1.1                          A bill for an act 
  1.2             relating to human services; modifying background study 
  1.3             and other provisions in the Human Services Licensing 
  1.4             Act; expanding foster care license capacity; granting 
  1.5             authority for variances for overnight supervision in 
  1.6             adult foster care homes; modifying law providing for 
  1.7             consumer services for mental retardation conditions; 
  1.8             requiring a risk management plan for mental 
  1.9             retardation consumers; requiring providing mental 
  1.10            retardation consumers a copy of revisions to policies 
  1.11            and procedures affecting service-related or 
  1.12            protection-related rights; authorizing relocation 
  1.13            target case management providers to subcontract with 
  1.14            other providers; providing for diagnostic assessment 
  1.15            for adult rehabilitative mental health services; 
  1.16            providing for tribal management of elderly waivers; 
  1.17            amending Minnesota Statutes 2002, sections 245A.04, 
  1.18            subdivisions 3, 3b; 245A.09, subdivision 7; 245A.11, 
  1.19            subdivision 2a, by adding a subdivision; 245B.03, 
  1.20            subdivision 2, by adding a subdivision; 245B.04, 
  1.21            subdivision 2; 245B.06, subdivisions 2, 5; 245B.07, 
  1.22            subdivisions 6, 9; 245B.08, subdivision 1; 256B.0621, 
  1.23            subdivision 4; 256B.0623, subdivisions 2, 4, 5, 6, 8; 
  1.24            256B.0625, subdivision 19c; 256B.0627, subdivisions 1, 
  1.25            4, 9; 256B.0911, subdivision 4d; 256B.0915, by adding 
  1.26            a subdivision; 256B.431, by adding a subdivision; 
  1.27            256B.47, subdivision 2. 
  1.28  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.29                             ARTICLE 1 
  1.30               DEPARTMENT OF HUMAN SERVICES LICENSING 
  1.31     Section 1.  Minnesota Statutes 2002, section 245A.04, 
  1.32  subdivision 3, is amended to read: 
  1.33     Subd. 3.  [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 
  1.34  (a) Individuals and organizations that are required in statute 
  1.35  to initiate background studies under this section shall comply 
  1.36  with the following requirements: 
  2.1      (1) Applicants for licensure, license holders, and other 
  2.2   entities as provided in this section must submit completed 
  2.3   background study forms to the commissioner before individuals 
  2.4   specified in paragraph (c), clauses (1) to (4), (6), and (7), 
  2.5   begin positions allowing direct contact in any licensed program. 
  2.6      (2) Applicants and license holders under the jurisdiction 
  2.7   of other state agencies who are required in other statutory 
  2.8   sections to initiate background studies under this section must 
  2.9   submit completed background study forms to the commissioner 
  2.10  prior to the background study subject beginning in a position 
  2.11  allowing direct contact in the licensed program, or where 
  2.12  applicable, prior to being employed. 
  2.13     (3) Organizations required to initiate background studies 
  2.14  under section 256B.0627 for individuals described in paragraph 
  2.15  (c), clause (5), must submit a completed background study form 
  2.16  to the commissioner before those individuals begin a position 
  2.17  allowing direct contact with persons served by the 
  2.18  organization.  The commissioner shall recover the cost of these 
  2.19  background studies through a fee of no more than $12 per study 
  2.20  charged to the organization responsible for submitting the 
  2.21  background study form.  The fees collected under this paragraph 
  2.22  are appropriated to the commissioner for the purpose of 
  2.23  conducting background studies.  
  2.24     Upon receipt of the background study forms from the 
  2.25  entities in clauses (1) to (3), the commissioner shall complete 
  2.26  the background study as specified under this section and provide 
  2.27  notices required in subdivision 3a.  Unless otherwise specified, 
  2.28  the subject of a background study may have direct contact with 
  2.29  persons served by a program after the background study form is 
  2.30  mailed or submitted to the commissioner pending notification of 
  2.31  the study results under subdivision 3a.  A county agency may 
  2.32  accept a background study completed by the commissioner under 
  2.33  this section in place of the background study required under 
  2.34  section 245A.16, subdivision 3, in programs with joint licensure 
  2.35  as home and community-based services and adult foster care for 
  2.36  people with developmental disabilities when the license holder 
  3.1   does not reside in the foster care residence and the subject of 
  3.2   the study has been continuously affiliated with the license 
  3.3   holder since the date of the commissioner's study. 
  3.4      (b) The definitions in this paragraph apply only to 
  3.5   subdivisions 3 to 3e. 
  3.6      (1) "Background study" means the review of records 
  3.7   conducted by the commissioner to determine whether a subject is 
  3.8   disqualified from direct contact with persons served by a 
  3.9   program, and where specifically provided in statutes, whether a 
  3.10  subject is disqualified from having access to persons served by 
  3.11  a program. 
  3.12     (2) "Continuous, direct supervision" means an individual is 
  3.13  within sight or hearing of the supervising person to the extent 
  3.14  that supervising person is capable at all times of intervening 
  3.15  to protect the health and safety of the persons served by the 
  3.16  program. 
  3.17     (3) "Contractor" means any person, regardless of employer, 
  3.18  who is providing program services for hire under the control of 
  3.19  the provider. 
  3.20     (4) "Direct contact" means providing face-to-face care, 
  3.21  training, supervision, counseling, consultation, or medication 
  3.22  assistance to persons served by the program. 
  3.23     (5) "Reasonable cause" means information or circumstances 
  3.24  exist which provide the commissioner with articulable suspicion 
  3.25  that further pertinent information may exist concerning a 
  3.26  subject.  The commissioner has reasonable cause when, but not 
  3.27  limited to, the commissioner has received a report from the 
  3.28  subject, the license holder, or a third party indicating that 
  3.29  the subject has a history that would disqualify the person or 
  3.30  that may pose a risk to the health or safety of persons 
  3.31  receiving services. 
  3.32     (6) "Subject of a background study" means an individual on 
  3.33  whom a background study is required or completed. 
  3.34     (c) The applicant, license holder, registrant under section 
  3.35  144A.71, subdivision 1, bureau of criminal apprehension, 
  3.36  commissioner of health, and county agencies, after written 
  4.1   notice to the individual who is the subject of the study, shall 
  4.2   help with the study by giving the commissioner criminal 
  4.3   conviction data and reports about the maltreatment of adults 
  4.4   substantiated under section 626.557 and the maltreatment of 
  4.5   minors in licensed programs substantiated under section 
  4.6   626.556.  If a background study is initiated by an applicant or 
  4.7   license holder and the applicant or license holder receives 
  4.8   information about the possible criminal or maltreatment history 
  4.9   of an individual who is the subject of the background study, the 
  4.10  applicant or license holder must immediately provide the 
  4.11  information to the commissioner.  The individuals to be studied 
  4.12  shall include: 
  4.13     (1) the applicant; 
  4.14     (2) persons age 13 and over living in the household where 
  4.15  the licensed program will be provided; 
  4.16     (3) current employees or contractors of the applicant who 
  4.17  will have direct contact with persons served by the facility, 
  4.18  agency, or program; 
  4.19     (4) volunteers or student volunteers who have direct 
  4.20  contact with persons served by the program to provide program 
  4.21  services, if the contact is not under the continuous, direct 
  4.22  supervision by an individual listed in clause (1) or (3); 
  4.23     (5) any person required under section 256B.0627 to have a 
  4.24  background study completed under this section; 
  4.25     (6) persons ages 10 to 12 living in the household where the 
  4.26  licensed services will be provided when the commissioner has 
  4.27  reasonable cause; and 
  4.28     (7) persons who, without providing direct contact services 
  4.29  at a licensed program, may have unsupervised access to children 
  4.30  or vulnerable adults receiving services from the program 
  4.31  licensed to provide family child care for children, foster care 
  4.32  for children in the provider's own home, or foster care or day 
  4.33  care services for adults in the provider's own home when the 
  4.34  commissioner has reasonable cause. 
  4.35     (d) According to paragraph (c), clauses (2) and (6), the 
  4.36  commissioner shall review records from the juvenile courts.  For 
  5.1   persons under paragraph (c), clauses (1), (3), (4), (5), and 
  5.2   (7), who are ages 13 to 17, the commissioner shall review 
  5.3   records from the juvenile courts when the commissioner has 
  5.4   reasonable cause.  The juvenile courts shall help with the study 
  5.5   by giving the commissioner existing juvenile court records on 
  5.6   individuals described in paragraph (c), clauses (2), (6), and 
  5.7   (7), relating to delinquency proceedings held within either the 
  5.8   five years immediately preceding the background study or the 
  5.9   five years immediately preceding the individual's 18th birthday, 
  5.10  whichever time period is longer.  The commissioner shall destroy 
  5.11  juvenile records obtained pursuant to this subdivision when the 
  5.12  subject of the records reaches age 23. 
  5.13     (e) Beginning August 1, 2001, the commissioner shall 
  5.14  conduct all background studies required under this chapter and 
  5.15  initiated by supplemental nursing services agencies registered 
  5.16  under section 144A.71, subdivision 1.  Studies for the agencies 
  5.17  must be initiated annually by each agency.  The commissioner 
  5.18  shall conduct the background studies according to this chapter.  
  5.19  The commissioner shall recover the cost of the background 
  5.20  studies through a fee of no more than $8 per study, charged to 
  5.21  the supplemental nursing services agency.  The fees collected 
  5.22  under this paragraph are appropriated to the commissioner for 
  5.23  the purpose of conducting background studies. 
  5.24     (f) For purposes of this section, a finding that a 
  5.25  delinquency petition is proven in juvenile court shall be 
  5.26  considered a conviction in state district court. 
  5.27     (g) A study of an individual in paragraph (c), clauses (1) 
  5.28  to (7), shall be conducted at least upon application for initial 
  5.29  license for all license types or registration under section 
  5.30  144A.71, subdivision 1, and at reapplication for a license for 
  5.31  family child care, child foster care, and adult foster care.  
  5.32  The commissioner is not required to conduct a study of an 
  5.33  individual at the time of reapplication for a license or if the 
  5.34  individual has been continuously affiliated with a foster care 
  5.35  provider licensed by the commissioner of human services and 
  5.36  registered under chapter 144D, other than a family day care or 
  6.1   foster care license, if:  (i) a study of the individual was 
  6.2   conducted either at the time of initial licensure or when the 
  6.3   individual became affiliated with the license holder; (ii) the 
  6.4   individual has been continuously affiliated with the license 
  6.5   holder since the last study was conducted; and (iii) the 
  6.6   procedure described in paragraph (j) has been implemented and 
  6.7   was in effect continuously since the last study was conducted.  
  6.8   For the purposes of this section, a physician licensed under 
  6.9   chapter 147 is considered to be continuously affiliated upon the 
  6.10  license holder's receipt from the commissioner of health or 
  6.11  human services of the physician's background study results.  For 
  6.12  individuals who are required to have background studies under 
  6.13  paragraph (c) and who have been continuously affiliated with a 
  6.14  foster care provider that is licensed in more than one county, 
  6.15  criminal conviction data may be shared among those counties in 
  6.16  which the foster care programs are licensed.  A county agency's 
  6.17  receipt of criminal conviction data from another county agency 
  6.18  shall meet the criminal data background study requirements of 
  6.19  this section. 
  6.20     (h) The commissioner may also conduct studies on 
  6.21  individuals specified in paragraph (c), clauses (3) and (4), 
  6.22  when the studies are initiated by: 
  6.23     (i) personnel pool agencies; 
  6.24     (ii) temporary personnel agencies; 
  6.25     (iii) educational programs that train persons by providing 
  6.26  direct contact services in licensed programs; and 
  6.27     (iv) professional services agencies that are not licensed 
  6.28  and which contract with licensed programs to provide direct 
  6.29  contact services or individuals who provide direct contact 
  6.30  services. 
  6.31     (i) Studies on individuals in paragraph (h), items (i) to 
  6.32  (iv), must be initiated annually by these agencies, programs, 
  6.33  and individuals.  Except as provided in paragraph (a), clause 
  6.34  (3), no applicant, license holder, or individual who is the 
  6.35  subject of the study shall pay any fees required to conduct the 
  6.36  study. 
  7.1      (1) At the option of the licensed facility, rather than 
  7.2   initiating another background study on an individual required to 
  7.3   be studied who has indicated to the licensed facility that a 
  7.4   background study by the commissioner was previously completed, 
  7.5   the facility may make a request to the commissioner for 
  7.6   documentation of the individual's background study status, 
  7.7   provided that: 
  7.8      (i) the facility makes this request using a form provided 
  7.9   by the commissioner; 
  7.10     (ii) in making the request the facility informs the 
  7.11  commissioner that either: 
  7.12     (A) the individual has been continuously affiliated with a 
  7.13  licensed facility since the individual's previous background 
  7.14  study was completed, or since October 1, 1995, whichever is 
  7.15  shorter; or 
  7.16     (B) the individual is affiliated only with a personnel pool 
  7.17  agency, a temporary personnel agency, an educational program 
  7.18  that trains persons by providing direct contact services in 
  7.19  licensed programs, or a professional services agency that is not 
  7.20  licensed and which contracts with licensed programs to provide 
  7.21  direct contact services or individuals who provide direct 
  7.22  contact services; and 
  7.23     (iii) the facility provides notices to the individual as 
  7.24  required in paragraphs (a) to (j), and that the facility is 
  7.25  requesting written notification of the individual's background 
  7.26  study status from the commissioner.  
  7.27     (2) The commissioner shall respond to each request under 
  7.28  paragraph (1) with a written or electronic notice to the 
  7.29  facility and the study subject.  If the commissioner determines 
  7.30  that a background study is necessary, the study shall be 
  7.31  completed without further request from a licensed agency or 
  7.32  notifications to the study subject.  
  7.33     (3) When a background study is being initiated by a 
  7.34  licensed facility or a foster care provider that is also 
  7.35  registered under chapter 144D, a study subject affiliated with 
  7.36  multiple licensed facilities may attach to the background study 
  8.1   form a cover letter indicating the additional facilities' names, 
  8.2   addresses, and background study identification numbers.  When 
  8.3   the commissioner receives such notices, each facility identified 
  8.4   by the background study subject shall be notified of the study 
  8.5   results.  The background study notice sent to the subsequent 
  8.6   agencies shall satisfy those facilities' responsibilities for 
  8.7   initiating a background study on that individual. 
