69.11 ARTICLE 4 69.12 CONTINUING CARE 50.15 ARTICLE 4 50.16 CONTINUING CARE 69.13 Section 1. Minnesota Statutes 2010, section 62J.496, subdivision 2, is amended to read: 50.17 Section 1. Minnesota Statutes 2010, section 62J.496, subdivision 2, is amended to read: 69.14 Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following: 50.18 Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following: 69.15 (1) federally qualified health centers; 50.19 (1) federally qualified health centers; 69.16 (2) community clinics, as defined under section 145.9268; 50.20 (2) community clinics, as defined under section 145.9268; 69.17 (3) nonprofit or local unit of government hospitals licensed under sections 144.50 69.18 to 144.56; 69.19 (4) individual or small group physician practices that are focused primarily on 69.20 primary care; 50.21 (3) nonprofit or local unit of government hospitals licensed under sections 144.50 50.22 to 144.56; 50.23 (4) individual or small group physician practices that are focused primarily on 50.24 primary care; 69.21 (5) nursing facilities licensed under sections 144A.01 to 144A.27; 50.25 (5) nursing facilities licensed under sections 144A.01 to 144A.27; 69.22 (6) local public health departments as defined in chapter 145A; and 50.26 (6) local public health departments as defined in chapter 145A; and 69.23 (7) other providers of health or health care services approved by the commissioner 69.24 for which interoperable electronic health record capability would improve quality of 69.25 care, patient safety, or community health. 69.26 (b) The commissioner shall administer the loan fund to prioritize support and 69.27 assistance to: 69.28 (1) critical access hospitals; 50.32 (1) critical access hospitals; 50.27 (7) other providers of health or health care services approved by the commissioner 50.28 for which interoperable electronic health record capability would improve quality of 50.29 care, patient safety, or community health. 50.30 (b) The commissioner shall administer the loan fund to prioritize support and 50.31 assistance to: 69.29 (2) federally qualified health centers; 50.33 (2) federally qualified health centers; 69.30 (3) entities that serve uninsured, underinsured, and medically underserved 69.31 individuals, regardless of whether such area is urban or rural; a n d 51.1 (3) entities that serve uninsured, underinsured, and medically underserved 51.2 individuals, regardless of whether such area is urban or rural; a n d 69.32 (4) individual or small group practices that are primarily focused on primary care. ; 51.3 (4) individual or small group practices that are primarily focused on primary care; 69.33 (5) nursing facilities certified to participate in the medical assistance program; and 51.4 (5) nursing facilities certified to participate in the medical assistance program; and 70.1 (6) providers enrolled in the elderly waiver program of customized living or 24-hour 70.2 customized living of the medical assistance program, if at least half of their annual 70.3 operating revenue is paid under the medical assistance program. 70.4 (c) An eligible applicant must submit a loan application to the commissioner of 70.5 health on forms prescribed by the commissioner. The application must include, at a 70.6 minimum: 70.7 (1) the amount of the loan requested and a description of the purpose or project 70.8 for which the loan proceeds will be used; 70.9 (2) a quote from a vendor; 51.13 (2) a quote from a vendor; 51.5 (6) providers enrolled in the elderly waiver program of customized living or 24-hour 51.6 customized living of the medical assistance program, if at least half of their annual 51.7 operating revenue is paid under that medical assistance program. 51.8 (c) An eligible applicant must submit a loan application to the commissioner of 51.9 health on forms prescribed by the commissioner. The application must include, at a 51.10 minimum: 51.11 (1) the amount of the loan requested and a description of the purpose or project 51.12 for which the loan proceeds will be used; PAGE R1
70.10 (3) a description of the health care entities and other groups participating in the 70.11 project; 51.14 (3) a description of the health care entities and other groups participating in the 51.15 project; 70.12 (4) evidence of financial stability and a demonstrated ability to repay the loan; and 51.16 (4) evidence of financial stability and a demonstrated ability to repay the loan; and 70.13 (5) a description of how the system to be financed interoperates or plans in the 70.14 future to interoperate with other health care entities and provider groups located in the 70.15 same geographical area; 70.16 (6) a plan on how the certified electronic health record technology will be maintained 70.17 and supported over time; and 70.18 (7) any other requirements for applications included or developed pursuant to 70.19 section 3014 of the HITECH Act. 51.17 (5) a description of how the system to be financed interoperates or plans in the 51.18 future to interoperate with other health care entities and provider groups located in the 51.19 same geographical area; 51.20 (6) a plan on how the certified electronic health record technology will be maintained 51.21 and supported over time; and 51.22 (7) any other requirements for applications included or developed pursuant to 51.23 section 3014 of the HITECH Act. 51.24 Sec. 2. [144.595] HOSPITAL FUTILITY POLICY. 