administration procedures;
16.10(iv) a medication administration record documenting the implementation of the
16.11medication administration procedures, and the medication administration record reviews,
16.12including any agreements for administration of injectable medications by the license
16.13holder according to the requirements in section245D.05 ; and
16.14(v) a medical appointment schedule when the license holder is assigned
16.15responsibility for assisting with medical appointments;
16.16(4) the person's current coordinated service and support plan or that portion of the
16.17plan assigned to the license holder;
16.18(5) copies of theindividual abuse prevention plan and assessments as required under
16.19section245D.071, subdivisions 2 and subdivision 3;
16.20(6) a record of other service providers serving the person when the person's
16.21coordinated service and support plan or coordinated service and support plan addendum
16.22identifies the need for coordination between the service providers, that includes a contact
16.23person and telephone numbers, services being provided, and names of staff responsible for
16.24coordination;
16.25(7) documentation of orientation to service recipient rights according to section
16.26245D.04, subdivision 1
, and maltreatment reporting policies and procedures according to
16.27section245A.65, subdivision 1 , paragraph (c);
16.28(8) copies of authorizations to handle a person's funds, according to section245D.06 ,
16.29subdivision 4, paragraph (a);
16.30(9) documentation of complaints received and grievance resolution;
16.31(10) incident reports involving the person, required under section245D.06 ,
16.32subdivision 1;
16.33(11) copies of written reports regarding the person's status when requested according
16.34to section245D.07, subdivision 3 , progress review reports as required under section
16.35245D.071, subdivision 5
, progress or daily log notes that are recorded by the program,
17.1and reports received from other agencies involved in providing services or care to the
17.2person; and
17.3(12) discharge summary, including service termination notice and related
17.4documentation, when applicable.
17.5 Sec. 20. Minnesota Statutes 2013 Supplement, section 245D.22, subdivision 4, is
17.6amended to read:
17.7 Subd. 4. First aid must be available on site. (a) A staff person trained in first
17.8aid must be available on site and, when required in a person's coordinated service and
17.9support plan or coordinated service and support plan addendum, be able to provide
17.10cardiopulmonary resuscitation, whenever persons are present and staff are required to be
17.11at the site to provide direct service. The CPR training must includein-person instruction,
17.12hands-on practice, and an observed skills assessment under the direct supervision of a
17.13CPR instructor.
17.14(b) A facility must have first aid kits readily available for use by, and that meet
17.15the needs of, persons receiving services and staff. At a minimum, the first aid kit must
17.16be equipped with accessible first aid supplies including bandages, sterile compresses,
17.17scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
17.18adhesive tape, and first aid manual.
17.19 Sec. 21. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 3, is
17.20amended to read:
17.21 Subd. 3. Staff ratio requirement for each person receiving services. The case
17.22manager, in consultation with the interdisciplinary team, must determine at least once each
17.23year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
17.24services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
17.25assigned each person and the documentation of how the ratio was arrived at must be kept
17.26in each person's individual service plan. Documentation must include an assessment of the
17.27person with respect to the characteristics in subdivisions 4, 5, and 6recorded on a standard
17.28assessment form required by the commissioner.
17.29 Sec. 22. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 4, is
17.30amended to read:
17.31 Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
17.32staff ratio requirement of one to four if:
18.1(1) on a daily basis the person requires total care and monitoring or constant
18.2hand-over-hand physical guidance to successfully complete at least three of the following
18.3activities: toileting, communicating basic needs, eating, ambulating; oris not capable of
18.4taking appropriate action for self-preservation under emergency conditions; or
18.5(2) the person engages in conduct that poses an imminent risk of physical harm to
18.6self or others at a documented level of frequency, intensity, or duration requiring frequent
18.7daily ongoing intervention and monitoring as established in the person's coordinated
18.8service and support plan or coordinated service and support plan addendum.
18.9 Sec. 23. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 5, is
18.10amended to read:
18.11 Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
18.12staff ratio requirement of one to eight if:
18.13(1) the person does not meet the requirements in subdivision 4; and
18.14(2) on a daily basis the person requires verbal prompts or spot checks and minimal
18.15or no physical assistance to successfully complete at leastfour three of the following
18.16activities: toileting, communicating basic needs, eating, or ambulating, or taking
18.17appropriate action for self-preservation under emergency conditions.
18.18 Sec. 24. REPEALER.
18.19Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 2, is repealed.