  8.8      (j) If an individual who is affiliated with a program or 
  8.9   facility regulated by the department of human services or 
  8.10  department of health or who is affiliated with any type of home 
  8.11  care agency or provider of personal care assistance services, is 
  8.12  convicted of a crime constituting a disqualification under 
  8.13  subdivision 3d, the probation officer or corrections agent shall 
  8.14  notify the commissioner of the conviction.  For the purpose of 
  8.15  this paragraph, "conviction" has the meaning given it in section 
  8.16  609.02, subdivision 5.  The commissioner, in consultation with 
  8.17  the commissioner of corrections, shall develop forms and 
  8.18  information necessary to implement this paragraph and shall 
  8.19  provide the forms and information to the commissioner of 
  8.20  corrections for distribution to local probation officers and 
  8.21  corrections agents.  The commissioner shall inform individuals 
  8.22  subject to a background study that criminal convictions for 
  8.23  disqualifying crimes will be reported to the commissioner by the 
  8.24  corrections system.  A probation officer, corrections agent, or 
  8.25  corrections agency is not civilly or criminally liable for 
  8.26  disclosing or failing to disclose the information required by 
  8.27  this paragraph.  Upon receipt of disqualifying information, the 
  8.28  commissioner shall provide the notifications required in 
  8.29  subdivision 3a, as appropriate to agencies on record as having 
  8.30  initiated a background study or making a request for 
  8.31  documentation of the background study status of the individual.  
  8.32  This paragraph does not apply to family day care and child 
  8.33  foster care programs. 
  8.34     (k) The individual who is the subject of the study must 
  8.35  provide the applicant or license holder with sufficient 
  8.36  information to ensure an accurate study including the 
  9.1   individual's first, middle, and last name and all other names by 
  9.2   which the individual has been known; home address, city, county, 
  9.3   and state of residence for the past five years; zip code; sex; 
  9.4   date of birth; and driver's license number or state 
  9.5   identification number.  The applicant or license holder shall 
  9.6   provide this information about an individual in paragraph (c), 
  9.7   clauses (1) to (7), on forms prescribed by the commissioner.  By 
  9.8   January 1, 2000, for background studies conducted by the 
  9.9   department of human services, the commissioner shall implement a 
  9.10  system for the electronic transmission of:  (1) background study 
  9.11  information to the commissioner; and (2) background study 
  9.12  results to the license holder.  The commissioner may request 
  9.13  additional information of the individual, which shall be 
  9.14  optional for the individual to provide, such as the individual's 
  9.15  social security number or race. 
  9.16     (l) For programs directly licensed by the commissioner, a 
  9.17  study must include information related to names of substantiated 
  9.18  perpetrators of maltreatment of vulnerable adults that has been 
  9.19  received by the commissioner as required under section 626.557, 
  9.20  subdivision 9c, paragraph (i), and the commissioner's records 
  9.21  relating to the maltreatment of minors in licensed programs, 
  9.22  information from juvenile courts as required in paragraph (c) 
  9.23  for persons listed in paragraph (c), clauses (2), (6), and (7), 
  9.24  and information from the bureau of criminal apprehension.  For 
  9.25  child foster care, adult foster care, and family day care homes, 
  9.26  the study must include information from the county agency's 
  9.27  record of substantiated maltreatment of adults, and the 
  9.28  maltreatment of minors, information from juvenile courts as 
  9.29  required in paragraph (c) for persons listed in paragraph (c), 
  9.30  clauses (2), (6), and (7), and information from the bureau of 
  9.31  criminal apprehension.  The commissioner may also review arrest 
  9.32  and investigative information from the bureau of criminal 
  9.33  apprehension, the commissioner of health, a county attorney, 
  9.34  county sheriff, county agency, local chief of police, other 
  9.35  states, the courts, or the Federal Bureau of Investigation if 
  9.36  the commissioner has reasonable cause to believe the information 
 10.1   is pertinent to the disqualification of an individual listed in 
 10.2   paragraph (c), clauses (1) to (7).  The commissioner is not 
 10.3   required to conduct more than one review of a subject's records 
 10.4   from the Federal Bureau of Investigation if a review of the 
 10.5   subject's criminal history with the Federal Bureau of 
 10.6   Investigation has already been completed by the commissioner and 
 10.7   there has been no break in the subject's affiliation with the 
 10.8   license holder who initiated the background study. 
 10.9      (m) For any background study completed under this section, 
 10.10  when the commissioner has reasonable cause to believe that 
 10.11  further pertinent information may exist on the subject, the 
 10.12  subject shall provide a set of classifiable fingerprints 
 10.13  obtained from an authorized law enforcement agency.  For 
 10.14  purposes of requiring fingerprints, the commissioner shall be 
 10.15  considered to have reasonable cause under, but not limited to, 
 10.16  the following circumstances: 
 10.17     (1) information from the bureau of criminal apprehension 
 10.18  indicates that the subject is a multistate offender; 
 10.19     (2) information from the bureau of criminal apprehension 
 10.20  indicates that multistate offender status is undetermined; or 
 10.21     (3) the commissioner has received a report from the subject 
 10.22  or a third party indicating that the subject has a criminal 
 10.23  history in a jurisdiction other than Minnesota. 
 10.24     (n) The failure or refusal of an applicant, license holder, 
 10.25  or registrant under section 144A.71, subdivision 1, to cooperate 
 10.26  with the commissioner is reasonable cause to disqualify a 
 10.27  subject, deny a license application or immediately suspend, 
 10.28  suspend, or revoke a license or registration.  Failure or 
 10.29  refusal of an individual to cooperate with the study is just 
 10.30  cause for denying or terminating employment of the individual if 
 10.31  the individual's failure or refusal to cooperate could cause the 
 10.32  applicant's application to be denied or the license holder's 
 10.33  license to be immediately suspended, suspended, or revoked. 
 10.34     (o) The commissioner shall not consider an application to 
 10.35  be complete until all of the information required to be provided 
 10.36  under this subdivision has been received.  
 11.1      (p) No person in paragraph (c), clauses (1) to (7), who is 
 11.2   disqualified as a result of this section may be retained by the 
 11.3   agency in a position involving direct contact with persons 
 11.4   served by the program and no person in paragraph (c), clauses 
 11.5   (2), (6), and (7), or as provided elsewhere in statute who is 
 11.6   disqualified as a result of this section may be allowed access 
 11.7   to persons served by the program, unless the commissioner has 
 11.8   provided written notice to the agency stating that: 
 11.9      (1) the individual may remain in direct contact during the 
 11.10  period in which the individual may request reconsideration as 
 11.11  provided in subdivision 3a, paragraph (b), clause (2) or (3); 
 11.12     (2) the individual's disqualification has been set aside 
 11.13  for that agency as provided in subdivision 3b, paragraph (b); or 
 11.14     (3) the license holder has been granted a variance for the 
 11.15  disqualified individual under subdivision 3e. 
 11.16     (q) Termination of affiliation with persons in paragraph 
 11.17  (c), clauses (1) to (7), made in good faith reliance on a notice 
 11.18  of disqualification provided by the commissioner shall not 
 11.19  subject the applicant or license holder to civil liability. 
 11.20     (r) The commissioner may establish records to fulfill the 
 11.21  requirements of this section. 
 11.22     (s) The commissioner may not disqualify an individual 
 11.23  subject to a study under this section because that person has, 
 11.24  or has had, a mental illness as defined in section 245.462, 
 11.25  subdivision 20. 
 11.26     (t) An individual subject to disqualification under this 
 11.27  subdivision has the applicable rights in subdivision 3a, 3b, or 
 11.28  3c. 
 11.29     (u) For the purposes of background studies completed by 
 11.30  tribal organizations performing licensing activities otherwise 
 11.31  required of the commissioner under this chapter, after obtaining 
 11.32  consent from the background study subject, tribal licensing 
 11.33  agencies shall have access to criminal history data in the same 
 11.34  manner as county licensing agencies and private licensing 
 11.35  agencies under this chapter. 
 11.36     (v) County agencies shall have access to the criminal 
 12.1   history data in the same manner as county licensing agencies 
 12.2   under this chapter for purposes of background studies completed 
 12.3   by county agencies on legal nonlicensed child care providers to 
 12.4   determine eligibility for child care funds under chapter 119B. 
 12.5      Sec. 2.  Minnesota Statutes 2002, section 245A.04, 
 12.6   subdivision 3b, is amended to read: 
 12.7      Subd. 3b.  [RECONSIDERATION OF DISQUALIFICATION.] (a) The 
 12.8   individual who is the subject of the disqualification may 
 12.9   request a reconsideration of the disqualification.  
 12.10     The individual must submit the request for reconsideration 
 12.11  to the commissioner in writing.  A request for reconsideration 
 12.12  for an individual who has been sent a notice of disqualification 
 12.13  under subdivision 3a, paragraph (b), clause (1) or (2), must be 
 12.14  submitted within 30 calendar days of the disqualified 
 12.15  individual's receipt of the notice of disqualification.  Upon 
 12.16  showing that the information in clause (1) or (2) cannot be 
 12.17  obtained within 30 days, the disqualified individual may request 
 12.18  additional time, not to exceed 30 days, to obtain that 
 12.19  information.  A request for reconsideration for an individual 
 12.20  who has been sent a notice of disqualification under subdivision 
 12.21  3a, paragraph (b), clause (3), must be submitted within 15 
 12.22  calendar days of the disqualified individual's receipt of the 
 12.23  notice of disqualification.  An individual who was determined to 
 12.24  have maltreated a child under section 626.556 or a vulnerable 
 12.25  adult under section 626.557, and who was disqualified under this 
 12.26  section on the basis of serious or recurring maltreatment, may 
 12.27  request reconsideration of both the maltreatment and the 
 12.28  disqualification determinations.  The request for 
 12.29  reconsideration of the maltreatment determination and the 
 12.30  disqualification must be submitted within 30 calendar days of 
 12.31  the individual's receipt of the notice of disqualification.  
 12.32  Removal of a disqualified individual from direct contact shall 
 12.33  be ordered if the individual does not request reconsideration 
 12.34  within the prescribed time, and for an individual who submits a 
 12.35  timely request for reconsideration, if the disqualification is 
 12.36  not set aside.  The individual must present information showing 
 13.1   that: 
 13.2      (1) the information the commissioner relied upon in 
 13.3   determining that the underlying conduct giving rise to the 
 13.4   disqualification occurred, and for maltreatment, that the 
 13.5   maltreatment was serious or recurring, is incorrect; or 
 13.6      (2) the subject of the study does not pose a risk of harm 
 13.7   to any person served by the applicant, license holder, or 
 13.8   registrant under section 144A.71, subdivision 1. 
 13.9      (b) The commissioner shall rescind the disqualification if 
 13.10  the commissioner finds that the information relied on to 
 13.11  disqualify the subject is incorrect.  The commissioner may set 
 13.12  aside the disqualification under this section if the 
 13.13  commissioner finds that the individual does not pose a risk of 
 13.14  harm to any person served by the applicant, license holder, or 
 13.15  registrant under section 144A.71, subdivision 1.  In determining 
 13.16  that an individual does not pose a risk of harm, the 
 13.17  commissioner shall consider the nature, severity, and 
 13.18  consequences of the event or events that lead to 
 13.19  disqualification, whether there is more than one disqualifying 
 13.20  event, the age and vulnerability of the victim at the time of 
 13.21  the event, the harm suffered by the victim, the similarity 
 13.22  between the victim and persons served by the program, the time 
 13.23  elapsed without a repeat of the same or similar event, 
 13.24  documentation of successful completion by the individual studied 
 13.25  of training or rehabilitation pertinent to the event, and any 
 13.26  other information relevant to reconsideration.  In reviewing a 
 13.27  disqualification under this section, the commissioner shall give 
 13.28  preeminent weight to the safety of each person to be served by 
 13.29  the license holder, applicant, or registrant under section 
 13.30  144A.71, subdivision 1, over the interests of the license 
 13.31  holder, applicant, or registrant under section 144A.71, 
 13.32  subdivision 1.  If the commissioner sets aside a 
 13.33  disqualification under this section, the disqualified individual 
 13.34  remains disqualified, but may hold a license and have direct 
 13.35  contact with or access to persons receiving services.  The 
 13.36  commissioner's set aside of a disqualification is limited solely 
 14.1   to the licensed program, applicant, or agency specified in the 
 14.2   set aside notice, unless otherwise specified in the notice.  The 
 14.3   commissioner may rescind a previous set aside of a 
 14.4   disqualification under this section based on new information 
 14.5   that indicates the individual may pose a risk of harm to persons 
 14.6   served by the applicant, license holder, or registrant. 