51.25 (a) A hospital licensed under sections 144.50 to 144.56 that adopts or implements a 51.26 futility policy that applies to treatment of any child, from birth to 18 years of age, must 51.27 disclose the futility policy to the parents of children treated at the hospital when the 51.28 hospital identifies the need for a formal process to address concerns over the proposed 51.29 treatment of a child. The hospital must, upon request of a parent of a patient or prospective 51.30 patient, provide a copy of the current policy, if any. 51.31 (b) For purposes of this section, a "futility policy" is any written policy that 51.32 encourages or allows hospital employees, or other medical professionals who provide 51.33 care to patients at the hospital, to withhold or discontinue treatment for a patient on the 51.34 grounds of medical futility. 52.1 Sec. 3. Minnesota Statutes 2010, section 144A.073, is amended by adding a 52.2 subdivision to read: 52.3 S_u_b_d_. 1_3_._ Moratorium exception funding. In fiscal year 2013, the commissioner 52.4 of health may approve moratorium exception projects under this section for which the full 52.5 annualized state share of medical assistance costs does not exceed $1,000,000. 70.20 Sec. 2. Minnesota Statutes 2010, section 144A.351, is amended to read: 70.21 144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS: 70.22 REPORT REQUIRED. 70.23 The commissioners of health and human services, with the cooperation of counties 70.24 and in consultation with stakeholders, including persons who need or are using long-term 70.25 care services and supports, lead agencies, regional entities, senior, disability, and mental 70.26 health organization representatives, service providers, and community members shall 70.27 prepare a report to the legislature by August 15, 2 0 0 4 2013, and biennially thereafter, 70.28 regarding the status of the full range of long-term care services and supports for the 70.29 elderly and children and adults with disabilities and mental illnesses in Minnesota. The 70.30 report shall address: 52.6 Sec. 4. Minnesota Statutes 2010, section 144A.351, is amended to read: 52.7 144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS: 52.8 REPORT REQUIRED. 52.9 The commissioners of health and human services, with t h e c o o p e r a t i o n o f c o u n t i e s 52.10 a n d stakeholders, including persons who need or are using long-term care services and 52.11 supports; lead agencies; regional entities, ; senior, mental health, and disability organization 52.12 representatives; services providers; and community members, including representatives of 52.13 local business and faith communities shall prepare a report to the legislature by August 15, 52.14 2 0 0 4 2013, and biennially thereafter, regarding the status of the full range of long-term 52.15 care services and supports for the elderly and children and adults with disabilities and 52.16 mental illnesses in Minnesota. The report shall address: PAGE R2
70.31 (1) demographics and need for long-term care services and supports in Minnesota; 52.17 (1) demographics and need for long-term care services and supports in Minnesota; 70.32 (2) summary of county and regional reports on long-term care gaps, surpluses, 70.33 imbalances, and corrective action plans; 70.34 (3) status of long-term care services and mental illnesses, housing options, and 70.35 supports by county and region including: 71.1 (i) changes in availability of the range of long-term care services and housing 71.2 options; 71.3 (ii) access problems, including access to the least restrictive and most integrated 71.4 services and settings, regarding long-term care services; and 71.5 (iii) comparative measures of long-term care services availability, including serving 71.6 people in their home areas near family, and p r o g r e s s changes over time; and 71.7 (4) recommendations regarding goals for the future of long-term care services and 71.8 supports, policy and fiscal changes, and resource development and transition needs. 