Source: https://www.revisor.mn.gov/statutes/cite/245D/full
Timestamp: 2019-06-16 05:49:42
Document Index: 444929128

Matched Legal Cases: ['art 8', 'art 18', 'art 18', 'art 8', 'art 1', 'art 27', 'art 6', 'art 1', 'art 8', 'art 27', 'art 1', 'art 1', 'arts 160', 'art 8', 'art 1', 'art 4', 'art 27', 'art 8', 'art 7', 'art 8', 'art 8', 'art 8', 'art 8', 'art 8', 'art 8', 'art 3']

245D.02 subd. 3 has been amended by Chapter 54, Article 2, Section 11
245D.02 subd. 4b has been amended by Chapter 54, Article 2, Section 12
245D.02 subd. 10 has been amended by Chapter 54, Article 2, Section 13
245D.03 subd. 1 has been amended by Chapter 54, Article 2, Section 14
245D.03 subd. 1 has been amended by Chapter 9, Article 5, Section 11
245D.071 subd. 1 has been amended by Chapter 9, Article 5, Section 12
245D.071 subd. 5 has been amended by Chapter 9, Article 5, Section 13
245D.081 subd. 3 has been amended by Chapter 9, Article 7, Section 6
245D.09 subd. 5 has been amended by Chapter 9, Article 5, Section 14
245D.09 subd. 5a has been amended by Chapter 9, Article 5, Section 15
245D.091 subd. 2 has been amended by Chapter 9, Article 5, Section 16
245D.091 subd. 3 has been amended by Chapter 9, Article 5, Section 17
245D.091 subd. 4 has been amended by Chapter 9, Article 5, Section 18
245D.12 has been added by Chapter 9, Article 5, Section 19
245D.22 subd. 2 has been amended by Chapter 50, Article 1, Section 66
245D.01 CITATION.
245D.061 EMERGENCY USE OF MANUAL RESTRAINTS.
245D.08 [Repealed, 2013 c 108 art 8 s 61]
245D.11 POLICIES AND PROCEDURES; INTENSIVE SUPPORT SERVICES.
245D.25 COMMUNITY RESIDENTIAL SETTINGS; FOOD AND WATER.
DAY SERVICES FACILITIES
245D.27 DAY SERVICES FACILITIES; SATELLITE LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
245D.28 DAY SERVICES FACILITIES; PHYSICAL PLANT AND SPACE REQUIREMENTS.
245D.29 DAY SERVICES FACILITIES; HEALTH AND SAFETY REQUIREMENTS.
ALTERNATIVE LICENSING INSPECTIONS
245D.32 ALTERNATIVE LICENSING INSPECTIONS.
245D.33 ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
This chapter may be cited as the "Home and Community-Based Services Standards" or "HCBS Standards."
2012 c 216 art 18 s 16
(5) night supervision services as defined under the brain injury waiver plan;
(6) homemaker services as defined under the community access for disability inclusion, brain injury, community alternative care, developmental disability, and elderly waiver plans, excluding providers licensed by the Department of Health under chapter 144A and those providers providing cleaning services only; and
(ii) independent living services training as defined under the brain injury and community access for disability inclusion waiver plans;
(5) employment exploration services as defined under the brain injury, community alternative care, community access for disability inclusion, and developmental disability waiver plans;
(6) employment development services as defined under the brain injury, community alternative care, community access for disability inclusion, and developmental disability waiver plans; and
(7) employment support services as defined under the brain injury, community alternative care, community access for disability inclusion, and developmental disability waiver plans.
2012 c 216 art 18 s 18; 2013 c 108 art 8 s 23; 2014 c 275 art 1 s 48; 2014 c 312 art 27 s 19-22,77; 2015 c 78 art 6 s 31; 2017 c 90 s 10; 1Sp2017 c 6 art 1 s 2
NOTE: The amendment to subdivision 1, paragraph (c), clauses (5) to (7), by Laws 2017, First Special Session chapter 6, article 1, section 2, received federal approval and is effective March 8, 2018. Laws 2017, First Special Session chapter 6, article 1, section 2, the effective date.