1.3standards; requiring review of the use of monitoring technology; imposing
1.4sanctions;amending Minnesota Statutes 2012, sections 245A.11, by adding a
1.5subdivision; 245A.155, subdivisions 1, 2, 3; 245A.65, subdivision 2; Minnesota
1.6Statutes 2013 Supplement, sections 245D.02, by adding a subdivision; 245D.05,
1.7subdivisions 1, 1b; 245D.06, subdivision 1; 245D.07, subdivision 2; 245D.071,
1.8subdivisions 1, 3, 4, 5; 245D.09, subdivisions 3, 4, 4a, 5; 245D.095, subdivision
1.93; 245D.22, subdivision 4; 245D.31, subdivisions 3, 4, 5; repealing Minnesota
1.10Statutes 2013 Supplement, section 245D.071, subdivision 2.
1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.12 Section 1. Minnesota Statutes 2012, section 245A.11, is amended by adding a
1.13subdivision to read:
1.14 Subd. 7c. Review; services through monitoring technology. (a) Lead agencies
1.15must submit individual service plans that include residential direct service care provided
1.16remotely through monitoring technology to the Monitoring Technology Review Panel
1.17established in section 256B.4914, subdivision 6, paragraph (d). The panel must verify that:
1.18(1) licensing standards have been applied;
1.19(2) the person's coordinated service and support plan includes the use of monitoring
1.20technology; and
1.21(3) signed informed consent has been obtained from the person or the person's
1.22legal representative.
1.23(b) The panel must meet quarterly to review service plans submitted by the lead
1.24agencies.
1.25(c) If the panel determines a service plan does not contain the information required
1.26in paragraph (a), clauses (1) to (3), the panel shall provide a written notice of the
1.27deficiencies to the lead agency and license holder. The lead agency and the license holder
2.1must submit to the panel missing or corrected documentation to cure the deficiencies
2.2within 90 calendar days.
2.3(d) If the lead agency and license holder contest the findings of the panel, the lead
2.4agency and license holder must submit a written request for reconsideration of the panel's
2.5findings to the commissioner within 60 calendar days. The commissioner's disposition of
2.6a request for reconsideration is final and not subject to appeal under chapter 14.
2.7(e) If neither the missing or corrected documentation nor a written request for
2.8reconsideration has been received by the panel within the designated time frames, the panel
2.9may recommend to the licensing authority that direct care staff supervision be placed on
2.10site during the hours remote monitoring had been approved for use, and that the payment
2.11rate to the provider be adjusted until the service plan deficiencies have been resolved.
2.12 Sec. 2. Minnesota Statutes 2012, section 245A.155, subdivision 1, is amended to read:
2.13 Subdivision 1. Licensed foster care and respite care. This section applies to
2.14foster care agencies and licensed foster care providers who place, supervise, or care for
2.15individuals who rely on medical
2.16ventilators, feeding tubes, or endotracheal tubes, to sustain life
2.17
2.18 Sec. 3. Minnesota Statutes 2012, section 245A.155, subdivision 2, is amended to read:
2.19 Subd. 2. Foster care agency requirements. In order for an agency to place an
2.20individual who relies on medical equipment to sustain life
2.21 with a foster care provider, the agency must ensure that the foster care provider has
2.22received the training to operate such equipment as observed and confirmed by a qualified
2.23source, and that the provider:
2.24(1) is currently caring for an individual who is using the same equipment in the
2.25foster home; or
2.26(2) has written documentation that the foster care provider has cared for an
2.27individual who relied on such equipment within the past six months; or
2.28(3) has successfully completed training with the individual being placed with the
2.29provider.
2.30 Sec. 4. Minnesota Statutes 2012, section 245A.155, subdivision 3, is amended to read:
2.31 Subd. 3. Foster care provider requirements. A foster care provider shall not care
2.32for an individual who relies on medical equipment to sustain life
3.1
3.2observed and confirmed by a qualified source, and:
3.3(1) is currently caring for an individual who is using the same equipment in the
3.4foster home; or
3.5(2) has written documentation that the foster care provider has cared for an
3.6individual who relied on such equipment within the past six months; or
3.7(3) has successfully completed training with the individual being placed with the
3.8provider.
3.9 Sec. 5. Minnesota Statutes 2012, section 245A.65, subdivision 2, is amended to read:
3.10 Subd. 2. Abuse prevention plans. All license holders shall establish and enforce
3.11ongoing written program abuse prevention plans and individual abuse prevention plans as
3.12required under section
3.13(a) The scope of the program abuse prevention plan is limited to the population,
3.14physical plant, and environment within the control of the license holder and the location
3.15where licensed services are provided. In addition to the requirements in section
3.16subdivision 14
3.17(1) to (5).
3.18(1) The assessment of the population shall include an evaluation of the following
3.19factors: age, gender, mental functioning, physical and emotional health or behavior of the
3.20client; the need for specialized programs of care for clients; the need for training of staff to
3.21meet identified individual needs; and the knowledge a license holder may have regarding
3.22previous abuse that is relevant to minimizing risk of abuse for clients.