71.9 Sec. 3. Minnesota Statutes 2010, section 144D.04, subdivision 2, is amended to read: 71.10 Subd. 2. Contents of contract. A housing with services contract, which need not be 71.11 entitled as such to comply with this section, shall include at least the following elements 71.12 in itself or through supporting documents or attachments: 71.13 (1) the name, street address, and mailing address of the establishment; 71.14 (2) the name and mailing address of the owner or owners of the establishment and, if 71.15 the owner or owners is not a natural person, identification of the type of business entity 71.16 of the owner or owners; 71.17 (3) the name and mailing address of the managing agent, through management 71.18 agreement or lease agreement, of the establishment, if different from the owner or owners; 71.19 (4) the name and address of at least one natural person who is authorized to accept 71.20 service of process on behalf of the owner or owners and managing agent; 71.21 (5) a statement describing the registration and licensure status of the establishment 71.22 and any provider providing health-related or supportive services under an arrangement 71.23 with the establishment; 71.24 (6) the term of the contract; 71.25 (7) a description of the services to be provided to the resident in the base rate to be 71.26 paid by resident, including a delineation of the portion of the base rate that constitutes rent 71.27 and a delineation of charges for each service included in the base rate; 52.18 (2) summary of county and regional reports on long-term care gaps, surpluses, 52.19 imbalances, and corrective action plans; 52.20 (3) status of long-term care services by county and region including: 52.21 (i) changes in availability of the range of long-term care services and housing 52.22 options; 52.23 (ii) access problems regarding long-term care services; and 52.24 (iii) comparative measures of long-term care services availability and p r o g r e s s 52.25 changes over time; and 52.26 (4) recommendations regarding goals for the future of long-term care services, 52.27 policy and fiscal changes, and resource needs. PAGE R3
71.28 (8) a description of any additional services, including home care services, available 71.29 for an additional fee from the establishment directly or through arrangements with the 71.30 establishment, and a schedule of fees charged for these services; 71.31 (9) a description of the process through which the contract may be modified, 71.32 amended, or terminated, including whether a move to a different room or sharing a room 71.33 would be required in the event that the tenant can no longer pay the current rent; 72.1 (10) a description of the establishment's complaint resolution process available 72.2 to residents including the toll-free complaint line for the Office of Ombudsman for 72.3 Long-Term Care; 72.4 (11) the resident's designated representative, if any; 72.5 (12) the establishment's referral procedures if the contract is terminated; 72.6 (13) requirements of residency used by the establishment to determine who may 72.7 reside or continue to reside in the housing with services establishment; 72.8 (14) billing and payment procedures and requirements; 72.9 (15) a statement regarding the ability of residents to receive services from service 72.10 providers with whom the establishment does not have an arrangement; 72.11 (16) a statement regarding the availability of public funds for payment for residence 72.12 or services in the establishment; and 72.13 (17) a statement regarding the availability of and contact information for 72.14 long-term care consultation services under section 256B.0911 in the county in which the 72.15 establishment is located. 72.16 Sec. 4. Minnesota Statutes 2010, section 245A.03, is amended by adding a subdivision 72.17 to read: 72.18 S_u_b_d_. 6_a_._ Adult foster care homes serving people with mental illness; 72.19 certification. (a) The commissioner of human services shall issue a mental health 72.20 certification for adult foster care homes licensed under this chapter and Minnesota Rules, 72.21 parts 9555.5105 to 9555.6265, that serve people with mental illness where the home is not 72.22 the primary residence of the license holder when a provider is determined to have met 72.23 the requirements under paragraph (b). This certification is voluntary for license holders. 72.24 The certification shall be printed on the license, and identified on the commissioner's 72.25 public Web site. 52.28 Sec. 5. Minnesota Statutes 2010, section 245A.03, is amended by adding a subdivision 52.29 to read: 72.26 (b) The requirements for certification are: 53.4 (b) The requirements for certification are: 72.27 (1) all staff working in the adult foster care home have received at least seven hours 72.28 of annual training covering all of the following topics: 72.29 (i) mental health diagnoses; 53.7 (i) mental health diagnoses; 52.30 S_u_b_d_. 6_a_._ Adult foster care homes serving people with mental illness; 52.31 certification. (a) The commissioner of human services shall issue a mental health 52.32 certification for adult foster care homes licensed under this chapter and Minnesota Rules, 52.33 parts 9555.5105 to 9555.6265, that serve people with mental illness where the home is not 52.34 the primary residence of the license holder when a provider is determined to have met 53.1 the requirements under paragraph (b). This certification is voluntary for license holders. 53.2 The certification shall be printed on the license, and identified on the commissioner's 53.3 public Web site. 53.5 (1) all staff working in the adult foster care home have received at least seven hours 53.6 of annual training covering all of the following topics: PAGE R4