(10) know the name, telephone number, and the website, e-mail, and street addresses of protection and advocacy services, including the appropriate state-appointed ombudsman, and a brief description of how to file a complaint with these offices;
Subdivision 1.Standards for emergency use of manual restraints.
The license holder must ensure that emergency use of manual restraints complies with the requirements of this chapter and the license holder's policy and procedures as required under subdivision 9.
Subd. 2.Conditions for emergency use of manual restraint.
Emergency use of manual restraint must meet the following conditions:
(1) immediate intervention must be needed to protect the person or others from imminent risk of physical harm; and
(2) the type of manual restraint used must be the least restrictive intervention to eliminate the immediate risk of harm and effectively achieve safety. The manual restraint must end when the threat of harm ends.
Subd. 4.Monitoring emergency use of manual restraint.
The license holder shall monitor a person's health and welfare during an emergency use of a manual restraint. Staff monitoring the procedure must not be the staff implementing the procedure when possible. The license holder shall complete a monitoring form, approved by the commissioner, for each incident involving the emergency use of a manual restraint.
Subd. 5.Reporting emergency use of manual restraint incident.
(a) Within three calendar days after an emergency use of a manual restraint, the staff person who implemented the emergency use must report in writing to the designated coordinator the following information about the emergency use:
(1) the staff and persons receiving services who were involved in the incident leading up to the emergency use of manual restraint;
(2) a description of the physical and social environment, including who was present before and during the incident leading up to the emergency use of manual restraint;
(3) a description of what less restrictive alternative measures were attempted to de-escalate the incident and maintain safety before the manual restraint was implemented that identifies when, how, and how long the alternative measures were attempted before manual restraint was implemented;
(4) a description of the mental, physical, and emotional condition of the person who was restrained, and other persons involved in the incident leading up to, during, and following the manual restraint;
(5) whether there was any injury to the person who was restrained or other persons involved in the incident, including staff, before or as a result of the use of manual restraint;
(6) whether there was a debriefing with the staff, and, if not contraindicated, with the person who was restrained and other persons who were involved in or who witnessed the restraint, following the incident and the outcome of the debriefing. If the debriefing was not conducted at the time the incident report was made, the report should identify whether a debriefing is planned; and
(7) a copy of the report must be maintained in the person's service recipient record.
(b) Each single incident of emergency use of manual restraint must be reported separately. For the purposes of this subdivision, an incident of emergency use of manual restraint is a single incident when the following conditions have been met:
(1) after implementing the manual restraint, staff attempt to release the person at the moment staff believe the person's conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies can be implemented to maintain safety;
(2) upon the attempt to release the restraint, the person's behavior immediately re-escalates; and
(3) staff must immediately reimplement the restraint in order to maintain safety.
Subd. 6.Internal review of emergency use of manual restraint.
(a) Within five working days of the emergency use of manual restraint, the license holder must complete and document an internal review of each report of emergency use of manual restraint. The review must include an evaluation of whether:
(1) the person's service and support strategies developed according to sections 245D.07 and 245D.071 need to be revised;
(2) related policies and procedures were followed;
(3) the policies and procedures were adequate;
(4) there is a need for additional staff training;
(5) the reported event is similar to past events with the persons, staff, or the services involved; and
(6) there is a need for corrective action by the license holder to protect the health and welfare of persons.
(b) Based on the results of the internal review, the license holder must develop, document, and implement a corrective action plan for the program designed to correct current lapses and prevent future lapses in performance by individuals or the license holder, if any. The corrective action plan, if any, must be implemented within 30 days of the internal review being completed.
(c) The license holder must maintain a copy of the internal review and the corrective action plan, if any, in the person's service recipient record.
Subd. 7.Expanded support team review.
(a) Within five working days after the completion of the internal review required in subdivision 6, the license holder must consult with the expanded support team following the emergency use of manual restraint to:
(1) discuss the incident reported in subdivision 5, to define the antecedent or event that gave rise to the behavior resulting in the manual restraint and identify the perceived function the behavior served; and
(2) determine whether the person's coordinated service and support plan addendum needs to be revised according to sections 245D.07 and 245D.071 to positively and effectively help the person maintain stability and to reduce or eliminate future occurrences requiring emergency use of manual restraint.