3.23(2) The assessment of the physical plant where the licensed services are provided
3.24shall include an evaluation of the following factors: the condition and design of the
3.25building as it relates to the safety of the clients; and the existence of areas in the building
3.26which are difficult to supervise.
3.27(3) The assessment of the environment for each facility and for each site when living
3.28arrangements are provided by the agency shall include an evaluation of the following
3.29factors: the location of the program in a particular neighborhood or community; the type
3.30of grounds and terrain surrounding the building; the type of internal programming; and
3.31the program's staffing patterns.
3.32(4) The license holder shall provide an orientation to the program abuse prevention
3.33plan for clients receiving services. If applicable, the client's legal representative must be
3.34notified of the orientation. The license holder shall provide this orientation for each new
4.1person within 24 hours of admission, or for persons who would benefit more from a later
4.2orientation, the orientation may take place within 72 hours.
4.3(5) The license holder's
4.4the plan at least annually using the assessment factors in the plan and any substantiated
4.5maltreatment findings that occurred since the last review. The
4.6representative shall revise the plan, if necessary, to reflect the review results.
4.7(6) A copy of the program abuse prevention plan shall be posted in a prominent
4.8location in the program and be available upon request to mandated reporters, persons
4.9receiving services, and legal representatives.
4.10(b) In addition to the requirements in section
4.11abuse prevention plan shall meet the requirements in clauses (1) and (2).
4.12(1) The plan shall include a statement of measures that will be taken to minimize the
4.13risk of abuse to the vulnerable adult when the individual assessment required in section
4.15specific measures identified in the program abuse prevention plan. The measures shall
4.16include the specific actions the program will take to minimize the risk of abuse within
4.17the scope of the licensed services, and will identify referrals made when the vulnerable
4.18adult is susceptible to abuse outside the scope or control of the licensed services. When
4.19the assessment indicates that the vulnerable adult does not need specific risk reduction
4.20measures in addition to those identified in the program abuse prevention plan, the
4.21individual abuse prevention plan shall document this determination.
4.22(2) An individual abuse prevention plan shall be developed for each new person as
4.23part of the initial individual program plan or service plan required under the applicable
4.24licensing rule. The review and evaluation of the individual abuse prevention plan shall
4.25be done as part of the review of the program plan or service plan. The person receiving
4.26services shall participate in the development of the individual abuse prevention plan to the
4.27full extent of the person's abilities. If applicable, the person's legal representative shall be
4.28given the opportunity to participate with or for the person in the development of the plan.
4.29The interdisciplinary team shall document the review of all abuse prevention plans at least
4.30annually, using the individual assessment and any reports of abuse relating to the person.
4.31The plan shall be revised to reflect the results of this review.
4.32 Sec. 6. Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding a
4.33subdivision to read:
4.34 Subd. 37. Working day. "Working day" means Monday, Tuesday, Wednesday,
4.35Thursday, or Friday, excluding any legal holiday.
5.1 Sec. 7. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
5.2amended to read:
5.3 Subdivision 1. Health needs. (a) The license holder is responsible for meeting
5.4health service needs assigned in the coordinated service and support plan or the
5.5coordinated service and support plan addendum, consistent with the person's health needs.
5.6The license holder is responsible for
5.7if any, and the case manager of changes in a person's physical and mental health needs
5.8affecting health service needs assigned to the license holder in the coordinated service and
5.9support plan or the coordinated service and support plan addendum
5.10the coordinated service and support plan or within 24 hours of being discovered by the
5.11license holder, unless the license holder has reason to know the change has already been
5.12reported. The license holder must document when the notice is provided.
5.13(b) If responsibility for meeting the person's health service needs has been assigned
5.14to the license holder in the coordinated service and support plan or the coordinated service
5.15and support plan addendum, the license holder must maintain documentation on how the
5.16person's health needs will be met, including a description of the procedures the license
5.17holder will follow in order to:
5.18(1) provide medication assistance or medication administration according to this
5.19chapter;
5.20(2) monitor health conditions according to written instructions from a licensed
5.21health professional;
5.22(3) assist with or coordinate medical, dental, and other health service appointments; or
5.23(4) use medical equipment, devices, or adaptive aides or technology safely and
5.24correctly according to written instructions from a licensed health professional.