 14.7      (c) Unless the information the commissioner relied on in 
 14.8   disqualifying an individual is incorrect, the commissioner may 
 14.9   not set aside the disqualification of an individual in 
 14.10  connection with a license to provide family day care for 
 14.11  children, foster care for children in the provider's own home, 
 14.12  or foster care or day care services for adults in the provider's 
 14.13  own home if: 
 14.14     (1) less than ten years have passed since the discharge of 
 14.15  the sentence imposed for the offense; and the individual has 
 14.16  been convicted of a violation of any offense listed in sections 
 14.17  609.165 (felon ineligible to possess firearm), criminal 
 14.18  vehicular homicide under 609.21 (criminal vehicular homicide and 
 14.19  injury), 609.215 (aiding suicide or aiding attempted suicide), 
 14.20  felony violations under 609.223 or 609.2231 (assault in the 
 14.21  third or fourth degree), 609.713 (terroristic threats), 609.235 
 14.22  (use of drugs to injure or to facilitate crime), 609.24 (simple 
 14.23  robbery), 609.255 (false imprisonment), 609.562 (arson in the 
 14.24  second degree), 609.71 (riot), 609.498, subdivision 1 or 1a 
 14.25  (aggravated first degree or first degree tampering with a 
 14.26  witness), burglary in the first or second degree under 609.582 
 14.27  (burglary), 609.66 (dangerous weapon), 609.665 (spring guns), 
 14.28  609.67 (machine guns and short-barreled shotguns), 609.749, 
 14.29  subdivision 2 (gross misdemeanor harassment; stalking), 152.021 
 14.30  or 152.022 (controlled substance crime in the first or second 
 14.31  degree), 152.023, subdivision 1, clause (3) or (4), or 
 14.32  subdivision 2, clause (4) (controlled substance crime in the 
 14.33  third degree), 152.024, subdivision 1, clause (2), (3), or (4) 
 14.34  (controlled substance crime in the fourth degree), 609.224, 
 14.35  subdivision 2, paragraph (c) (fifth-degree assault by a 
 14.36  caregiver against a vulnerable adult), 609.23 (mistreatment of 
 15.1   persons confined), 609.231 (mistreatment of residents or 
 15.2   patients), 609.2325 (criminal abuse of a vulnerable adult), 
 15.3   609.233 (criminal neglect of a vulnerable adult), 609.2335 
 15.4   (financial exploitation of a vulnerable adult), 609.234 (failure 
 15.5   to report), 609.265 (abduction), 609.2664 to 609.2665 
 15.6   (manslaughter of an unborn child in the first or second degree), 
 15.7   609.267 to 609.2672 (assault of an unborn child in the first, 
 15.8   second, or third degree), 609.268 (injury or death of an unborn 
 15.9   child in the commission of a crime), 617.293 (disseminating or 
 15.10  displaying harmful material to minors), a felony level 
 15.11  conviction involving alcohol or drug use, a gross misdemeanor 
 15.12  offense under 609.324, subdivision 1 (other prohibited acts), a 
 15.13  gross misdemeanor offense under 609.378 (neglect or endangerment 
 15.14  of a child), a gross misdemeanor offense under 609.377 
 15.15  (malicious punishment of a child), 609.72, subdivision 3 
 15.16  (disorderly conduct against a vulnerable adult); or an attempt 
 15.17  or conspiracy to commit any of these offenses, as each of these 
 15.18  offenses is defined in Minnesota Statutes; or an offense in any 
 15.19  other state, the elements of which are substantially similar to 
 15.20  the elements of any of the foregoing offenses; 
 15.21     (2) regardless of how much time has passed since the 
 15.22  involuntary termination of parental rights under section 
 15.23  260C.301 or the discharge of the sentence imposed for the 
 15.24  offense, the individual was convicted of a violation of any 
 15.25  offense listed in sections 609.185 to 609.195 (murder in the 
 15.26  first, second, or third degree), 609.20 (manslaughter in the 
 15.27  first degree), 609.205 (manslaughter in the second degree), 
 15.28  609.245 (aggravated robbery), 609.25 (kidnapping), 609.561 
 15.29  (arson in the first degree), 609.749, subdivision 3, 4, or 5 
 15.30  (felony-level harassment; stalking), 609.228 (great bodily harm 
 15.31  caused by distribution of drugs), 609.221 or 609.222 (assault in 
 15.32  the first or second degree), 609.66, subdivision 1e (drive-by 
 15.33  shooting), 609.855, subdivision 5 (shooting in or at a public 
 15.34  transit vehicle or facility), 609.2661 to 609.2663 (murder of an 
 15.35  unborn child in the first, second, or third degree), a felony 
 15.36  offense under 609.377 (malicious punishment of a child), a 
 16.1   felony offense under 609.324, subdivision 1 (other prohibited 
 16.2   acts), a felony offense under 609.378 (neglect or endangerment 
 16.3   of a child), 609.322 (solicitation, inducement, and promotion of 
 16.4   prostitution), 609.342 to 609.345 (criminal sexual conduct in 
 16.5   the first, second, third, or fourth degree), 609.352 
 16.6   (solicitation of children to engage in sexual conduct), 617.246 
 16.7   (use of minors in a sexual performance), 617.247 (possession of 
 16.8   pictorial representations of a minor), 609.365 (incest), a 
 16.9   felony offense under sections 609.2242 and 609.2243 (domestic 
 16.10  assault), a felony offense of spousal abuse, a felony offense of 
 16.11  child abuse or neglect, a felony offense of a crime against 
 16.12  children, or an attempt or conspiracy to commit any of these 
 16.13  offenses as defined in Minnesota Statutes, or an offense in any 
 16.14  other state, the elements of which are substantially similar to 
 16.15  any of the foregoing offenses; 
 16.16     (3) within the seven years preceding the study, the 
 16.17  individual committed an act that constitutes maltreatment of a 
 16.18  child under section 626.556, subdivision 10e, and that resulted 
 16.19  in substantial bodily harm as defined in section 609.02, 
 16.20  subdivision 7a, or substantial mental or emotional harm as 
 16.21  supported by competent psychological or psychiatric evidence; or 
 16.22     (4) within the seven years preceding the study, the 
 16.23  individual was determined under section 626.557 to be the 
 16.24  perpetrator of a substantiated incident of maltreatment of a 
 16.25  vulnerable adult that resulted in substantial bodily harm as 
 16.26  defined in section 609.02, subdivision 7a, or substantial mental 
 16.27  or emotional harm as supported by competent psychological or 
 16.28  psychiatric evidence. 
 16.29     In the case of any ground for disqualification under 
 16.30  clauses (1) to (4), if the act was committed by an individual 
 16.31  other than the applicant, license holder, or registrant under 
 16.32  section 144A.71, subdivision 1, residing in the applicant's or 
 16.33  license holder's home, or the home of a registrant under section 
 16.34  144A.71, subdivision 1, the applicant, license holder, or 
 16.35  registrant under section 144A.71, subdivision 1, may seek 
 16.36  reconsideration when the individual who committed the act no 
 17.1   longer resides in the home.  
 17.2      The disqualification periods provided under clauses (1), 
 17.3   (3), and (4) are the minimum applicable disqualification 
 17.4   periods.  The commissioner may determine that an individual 
 17.5   should continue to be disqualified from licensure or 
 17.6   registration under section 144A.71, subdivision 1, because the 
 17.7   license holder, applicant, or registrant under section 144A.71, 
 17.8   subdivision 1, poses a risk of harm to a person served by that 
 17.9   individual after the minimum disqualification period has passed. 
 17.10     (d) The commissioner shall respond in writing or by 
 17.11  electronic transmission to all reconsideration requests for 
 17.12  which the basis for the request is that the information relied 
 17.13  upon by the commissioner to disqualify is incorrect or 
 17.14  inaccurate within 30 working days of receipt of a request and 
 17.15  all relevant information.  If the basis for the request is that 
 17.16  the individual does not pose a risk of harm, the commissioner 
 17.17  shall respond to the request within 15 working days after 
 17.18  receiving the request for reconsideration and all relevant 
 17.19  information.  If the request is based on both the correctness or 
 17.20  accuracy of the information relied on to disqualify the 
 17.21  individual and the risk of harm, the commissioner shall respond 
 17.22  to the request within 45 working days after receiving the 
 17.23  request for reconsideration and all relevant information.  If 
 17.24  the disqualification is set aside, the commissioner shall notify 
 17.25  the applicant or license holder in writing or by electronic 
 17.26  transmission of the decision. 
 17.27     (e) Except as provided in subdivision 3c, if a 
 17.28  disqualification for which reconsideration was requested is not 
 17.29  set aside or is not rescinded, an individual who was 
 17.30  disqualified on the basis of a preponderance of evidence that 
 17.31  the individual committed an act or acts that meet the definition 
 17.32  of any of the crimes listed in subdivision 3d, paragraph (a), 
 17.33  clauses (1) to (4); for a determination under section 626.556 or 
 17.34  626.557 of substantiated maltreatment that was serious or 
 17.35  recurring under subdivision 3d, paragraph (a), clause (4); or 
 17.36  for failure to make required reports under section 626.556, 
 18.1   subdivision 3, or 626.557, subdivision 3, pursuant to 
 18.2   subdivision 3d, paragraph (a), clause (4), may request a fair 
 18.3   hearing under section 256.045.  Except as provided under 
 18.4   subdivision 3c, the fair hearing is the only administrative 
 18.5   appeal of the final agency determination for purposes of appeal 
 18.6   by the disqualified individual, specifically, including a 
 18.7   challenge to the accuracy and completeness of data under section 
 18.8   13.04.  If the individual was disqualified based on a conviction 
 18.9   or admission to any crimes listed in subdivision 3d, paragraph 
 18.10  (a), clauses (1) to (4), the reconsideration decision under this 
 18.11  subdivision is the final agency determination for purposes of 
 18.12  appeal by the disqualified individual and is not subject to a 
 18.13  hearing under section 256.045. 
 18.14     (f) Except as provided under subdivision 3c, if an 
 18.15  individual was disqualified on the basis of a determination of 
 18.16  maltreatment under section 626.556 or 626.557, which was serious 
 18.17  or recurring, and the individual has requested reconsideration 
 18.18  of the maltreatment determination under section 626.556, 
 18.19  subdivision 10i, or 626.557, subdivision 9d, and also requested 
 18.20  reconsideration of the disqualification under this subdivision, 
 18.21  reconsideration of the maltreatment determination and 
 18.22  reconsideration of the disqualification shall be consolidated 
 18.23  into a single reconsideration.  For maltreatment and 
 18.24  disqualification determinations made by county agencies, the 
 18.25  consolidated reconsideration shall be conducted by the county 
 18.26  agency.  If the county agency has disqualified an individual on 
 18.27  multiple bases, one of which is a county maltreatment 
 18.28  determination for which the individual has a right to request 
 18.29  reconsideration, the county shall conduct the reconsideration of 
 18.30  all disqualifications.  Except as provided under subdivision 3c, 
 18.31  if an individual who was disqualified on the basis of serious or 
 18.32  recurring maltreatment requests a fair hearing on the 
 18.33  maltreatment determination under section 626.556, subdivision 
 18.34  10i, or 626.557, subdivision 9d, and requests a fair hearing on 
 18.35  the disqualification, which has not been set aside or rescinded 
 18.36  under this subdivision, the scope of the fair hearing under 
 19.1   section 256.045 shall include the maltreatment determination and 
 19.2   the disqualification.  Except as provided under subdivision 3c, 
 19.3   a fair hearing is the only administrative appeal of the final 
 19.4   agency determination, specifically, including a challenge to the 
 19.5   accuracy and completeness of data under section 13.04. 
 19.6      (g) In the notice from the commissioner that a 
 19.7   disqualification has been set aside, the license holder must be 
 19.8   informed that information about the nature of the 
 19.9   disqualification and which factors under paragraph (b) were the 
 19.10  bases of the decision to set aside the disqualification is 
 19.11  available to the license holder upon request without consent of 
 19.12  the background study subject.  With the written consent of a 
 19.13  background study subject, the commissioner may release to the 
 19.14  license holder copies of all information related to the 
 19.15  background study subject's disqualification and the 
 19.16  commissioner's decision to set aside the disqualification as 
 19.17  specified in the written consent. 
 19.18     Sec. 3.  Minnesota Statutes 2002, section 245A.09, 
 19.19  subdivision 7, is amended to read: 
 19.20     Subd. 7.  [REGULATORY METHODS.] (a) Where appropriate and 
 19.21  feasible the commissioner shall identify and implement 
 19.22  alternative methods of regulation and enforcement to the extent 
 19.23  authorized in this subdivision.  These methods shall include: 
 19.24     (1) expansion of the types and categories of licenses that 
 19.25  may be granted; 
 19.26     (2) when the standards of another state or federal 
 19.27  governmental agency or an independent accreditation body have 
 19.28  been shown to ~~predict compliance with the rules~~ require the same 
 19.29  standards, methods, or alternative methods to achieve 
 19.30  substantially the same intended outcomes as the licensing 
 19.31  standards, the commissioner shall consider compliance with the 
 19.32  governmental or accreditation standards to be equivalent to 
 19.33  partial compliance with the ~~rules~~ licensing standards; and 
 19.34     (3) use of an abbreviated inspection that employs key 
 19.35  standards that have been shown to predict full compliance with 
 19.36  the rules. 
 20.1      (b) If the commissioner accepts accreditation as 
 20.2   documentation of compliance with a licensing standard under 
 20.3   paragraph (a), the commissioner shall continue to investigate 
 20.4   complaints related to noncompliance with all licensing standards.
 20.5   The commissioner may take a licensing action for noncompliance 
 20.6   under this chapter and shall recognize all existing appeal 
 20.7   rights regarding any licensing actions taken under this chapter. 
 20.8      (c) The commissioner shall work with the commissioners of 
 20.9   health, public safety, administration, and children, families, 
 20.10  and learning in consolidating duplicative licensing and 
 20.11  certification rules and standards if the commissioner determines 
 20.12  that consolidation is administratively feasible, would 
 20.13  significantly reduce the cost of licensing, and would not reduce 
 20.14  the protection given to persons receiving services in licensed 
 20.15  programs.  Where administratively feasible and appropriate, the 
 20.16  commissioner shall work with the commissioners of health, public 
 20.17  safety, administration, and children, families, and learning in 
 20.18  conducting joint agency inspections of programs. 
 20.19     ~~(c)~~ (d) The commissioner shall work with the commissioners 
 20.20  of health, public safety, administration, and children, 
 20.21  families, and learning in establishing a single point of 
 20.22  application for applicants who are required to obtain concurrent 
 20.23  licensure from more than one of the commissioners listed in this 
 20.24  clause. 
 20.25     ~~(d)~~ (e) Unless otherwise specified in statute, the 
 20.26  commissioner may ~~specify in rule periods of licensure up to two~~ 
 20.27  ~~years~~ conduct routine inspections biennially. 
 20.28     Sec. 4.  Minnesota Statutes 2002, section 245A.11, 
 20.29  subdivision 2a, is amended to read: 
 20.30     Subd. 2a.  [ADULT FOSTER CARE LICENSE CAPACITY.] (a) An 
 20.31  adult foster care license holder may have a maximum license 
 20.32  capacity of five if all persons in care are age 55 or over and 
 20.33  do not have a serious and persistent mental illness or a 
 20.34  developmental disability.  
 20.35     (b) The commissioner may grant variances to paragraph (a) 
 20.36  to allow a foster care provider with a licensed capacity of five 
 21.1   persons to admit an individual under the age of 55 if the 
 21.2   variance complies with section 245A.04, subdivision 9, and 
 21.3   approval of the variance is recommended by the county in which 
 21.4   the licensed foster care provider is located. 
 21.5      (c) The commissioner may grant variances to paragraph (a) 
 21.6   to allow the use of a fifth bed for emergency crisis services 
 21.7   for a person with serious and persistent mental illness or a 
 21.8   developmental disability, regardless of age, if the variance 
 21.9   complies with section 245A.04, subdivision 9, and approval of 
 21.10  the variance is recommended by the county in which the licensed 
 21.11  foster care provider is located. 