(b) The license holder must maintain a written summary of the expanded support team's discussion and decisions required in paragraph (a) in the person's service recipient record.
Subd. 8.External review and reporting.
Within five working days of the expanded support team review, the license holder must submit the following to the Department of Human Services, and the Office of the Ombudsman for Mental Health and Developmental Disabilities, as required under section 245.94, subdivision 2a:
(1) the report required under subdivision 5;
(2) the internal review and the corrective action plan required under subdivision 6; and
(3) the summary of the expanded support team review required under subdivision 7.
Subd. 9.Emergency use of manual restraints policy and procedures.
The license holder must develop, document, and implement a policy and procedures that promote service recipient rights and protect health and welfare during the emergency use of manual restraints. The policy and procedures must comply with the requirements of this section and must specify the following:
(1) a description of the positive support strategies and techniques staff must use to attempt to de-escalate a person's behavior before it poses an imminent risk of physical harm to self or others;
(2) a description of the types of manual restraints the license holder allows staff to use on an emergency basis, if any. If the license holder will not allow the emergency use of manual restraint, the policy and procedure must identify the alternative measures the license holder will require staff to use when a person's conduct poses an imminent risk of physical harm to self or others and less restrictive strategies would not achieve safety;
(3) instructions for safe and correct implementation of the allowed manual restraint procedures;
(4) the training that staff must complete and the timelines for completion, before they may implement an emergency use of manual restraint. In addition to the training on this policy and procedure and the orientation and annual training required in section 245D.09, subdivision 4, the training for emergency use of manual restraint must incorporate the following subjects:
(i) alternatives to manual restraint procedures, including techniques to identify events and environmental factors that may escalate conduct that poses an imminent risk of physical harm to self or others;
(ii) de-escalation methods, positive support strategies, and how to avoid power struggles;
(iii) simulated experiences of administering and receiving manual restraint procedures allowed by the license holder on an emergency basis;
(iv) how to properly identify thresholds for implementing and ceasing restrictive procedures;
(v) how to recognize, monitor, and respond to the person's physical signs of distress, including positional asphyxia;
(vi) the physiological and psychological impact on the person and the staff when restrictive procedures are used;
(vii) the communicative intent of behaviors; and
(viii) relationship building;
(5) the procedures and forms to be used to monitor the emergency use of manual restraints, including what must be monitored and the frequency of monitoring per each incident of emergency use of manual restraint, and the person or position who is responsible for monitoring the use;
(6) the instructions, forms, and timelines required for completing and submitting an incident report by the person or persons who implemented the manual restraint; and
(7) the procedures and timelines for conducting the internal review and the expanded support team review, and the person or position responsible for completing the reviews and for ensuring that corrective action is taken or the person's coordinated service and support plan addendum is revised, when determined necessary.
2013 c 108 art 8 s 28; 2014 c 312 art 27 s 77; 2015 c 21 art 1 s 50; 2016 c 158 art 1 s 98
A license holder providing intensive support services as identified in section 245D.03, subdivision 1, paragraph (c), must establish, enforce, and maintain policies and procedures as required in this section.
Subd. 2.Health and welfare.