5.25 Sec. 8. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b, is
5.26amended to read:
5.27 Subd. 1b. Medication assistance. If responsibility for medication assistance
5.28is assigned to the license holder in the coordinated service and support plan or the
5.29coordinated service and support plan addendum,
5.30
5.31 medication assistance must be provided to enable a person to self-administer medication
5.32or treatment when the person is capable of directing the person's own care, or when the
5.33person's legal representative is present and able to direct care for the person. For the
5.34purposes of this subdivision, "medication assistance" means any of the following:
6.1(1) bringing to the person and opening a container of previously set up medications,
6.2emptying the container into the person's hand, or opening and giving the medications in
6.3the original container to the person;
6.4(2) bringing to the person liquids or food to accompany the medication; or
6.5(3) providing reminders, in person, remotely, or through programming devices
6.6such as telephones, alarms, or medication boxes, to take regularly scheduled medication
6.7or perform regularly scheduled treatments and exercises.
6.8 Sec. 9. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
6.9amended to read:
6.10 Subdivision 1. Incident response and reporting. (a) The license holder must
6.11respond to incidents under section
6.12services to protect the health and safety of and minimize risk of harm to the person.
6.13(b) The license holder must maintain information about and report incidents to the
6.14person's legal representative or designated emergency contact and case manager within
6.1524 hours of an incident occurring while services are being provided, within 24 hours of
6.16discovery or receipt of information that an incident occurred, unless the license holder
6.17has reason to know that the incident has already been reported, or as otherwise directed
6.18in a person's coordinated service and support plan or coordinated service and support
6.19plan addendum. An incident of suspected or alleged maltreatment must be reported as
6.20required under paragraph (d), and an incident of serious injury or death must be reported
6.21as required under paragraph (e).
6.22(c) When the incident involves more than one person, the license holder must not
6.23disclose personally identifiable information about any other person when making the report
6.24to each person and case manager unless the license holder has the consent of the person.
6.25(d) Within 24 hours of reporting maltreatment as required under section
6.27reason to believe that the case manager is involved in the suspected maltreatment. The
6.28license holder must disclose the nature of the activity or occurrence reported and the
6.29agency that received the report.
6.30(e) The license holder must report the death or serious injury of the person as
6.31required in paragraph (b) and to the Department of Human Services Licensing Division,
6.32and the Office of Ombudsman for Mental Health and Developmental Disabilities as
6.33required under section
6.34injury, or receipt of information that the death or serious injury occurred, unless the license
6.35holder has reason to know that the death or serious injury has already been reported.
7.1(f) When a death or serious injury occurs in a facility certified as an intermediate
7.2care facility for persons with developmental disabilities, the death or serious injury must
7.3be reported to the Department of Health, Office of Health Facility Complaints, and the
7.4Office of Ombudsman for Mental Health and Developmental Disabilities, as required
7.5under sections
7.6know that the death or serious injury has already been reported.
7.7(g) The license holder must conduct an internal review of incident reports of deaths
7.8and serious injuries that occurred while services were being provided and that were not
7.9reported by the program as alleged or suspected maltreatment, for identification of incident
7.10patterns, and implementation of corrective action as necessary to reduce occurrences.
7.11The review must include an evaluation of whether related policies and procedures were
7.12followed, whether the policies and procedures were adequate, whether there is a need for
7.13additional staff training, whether the reported event is similar to past events with the
7.14persons or the services involved, and whether there is a need for corrective action by the
7.15license holder to protect the health and safety of persons receiving services. Based on
7.16the results of this review, the license holder must develop, document, and implement a
7.17corrective action plan designed to correct current lapses and prevent future lapses in
7.18performance by staff or the license holder, if any.
7.19(h) The license holder must verbally report the emergency use of manual restraint of
7.20a person as required in paragraph (b) within 24 hours of the occurrence. The license holder
7.21must ensure the written report and internal review of all incident reports of the emergency
7.22use of manual restraints are completed according to the requirements in section
7.23 Sec. 10. Minnesota Statutes 2013 Supplement, section 245D.07, subdivision 2, is
7.24amended to read:
7.25 Subd. 2. Service planning requirements for basic support services and certain
7.26intensive support services. (a) License holders providing basic support services or
7.27intensive support services identified in section 245D.03, subdivision 1, paragraph (c),
7.28clauses (1) and (2), must meet the requirements of this subdivision.
7.29(b) Within 15 calendar days of service initiation the license holder must complete
7.30a preliminary coordinated service and support plan addendum based on the coordinated
7.31service and support plan.
7.32(c) Within 60 calendar days of service initiation the license holder must review
7.33and revise as needed the preliminary coordinated service and support plan addendum to
7.34document the services that will be provided including how, when, and by whom services
8.1will be provided, and the person responsible for overseeing the delivery and coordination
8.2of services.