 21.12     (d) Notwithstanding paragraph (a), the commissioner may 
 21.13  issue an adult foster care license with a capacity of five 
 21.14  adults when the capacity is recommended by the county licensing 
 21.15  agency of the county in which the facility is located and if the 
 21.16  recommendation verifies that: 
 21.17     (1) the facility meets the physical environment 
 21.18  requirements in the adult foster care licensing rule; 
 21.19     (2) the five-bed living arrangement is specified for each 
 21.20  resident in the resident's (i) individualized plan of care; (ii) 
 21.21  individual service plan under section 256B.092, subdivision 1b, 
 21.22  if required; or (iii) individual resident placement agreement 
 21.23  under Minnesota Rules, part 9555.5105, subpart 19, if required; 
 21.24     (3) the license holder obtains written and signed informed 
 21.25  consent from each resident or resident's legal representative 
 21.26  documenting the resident's informed choice to living in the home 
 21.27  and that the resident's refusal to consent would not have 
 21.28  resulted in service termination; and 
 21.29     (4) the facility was licensed for adult foster care before 
 21.30  March 1, 2003. 
 21.31     (e) The commissioner shall not issue a new adult foster 
 21.32  care license under paragraph (d) after June 30, 2005.  The 
 21.33  commissioner shall allow a facility with an adult foster care 
 21.34  license issued under paragraph (d) before June 30, 2005, to 
 21.35  continue with a capacity of five adults if the license holder 
 21.36  continues to comply with the requirements in paragraph (d). 
 22.1      Sec. 5.  Minnesota Statutes 2002, section 245A.11, is 
 22.2   amended by adding a subdivision to read: 
 22.3      Subd. 7.  [ADULT FOSTER CARE; VARIANCE FOR ALTERNATE 
 22.4   OVERNIGHT SUPERVISION.] (a) The commissioner may grant a 
 22.5   variance under section 245A.04, subdivision 9, to rule parts 
 22.6   requiring a caregiver to be present in an adult foster care home 
 22.7   during normal sleeping hours to allow for alternative methods of 
 22.8   overnight supervision.  The commissioner may grant the variance 
 22.9   if the local county licensing agency recommends the variance and 
 22.10  the county recommendation includes documentation verifying that: 
 22.11     (1) the county has approved the license holder's plan for 
 22.12  alternative methods of providing overnight supervision and 
 22.13  determined the plan protects the residents' health, safety, and 
 22.14  rights; 
 22.15     (2) the license holder has obtained written and signed 
 22.16  informed consent from each resident or each resident's legal 
 22.17  representative documenting the resident's or legal 
 22.18  representative's agreement with the alternative method of 
 22.19  overnight supervision; and 
 22.20     (3) the alternative method of providing overnight 
 22.21  supervision is specified for each resident in the resident's: 
 22.22  (i) individualized plan of care; (ii) individual service plan 
 22.23  under section 256B.092, subdivision 1b, if required; or (iii) 
 22.24  individual resident placement agreement under Minnesota Rules, 
 22.25  part 9555.5105, subpart 19, if required. 
 22.26     (b) To be eligible for a variance under paragraph (a), the 
 22.27  adult foster care license holder must not have had a licensing 
 22.28  action under section 245A.06 or 245A.07 during the prior 24 
 22.29  months based on failure to provide adequate supervision, health 
 22.30  care services, or resident safety in the adult foster care home. 
 22.31     Sec. 6.  Minnesota Statutes 2002, section 245B.03, 
 22.32  subdivision 2, is amended to read: 
 22.33     Subd. 2.  [RELATIONSHIP TO OTHER STANDARDS GOVERNING 
 22.34  SERVICES FOR PERSONS WITH MENTAL RETARDATION OR RELATED 
 22.35  CONDITIONS.] (a) ICFs/MR are exempt from: 
 22.36     (1) section 245B.04; 
 23.1      (2) section 245B.06, subdivisions 4 and 6; and 
 23.2      (3) section 245B.07, subdivisions 4, paragraphs (b) and 
 23.3   (c); 7; and 8, paragraphs (1), clause (iv), and (2). 
 23.4      (b) License holders also licensed under chapter 144 as a 
 23.5   supervised living facility are exempt from section 245B.04. 
 23.6      (c) Residential service sites controlled by license holders 
 23.7   licensed under chapter 245B for home and community-based 
 23.8   waivered services for four or fewer adults are exempt from 
 23.9   compliance with Minnesota Rules, parts 9543.0040, subpart 2, 
 23.10  item C; 9555.5505; 9555.5515, items B and G; 9555.5605; 
 23.11  9555.5705; 9555.6125, subparts 3, item C, subitem (2), and 4 to 
 23.12  6; 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 
 23.13  9555.6265; and as provided under section 245B.06, subdivision 2, 
 23.14  the license holder is exempt from the program abuse prevention 
 23.15  plans and individual abuse prevention plans otherwise required 
 23.16  under sections 245A.65, subdivision 2, and 626.557, subdivision 
 23.17  14.  The commissioner may approve alternative methods of 
 23.18  providing overnight supervision using the process and criteria 
 23.19  for granting a variance in section 245A.04, subdivision 9.  This 
 23.20  chapter does not apply to foster care homes that do not provide 
 23.21  residential habilitation services funded under the home and 
 23.22  community-based waiver programs defined in section 256B.092. 
 23.23     (d) Residential service sites controlled by license holders 
 23.24  licensed under this chapter for home and community-based 
 23.25  waivered services for four or fewer children are exempt from 
 23.26  compliance with Minnesota Rules, parts 9545.0130; 9545.0140; 
 23.27  9545.0150; 9545.0170; 9545.0220, subparts 1, items C, F, and I, 
 23.28  and 3; and 9545.0230. 
 23.29     (e) The commissioner may exempt license holders from 
 23.30  applicable standards of this chapter when the license holder 
 23.31  meets the standards under section 245A.09, subdivision 7.  
 23.32  License holders that are accredited by an independent 
 23.33  accreditation body shall continue to be licensed under this 
 23.34  chapter. 
 23.35     ~~(e)~~ (f) License holders governed by sections 245B.02 to 
 23.36  245B.07 must also meet the licensure requirements in chapter 
 24.1   245A.  
 24.2      ~~(f)~~ (g) Nothing in this chapter prohibits license holders 
 24.3   from concurrently serving consumers with and without mental 
 24.4   retardation or related conditions provided this chapter's 
 24.5   standards are met as well as other relevant standards. 
 24.6      ~~(g)~~ (h) The documentation that sections 245B.02 to 245B.07 
 24.7   require of the license holder meets the individual program plan 
 24.8   required in section 256B.092 or successor provisions.  
 24.9      Sec. 7.  Minnesota Statutes 2002, section 245B.03, is 
 24.10  amended by adding a subdivision to read: 
 24.11     Subd. 3.  [CONTINUITY OF CARE.] (a) When a consumer changes 
 24.12  service to the same type of service provided under a different 
 24.13  license held by the same license holder and the policies and 
 24.14  procedures under section 245B.07, subdivision 8, are 
 24.15  substantially similar, the license holder is exempt from the 
 24.16  requirements in sections 245B.06, subdivisions 2, paragraphs (e) 
 24.17  and (f), and 4; and 245B.07, subdivision 9, clause (2). 
 24.18     (b) When a direct service staff person begins providing 
 24.19  direct service under one or more licenses other than the license 
 24.20  for which the staff person initially received the staff 
 24.21  orientation requirements under section 245B.07, subdivision 5, 
 24.22  the license holder is exempt from all staff orientation 
 24.23  requirements under section 245B.07, subdivision 5, except that: 
 24.24     (1) if the service provision location changes, the staff 
 24.25  person must receive orientation regarding any policies or 
 24.26  procedures under section 245B.07, subdivision 8, that are 
 24.27  specific to the service provision location; and 
 24.28     (2) if the staff person provides direct service to one or 
 24.29  more consumers to whom the staff person has not previously 
 24.30  provided direct service, the staff person must review each 
 24.31  consumer's:  (i) service plans and risk management plan in 
 24.32  accordance with section 245B.07, subdivision 5, paragraph (b), 
 24.33  clause (1); and (ii) medication administration in accordance 
 24.34  with section 245B.07, subdivision 5, paragraph (b), clause (6). 
 24.35     Sec. 8.  Minnesota Statutes 2002, section 245B.04, 
 24.36  subdivision 2, is amended to read: 
 25.1      Subd. 2.  [SERVICE-RELATED RIGHTS.] A consumer's 
 25.2   service-related rights include the right to: 
 25.3      (1) refuse or terminate services and be informed of the 
 25.4   consequences of refusing or terminating services; 
 25.5      (2) know, in advance, limits to the services available from 
 25.6   the license holder; 
 25.7      (3) know conditions and terms governing the provision of 
 25.8   services, including those related to initiation and termination; 
 25.9      (4) know what the charges are for services, regardless of 
 25.10  who will be paying for the services, and be notified upon 
 25.11  request of changes in those charges; 
 25.12     (5) know, in advance, whether services are covered by 
 25.13  insurance, government funding, or other sources, and be told of 
 25.14  any charges the consumer or other private party may have to pay; 
 25.15  and 
 25.16     (6) receive licensed services from individuals who are 
 25.17  competent and trained, who have professional certification or 
 25.18  licensure, as required, and who meet additional qualifications 
 25.19  identified in the individual service plan. 
 25.20     Sec. 9.  Minnesota Statutes 2002, section 245B.06, 
 25.21  subdivision 2, is amended to read: 
 25.22     Subd. 2.  [RISK MANAGEMENT PLAN.] (a) The license holder 
 25.23  must develop ~~and~~, document in writing, and implement a risk 
 25.24  management plan that ~~incorporates the individual abuse~~ 
 25.25  ~~prevention plan as required in section 245A.65~~ meets the 
 25.26  requirements of this subdivision.  License holders licensed 
 25.27  under this chapter are exempt from sections 245A.65, subdivision 
 25.28  2, and 626.557, subdivision 14, if the requirements of this 
 25.29  subdivision are met.  
 25.30     (b) The risk management plan must identify areas in which 
 25.31  the consumer is vulnerable, based on an assessment, at a 
 25.32  minimum, of the following areas: 
 25.33     (1) an adult consumer's susceptibility to physical, 
 25.34  emotional, and sexual abuse as defined in section 626.5572, 
 25.35  subdivision 2, and financial exploitation as defined in section 
 25.36  626.5572, subdivision 9; a minor consumer's susceptibility to 
 26.1   sexual and physical abuse as defined in section 626.556, 
 26.2   subdivision 2; and a consumer's susceptibility to self-abuse, 
 26.3   regardless of age; 
 26.4      (2) the consumer's health needs, considering the consumer's 
 26.5   physical disabilities; allergies; sensory impairments; seizures; 
 26.6   diet; need for medications; and ability to obtain medical 
 26.7   treatment; 
 26.8      (3) the consumer's safety needs, considering the consumer's 
 26.9   ability to take reasonable safety precautions; community 
 26.10  survival skills; water survival skills; ability to seek 
 26.11  assistance or provide medical care; and access to toxic 
 26.12  substances or dangerous items; 
 26.13     (4) environmental issues, considering the program's 
 26.14  location in a particular neighborhood or community; the type of 
 26.15  grounds and terrain surrounding the building; and the consumer's 
 26.16  ability to respond to weather-related conditions, open locked 
 26.17  doors, and remain alone in any environment; and 
 26.18     (5) the consumer's behavior, including behaviors that may 
 26.19  increase the likelihood of physical aggression between consumers 
 26.20  or sexual activity between consumers involving force or 
 26.21  coercion, as defined under section 245B.02, subdivision 10, 
 26.22  clauses (6) and (7). 
 26.23     (c) When assessing a consumer's vulnerability, the license 
 26.24  holder must consider only the consumer's skills and abilities, 
 26.25  independent of staffing patterns, supervision plans, the 
 26.26  environment, or other situational elements.  
 26.27     (d) License holders jointly providing services to a 
 26.28  consumer shall coordinate and use the resulting assessment of 
 26.29  risk areas for the development of ~~this~~ each license holder's 
 26.30  risk management or the shared risk management plan.  ~~Upon~~ 
 26.31  ~~initiation of services, the license holder will have in place an~~ 
 26.32  ~~initial risk management plan that identifies areas in which the~~ 
 26.33  ~~consumer is vulnerable, including health, safety, and~~ 
 26.34  ~~environmental issues and the supports the provider will have in~~ 
 26.35  ~~place to protect the consumer and to minimize these risks.  The~~ 
 26.36  ~~plan must be changed based on the needs of the individual~~ 
 27.1   ~~consumer and reviewed at least annually.~~  The license holder's 
 27.2   plan must include the specific actions a staff person will take 
 27.3   to protect the consumer and minimize risks for the identified 
 27.4   vulnerability areas.  The specific actions must include the 
 27.5   proactive measures being taken, training being provided, or a 
 27.6   detailed description of actions a staff person will take when 
 27.7   intervention is needed. 
 27.8      (e) Prior to or upon initiating services, a license holder 
 27.9   must develop an initial risk management plan that is, at a 
 27.10  minimum, verbally approved by the consumer or consumer's legal 
 27.11  representative and case manager.  The license holder must 
 27.12  document the date the license holder receives the consumer's or 
 27.13  consumer's legal representative's and case manager's verbal 
 27.14  approval of the initial plan. 
 27.15     (f) As part of the meeting held within 45 days of 
 27.16  initiating service, as required under section 245B.06, 
 27.17  subdivision 4, the license holder must review the initial risk 
 27.18  management plan for accuracy and revise the plan if necessary.  
 27.19  The license holder must give the consumer or consumer's legal 
 27.20  representative and case manager an opportunity to participate in 
 27.21  this plan review.  If the license holder revises the plan, or if 
 27.22  the consumer or consumer's legal representative and case manager 
 27.23  have not previously signed and dated the plan, the license 
 27.24  holder must obtain dated signatures to document the plan's 
 27.25  approval. 
 27.26     (g) After plan approval, the license holder must review the 
 27.27  plan at least annually and update the plan based on the 
 27.28  individual consumer's needs and changes to the environment.  The 
 27.29  license holder must give the consumer or consumer's legal 
 27.30  representative and case manager an opportunity to participate in 
 27.31  the ongoing plan development.  The license holder shall obtain 
 27.32  dated signatures from the consumer or consumer's legal 
 27.33  representative and case manager to document completion of the 
 27.34  annual review and approval of plan changes. 