The license holder must establish policies and procedures that promote health and welfare by ensuring:
(1) use of universal precautions and sanitary practices in compliance with section 245D.06, subdivision 2, clause (5);
(2) if the license holder operates a residential program, health service coordination and care according to the requirements in section 245D.05, subdivision 1;
(3) safe medication assistance and administration according to the requirements in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in consultation with a registered nurse, nurse practitioner, physician assistant, or medical doctor and require completion of medication administration training according to the requirements in section 245D.09, subdivision 4a, paragraph (d). Medication assistance and administration includes, but is not limited to:
(i) providing medication-related services for a person;
(ii) medication setup;
(iii) medication administration;
(iv) medication storage and security;
(v) medication documentation and charting;
(vi) verification and monitoring of effectiveness of systems to ensure safe medication handling and administration;
(vii) coordination of medication refills;
(viii) handling changes to prescriptions and implementation of those changes;
(ix) communicating with the pharmacy; and
(x) coordination and communication with prescriber;
(4) safe transportation, when the license holder is responsible for transportation of persons, with provisions for handling emergency situations according to the requirements in section 245D.06, subdivision 2, clauses (2) to (4);
(5) a plan for ensuring the safety of persons served by the program in emergencies as defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies to the license holder. A license holder with a community residential setting or a day service facility license must ensure the policy and procedures comply with the requirements in section 245D.22, subdivision 4;
(6) a plan for responding to all incidents as defined in section 245D.02, subdivision 11; and reporting all incidents required to be reported according to section 245D.06, subdivision 1. The plan must:
(i) provide the contact information of a source of emergency medical care and transportation; and
(ii) require staff to first call 911 when the staff believes a medical emergency may be life threatening, or to call the mental health crisis intervention team or similar mental health response team or service when such a team is available and appropriate when the person is experiencing a mental health crisis; and
(7) a procedure for the review of incidents and emergencies to identify trends or patterns, and corrective action if needed. The license holder must establish and maintain a record-keeping system for the incident and emergency reports. Each incident and emergency report file must contain a written summary of the incident. The license holder must conduct a review of incident reports for identification of incident patterns, and implementation of corrective action as necessary to reduce occurrences. Each incident report must include:
(i) the name of the person or persons involved in the incident. It is not necessary to identify all persons affected by or involved in an emergency unless the emergency resulted in an incident;
(ii) the date, time, and location of the incident or emergency;
(iii) a description of the incident or emergency;
(iv) a description of the response to the incident or emergency and whether a person's coordinated service and support plan addendum or program policies and procedures were implemented as applicable;
(v) the name of the staff person or persons who responded to the incident or emergency; and
(vi) the determination of whether corrective action is necessary based on the results of the review.
Subd. 3.Data privacy.
The license holder must establish policies and procedures that promote service recipient rights by ensuring data privacy according to the requirements in:
(1) the Minnesota Government Data Practices Act, section 13.46, and all other applicable Minnesota laws and rules in handling all data related to the services provided; and
(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the extent that the license holder performs a function or activity involving the use of protected health information as defined under Code of Federal Regulations, title 45, section 164.501, including, but not limited to, providing health care services; health care claims processing or administration; data analysis, processing, or administration; utilization review; quality assurance; billing; benefit management; practice management; repricing; or as otherwise provided by Code of Federal Regulations, title 45, section 160.103. The license holder must comply with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164, and all applicable requirements.
Subd. 4.Admission criteria.
(3) requires a license holder providing services in a health care facility to comply with the requirements in section 243.166, subdivision 4b, to provide notification to residents when a registered predatory offender is admitted into the program or to a potential admission when the facility was already serving a registered predatory offender. For purposes of this clause, "health care facility" means a facility licensed by the commissioner as a residential facility under chapter 245A to provide adult foster care or residential services to persons with disabilities;
2013 c 108 art 8 s 36; 2014 c 275 art 1 s 52; 2014 c 291 art 4 s 58; 2014 c 312 art 27 s 48,77; 2017 c 90 s 15
(a) A staff person trained in first aid must be available on site and, when required in a person's coordinated service and support plan or coordinated service and support plan addendum, be able to provide cardiopulmonary resuscitation, whenever persons are present and staff are required to be at the site to provide direct service. The CPR training must include instruction, hands-on practice, and an observed skills assessment under the direct supervision of a CPR instructor.
2013 c 108 art 8 s 38; 2015 c 71 art 7 s 20
Subdivision 1.Water.
Potable water from privately owned wells must be tested annually by a Department of Health-certified laboratory for coliform bacteria and nitrate nitrogens to verify safety. The health authority may require retesting and corrective measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in the event of flooding or an incident which may put the well at risk of contamination. To prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
Subd. 2.Food.