8.3(d) The license holder must participate in service planning and support team
8.4meetings for the person following stated timelines established in the person's coordinated
8.5service and support plan or as requested by the person or the person's legal representative,
8.6the support team or the expanded support team.
8.7 Sec. 11. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 1,
8.8is amended to read:
8.9 Subdivision 1. Requirements for certain intensive support services. A license
8.10holder providing intensive support services identified in section
8.11paragraph (c), clauses (3) to (5), must comply with the requirements in this section and
8.12section
8.13 Sec. 12. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
8.14is amended to read:
8.15 Subd. 3. Assessment and initial service planning. (a) Within 15 calendar days of
8.16service initiation the license holder must complete a preliminary coordinated service and
8.17support plan addendum based on the coordinated service and support plan.
8.18(b) Within 45 calendar days of service initiation the license holder must meet with
8.19the person, the person's legal representative, the case manager, and other members of the
8.20support team or expanded support team to assess and determine the following based on the
8.21person's coordinated service and support plan and the requirements in subdivision 4 and
8.22section
8.23(1) the scope of the services to be provided to support the person's daily needs
8.24and activities;
8.25(2) the person's desired outcomes and the supports necessary to accomplish the
8.26person's desired outcomes;
8.27(3) the person's preferences for how services and supports are provided;
8.28(4) whether the current service setting is the most integrated setting available and
8.29appropriate for the person; and
8.30(5) how services must be coordinated across other providers licensed under this
8.31chapter serving the same person to ensure continuity of care for the person.
8.32(c) Within the scope of services, the license holder must, at a minimum, assess
8.33the following areas:
9.1(1) the person's ability to self-manage health and medical needs to maintain or
9.2improve physical, mental, and emotional well-being, including, when applicable, allergies,
9.3seizures, choking, special dietary needs, chronic medical conditions, self-administration
9.4of medication or treatment orders, preventative screening, and medical and dental
9.5appointments;
9.6(2) the person's ability to self-manage personal safety to avoid injury or accident in
9.7the service setting, including, when applicable, risk of falling, mobility, regulating water
9.8temperature, community survival skills, water safety skills, and sensory disabilities; and
9.9(3) the person's ability to self-manage symptoms or behavior that may otherwise
9.10result in an incident as defined in section
9.11suspension or termination of services by the license holder, or other symptoms or
9.12behaviors that may jeopardize the health and safety of the person or others.
9.13The assessments must produce information about the person that is descriptive of the
9.14person's overall strengths, functional skills and abilities, and behaviors or symptoms.
9.15 Sec. 13. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 4,
9.16is amended to read:
9.17 Subd. 4. Service outcomes and supports. (a) Within ten working days of the
9.1845-day meeting, the license holder must develop and document the service outcomes and
9.19supports based on the assessments completed under subdivision 3 and the requirements
9.20in section
9.21coordinated service and support plan addendum.
9.22(b) The license holder must document the supports and methods to be implemented
9.23to support the accomplishment of outcomes related to acquiring, retaining, or improving
9.24skills. The documentation must include:
9.25(1) the methods or actions that will be used to support the person and to accomplish
9.26the service outcomes, including information about:
9.27(i) any changes or modifications to the physical and social environments necessary
9.28when the service supports are provided;
9.29(ii) any equipment and materials required; and
9.30(iii) techniques that are consistent with the person's communication mode and
9.31learning style;
9.32(2) the measurable and observable criteria for identifying when the desired outcome
9.33has been achieved and how data will be collected;
10.1(3) the projected starting date for implementing the supports and methods and
10.2the date by which progress towards accomplishing the outcomes will be reviewed and
10.3evaluated; and
10.4(4) the names of the staff or position responsible for implementing the supports
10.5and methods.
10.6(c) Within 20 working days of the 45-day meeting, the license holder must submit
10.7to and obtain dated signatures from the person or the person's legal representative and
10.8case manager to document completion and approval of the assessment and coordinated
10.9service and support plan addendum. If, within ten working days of the submission of the
10.10assessment or coordinated service and support plan addendum, the person or the person's
10.11legal representative or case manager has not signed and returned to the license holder the
10.12assessment and coordinated service and support plan addendum or has not proposed
10.13written modifications to the license holder's submission, the submission is deemed
10.14approved and the assessment and coordinated service and support plan addendum become
10.15effective and remain in effect until the legal representative or case manager submits a
10.16written request to revise the assessment or coordinated service and support plan addendum.