72.30 (ii) mental health crisis response and de-escalation techniques; 53.8 (ii) mental health crisis response and de-escalation techniques; 72.31 (iii) recovery from mental illness; 53.9 (iii) recovery from mental illness; 72.32 (iv) treatment options including evidence-based practices; 53.10 (iv) treatment options including evidence-based practices; 72.33 (v) medications and their side effects; 53.11 (v) medications and their side effects; 72.34 (vi) co-occurring substance abuse and health conditions; and 53.12 (vi) co-occurring substance abuse and health conditions; and 72.35 (vii) community resources; and 53.13 (vii) community resources; 73.1 (2) a mental health professional, as defined in section 245.462, subdivision 18, or 73.2 a mental health practitioner as defined in section 245.462, subdivision 17, are available 73.3 for consultation and assistance; 53.14 (2) a mental health professional, as defined in section 245.462, subdivision 18, or 53.15 a mental health practitioner as defined in section 245.462, subdivision 17, are available 53.16 for consultation and assistance; 73.4 (3) there is a plan and protocol in place to address a mental health crisis; and 53.17 (3) there is a plan and protocol in place to address a mental health crisis; and 73.5 (4) each individual's individual placement agreement identifies who is providing 73.6 clinical services and their contact information, and includes an individual crisis prevention 73.7 and management plan developed with the individual. 73.8 (c) License holders seeking certification under this subdivision must request this 73.9 certification on forms provided by the commissioner and must submit the request to the 73.10 county licensing agency in which the home is located. The county licensing agency must 73.11 forward the request to the commissioner with a county recommendation regarding whether 73.12 the commissioner should issue the certification. 73.13 (d) Ongoing compliance with the certification requirements under paragraph (b) 73.14 shall be reviewed by the county licensing agency at each licensing review. When a county 73.15 licensing agency determines that the requirements of paragraph (b) are not met, the county 73.16 shall inform the commissioner, and the commissioner will remove the certification. 73.17 (e) A denial of the certification or the removal of the certification based on a 73.18 determination that the requirements under paragraph (b) have not been met by the adult 73.19 foster care license holder are not subject to appeal. A license holder that has been denied a 73.20 certification or that has had a certification removed may again request certification when 73.21 the license holder is in compliance with the requirements of paragraph (b). 73.22 Sec. 5. Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7, is 73.23 amended to read: 53.18 (4) each individual's Individual Placement Agreement identifies who is providing 53.19 clinical services and their contact information, and includes an individual crisis prevention 53.20 and management plan developed with the individual. 53.21 (c) License holders seeking certification under this subdivision must request this 53.22 certification on forms provided by the commissioner and must submit the request to the 53.23 county licensing agency in which the home is located. The county licensing agency must 53.24 forward the request to the commissioner with a county recommendation regarding whether 53.25 the commissioner should issue the certification. 53.26 (d) Ongoing compliance with the certification requirements under paragraph (b) 53.27 shall be reviewed by the county licensing agency at each licensing review. When a county 53.28 licensing agency determines that the requirements of paragraph (b) are not met, the county 53.29 shall inform the commissioner, and the commissioner will remove the certification. 53.30 (e) A denial of the certification or the removal of the certification based on a 53.31 determination that the requirements under paragraph (b) have not been met by the adult 53.32 foster care license holder are not subject to appeal. A license holder that has been denied a 53.33 certification or that has had a certification removed may again request certification when 53.34 the license holder is in compliance with the requirements of paragraph (b). 54.1 Sec. 6. Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7, is 54.2 amended to read: PAGE R5