Food served must meet any special dietary needs of a person as prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day must be served or made available to persons, and nutritious snacks must be available between meals.
Subd. 3.Food safety.
Food must be obtained, handled, and properly stored to prevent contamination, spoilage, or a threat to the health of a person.
2013 c 108 art 8 s 41
Except for day service facilities on the same or adjoining lot, the license holder providing day services must apply for a separate license for each facility-based service site when the license holder is the owner, lessor, or tenant of the service site at which persons receive day services and the license holder's employees who provide day services are present for a cumulative total of more than 30 days within any 12-month period. For purposes of this chapter, a day services facility license is a satellite license of the day services program. A day services program may operate multiple licensed day service facilities in one or more counties in the state. For the purposes of this section, "adjoining lot" means day services facilities that are next door to or across the street from one another.
2013 c 108 art 8 s 43
Subdivision 1.Facility capacity and useable space requirements.
(a) The facility capacity of each day service facility must be determined by the amount of primary space available, the scheduling of activities at other service sites, and the space requirements of all persons receiving services at the facility, not just the licensed services. The facility capacity must specify the maximum number of persons that may receive services on site at any one time.
(b) When a facility is located in a multifunctional organization, the facility may share common space with the multifunctional organization if the required available primary space for use by persons receiving day services is maintained while the facility is operating. The license holder must comply at all times with all applicable fire and safety codes under section 245A.04, subdivision 2a, and adequate supervision requirements under section 245D.31 for all persons receiving day services.
(c) A day services facility must have a minimum of 40 square feet of primary space available for each person receiving services who is present at the site at any one time. Primary space does not include:
(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms, and kitchens;
(2) floor areas beneath stationary equipment; or
(3) any space occupied by persons associated with the multifunctional organization while persons receiving day services are using common space.
Subd. 2.Individual personal articles.
Each person must be provided space in a closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own use while receiving services at the facility, unless doing so would interfere with safety precautions, another person's work space, or violate a building or fire code.
2013 c 108 art 8 s 44
Subdivision 1.Refrigeration.
If the license holder provides refrigeration at service sites owned or leased by the license holder for storing perishable foods and perishable portions of bag lunches, whether the foods are supplied by the license holder or the persons receiving services, the refrigeration must have a temperature of 40 degrees Fahrenheit or less.
Subd. 2.Drinking water.
Drinking water must be available to all persons receiving services. If a person is unable to request or obtain drinking water, it must be provided according to that person's individual needs. Drinking water must be provided in single-service containers or from drinking fountains accessible to all persons.
Subd. 3.Individuals who become ill during the day.
There must be an area in which a person receiving services can rest if:
(1) the person becomes ill during the day;
(2) the person does not live in a licensed residential site;
(3) the person requires supervision; and
(4) there is not a caretaker immediately available. Supervision must be provided until the caretaker arrives to bring the person home.
Subd. 4.Safety procedures.
The license holder must establish general written safety procedures that include criteria for selecting, training, and supervising persons who work with hazardous machinery, tools, or substances. Safety procedures specific to each person's activities must be explained and be available in writing to all staff members and persons receiving services.
2013 c 108 art 8 s 45
Subdivision 1.Eligibility for an alternative licensing inspection.
(a) A license holder providing services licensed under this chapter, with a qualifying accreditation and meeting the eligibility criteria in paragraphs (b) and (c), may request approval for an alternative licensing inspection when all services provided under the license holder's license are accredited. A license holder with a qualifying accreditation and meeting the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative licensing inspection for individual community residential settings or day services facilities licensed under this chapter.
(b) In order to be eligible for an alternative licensing inspection, the program must have had at least one inspection by the commissioner following issuance of the initial license. For programs operating a day services facility, each facility must have had at least one on-site inspection by the commissioner following issuance of the initial license.