10.17 Sec. 14. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 5,
10.18is amended to read:
10.19 Subd. 5. Progress reviews. (a) The license holder must give the person or the
10.20person's legal representative and case manager an opportunity to participate in the ongoing
10.21review and development of the methods used to support the person and accomplish
10.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
10.23the person's support team or expanded support team, must meet with the person, the
10.24person's legal representative, and the case manager, and participate in progress review
10.25meetings following stated timelines established in the person's coordinated service and
10.26support plan or coordinated service and support plan addendum or within 30 days of a
10.27written request by the person, the person's legal representative, or the case manager,
10.28at a minimum of once per year.
10.29(b) The license holder must summarize the person's progress toward achieving the
10.30identified outcomes and make recommendations and identify the rationale for changing,
10.31continuing, or discontinuing implementation of supports and methods identified in
10.32subdivision 4
10.33
10.34
10.35 available at the time of the progress review meeting. The report must be sent five working
11.1days prior to the progress review meeting if requested by the team in the coordinated
11.2service and support plan or coordinated service and support plan addendum.
11.3(c) Within ten working days of the progress review meeting, the license holder
11.4must obtain dated signatures from the person or the person's legal representative and
11.5the case manager to document approval of any changes to the coordinated service and
11.6support plan addendum.
11.7(d) If, within ten working days of the submission of the changes to the coordinated
11.8service and support plan addendum, the person or the person's legal representative or case
11.9manager has not signed and returned to the license holder the coordinated service and
11.10support plan addendum or has not proposed written modifications to the license holder's
11.11submission, the submission is deemed approved and the coordinated service and support
11.12plan addendum becomes effective and remains in effect until the legal representative or
11.13case manager submits a written request to revise the coordinated service and support plan.
11.14 Sec. 15. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 3, is
11.15amended to read:
11.16 Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
11.17direct support, or staff who have responsibilities related to supervising or managing the
11.18provision of direct support service, are competent as demonstrated through skills and
11.19knowledge training, experience, and education to meet the person's needs and additional
11.20requirements as written in the coordinated service and support plan or coordinated
11.21service and support plan addendum, or when otherwise required by the case manager or
11.22the federal waiver plan. The license holder must verify and maintain evidence of staff
11.23competency, including documentation of:
11.24(1) education and experience qualifications relevant to the job responsibilities
11.25assigned to the staff and the needs of the general population of persons served by the
11.26program, including a valid degree and transcript, or a current license, registration, or
11.27certification, when a degree or licensure, registration, or certification is required by this
11.28chapter or in the coordinated service and support plan or coordinated service and support
11.29plan addendum;
11.30(2) demonstrated competency in the orientation and training areas required under
11.31this chapter, and when applicable, completion of continuing education required to
11.32maintain professional licensure, registration, or certification requirements. Competency in
11.33these areas is determined by the license holder through knowledge testing
11.34skill assessment conducted by the trainer or instructor, the person served if the person is
11.35self-directing services, or another person already deemed competent; and
12.1(3) except for a license holder who is the sole direct support staff, periodic
12.2performance evaluations completed by the license holder of the direct support staff
12.3person's ability to perform the job functions based on direct observation.
12.4(b) Staff under 18 years of age may not perform overnight duties or administer
12.5medication.
12.6 Sec. 16. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4, is
12.7amended to read:
12.8 Subd. 4. Orientation to program requirements. Except for a license holder
12.9who does not supervise any direct support staff, within 60 calendar days of hire, unless
12.10stated otherwise, the license holder must provide and ensure completion of ten hours of
12.11orientation for direct support staff providing basic services and 30 hours of orientation
12.12for direct support staff providing intensive services that combines supervised on-the-job
12.13training with review of and instruction in the following areas:
12.14(1) the job description and how to complete specific job functions, including:
12.15(i) responding to and reporting incidents as required under section
12.16subdivision 1; and
12.17(ii) following safety practices established by the license holder and as required in
12.18section
12.19(2) the license holder's current policies and procedures required under this chapter,
12.20including their location and access, and staff responsibilities related to implementation
12.21of those policies and procedures;
12.22(3) data privacy requirements according to sections
12.23federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
12.24responsibilities related to complying with data privacy practices;
12.25(4) the service recipient rights and staff responsibilities related to ensuring the
12.26exercise and protection of those rights according to the requirements in section
12.27(5) sections
12.28reporting and service planning for children and vulnerable adults, and staff responsibilities
12.29related to protecting persons from maltreatment and reporting maltreatment. This
12.30orientation must be provided within 72 hours of first providing direct contact services and
12.31annually thereafter according to section
12.32(6) the principles of person-centered service planning and delivery as identified in
12.33section
12.34by the staff person;
13.1(7) the safe and correct use of manual restraint on an emergency basis according to
13.2the requirements in section 245D.061 and what constitutes the use of restraints, time out,
13.3and seclusion, including chemical restraint;
13.4(8) staff responsibilities related to prohibited procedures under section 245D.06,
13.5subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
13.6or undesired behavior, and why such procedures are not safe;
13.7(9) competence in providing basic first aid; and
13.8(10) other topics as determined necessary in the person's coordinated service and
13.9support plan by the case manager or other areas identified by the license holder.