 27.35     Sec. 10.  Minnesota Statutes 2002, section 245B.06, 
 27.36  subdivision 5, is amended to read: 
 28.1      Subd. 5.  [PROGRESS REVIEWS.] The license holder must 
 28.2   participate in progress review meetings following stated time 
 28.3   lines established in the consumer's individual service plan or 
 28.4   as requested in writing by the consumer, the consumer's legal 
 28.5   representative, or the case manager, at a minimum of once a 
 28.6   year.  The license holder must summarize the progress toward 
 28.7   achieving the desired outcomes and make recommendations in a 
 28.8   written report sent to the consumer or the consumer's legal 
 28.9   representative and case manager prior to the review meeting.  
 28.10  ~~For consumers under public guardianship, the license holder is~~ 
 28.11  ~~required to provide quarterly written progress review reports to~~ 
 28.12  ~~the consumer, designated family member, and case manager.~~  
 28.13     Sec. 11.  Minnesota Statutes 2002, section 245B.07, 
 28.14  subdivision 6, is amended to read: 
 28.15     Subd. 6.  [STAFF TRAINING.] (a) The license holder shall 
 28.16  ensure that direct service staff annually complete hours of 
 28.17  training equal to two percent of the number of hours the staff 
 28.18  person worked or one percent for license holders providing 
 28.19  semi-independent living services.  Direct service staff who have 
 28.20  worked for the license holder for an average of at least 30 
 28.21  hours per week for 24 or more months must annually complete 
 28.22  hours of training equal to one percent of the number of hours 
 28.23  the staff person worked.  If direct service staff has received 
 28.24  training from a license holder licensed under a program rule 
 28.25  identified in this chapter or completed course work regarding 
 28.26  disability-related issues from a post-secondary educational 
 28.27  institute, that training may also count toward training 
 28.28  requirements for other services and for other license holders. 
 28.29     (b) The license holder must document the training completed 
 28.30  by each employee. 
 28.31     (c) Training shall address staff competencies necessary to 
 28.32  address the consumer needs as identified in the consumer's 
 28.33  individual service plan and ensure consumer health, safety, and 
 28.34  protection of rights.  Training may also include other areas 
 28.35  identified by the license holder. 
 28.36     (d) For consumers requiring a 24-hour plan of care, the 
 29.1   license holder shall provide training in cardiopulmonary 
 29.2   resuscitation, from a qualified source determined by the 
 29.3   commissioner, if the consumer's health needs as determined by 
 29.4   the consumer's physician indicate trained staff would be 
 29.5   necessary to the consumer. 
 29.6      Sec. 12.  Minnesota Statutes 2002, section 245B.07, 
 29.7   subdivision 9, is amended to read: 
 29.8      Subd. 9.  [AVAILABILITY OF CURRENT WRITTEN POLICIES AND 
 29.9   PROCEDURES.] The license holder shall: 
 29.10     (1) review and update, as needed, the written policies and 
 29.11  procedures in this chapter ~~and inform all consumers or the~~ 
 29.12  ~~consumer's legal representatives, case managers, and employees~~ 
 29.13  ~~of the revised policies and procedures when they affect the~~ 
 29.14  ~~service provision~~; 
 29.15     (2) inform consumers or the consumer's legal 
 29.16  representatives of the written policies and procedures in this 
 29.17  chapter upon service initiation.  Copies must be available to 
 29.18  consumers or the consumer's legal representatives, case 
 29.19  managers, the county where services are located, and the 
 29.20  commissioner upon request; ~~and~~ 
 29.21     (3) provide all consumers or the consumers' legal 
 29.22  representatives and case managers a copy and explanation of 
 29.23  revisions to policies and procedures that affect consumers' 
 29.24  service-related or protection-related rights under section 
 29.25  245B.04.  Unless there is reasonable cause, the license holder 
 29.26  must provide this notice at least 30 days before implementing 
 29.27  the revised policy and procedure.  The license holder must 
 29.28  document the reason for not providing the notice at least 30 
 29.29  days before implementing the revisions; 
 29.30     (4) annually notify all consumers or the consumers' legal 
 29.31  representatives and case managers of any revised policies and 
 29.32  procedures under this chapter, other than those in clause (3).  
 29.33  Upon request, the license holder must provide the consumer or 
 29.34  consumer's legal representative and case manager copies of the 
 29.35  revised policies and procedures; 
 29.36     (5) before implementing revisions to policies and 
 30.1   procedures under this chapter, inform all employees of the 
 30.2   revised policies and procedures; and 
 30.3      (6) document and maintain relevant information related to 
 30.4   the policies and procedures in this chapter. 
 30.5      Sec. 13.  Minnesota Statutes 2002, section 245B.08, 
 30.6   subdivision 1, is amended to read: 
 30.7      Subdivision 1.  [ALTERNATIVE METHODS OF DETERMINING 
 30.8   COMPLIANCE.] (a) In addition to methods specified in chapter 
 30.9   245A, the commissioner may use alternative methods and new 
 30.10  regulatory strategies to determine compliance with this 
 30.11  section.  The commissioner may use sampling techniques to ensure 
 30.12  compliance with this section.  Notwithstanding section 245A.09, 
 30.13  subdivision 7, paragraph ~~(d)~~ (e), the commissioner may also 
 30.14  extend periods of licensure, not to exceed five years, for 
 30.15  license holders who have demonstrated substantial and consistent 
 30.16  compliance with sections 245B.02 to 245B.07 and have 
 30.17  consistently maintained the health and safety of consumers and 
 30.18  have demonstrated by alternative methods in paragraph (b) that 
 30.19  they meet or exceed the requirements of this section.  For 
 30.20  purposes of this section, "substantial and consistent 
 30.21  compliance" means that during the current licensing period: 
 30.22     (1) the license holder's license has not been made 
 30.23  conditional, suspended, or revoked; 
 30.24     (2) there have been no substantiated allegations of 
 30.25  maltreatment against the license holder; 
 30.26     (3) there have been no program deficiencies that have been 
 30.27  identified that would jeopardize the health or safety of 
 30.28  consumers being served; and 
 30.29     (4) the license holder is in substantial compliance with 
 30.30  the other requirements of chapter 245A and other applicable laws 
 30.31  and rules. 
 30.32     (b) To determine the length of a license, the commissioner 
 30.33  shall consider: 
 30.34     (1) information from affected consumers, and the license 
 30.35  holder's responsiveness to consumers' concerns and 
 30.36  recommendations; 
 31.1      (2) self assessments and peer reviews of the standards of 
 31.2   this section, corrective actions taken by the license holder, 
 31.3   and sharing the results of the inspections with consumers, the 
 31.4   consumers' families, and others, as requested; 
 31.5      (3) length of accreditation by an independent accreditation 
 31.6   body, if applicable; 
 31.7      (4) information from the county where the license holder is 
 31.8   located; and 
 31.9      (5) information from the license holder demonstrating 
 31.10  performance that meets or exceeds the minimum standards of this 
 31.11  chapter. 
 31.12     (c) The commissioner may reduce the length of the license 
 31.13  if the license holder fails to meet the criteria in paragraph 
 31.14  (a) and the conditions specified in paragraph (b). 
 31.15                             ARTICLE 2 
 31.16                          CONTINUING CARE  
 31.17     Section 1.  Minnesota Statutes 2002, section 256B.0621, 
 31.18  subdivision 4, is amended to read: 
 31.19     Subd. 4.  [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 
 31.20  QUALIFICATIONS.] ~~The following qualifications and certification~~ 
 31.21  ~~standards must be met by providers of relocation targeted case~~ 
 31.22  ~~management:~~ 
 31.23     ~~(a) The commissioner must certify each provider of~~ 
 31.24  ~~relocation targeted case management before enrollment.  The~~ 
 31.25  ~~certification process shall examine the provider's ability to~~ 
 31.26  ~~meet the requirements in this subdivision and other federal and~~ 
 31.27  ~~state requirements of this service.  A certified relocation~~ 
 31.28  ~~targeted case management provider may subcontract with another~~ 
 31.29  ~~provider to deliver relocation targeted case management~~ 
 31.30  ~~services.  Subcontracted providers must demonstrate the ability~~ 
 31.31  ~~to provide the services outlined in subdivision 6.~~ 
 31.32     ~~(b)~~ (a) A relocation targeted case management provider is 
 31.33  an enrolled medical assistance provider who is determined by the 
 31.34  commissioner to have all of the following characteristics: 
 31.35     (1) the legal authority to provide public welfare under 
 31.36  sections 393.01, subdivision 7; and 393.07; or a federally 
 32.1   recognized Indian tribe; 
 32.2      (2) the demonstrated capacity and experience to provide the 
 32.3   components of case management to coordinate and link community 
 32.4   resources needed by the eligible population; 
 32.5      (3) the administrative capacity and experience to serve the 
 32.6   target population for whom it will provide services and ensure 
 32.7   quality of services under state and federal requirements; 
 32.8      (4) the legal authority to provide complete investigative 
 32.9   and protective services under section 626.556, subdivision 10; 
 32.10  and child welfare and foster care services under section 393.07, 
 32.11  subdivisions 1 and 2; or a federally recognized Indian tribe; 
 32.12     (5) a financial management system that provides accurate 
 32.13  documentation of services and costs under state and federal 
 32.14  requirements; and 
 32.15     (6) the capacity to document and maintain individual case 
 32.16  records under state and federal requirements. 
 32.17     (b) A provider of targeted case management under section 
 32.18  256B.0625, subdivision 20, may be deemed a certified provider of 
 32.19  relocation targeted case management. 
 32.20     (c) A relocation targeted case management provider may 
 32.21  subcontract with another provider to deliver relocation targeted 
 32.22  case management services.  Subcontracted providers must 
 32.23  demonstrate the ability to provide the services outlined in 
 32.24  subdivision 6, and have a procedure in place that notifies the 
 32.25  recipient and the recipient's legal representative of any 
 32.26  conflict of interest if the contracted targeted case management 
 32.27  provider also provides, or will provide, the recipient's 
 32.28  services and supports.  Contracted providers must provide 
 32.29  information on all conflicts of interest and obtain the 
 32.30  recipient's informed consent or provide the recipient with 
 32.31  alternatives.  
 32.32     Sec. 2.  Minnesota Statutes 2002, section 256B.0623, 
 32.33  subdivision 2, is amended to read: 
 32.34     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 32.35  following terms have the meanings given them. 
 32.36     (a) "Adult rehabilitative mental health services" means 
 33.1   mental health services which are rehabilitative and enable the 
 33.2   recipient to develop and enhance psychiatric stability, social 
 33.3   competencies, personal and emotional adjustment, and independent 
 33.4   living and community skills, when these abilities are impaired 
 33.5   by the symptoms of mental illness.  Adult rehabilitative mental 
 33.6   health services are also appropriate when provided to enable a 
 33.7   recipient to retain stability and functioning, if the recipient 
 33.8   would be at risk of significant functional decompensation or 
 33.9   more restrictive service settings without these services. 
 33.10     (1) Adult rehabilitative mental health services instruct, 
 33.11  assist, and support the recipient in areas such as:  
 33.12  interpersonal communication skills, community resource 
 33.13  utilization and integration skills, crisis assistance, relapse 
 33.14  prevention skills, health care directives, budgeting and 
 33.15  shopping skills, healthy lifestyle skills and practices, cooking 
 33.16  and nutrition skills, transportation skills, medication 
 33.17  education and monitoring, mental illness symptom management 
 33.18  skills, household management skills, employment-related skills, 
 33.19  and transition to community living services. 
 33.20     (2) These services shall be provided to the recipient on a 
 33.21  one-to-one basis in the recipient's home or another community 
 33.22  setting or in groups. 
 33.23     (b) "Medication education services" means services provided 
 33.24  individually or in groups which focus on educating the recipient 
 33.25  about mental illness and symptoms; the role and effects of 
 33.26  medications in treating symptoms of mental illness; and the side 
 33.27  effects of medications.  Medication education is coordinated 
 33.28  with medication management services and does not duplicate it.  
 33.29  Medication education services are provided by physicians, 
 33.30  pharmacists, physician's assistants, or registered nurses. 
 33.31     (c) "Transition to community living services" means 
 33.32  services which maintain continuity of contact between the 
 33.33  rehabilitation services provider and the recipient and which 
 33.34  facilitate discharge from a hospital, residential treatment 
 33.35  program under Minnesota Rules, chapter 9505, board and lodging 
 33.36  facility, or nursing home.  Transition to community living 
 34.1   services are not intended to provide other areas of adult 
 34.2   rehabilitative mental health services.  
 34.3      Sec. 3.  Minnesota Statutes 2002, section 256B.0623, 
 34.4   subdivision 4, is amended to read: 
 34.5      Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) The provider 
 34.6   entity must be~~:~~ 
 34.7      ~~(1) a county operated entity certified by the state; or~~ 
 34.8      ~~(2) a noncounty entity certified by the entity's host~~ 
 34.9   ~~county~~ certified by the state following the certification 
 34.10  process and procedures developed by the commissioner. 
 34.11     (b) The certification process is a determination as to 
 34.12  whether the entity meets the standards in this subdivision.  The 
 34.13  certification must specify which adult rehabilitative mental 
 34.14  health services the entity is qualified to provide. 
 34.15     (c) ~~If an entity seeks to provide services outside its host~~ 
 34.16  ~~county, it~~ A noncounty provider entity must obtain additional 
 34.17  certification from each county in which it will provide 
 34.18  services.  The additional certification must be based on the 
 34.19  adequacy of the entity's knowledge of that county's local health 
 34.20  and human service system, and the ability of the entity to 
 34.21  coordinate its services with the other services available in 
 34.22  that county.  A county-operated entity must obtain this 
 34.23  additional certification from any other county in which it will 
 34.24  provide services. 
 34.25     (d) Recertification must occur at least every ~~two~~ three 
 34.26  years. 
 34.27     (e) The commissioner may intervene at any time and 
 34.28  decertify providers with cause.  The decertification is subject 
 34.29  to appeal to the state.  A county board may recommend that the 
 34.30  state decertify a provider for cause. 