73.24 Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an 73.25 initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 73.26 2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 73.27 9555.6265, under this chapter for a physical location that will not be the primary residence 73.28 of the license holder for the entire period of licensure. If a license is issued during this 73.29 moratorium, and the license holder changes the license holder's primary residence away 73.30 from the physical location of the foster care license, the commissioner shall revoke the 73.31 license according to section 245A.07. Exceptions to the moratorium include: 54.3 Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an 54.4 initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 54.5 2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 54.6 9555.6265, under this chapter for a physical location that will not be the primary residence 54.7 of the license holder for the entire period of licensure. If a license is issued during this 54.8 moratorium, and the license holder changes the license holder's primary residence away 54.9 from the physical location of the foster care license, the commissioner shall revoke the 54.10 license according to section 245A.07. Exceptions to the moratorium include: 73.32 (1) foster care settings that are required to be registered under chapter 144D; 54.11 (1) foster care settings that are required to be registered under chapter 144D; 73.33 (2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 73.34 and determined to be needed by the commissioner under paragraph (b); 74.1 (3) new foster care licenses determined to be needed by the commissioner under 74.2 paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or 74.3 restructuring of state-operated services that limits the capacity of state-operated facilities; 74.4 (4) new foster care licenses determined to be needed by the commissioner under 74.5 paragraph (b) for persons requiring hospital level care; or 74.6 (5) new foster care licenses determined to be needed by the commissioner for the 74.7 transition of people from personal care assistance to the home and community-based 74.8 services. 74.9 (b) The commissioner shall determine the need for newly licensed foster care homes 74.10 as defined under this subdivision using the resource need determination process described 74.11 in paragraph (f). As part of the determination, the commissioner shall consider the 74.12 availability of foster care capacity in the area in which the licensee seeks to operate, a n d 74.13 t h e r e c o m m e n d a t i o n o f t h e l o c a l c o u n t y b o a r d. T h e d e t e r m i n a t i o n b y t h e c o m m i s s i o n e r 74.14 m u s t b e fi n a l. A d e t e r m i n a t i o n o f n e e d i s n o t r e q u i r e d f o r a c h a n g e i n o w n e r s h i p a t 74.15 t h e s a m e a d d r e s s and other data and information, including the report on the status of 74.16 long-term care services required under section 144A.351. 74.17 (c) Residential settings that would otherwise be subject to the moratorium established 74.18 in paragraph (a), that are in the process of receiving an adult or child foster care license as 74.19 of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 74.20 or child foster care license. For this paragraph, all of the following conditions must be met 74.21 to be considered in the process of receiving an adult or child foster care license: 74.22 (1) participants have made decisions to move into the residential setting, including 74.23 documentation in each participant's care plan; 74.24 (2) the provider has purchased housing or has made a financial investment in the 74.25 property; 74.26 (3) the lead agency has approved the plans, including costs for the residential setting 74.27 for each individual; 54.12 (2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 54.13 and determined to be needed by the commissioner under paragraph (b); 54.14 (3) new foster care licenses determined to be needed by the commissioner under 54.15 paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or 54.16 restructuring of state-operated services that limits the capacity of state-operated facilities; 54.17 (4) new foster care licenses determined to be needed by the commissioner under 54.18 paragraph (b) for persons requiring hospital level care; or 54.19 (5) new foster care licenses determined to be needed by the commissioner for the 54.20 transition of people from personal care assistance to the home and community-based 54.21 services. 54.22 (b) The commissioner shall determine the need for newly licensed foster care homes 54.23 as defined under this subdivision. As part of the determination, the commissioner shall 54.24 consider the availability of foster care capacity in the area in which the licensee seeks to 54.25 operate, and the recommendation of the local county board. The determination by the 54.26 commissioner must be final. A determination of need is not required for a change in 54.27 ownership at the same address. 54.28 (c) Residential settings that would otherwise be subject to the moratorium established 54.29 in paragraph (a), that are in the process of receiving an adult or child foster care license as 54.30 of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 54.31 or child foster care license. For this paragraph, all of the following conditions must be met 54.32 to be considered in the process of receiving an adult or child foster care license: 54.33 (1) participants have made decisions to move into the residential setting, including 54.34 documentation in each participant's care plan; 54.35 (2) the provider has purchased housing or has made a financial investment in the 54.36 property; 55.1 (3) the lead agency has approved the plans, including costs for the residential setting 55.2 for each individual; PAGE R6