13.10 Sec. 17. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4a,
13.11is amended to read:
13.12 Subd. 4a. Orientation to individual service recipient needs. (a) Before having
13.13unsupervised direct contact with a person served by the program, or for whom the staff
13.14person has not previously provided direct support, or any time the plans or procedures
13.15identified in paragraphs (b) to
13.16instruction on the requirements in paragraphs (b) to
13.17person's job functions for that person.
13.18(b) For community residential services, training and competency evaluations must
13.19include the following, if identified in the coordinated service and support plan:
13.20(1) appropriate and safe techniques in personal hygiene and grooming, including
13.21hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
13.22daily living (ADLs) as defined under section
13.23(2) an understanding of what constitutes a healthy diet according to data from the
13.24Centers for Disease Control and Prevention and the skills necessary to prepare that diet; and
13.25(3) skills necessary to provide appropriate support in instrumental activities of daily
13.26living (IADLs) as defined under section
13.27
13.28(c) The staff person must review and receive instruction on the person's coordinated
13.29service and support plan or coordinated service and support plan addendum as it relates
13.30to the responsibilities assigned to the license holder, and when applicable, the person's
13.31individual abuse prevention plan, to achieve and demonstrate an understanding of the
13.32person as a unique individual, and how to implement those plans.
13.33(d) The staff person must review and receive instruction on medication
13.34administration procedures established for the person when medication administration is
13.35assigned to the license holder according to section
14.1(b). Unlicensed staff may administer medications only after successful completion of a
14.2medication administration training, from a training curriculum developed by a registered
14.3nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
14.4practitioner, physician's assistant, or physician. The training curriculum must incorporate
14.5an observed skill assessment conducted by the trainer to ensure staff demonstrate the
14.6ability to safely and correctly follow medication procedures.
14.7Medication administration must be taught by a registered nurse, clinical nurse
14.8specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
14.9service initiation or any time thereafter, the person has or develops a health care condition
14.10that affects the service options available to the person because the condition requires:
14.11(1) specialized or intensive medical or nursing supervision; and
14.12(2) nonmedical service providers to adapt their services to accommodate the health
14.13and safety needs of the person.
14.14(e) The staff person must review and receive instruction on the safe and correct
14.15operation of medical equipment used by the person to sustain life, including but not
14.16limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
14.17by a licensed health care professional or a manufacturer's representative and incorporate
14.18an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
14.19operate the equipment according to the treatment orders and the manufacturer's instructions.
14.20(f)
14.21
14.22
14.23
14.24
14.25
14.26
14.27the training required in this subdivision occurs within 72 hours of the direct support staff
14.28person first having unsupervised contact with the person receiving services. The license
14.29holder must document the reason for the unplanned or emergency service initiation and
14.30maintain the documentation in the person's service recipient record.
14.31
14.32complete the orientation required in subdivision 4, clauses (3) to
14.33 Sec. 18. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 5, is
14.34amended to read:
15.1 Subd. 5. Annual training. A license holder must provide annual training to direct
15.2support staff on the topics identified in subdivision 4, clauses (3) to
15.3
15.4direct service staff
15.5of documented experience and 12 hours of annual training to direct service staff
15.6 providing intensive services and having five or more years of documented experience in
15.7topics described in subdivisions 4 and 4a, paragraphs (a) to
15.8topics received from sources other than the license holder may count toward training
15.9requirements. A license holder must provide a minimum of 12 hours of annual training
15.10to direct service staff providing basic services and having fewer than five years of
15.11documented experience and six hours of annual training to direct service staff providing
15.12basic services and having five or more years of documented experience.