(c) In order to be eligible for an alternative licensing inspection, the program must have been in substantial and consistent compliance at the time of the last licensing inspection and during the current licensing period. For purposes of this section, "substantial and consistent compliance" means:
(1) the license holder's license was not made conditional, suspended, or revoked;
(2) there have been no substantiated allegations of maltreatment against the license holder;
(3) there were no program deficiencies identified that would jeopardize the health, safety, or rights of persons being served; and
(4) the license holder maintained substantial compliance with the other requirements of chapters 245A and 245C and other applicable laws and rules.
(d) For the purposes of this section, the license holder's license includes services licensed under this chapter that were previously licensed under chapter 245B until December 31, 2013.
Subd. 2.Qualifying accreditation.
The commissioner must accept a three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) as a qualifying accreditation.
Subd. 3.Request for approval of an alternative inspection status.
(a) A request for an alternative inspection must be made on the forms and in the manner prescribed by the commissioner. When submitting the request, the license holder must submit all documentation issued by the accrediting body verifying that the license holder has obtained and maintained the qualifying accreditation and has complied with recommendations or requirements from the accrediting body during the period of accreditation. Based on the request and the additional required materials, the commissioner may approve an alternative inspection status.
(b) The commissioner must notify the license holder in writing that the request for an alternative inspection status has been approved. Approval must be granted until the end of the qualifying accreditation period.
(c) The license holder must submit a written request for approval to be renewed one month before the end of the current approval period according to the requirements in paragraph (a). If the license holder does not submit a request to renew approval as required, the commissioner must conduct a licensing inspection.
Subd. 4.Programs approved for alternative licensing inspection; deemed compliance licensing requirements.
(a) A license holder approved for alternative licensing inspection under this section is required to maintain compliance with all licensing standards according to this chapter.
(b) A license holder approved for alternative licensing inspection under this section must be deemed to be in compliance with all the requirements of this chapter, and the commissioner must not perform routine licensing inspections.
(c) Upon receipt of a complaint regarding the services of a license holder approved for alternative licensing inspection under this section, the commissioner must investigate the complaint and may take any action as provided under section 245A.06 or 245A.07.
Subd. 5.Investigations of alleged or suspected maltreatment.
Nothing in this section changes the commissioner's responsibilities to investigate alleged or suspected maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
Subd. 6.Termination or denial of subsequent approval.
Following approval of an alternative licensing inspection, the commissioner may terminate or deny subsequent approval of an alternative licensing inspection if the commissioner determines that:
(1) the license holder has not maintained the qualifying accreditation;
(2) the commissioner has substantiated maltreatment for which the license holder or facility is determined to be responsible during the qualifying accreditation period; or
(3) during the qualifying accreditation period, the license holder has been issued an order for conditional license, fine, suspension, or license revocation that has not been reversed upon appeal.
The commissioner's decision that the conditions for approval for an alternative licensing inspection have not been met is final and not subject to appeal under the provisions of chapter 14.
Subd. 8.Commissioner's programs.
Home and community-based services licensed under this chapter for which the commissioner is the license holder with a qualifying accreditation are excluded from being approved for an alternative licensing inspection.
2013 c 108 art 8 s 47
(a) The commissioner of human services shall issue a mental health certification for services licensed under this chapter when a license holder is determined to have met the requirements under section 245A.03, subdivision 6a, paragraph (b). This certification is voluntary for license holders. The certification shall be printed on the license and identified on the commissioner's public website.
(b) License holders seeking certification under this section must request this certification on forms and in the manner prescribed by the commissioner.
(c) If the commissioner finds that the license holder has failed to comply with the certification requirements under section 245A.03, subdivision 6a, paragraph (b), the commissioner may issue a correction order and an order of conditional license in accordance with section 245A.06 or may issue a sanction in accordance with section 245A.07, including and up to removal of the certification.
(d) A denial of the certification or the removal of the certification based on a determination that the requirements under section 245A.03, subdivision 6a, paragraph (b), have not been met is not subject to appeal. A license holder that has been denied a certification or that has had a certification removed may again request certification when the license holder is in compliance with the requirements of section 245A.03, subdivision 6a, paragraph (b).
2013 c 108 art 8 s 48; 2014 c 291 art 3 s 2