74.28 (4) the completion of the licensing process, including all necessary inspections, is 74.29 the only remaining component prior to being able to provide services; and 74.30 (5) the needs of the individuals cannot be met within the existing capacity in that 74.31 county. 74.32 To qualify for the process under this paragraph, the lead agency must submit 74.33 documentation to the commissioner by August 1, 2009, that all of the above criteria are 74.34 met. 75.1 (d) The commissioner shall study the effects of the license moratorium under this 75.2 subdivision and shall report back to the legislature by January 15, 2011. This study shall 75.3 include, but is not limited to the following: 75.4 (1) the overall capacity and utilization of foster care beds where the physical location 75.5 is not the primary residence of the license holder prior to and after implementation 75.6 of the moratorium; 75.7 (2) the overall capacity and utilization of foster care beds where the physical 75.8 location is the primary residence of the license holder prior to and after implementation 75.9 of the moratorium; and 75.10 (3) the number of licensed and occupied ICF/MR beds prior to and after 75.11 implementation of the moratorium. 75.12 (e) When a foster care recipient moves out of a foster home that is not the 75.13 primary residence of the license holder according to section 256B.092, subdivision 1e, 75.14 paragraph (d), or 256B.49, subdivision 15, paragraph (f), the county shall immediately 75.15 inform the Department of Human Services Licensing Division, a n d. The department 75.16 shall i m m e d i a t e l y decrease the licensed capacity for the home. If the voluntary changes 75.17 described in paragraph (f) are not sufficient to meet the savings required by 2011 and 2012 75.18 reductions in licensed bed capacity and maintain statewide long-term care residential 75.19 services capacity within budgetary limits, the commissioner shall delicense 183 beds 75.20 by June 30, 2013, using the needs determination process. Under this paragraph, the 75.21 commissioner has the authority to reduce unused licensed capacity of a current foster care 75.22 program to accomplish the consolidation or closure of settings or close or relocate other 75.23 occupied beds, consistent with the information gathered through the needs determination 75.24 process. Beds used for emergency crisis purposes under section 245A.11, subdivision 2a, 75.25 paragraph (d), are not subject to this provision. A decreased licensed capacity according 75.26 to this paragraph is not subject to appeal under this chapter. 55.3 (4) the completion of the licensing process, including all necessary inspections, is 55.4 the only remaining component prior to being able to provide services; and 55.5 (5) the needs of the individuals cannot be met within the existing capacity in that 55.6 county. 55.7 To qualify for the process under this paragraph, the lead agency must submit 55.8 documentation to the commissioner by August 1, 2009, that all of the above criteria are 55.9 met. 55.10 (d) The commissioner shall study the effects of the license moratorium under this 55.11 subdivision and shall report back to the legislature by January 15, 2011. This study shall 55.12 include, but is not limited to the following: 55.13 (1) the overall capacity and utilization of foster care beds where the physical location 55.14 is not the primary residence of the license holder prior to and after implementation 55.15 of the moratorium; 55.16 (2) the overall capacity and utilization of foster care beds where the physical 55.17 location is the primary residence of the license holder prior to and after implementation 55.18 of the moratorium; and 55.19 (3) the number of licensed and occupied ICF/MR beds prior to and after 55.20 implementation of the moratorium. 55.21 (e) When a foster care recipient moves out of a foster home that is not the primary 55.22 residence of the license holder according to section 256B.49, subdivision 15, paragraph 55.23 (f), the county shall immediately inform the Department of Human Services Licensing 55.24 Division, a n d. The department shall i m m e d i a t e l y decrease the licensed capacity for the 55.25 home, if the voluntary changes described in paragraph (g) are not sufficient to meet the 55.26 savings required by 2011 reductions in licensed bed capacity and maintain statewide 55.27 long-term care residential services capacity within budgetary limits. The commissioner 55.28 shall delicense up to 128 beds by June 30, 2013, using the needs determination process. 55.29 Under this paragraph, the commissioner has the authority to reduce unused licensed 55.30 capacity of a current foster care program to accomplish the consolidation or closure of 55.31 settings. A decreased licensed capacity according to this paragraph is not subject to appeal 55.32 under this chapter. 55.33 (f) Residential settings that would otherwise be subject to the decreased license 55.34 capacity established in paragraph (e) shall be exempt under the following circumstances: 55.35 (1) until August 1, 2013, the license holder's beds occupied by residents whose 55.36 primary diagnosis is mental illness and the license holder is: PAGE R7