15.13 Sec. 19. Minnesota Statutes 2013 Supplement, section 245D.095, subdivision 3,
15.14is amended to read:
15.15 Subd. 3. Service recipient record. (a) The license holder must maintain a record of
15.16current services provided to each person on the premises where the services are provided
15.17or coordinated. When the services are provided in a licensed facility, the records must
15.18be maintained at the facility, otherwise the records must be maintained at the license
15.19holder's program office. The license holder must protect service recipient records against
15.20loss, tampering, or unauthorized disclosure according to the requirements in sections
15.22(b) The license holder must maintain the following information for each person:
15.23(1) an admission form signed by the person or the person's legal representative
15.24that includes:
15.25(i) identifying information, including the person's name, date of birth, address,
15.26and telephone number; and
15.27(ii) the name, address, and telephone number of the person's legal representative, if
15.28any, and a primary emergency contact, the case manager, and family members or others as
15.29identified by the person or case manager;
15.30(2) service information, including service initiation information, verification of the
15.31person's eligibility for services, documentation verifying that services have been provided
15.32as identified in the coordinated service and support plan or coordinated service and support
15.33plan addendum according to paragraph (a), and date of admission or readmission;
16.1(3) health information, including medical history, special dietary needs, and
16.2allergies, and when the license holder is assigned responsibility for meeting the person's
16.3health service needs according to section
16.4(i) current orders for medication, treatments, or medical equipment and a signed
16.5authorization from the person or the person's legal representative to administer or assist in
16.6administering the medication or treatments, if applicable;
16.7(ii) a signed statement authorizing the license holder to act in a medical emergency
16.8when the person's legal representative, if any, cannot be reached or is delayed in arriving;
16.9(iii) medication administration procedures;
16.10(iv) a medication administration record documenting the implementation of the
16.11medication administration procedures, and the medication administration record reviews,
16.12including any agreements for administration of injectable medications by the license
16.13holder according to the requirements in section
16.14(v) a medical appointment schedule when the license holder is assigned
16.15responsibility for assisting with medical appointments;
16.16(4) the person's current coordinated service and support plan or that portion of the
16.17plan assigned to the license holder;
16.18(5) copies of the
16.19section
16.20(6) a record of other service providers serving the person when the person's
16.21coordinated service and support plan or coordinated service and support plan addendum
16.22identifies the need for coordination between the service providers, that includes a contact
16.23person and telephone numbers, services being provided, and names of staff responsible for
16.24coordination;
16.25(7) documentation of orientation to service recipient rights according to section
16.27section
16.28(8) copies of authorizations to handle a person's funds, according to section
16.29subdivision 4, paragraph (a);
16.30(9) documentation of complaints received and grievance resolution;
16.31(10) incident reports involving the person, required under section
16.32subdivision 1;
16.33(11) copies of written reports regarding the person's status when requested according
16.34to section
17.1and reports received from other agencies involved in providing services or care to the
17.2person; and
17.3(12) discharge summary, including service termination notice and related
17.4documentation, when applicable.
17.5 Sec. 20. Minnesota Statutes 2013 Supplement, section 245D.22, subdivision 4, is
17.6amended to read:
17.7 Subd. 4. First aid must be available on site. (a) A staff person trained in first
17.8aid must be available on site and, when required in a person's coordinated service and
17.9support plan or coordinated service and support plan addendum, be able to provide
17.10cardiopulmonary resuscitation, whenever persons are present and staff are required to be
17.11at the site to provide direct service. The CPR training must include
17.12hands-on practice, and an observed skills assessment under the direct supervision of a
17.13CPR instructor.
17.14(b) A facility must have first aid kits readily available for use by, and that meet
17.15the needs of, persons receiving services and staff. At a minimum, the first aid kit must
17.16be equipped with accessible first aid supplies including bandages, sterile compresses,
17.17scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
17.18adhesive tape, and first aid manual.
17.19 Sec. 21. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 3, is
17.20amended to read:
17.21 Subd. 3. Staff ratio requirement for each person receiving services. The case
17.22manager, in consultation with the interdisciplinary team, must determine at least once each
17.23year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
17.24services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
17.25assigned each person and the documentation of how the ratio was arrived at must be kept
17.26in each person's individual service plan. Documentation must include an assessment of the
17.27person with respect to the characteristics in subdivisions 4, 5, and 6
17.28
17.29 Sec. 22. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 4, is
17.30amended to read:
17.31 Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
17.32staff ratio requirement of one to four if:
18.1(1) on a daily basis the person requires total care and monitoring or constant
18.2hand-over-hand physical guidance to successfully complete at least three of the following
18.3activities: toileting, communicating basic needs, eating, ambulating; or
18.4
18.5(2) the person engages in conduct that poses an imminent risk of physical harm to
18.6self or others at a documented level of frequency, intensity, or duration requiring frequent
18.7daily ongoing intervention and monitoring as established in the person's coordinated
18.8service and support plan or coordinated service and support plan addendum.
18.9 Sec. 23. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 5, is
18.10amended to read:
18.11 Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
18.12staff ratio requirement of one to eight if:
18.13(1) the person does not meet the requirements in subdivision 4; and
18.14(2) on a daily basis the person requires verbal prompts or spot checks and minimal
18.15or no physical assistance to successfully complete at least
18.16activities: toileting, communicating basic needs, eating, or ambulating
18.17
18.18 Sec. 24. REPEALER.
18.19Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 2, is repealed.