 34.31     (f) The adult rehabilitative mental health services 
 34.32  provider entity must meet the following standards: 
 34.33     (1) have capacity to recruit, hire, manage, and train 
 34.34  mental health professionals, mental health practitioners, and 
 34.35  mental health rehabilitation workers; 
 34.36     (2) have adequate administrative ability to ensure 
 35.1   availability of services; 
 35.2      (3) ensure adequate preservice and inservice and ongoing 
 35.3   training for staff; 
 35.4      (4) ensure that mental health professionals, mental health 
 35.5   practitioners, and mental health rehabilitation workers are 
 35.6   skilled in the delivery of the specific adult rehabilitative 
 35.7   mental health services provided to the individual eligible 
 35.8   recipient; 
 35.9      (5) ensure that staff is capable of implementing culturally 
 35.10  specific services that are culturally competent and appropriate 
 35.11  as determined by the recipient's culture, beliefs, values, and 
 35.12  language as identified in the individual treatment plan; 
 35.13     (6) ensure enough flexibility in service delivery to 
 35.14  respond to the changing and intermittent care needs of a 
 35.15  recipient as identified by the recipient and the individual 
 35.16  treatment plan; 
 35.17     (7) ensure that the mental health professional or mental 
 35.18  health practitioner, who is under the clinical supervision of a 
 35.19  mental health professional, involved in a recipient's services 
 35.20  participates in the development of the individual treatment 
 35.21  plan; 
 35.22     (8) assist the recipient in arranging needed crisis 
 35.23  assessment, intervention, and stabilization services; 
 35.24     (9) ensure that services are coordinated with other 
 35.25  recipient mental health services providers and the county mental 
 35.26  health authority and the federally recognized American Indian 
 35.27  authority and necessary others after obtaining the consent of 
 35.28  the recipient.  Services must also be coordinated with the 
 35.29  recipient's case manager or care coordinator if the recipient is 
 35.30  receiving case management or care coordination services; 
 35.31     (10) develop and maintain recipient files, individual 
 35.32  treatment plans, and contact charting; 
 35.33     (11) develop and maintain staff training and personnel 
 35.34  files; 
 35.35     (12) submit information as required by the state; 
 35.36     (13) establish and maintain a quality assurance plan to 
 36.1   evaluate the outcome of services provided; 
 36.2      (14) keep all necessary records required by law; 
 36.3      (15) deliver services as required by section 245.461; 
 36.4      (16) comply with all applicable laws; 
 36.5      (17) be an enrolled Medicaid provider; 
 36.6      (18) maintain a quality assurance plan to determine 
 36.7   specific service outcomes and the recipient's satisfaction with 
 36.8   services; and 
 36.9      (19) develop and maintain written policies and procedures 
 36.10  regarding service provision and administration of the provider 
 36.11  entity. 
 36.12     ~~(g) The commissioner shall develop statewide procedures for~~ 
 36.13  ~~provider certification, including timelines for counties to~~ 
 36.14  ~~certify qualified providers.~~ 
 36.15     Sec. 4.  Minnesota Statutes 2002, section 256B.0623, 
 36.16  subdivision 5, is amended to read: 
 36.17     Subd. 5.  [QUALIFICATIONS OF PROVIDER STAFF.] Adult 
 36.18  rehabilitative mental health services must be provided by 
 36.19  qualified individual provider staff of a certified provider 
 36.20  entity.  Individual provider staff must be qualified under one 
 36.21  of the following criteria: 
 36.22     (1) a mental health professional as defined in section 
 36.23  245.462, subdivision 18, clauses (1) to (5); 
 36.24     (2) a mental health practitioner as defined in section 
 36.25  245.462, subdivision 17.  The mental health practitioner must 
 36.26  work under the clinical supervision of a mental health 
 36.27  professional; or 
 36.28     (3) a mental health rehabilitation worker.  A mental health 
 36.29  rehabilitation worker means a staff person working under the 
 36.30  direction of a mental health practitioner or mental health 
 36.31  professional and under the clinical supervision of a mental 
 36.32  health professional in the implementation of rehabilitative 
 36.33  mental health services as identified in the recipient's 
 36.34  individual treatment plan who: 
 36.35     (i) is at least 21 years of age; 
 36.36     (ii) has a high school diploma or equivalent; 
 37.1      (iii) has successfully completed 30 hours of training 
 37.2   during the past two years in all of the following areas:  
 37.3   recipient rights, recipient-centered individual treatment 
 37.4   planning, behavioral terminology, mental illness, co-occurring 
 37.5   mental illness and substance abuse, psychotropic medications and 
 37.6   side effects, functional assessment, local community resources, 
 37.7   adult vulnerability, recipient confidentiality; and 
 37.8      (iv) meets the qualifications in subitem (A) or (B): 
 37.9      (A) has an associate of arts degree in one of the 
 37.10  behavioral sciences or human services, or is a registered nurse 
 37.11  without a bachelor's degree, or who within the previous ten 
 37.12  years has:  
 37.13     (1) three years of personal life experience with serious 
 37.14  and persistent mental illness; 
 37.15     (2) three years of life experience as a primary caregiver 
 37.16  to an adult with a serious mental illness or traumatic brain 
 37.17  injury; or 
 37.18     (3) 4,000 hours of supervised paid work experience in the 
 37.19  delivery of mental health services to adults with a serious 
 37.20  mental illness or traumatic brain injury; or 
 37.21     (B)(1) is fluent in the non-English language or competent 
 37.22  in the culture of the ethnic group to which at least ~~50~~ 20 
 37.23  percent of the mental health rehabilitation worker's clients 
 37.24  belong; 
 37.25     (2) receives during the first 2,000 hours of work, monthly 
 37.26  documented individual clinical supervision by a mental health 
 37.27  professional; 
 37.28     (3) has 18 hours of documented field supervision by a 
 37.29  mental health professional or practitioner during the first 160 
 37.30  hours of contact work with recipients, and at least six hours of 
 37.31  field supervision quarterly during the following year; 
 37.32     (4) has review and cosignature of charting of recipient 
 37.33  contacts during field supervision by a mental health 
 37.34  professional or practitioner; and 
 37.35     (5) has 40 hours of additional continuing education on 
 37.36  mental health topics during the first year of employment. 
 38.1      Sec. 5.  Minnesota Statutes 2002, section 256B.0623, 
 38.2   subdivision 6, is amended to read: 
 38.3      Subd. 6.  [REQUIRED TRAINING AND SUPERVISION.] (a) Mental 
 38.4   health rehabilitation workers must receive ongoing continuing 
 38.5   education training of at least 30 hours every two years in areas 
 38.6   of mental illness and mental health services and other areas 
 38.7   specific to the population being served.  Mental health 
 38.8   rehabilitation workers must also be subject to the ongoing 
 38.9   direction and clinical supervision standards in paragraphs (c) 
 38.10  and (d). 
 38.11     (b) Mental health practitioners must receive ongoing 
 38.12  continuing education training as required by their professional 
 38.13  license; or if the practitioner is not licensed, the 
 38.14  practitioner must receive ongoing continuing education training 
 38.15  of at least 30 hours every two years in areas of mental illness 
 38.16  and mental health services.  Mental health practitioners must 
 38.17  meet the ongoing clinical supervision standards in paragraph (c).
 38.18     (c) Clinical supervision may be provided by a full or 
 38.19  part-time qualified professional employed by or under contract 
 38.20  with the provider entity.  Clinical supervision may be provided 
 38.21  by interactive videoconferencing according to procedures 
 38.22  developed by the commissioner.  A mental health professional 
 38.23  providing clinical supervision of staff delivering adult 
 38.24  rehabilitative mental health services must provide the following 
 38.25  guidance: 
 38.26     (1) review the information in the recipient's file; 
 38.27     (2) review and approve initial and updates of individual 
 38.28  treatment plans; 
 38.29     (3) meet with mental health rehabilitation workers and 
 38.30  practitioners, individually or in small groups, at least monthly 
 38.31  to discuss treatment topics of interest to the workers and 
 38.32  practitioners; 
 38.33     (4) meet with mental health rehabilitation workers and 
 38.34  practitioners, individually or in small groups, at least monthly 
 38.35  to discuss treatment plans of recipients, and approve by 
 38.36  signature and document in the recipient's file any resulting 
 39.1   plan updates; 
 39.2      (5) meet at least ~~twice a month~~ monthly with the directing 
 39.3   mental health practitioner, if there is one, to review needs of 
 39.4   the adult rehabilitative mental health services program, review 
 39.5   staff on-site observations and evaluate mental health 
 39.6   rehabilitation workers, plan staff training, review program 
 39.7   evaluation and development, and consult with the directing 
 39.8   practitioner; and 
 39.9      (6) be available for urgent consultation as the individual 
 39.10  recipient needs or the situation necessitates~~; and~~ 
 39.11     ~~(7) provide clinical supervision by full- or part-time~~ 
 39.12  ~~mental health professionals employed by or under contract with~~ 
 39.13  ~~the provider entity~~. 
 39.14     (d) An adult rehabilitative mental health services provider 
 39.15  entity must have a treatment director who is a mental health 
 39.16  practitioner or mental health professional.  The treatment 
 39.17  director must ensure the following: 
 39.18     (1) while delivering direct services to recipients, a newly 
 39.19  hired mental health rehabilitation worker must be directly 
 39.20  observed delivering services to recipients by ~~the~~ a mental 
 39.21  health practitioner or mental health professional for at least 
 39.22  six hours per 40 hours worked during the first 160 hours that 
 39.23  the mental health rehabilitation worker works; 
 39.24     (2) the mental health rehabilitation worker must receive 
 39.25  ongoing on-site direct service observation by a mental health 
 39.26  professional or mental health practitioner for at least six 
 39.27  hours for every six months of employment; 
 39.28     (3) progress notes are reviewed from on-site service 
 39.29  observation prepared by the mental health rehabilitation worker 
 39.30  and mental health practitioner for accuracy and consistency with 
 39.31  actual recipient contact and the individual treatment plan and 
 39.32  goals; 
 39.33     (4) immediate availability by phone or in person for 
 39.34  consultation by a mental health professional or a mental health 
 39.35  practitioner to the mental health rehabilitation services worker 
 39.36  during service provision; 
 40.1      (5) oversee the identification of changes in individual 
 40.2   recipient treatment strategies, revise the plan, and communicate 
 40.3   treatment instructions and methodologies as appropriate to 
 40.4   ensure that treatment is implemented correctly; 
 40.5      (6) model service practices which:  respect the recipient, 
 40.6   include the recipient in planning and implementation of the 
 40.7   individual treatment plan, recognize the recipient's strengths, 
 40.8   collaborate and coordinate with other involved parties and 
 40.9   providers; 
 40.10     (7) ensure that mental health practitioners and mental 
 40.11  health rehabilitation workers are able to effectively 
 40.12  communicate with the recipients, significant others, and 
 40.13  providers; and 
 40.14     (8) oversee the record of the results of on-site 
 40.15  observation and charting evaluation and corrective actions taken 
 40.16  to modify the work of the mental health practitioners and mental 
 40.17  health rehabilitation workers. 
 40.18     (e) A mental health practitioner who is providing treatment 
 40.19  direction for a provider entity must receive supervision at 
 40.20  least monthly from a mental health professional to: 
 40.21     (1) identify and plan for general needs of the recipient 
 40.22  population served; 
 40.23     (2) identify and plan to address provider entity program 
 40.24  needs and effectiveness; 
 40.25     (3) identify and plan provider entity staff training and 
 40.26  personnel needs and issues; and 
 40.27     (4) plan, implement, and evaluate provider entity quality 
 40.28  improvement programs.  
 40.29     Sec. 6.  Minnesota Statutes 2002, section 256B.0623, 
 40.30  subdivision 8, is amended to read: 
 40.31     Subd. 8.  [DIAGNOSTIC ASSESSMENT.] Providers of adult 
 40.32  rehabilitative mental health services must complete a diagnostic 
 40.33  assessment as defined in section 245.462, subdivision 9, within 
 40.34  five days after the recipient's second visit or within 30 days 
 40.35  after intake, whichever occurs first.  In cases where a 
 40.36  diagnostic assessment is available that reflects the recipient's 
 41.1   current status, and has been completed within 180 days preceding 
 41.2   admission, an update must be completed.  An update shall include 
 41.3   a written summary by a mental health professional of the 
 41.4   recipient's current mental health status and service needs.  If 
 41.5   the recipient's mental health status has changed significantly 
 41.6   since the adult's most recent diagnostic assessment, a new 
 41.7   diagnostic assessment is required.  For initial implementation 
 41.8   of adult rehabilitative mental health services, until June 30, 
 41.9   2005, a diagnostic assessment that reflects the recipient's 
 41.10  current status and has been completed within the past three 
 41.11  years preceding admission is acceptable. 
 41.12     Sec. 7.  Minnesota Statutes 2002, section 256B.0625, 
 41.13  subdivision 19c, is amended to read: 
 41.14     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 41.15  personal care assistant services provided by an individual who 
 41.16  is qualified to provide the services according to subdivision 
 41.17  19a and section 256B.0627, where the services are prescribed by 
 41.18  a physician in accordance with a plan of treatment and are 
 41.19  supervised by the recipient or a qualified professional.  
 41.20  "Qualified professional" means a mental health professional as 
 41.21  defined in section 245.462, subdivision 18, or 245.4871, 
 41.22  subdivision 27; or a registered nurse as defined in sections 
 41.23  148.171 to 148.285, or a licensed social worker as defined in 
 41.24  section 148B.21.  As part of the assessment, the county public 
 41.25  health nurse will assist the recipient or responsible party to 
 41.26  identify the most appropriate person to provide supervision of 
 41.27  the personal care assistant.  The qualified professional shall 
 41.28  perform the duties described in Minnesota Rules, part 9505.0335, 
 41.29  subpart 4.  
 41.30     Sec. 8.  Minnesota Statutes 2002, section 256B.0627, 
 41.31  subdivision 1, is amended to read: 
 41.32     Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
 41.33  living" includes eating, toileting, grooming, dressing, bathing, 
 41.34  transferring, mobility, and positioning.  
 41.35     (b) "Assessment" means a review and evaluation of a 
 41.36  recipient's need for home care services conducted in person.  