56.1 (i) a provider of assertive community treatment (ACT) or adult rehabilitative mental 56.2 health services (ARMHS) as defined in section 256B.0623; 56.3 (ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to 56.4 9520.0870; 56.5 (iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to 56.6 9520.0870; or 56.7 (iv) a provider of intensive residential treatment services (IRTS) licensed under 56.8 Minnesota Rules, parts 9520.0500 to 9520.0670; or 56.9 (2) the license holder is certified under the requirements in subdivision 6a. 75.27 (f) A resource need determination process, managed at the state level, using the 75.28 available reports required by section 144A.351, and other data and information shall be 75.29 used to determine where the reduced capacity required under paragraph (e) will occur. 75.30 The commissioner shall consult with the stakeholders described in section 144A.351, and 75.31 employ a variety of methods to improve the state's capacity to meet long-term care service 75.32 needs within budgetary limits, including seeking proposals from service providers or lead 75.33 agencies to change service type, capacity, or location to improve services, increase the 75.34 independence of residents, allow for payment to hold a person's bed open from permanent 75.35 reassignment up to 60 days while the person tries living in a more independent setting, 75.36 and better meet needs identified by the long-term care services reports and statewide data 76.1 and information. By February 1 of each year, the commissioner shall provide information 76.2 and data on the overall capacity of licensed long-term care services, actions taken under 76.3 this subdivision to manage statewide long-term care services and supports resources, and 76.4 any recommendations for change to the legislative committees with jurisdiction over the 76.5 health and human services budget. 56.10 (g) A resource need determination process, managed at the state level, using the 56.11 available reports required by section 144A.351, and other data and information shall 56.12 be used to determine where the reduced capacity required under paragraph (e) will be 56.13 implemented. The commissioner shall consult with the stakeholders described in section 56.14 144A.351, and employ a variety of methods to improve the state's capacity to meet 56.15 long-term care service needs within budgetary limits, including seeking proposals from 56.16 service providers or lead agencies to change service type, capacity, or location to improve 56.17 services, increase the independence of residents, and better meet needs identified by the 56.18 long-term care services reports and statewide data and information. By February 1 of each 56.19 year, the commissioner shall provide information and data on the overall capacity of 56.20 licensed long-term care services, actions taken under this subdivision to manage statewide 56.21 long-term care services and supports resources, and any recommendations for change to 56.22 the legislative committees with jurisdiction over health and human services budget. 76.6 EFFECTIVE DATE. This section is effective the day following final enactment. 76.7 Sec. 6. Minnesota Statutes 2010, section 245A.10, is amended by adding a subdivision 76.8 to read: PAGE R8
76.9 S_u_b_d_. 4_a_._ Application and annual license fees. For applicants and license 76.10 holders seeking licensure according to chapters 245A and 245D to provide home and 76.11 community-based services to persons with disabilities or persons age 65 and older, the 76.12 commissioner shall charge a license application fee that is sufficient to recover actual costs 76.13 related to the commissioner's evaluation of the application according to section 245A.04, 76.14 subdivision 6. The application fee will be waived for applicants who meet the criteria 76.15 identified in section 245A.042, subdivision 2. The commissioner shall charge license 76.16 holders subject to chapter 245D an annual nonrefundable license fee that is sufficient to 76.17 recover actual costs related to the commissioner's inspection of programs to determine 76.18 whether the program complies with all applicable rules and laws according to section 76.19 245A.04, subdivision 7. 56.23 Sec. 7. Minnesota Statutes 2010, section 245A.11, subdivision 2a, is amended to read: 56.24 Subd. 2a. Adult foster care license capacity. (a) The commissioner shall issue 56.25 adult foster care licenses with a maximum licensed capacity of four beds, including 56.26 nonstaff roomers and boarders, except that the commissioner may issue a license with a 56.27 capacity of five beds, including roomers and boarders, according to paragraphs (b) to (f). 