 42.1   Assessments for private duty nursing shall be conducted by a 
 42.2   registered private duty nurse.  Assessments for home health 
 42.3   agency services shall be conducted by a home health agency 
 42.4   nurse.  Assessments for personal care assistant services shall 
 42.5   be conducted by the county public health nurse or a certified 
 42.6   public health nurse under contract with the county.  A 
 42.7   face-to-face assessment must include:  documentation of health 
 42.8   status, determination of need, evaluation of service 
 42.9   effectiveness, identification of appropriate services, service 
 42.10  plan development or modification, coordination of services, 
 42.11  referrals and follow-up to appropriate payers and community 
 42.12  resources, completion of required reports, recommendation of 
 42.13  service authorization, and consumer education.  Once the need 
 42.14  for personal care assistant services is determined under this 
 42.15  section, the county public health nurse or certified public 
 42.16  health nurse under contract with the county is responsible for 
 42.17  communicating this recommendation to the commissioner and the 
 42.18  recipient.  A face-to-face assessment for personal care 
 42.19  assistant services is conducted on those recipients who have 
 42.20  never had a county public health nurse assessment.  A 
 42.21  face-to-face assessment must occur at least annually or when 
 42.22  there is a significant change in the recipient's condition or 
 42.23  when there is a change in the need for personal care assistant 
 42.24  services.  A service update may substitute for the annual 
 42.25  face-to-face assessment when there is not a significant change 
 42.26  in recipient condition or a change in the need for personal care 
 42.27  assistant service.  A service update or review for temporary 
 42.28  increase includes a review of initial baseline data, evaluation 
 42.29  of service effectiveness, redetermination of service need, 
 42.30  modification of service plan and appropriate referrals, update 
 42.31  of initial forms, obtaining service authorization, and on going 
 42.32  consumer education.  Assessments for medical assistance home 
 42.33  care services for mental retardation or related conditions and 
 42.34  alternative care services for developmentally disabled home and 
 42.35  community-based waivered recipients may be conducted by the 
 42.36  county public health nurse to ensure coordination and avoid 
 43.1   duplication.  Assessments must be completed on forms provided by 
 43.2   the commissioner within 30 days of a request for home care 
 43.3   services by a recipient or responsible party. 
 43.4      (c) "Care plan" means a written description of personal 
 43.5   care assistant services developed by the qualified professional 
 43.6   or the recipient's physician with the recipient or responsible 
 43.7   party to be used by the personal care assistant with a copy 
 43.8   provided to the recipient or responsible party. 
 43.9      (d) "Complex and regular private duty nursing care" means: 
 43.10     (1) complex care is private duty nursing provided to 
 43.11  recipients who are ventilator dependent or for whom a physician 
 43.12  has certified that were it not for private duty nursing the 
 43.13  recipient would meet the criteria for inpatient hospital 
 43.14  intensive care unit (ICU) level of care; and 
 43.15     (2) regular care is private duty nursing provided to all 
 43.16  other recipients. 
 43.17     (e) "Health-related functions" means functions that can be 
 43.18  delegated or assigned by a licensed health care professional 
 43.19  under state law to be performed by a personal care attendant. 
 43.20     (f) "Home care services" means a health service, determined 
 43.21  by the commissioner as medically necessary, that is ordered by a 
 43.22  physician and documented in a service plan that is reviewed by 
 43.23  the physician at least once every 60 days for the provision of 
 43.24  home health services, or private duty nursing, or at least once 
 43.25  every 365 days for personal care.  Home care services are 
 43.26  provided to the recipient at the recipient's residence that is a 
 43.27  place other than a hospital or long-term care facility or as 
 43.28  specified in section 256B.0625.  
 43.29     (g) "Instrumental activities of daily living" includes meal 
 43.30  planning and preparation, managing finances, shopping for food, 
 43.31  clothing, and other essential items, performing essential 
 43.32  household chores, communication by telephone and other media, 
 43.33  and getting around and participating in the community. 
 43.34     (h) "Medically necessary" has the meaning given in 
 43.35  Minnesota Rules, parts 9505.0170 to 9505.0475.  
 43.36     (i) "Personal care assistant" means a person who:  
 44.1      (1) is at least 18 years old, except for persons 16 to 18 
 44.2   years of age who participated in a related school-based job 
 44.3   training program or have completed a certified home health aide 
 44.4   competency evaluation; 
 44.5      (2) is able to effectively communicate with the recipient 
 44.6   and personal care provider organization; 
 44.7      (3) effective July 1, 1996, has completed one of the 
 44.8   training requirements as specified in Minnesota Rules, part 
 44.9   9505.0335, subpart 3, items A to D; 
 44.10     (4) has the ability to, and provides covered personal care 
 44.11  assistant services according to the recipient's care plan, 
 44.12  responds appropriately to recipient needs, and reports changes 
 44.13  in the recipient's condition to the supervising qualified 
 44.14  professional or physician; 
 44.15     (5) is not a consumer of personal care assistant services; 
 44.16  and 
 44.17     (6) is subject to criminal background checks and procedures 
 44.18  specified in section 245A.04.  
 44.19     (j) "Personal care provider organization" means an 
 44.20  organization enrolled to provide personal care assistant 
 44.21  services under the medical assistance program that complies with 
 44.22  the following:  (1) owners who have a five percent interest or 
 44.23  more, and managerial officials are subject to a background study 
 44.24  as provided in section 245A.04.  This applies to currently 
 44.25  enrolled personal care provider organizations and those agencies 
 44.26  seeking enrollment as a personal care provider organization.  An 
 44.27  organization will be barred from enrollment if an owner or 
 44.28  managerial official of the organization has been convicted of a 
 44.29  crime specified in section 245A.04, or a comparable crime in 
 44.30  another jurisdiction, unless the owner or managerial official 
 44.31  meets the reconsideration criteria specified in section 245A.04; 
 44.32  (2) the organization must maintain a surety bond and liability 
 44.33  insurance throughout the duration of enrollment and provides 
 44.34  proof thereof.  The insurer must notify the department of human 
 44.35  services of the cancellation or lapse of policy; and (3) the 
 44.36  organization must maintain documentation of services as 
 45.1   specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
 45.2   as evidence of compliance with personal care assistant training 
 45.3   requirements. 
 45.4      (k) "Responsible party" means an individual ~~residing with a~~ 
 45.5   ~~recipient of personal care assistant services~~ who is capable of 
 45.6   providing the ~~supportive care~~ support necessary to assist the 
 45.7   recipient to live in the community, is at least 18 years 
 45.8   old, actively participates in planning and directing of personal 
 45.9   care assistant services, and is not ~~a~~ the personal care 
 45.10  assistant.  The responsible party must be accessible to the 
 45.11  recipient and the personal care assistant when personal care 
 45.12  services are being provided and monitor the services at least 
 45.13  weekly according to the plan of care.  The responsible party 
 45.14  must be identified at the time of assessment and listed on the 
 45.15  recipient's service agreement and care plan.  Responsible 
 45.16  parties ~~who are parents of minors or guardians of minors or~~ 
 45.17  ~~incapacitated persons~~ may delegate the responsibility to another 
 45.18  adult ~~during a temporary absence of at least 24 hours but not~~ 
 45.19  ~~more than six months.  The person delegated as a responsible~~ 
 45.20  ~~party must be able to meet the definition of responsible party,~~ 
 45.21  ~~except that the delegated responsible party is required to~~ 
 45.22  ~~reside with the recipient only while serving as the responsible~~ 
 45.23  ~~party~~ who is not the personal care assistant.  The responsible 
 45.24  party must assure that the delegate performs the functions of 
 45.25  the responsible party, is identified at the time of the 
 45.26  assessment, and is listed on the service agreement and the care 
 45.27  plan.  Foster care license holders may be designated the 
 45.28  responsible party for residents of the foster care home if case 
 45.29  management is provided as required in section 256B.0625, 
 45.30  subdivision 19a.  For persons who, as of April 1, 1992, are 
 45.31  sharing personal care assistant services in order to obtain the 
 45.32  availability of 24-hour coverage, an employee of the personal 
 45.33  care provider organization may be designated as the responsible 
 45.34  party if case management is provided as required in section 
 45.35  256B.0625, subdivision 19a. 
 45.36     (l) "Service plan" means a written description of the 
 46.1   services needed based on the assessment developed by the nurse 
 46.2   who conducts the assessment together with the recipient or 
 46.3   responsible party.  The service plan shall include a description 
 46.4   of the covered home care services, frequency and duration of 
 46.5   services, and expected outcomes and goals.  The recipient and 
 46.6   the provider chosen by the recipient or responsible party must 
 46.7   be given a copy of the completed service plan within 30 calendar 
 46.8   days of the request for home care services by the recipient or 
 46.9   responsible party. 
 46.10     (m) "Skilled nurse visits" are provided in a recipient's 
 46.11  residence under a plan of care or service plan that specifies a 
 46.12  level of care which the nurse is qualified to provide.  These 
 46.13  services are: 
 46.14     (1) nursing services according to the written plan of care 
 46.15  or service plan and accepted standards of medical and nursing 
 46.16  practice in accordance with chapter 148; 
 46.17     (2) services which due to the recipient's medical condition 
 46.18  may only be safely and effectively provided by a registered 
 46.19  nurse or a licensed practical nurse; 
 46.20     (3) assessments performed only by a registered nurse; and 
 46.21     (4) teaching and training the recipient, the recipient's 
 46.22  family, or other caregivers requiring the skills of a registered 
 46.23  nurse or licensed practical nurse. 
 46.24     (n) "Telehomecare" means the use of telecommunications 
 46.25  technology by a home health care professional to deliver home 
 46.26  health care services, within the professional's scope of 
 46.27  practice, to a patient located at a site other than the site 
 46.28  where the practitioner is located. 
 46.29     Sec. 9.  Minnesota Statutes 2002, section 256B.0627, 
 46.30  subdivision 4, is amended to read: 
 46.31     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
 46.32  personal care assistant services that are eligible for payment 
 46.33  are services and supports furnished to an individual, as needed, 
 46.34  to assist in accomplishing activities of daily living; 
 46.35  instrumental activities of daily living; health-related 
 46.36  functions through hands-on assistance, supervision, and cuing; 
 47.1   and redirection and intervention for behavior including 
 47.2   observation and monitoring.  
 47.3      (b) Payment for services will be made within the limits 
 47.4   approved using the prior authorized process established in 
 47.5   subdivision 5. 
 47.6      (c) The amount and type of services authorized shall be 
 47.7   based on an assessment of the recipient's needs in these areas: 
 47.8      (1) bowel and bladder care; 
 47.9      (2) skin care to maintain the health of the skin; 
 47.10     (3) repetitive maintenance range of motion, muscle 
 47.11  strengthening exercises, and other tasks specific to maintaining 
 47.12  a recipient's optimal level of function; 
 47.13     (4) respiratory assistance; 
 47.14     (5) transfers and ambulation; 
 47.15     (6) bathing, grooming, and hairwashing necessary for 
 47.16  personal hygiene; 
 47.17     (7) turning and positioning; 
 47.18     (8) assistance with furnishing medication that is 
 47.19  self-administered; 
 47.20     (9) application and maintenance of prosthetics and 
 47.21  orthotics; 
 47.22     (10) cleaning medical equipment; 
 47.23     (11) dressing or undressing; 
 47.24     (12) assistance with eating and meal preparation and 
 47.25  necessary grocery shopping; 
 47.26     (13) accompanying a recipient to obtain medical diagnosis 
 47.27  or treatment; 
 47.28     (14) assisting, monitoring, or prompting the recipient to 
 47.29  complete the services in clauses (1) to (13); 
 47.30     (15) redirection, monitoring, and observation that are 
 47.31  medically necessary and an integral part of completing the 
 47.32  personal care assistant services described in clauses (1) to 
 47.33  (14); 
 47.34     (16) redirection and intervention for behavior, including 
 47.35  observation and monitoring; 
 47.36     (17) interventions for seizure disorders, including 
 48.1   monitoring and observation if the recipient has had a seizure 
 48.2   that requires intervention within the past three months; 
 48.3      (18) tracheostomy suctioning using a clean procedure if the 
 48.4   procedure is properly delegated by a registered nurse.  Before 
 48.5   this procedure can be delegated to a personal care assistant, a 
 48.6   registered nurse must determine that the tracheostomy suctioning 
 48.7   can be accomplished utilizing a clean rather than a sterile 
 48.8   procedure and must ensure that the personal care assistant has 
 48.9   been taught the proper procedure; and 
 48.10     (19) incidental household services that are an integral 
 48.11  part of a personal care service described in clauses (1) to (18).
 48.12  For purposes of this subdivision, monitoring and observation 
 48.13  means watching for outward visible signs that are likely to 
 48.14  occur and for which there is a covered personal care service or 
 48.15  an appropriate personal care intervention.  For purposes of this 
 48.16  subdivision, a clean procedure refers to a procedure that 
 48.17  reduces the numbers of microorganisms or prevents or reduces the 
 48.18  transmission of microorganisms from one person or place to 
 48.19  another.  A clean procedure may be used beginning 14 days after 
 48.20  insertion. 
 48.21     (d) The personal care assistant services that are not 
 48.22  eligible for payment are the following:  
 48.23     (1) services not ordered by the physician; 
 48.24     (2) assessments by personal care assistant provider 
 48.25  organizations or by independently enrolled registered nurses; 
 48.26     (3) services that are not in the service plan; 
 48.27     (4) services provided by the recipient's spouse, legal 
 48.28  guardian for an adult or child recipient, or parent of a 
 48.29  recipient under age 18; 
 48.30     (5) services provided by a foster care provider of a 
 48.31  recipient who cannot direct the recipient's own care, unless 
 48.32  monitored by a county or state case manager under section 
 48.33  256B.0625, subdivision 19a; 
 48.34     (6) services provided by the residential or program license 
 48.35  holder in a residence for more than four persons; 
 48.36     (7) services that are the responsibility of a residential 
 49.1   or program license holder under the terms of a service agreement 
 49.2   and administrative rules; 
 49.3      (8) sterile procedures; 
 49.4      (9) injections of fluids into veins, muscles, or skin; 
 49.5      (10) ~~services provided by parents of adult recipients,~~ 
 49.6   ~~adult children, or siblings of the recipient, unless these~~ 
 49.7   ~~relatives meet one of the following hardship criteria and the~~ 
 49.8   ~~commissioner waives this requirement:~~ 
 49.9      ~~(i) the relative resigns from a part-time or full-time job~~ 
 49.10  ~~to provide personal care for the recipient;~~ 
 49.11     ~~(ii) the relative goes from a full-time to a part-time job~~ 
 49.12  ~~with less compensation to provide personal care for the~~ 
 49.13  ~~recipient;~~ 
 49.14     ~~(iii) the relative takes a leave of absence without pay to~~ 
 49.15  ~~provide personal care for the recipient;~~ 
 49.16     ~~(iv) the relative incurs substantial expenses by providing~~ 
 49.17  ~~personal care for the recipient; or~~ 
 49.18     ~~(v) because of labor conditions, special language needs, or~~ 
 49.19  ~~intermittent hours of care needed, the relative is needed in~~ 
 49.20  ~~order to provide an adequate number of qualified personal care~~ 
 49.21  ~~assistants to meet the medical needs of the recipient;~~ 
 49.22     ~~(11)~~ homemaker services that are not an integral part of a 
 49.23  personal care assistant services; 
 49.24     ~~(12)~~ (11) home maintenance, or chore services; 
 49.25     ~~(13)~~ (12) services not specified under paragraph (a); and 
 49.26     ~~(14)~~ (13) services not authorized by the commissioner or 
 49.27  the commissioner's designee. 
 49.28     (e) The recipient or responsible party may choose to 
 49.29  supervise the personal care assistant or to have a qualified 
 49.30  professional, as defined in section 256B.0625, subdivision 19c, 
 49.31  provide the supervision.  As required under section 256B.0625, 
 49.32  subdivision 19c, the county public health nurse, as a part of 
 49.33  the assessment, will assist the recipient or responsible party 
 49.34  to identify the most appropriate person to provide supervision 
 49.35  of the personal care assistant.  Health-related delegated tasks 
 49.36  performed by the personal care assistant will be under the 
 50.1   supervision of a qualified professional or the direction of the 
 50.2   recipient's physician.  If the recipient has a qualified 
 50.3   professional, Minnesota Rules, part 9505.0335, subpart 4, 
 50.4   applies. 
 50.5      Sec. 10.  Minnesota Statutes 2002, section 256B.0627, 
 50.6   subdivision 9, is amended to read: 
 50.7      Subd. 9.  [FLEXIBLE USE OF PERSONAL CARE ASSISTANT HOURS.] 
 50.8   (a) ~~The commissioner may allow for the flexible use of personal~~ 
 50.9   ~~care assistant hours.~~  "Flexible use" means the scheduled use of 
 50.10  authorized hours of personal care assistant services, which vary 
 50.11  within the length of the service authorization in order to more 
 50.12  effectively meet the needs and schedule of the recipient.  
 50.13  Recipients may use their approved hours flexibly within the 
 50.14  service authorization period for medically necessary covered 
 50.15  services specified in the assessment required in subdivision 1.  
 50.16  The flexible use of authorized hours does not increase the total 
 50.17  amount of authorized hours available to a recipient as 
 50.18  determined under subdivision 5.  The commissioner shall not 
 50.19  authorize additional personal care assistant services to 
 50.20  supplement a service authorization that is exhausted before the 
 50.21  end date under a flexible service use plan, unless the county 
 50.22  public health nurse determines a change in condition and a need 
 50.23  for increased services is established. 
 50.24     (b) ~~The recipient or responsible party, together with the~~ 
 50.25  ~~county public health nurse, shall determine whether flexible use~~ 
 50.26  ~~is an appropriate option based on the needs and preferences of~~ 
 50.27  ~~the recipient or responsible party, and, if appropriate, must~~ 
 50.28  ~~ensure that the allocation of hours covers the ongoing needs of~~ 
 50.29  ~~the recipient over the entire service authorization period.  As~~ 
 50.30  ~~part of the assessment and service planning process, the~~ 
 50.31  ~~recipient or responsible party must work with the county public~~ 
 50.32  ~~health nurse to develop a written month-to-month plan of the~~ 
 50.33  ~~projected use of personal care assistant services that is part~~ 
 50.34  ~~of the service plan and ensures that the:~~ 
 50.35     ~~(1) health and safety needs of the recipient will be met;~~ 
 50.36     ~~(2) total annual authorization will not exceed before the~~ 
 51.1   ~~end date; and~~ 
 51.2      ~~(3) how actual use of hours will be monitored.~~  
 51.3      ~~(c) If the actual use of personal care assistant service~~ 
 51.4   ~~varies significantly from the use projected in the plan, the~~ 
 51.5   ~~written plan must be promptly updated by the recipient or~~ 
 51.6   ~~responsible party and the county public health nurse.~~ 
 51.7      ~~(d)~~ The recipient or responsible party, together with the 
 51.8   provider, must work to monitor and document the use of 
 51.9   authorized hours and ensure that a recipient is able to manage 
 51.10  services effectively throughout the authorized period.  ~~The~~ 
 51.11  ~~provider must ensure that the month-to-month plan is~~ 
 51.12  ~~incorporated into the care plan.~~  Upon request of the recipient 
 51.13  or responsible party, the provider must furnish regular updates 
 51.14  to the recipient or responsible party on the amount of personal 
 51.15  care assistant services used.  
 51.16     ~~(e) The recipient or responsible party may revoke the~~ 
 51.17  ~~authorization for flexible use of hours by notifying the~~ 
 51.18  ~~provider and county public health nurse in writing.~~ 
 51.19     ~~(f) If the requirements in paragraphs (a) to (e) have not~~ 
 51.20  ~~substantially been met, the commissioner shall deny, revoke, or~~ 
 51.21  ~~suspend the authorization to use authorized hours flexibly.  The~~ 
 51.22  ~~recipient or responsible party may appeal the commissioner's~~ 
 51.23  ~~action according to section 256.045.  The denial, revocation, or~~ 
 51.24  ~~suspension to use the flexible hours option shall not affect the~~ 
 51.25  ~~recipient's authorized level of personal care assistant services~~ 
 51.26  ~~as determined under subdivision 5.~~ 
 51.27     Sec. 11.  Minnesota Statutes 2002, section 256B.0911, 
 51.28  subdivision 4d, is amended to read: 
 51.29     Subd. 4d.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
 51.30  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
 51.31  ensure that individuals with disabilities or chronic illness are 
 51.32  served in the most integrated setting appropriate to their needs 
 51.33  and have the necessary information to make informed choices 
 51.34  about home and community-based service options. 
 51.35     (b) Individuals under 65 years of age who are admitted to a 
 51.36  nursing facility from a hospital must be screened prior to 
 52.1   admission as outlined in subdivisions 4a through 4c. 
 52.2      (c) Individuals under 65 years of age who are admitted to 
 52.3   nursing facilities with only a telephone screening must receive 
 52.4   a face-to-face assessment from the long-term care consultation 
 52.5   team member of the county in which the facility is located or 
 52.6   from the recipient's county case manager within ~~20 working~~ 40 
 52.7   calendar days of admission. 
 52.8      (d) Individuals under 65 years of age who are admitted to a 
 52.9   nursing facility without preadmission screening according to the 
 52.10  exemption described in subdivision 4b, paragraph (a), clause 
 52.11  (3), and who remain in the facility longer than 30 days must 
 52.12  receive a face-to-face assessment within 40 days of admission.  
 52.13     (e) At the face-to-face assessment, the long-term care 
 52.14  consultation team member or county case manager must perform the 
 52.15  activities required under subdivision 3b. 
 52.16     (f) For individuals under 21 years of age, a screening 
 52.17  interview which recommends nursing facility admission must be 
 52.18  face-to-face and approved by the commissioner before the 
 52.19  individual is admitted to the nursing facility. 
 52.20     (g) In the event that an individual under 65 years of age 
 52.21  is admitted to a nursing facility on an emergency basis, the 
 52.22  county must be notified of the admission on the next working 
 52.23  day, and a face-to-face assessment as described in paragraph (c) 
 52.24  must be conducted within ~~20 working days~~ 40 calendar days of 
 52.25  admission. 
 52.26     (h) At the face-to-face assessment, the long-term care 
 52.27  consultation team member or the case manager must present 
 52.28  information about home and community-based options so the 
 52.29  individual can make informed choices.  If the individual chooses 
 52.30  home and community-based services, the long-term care 
 52.31  consultation team member or case manager must complete a written 
 52.32  relocation plan within 20 working days of the visit.  The plan 
 52.33  shall describe the services needed to move out of the facility 
 52.34  and a time line for the move which is designed to ensure a 
 52.35  smooth transition to the individual's home and community. 
 52.36     (i) An individual under 65 years of age residing in a 
 53.1   nursing facility shall receive a face-to-face assessment at 
 53.2   least every 12 months to review the person's service choices and 
 53.3   available alternatives unless the individual indicates, in 
 53.4   writing, that annual visits are not desired.  In this case, the 
 53.5   individual must receive a face-to-face assessment at least once 
 53.6   every 36 months for the same purposes. 
 53.7      (j) Notwithstanding the provisions of subdivision 6, the 
 53.8   commissioner may pay county agencies directly for face-to-face 
 53.9   assessments for individuals under 65 years of age who are being 
 53.10  considered for placement or residing in a nursing facility. 
 53.11     Sec. 12.  Minnesota Statutes 2002, section 256B.0915, is 
 53.12  amended by adding a subdivision to read: 
 53.13     Subd. 9.  [TRIBAL MANAGEMENT OF ELDERLY WAIVER.] 
 53.14  Notwithstanding contrary provisions of this section, or those in 
 53.15  other state laws or rules, the commissioner and White Earth 
 53.16  reservation may develop a model for tribal management of the 
 53.17  elderly waiver program and implement this model through a 
 53.18  contract between the state and White Earth reservation.  The 
 53.19  model shall include the provision of tribal waiver case 
 53.20  management, assessment for personal care assistance, and 
 53.21  administrative requirements otherwise carried out by counties 
 53.22  but shall not include tribal financial eligibility determination 
 53.23  for medical assistance. 
 53.24     Sec. 13.  Minnesota Statutes 2002, section 256B.47, 
 53.25  subdivision 2, is amended to read: 
 53.26     Subd. 2.  [NOTICE TO RESIDENTS.] (a) No increase in nursing 
 53.27  facility rates for private paying residents shall be effective 
 53.28  unless the nursing facility notifies the resident or person 
 53.29  responsible for payment of the increase in writing 30 days 
 53.30  before the increase takes effect.  
 53.31     A nursing facility may adjust its rates without giving the 
 53.32  notice required by this subdivision when the purpose of the rate 
 53.33  adjustment is to reflect a ~~necessary~~ change in the ~~level of care~~ 
 53.34  ~~provided to a~~ case-mix classification of the resident.  If the 
 53.35  state fails to set rates as required by section 
 53.36  256B.431, subdivision 1, the time required for giving notice is 
 54.1   decreased by the number of days by which the state was late in 
 54.2   setting the rates. 
 54.3      (b) If the state does not set rates by the date required in 
 54.4   section 256B.431, subdivision 1, nursing facilities shall meet 
 54.5   the requirement for advance notice by informing the resident or 
 54.6   person responsible for payments, on or before the effective date 
 54.7   of the increase, that a rate increase will be effective on that 
 54.8   date.  If the exact amount has not yet been determined, the 
 54.9   nursing facility may raise the rates by the amount anticipated 
 54.10  to be allowed.  Any amounts collected from private pay residents 
 54.11  in excess of the allowable rate must be repaid to private pay 
 54.12  residents with interest at the rate used by the commissioner of 
 54.13  revenue for the late payment of taxes and in effect on the date 
 54.14  the rate increase is effective. 
 54.15                             ARTICLE 3 
 54.16                           MISCELLANEOUS 
 54.17     Section 1.  Minnesota Statutes 2002, section 256B.431, is 
 54.18  amended by adding a subdivision to read: 
 54.19     Subd. 38.  [DESIGNATION OF AREAS TO RECEIVE METROPOLITAN 
 54.20  RATES.] (a) For rate years beginning on or after July 1, 2003, 
 54.21  and subject to paragraph (b), nursing facilities located in 
 54.22  areas designated as metropolitan areas by the federal Office of 
 54.23  Management and Budget using census bureau data shall be 
 54.24  considered metro, in order to: 
 54.25     (1) determine rate increases under this section, section 
 54.26  256B.434, or any other section; and 
 54.27     (2) establish nursing facility reimbursement rates for the 
 54.28  new nursing facility reimbursement system developed under Laws 
 54.29  2002, chapter 220, article 14, section 35. 
 54.30     (b) Paragraph (a) applies only if designation as a metro 
 54.31  facility results in a level of reimbursement that is higher than 
 54.32  the level the facility would have received without application 
 54.33  of that paragraph. 
 54.34     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003. 
 54.35     Sec. 2.  [MEDICAL ASSISTANCE FOR MENTAL HEALTH SERVICES 
 54.36  PROVIDED IN OUT-OF-HOME PLACEMENT SETTINGS.] 
 55.1      The commissioner of human services, in consultation with 
 55.2   the commissioner of corrections and representatives of counties, 
 55.3   health care providers, and other stakeholders, shall develop a 
 55.4   plan to secure medical assistance funding for mental 
 55.5   health-related services provided in out-of-home placement 
 55.6   settings, including treatment foster care, group homes, and 
 55.7   residential programs licensed under Minnesota Statutes, chapters 
 55.8   241 and 245A.  The plan must include fiscal estimates and 
 55.9   related information and draft legislation.  Treatment foster 
 55.10  care services must be provided by a child placing agency 
 55.11  licensed under Minnesota Rules, parts 9545.0755 to 9545.0845 or 
 55.12  9543.0010 to 9543.0150.  The commissioner shall submit the plan 
 55.13  to the legislature by January 15, 2004.  
 55.14     Sec. 3.  [ASSESSMENT OF A DOULA SERVICES HEALTH BENEFIT 
 55.15  MANDATE.] 
 55.16     The commissioner of health, in consultation with the 
 55.17  commissioner of human services and stakeholders, shall complete 
 55.18  an assessment of statutorily requiring health plans that offer 
 55.19  maternity benefits to provide coverage for doula services when 
 55.20  provided by a certified doula, in terms of the public health, 
 55.21  economic, and fiscal impacts of the proposed mandate, including 
 55.22  the extent to which the provision of doula coverage will 
 55.23  increase or decrease the cost of maternity benefits. 
 55.24     "Doula services" means childbirth education and support 
 55.25  services, including emotional and physical support provided 
 55.26  during pregnancy, labor, birth, and postpartum. 
 55.27     "Certified doula" means an individual who has received a 
 55.28  certification to perform doula services from the International 
 55.29  Childbirth Education Association, the Doulas of North America, 
 55.30  the Association of Labor Assistance and Childbirth Educators, or 
 55.31  the Childbirth and Postpartum Professional Association. 
 55.32     The commissioner shall submit to the legislature a summary 
 55.33  report of all findings and recommendations by January 15, 2004.