56.28 (b) An adult foster care license holder may have a maximum license capacity of five 56.29 if all persons in care are age 55 or over and do not have a serious and persistent mental 56.30 illness or a developmental disability. 56.31 (c) The commissioner may grant variances to paragraph (b) to allow a foster care 56.32 provider with a licensed capacity of five persons to admit an individual under the age of 55 56.33 if the variance complies with section 245A.04, subdivision 9, and approval of the variance 56.34 is recommended by the county in which the licensed foster care provider is located. 57.1 (d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth 57.2 bed for emergency crisis services for a person with serious and persistent mental illness 57.3 or a developmental disability, regardless of age, if the variance complies with section 57.4 245A.04, subdivision 9, and approval of the variance is recommended by the county in 57.5 which the licensed foster care provider is located. 57.6 (e) The commissioner may grant a variance to paragraph (b) to allow for the 57.7 use of a fifth bed for respite services, as defined in section 245A.02, for persons with 57.8 disabilities, regardless of age, if the variance complies with section 245A.03, subdivision 57.9 7, and section 245A.04, subdivision 9, and approval of the variance is recommended by 57.10 the county in which the licensed foster care provider is licensed. Respite care may be 57.11 provided under the following conditions: 57.12 (1) staffing ratios cannot be reduced below the approved level for the individuals 57.13 being served in the home on a permanent basis; PAGE R9
57.14 (2) no more than two different individuals can be accepted for respite services in 57.15 any calendar month and the total respite days may not exceed 120 days per program in 57.16 any calendar year; 57.17 (3) the person receiving respite services must have his or her own bedroom, which 57.18 could be used for alternative purposes when not used as a respite bedroom, and cannot be 57.19 the room of another person who lives in the foster care home; and 57.20 (4) individuals living in the foster care home must be notified when the variance 57.21 is approved. The provider must give 60 days' notice in writing to the residents and their 57.22 legal representatives prior to accepting the first respite placement. Notice must be given to 57.23 residents at least two days prior to service initiation, or as soon as the license holder is 57.24 able if they receive notice of the need for respite less than two days prior to initiation, 57.25 each time a respite client will be served, unless the requirement for this notice is waived 57.26 by the resident or legal guardian. 57.27 ( e ) I f t h e 2 0 0 9 l e g i s l a t u r e a d o p t s a r a t e r e d u c t i o n t h a t i m p a c t s p r o v i d e r s o f a d u l t 57.28 f o s t e r c a r e s e r v i c e s, (f) The commissioner may issue an adult foster care license with a 57.29 capacity of five adults if the fifth bed does not increase the overall statewide capacity of 57.30 licensed adult foster care beds in homes that are not the primary residence of the license 57.31 holder, o v e r t h e l i c e n s e d c a p a c i t y i n s u c h h o m e s o n J u l y 1, 2 0 0 9, as identified in a plan 57.32 submitted to the commissioner by the county, when the capacity is recommended by 57.33 the county licensing agency of the county in which the facility is located and if the 57.34 recommendation verifies that: 57.35 (1) the facility meets the physical environment requirements in the adult foster 57.36 care licensing rule; 58.1 (2) the five-bed living arrangement is specified for each resident in the resident's: 58.2 (i) individualized plan of care; 58.3 (ii) individual service plan under section 256B.092, subdivision 1b, if required; or 58.4 (iii) individual resident placement agreement under Minnesota Rules, part 58.5 9555.5105, subpart 19, if required; 58.6 (3) the license holder obtains written and signed informed consent from each 58.7 resident or resident's legal representative documenting the resident's informed choice 58.8 to remain living in the home and that the resident's refusal to consent would not have 58.9 resulted in service termination; and 58.10 (4) the facility was licensed for adult foster care before March 1, 2 0 0 9 2011. PAGE R10
58.11 ( f ) (g) The commissioner shall not issue a new adult foster care license under 58.12 paragraph ( e ) (f) after June 30, 2 0 1 1 2016. The commissioner shall allow a facility with 58.13 an adult foster care license issued under paragraph ( e ) (f) before June 30, 2 0 1 1 2016, to 58.14 continue with a capacity of five adults if the license holder continues to comply with the 58.15 requirements in paragraph ( e ) (f). 76.20 Sec. 7. Minnesota Statutes 2010, section 245A.11, subdivision 7, is amended to read: 58.16 Sec. 8. Minnesota Statutes 2010, section 245A.11, subdivision 7, is amended to read: 76.21 Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The 76.22 commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts 76.23 requiring a caregiver to be present in an adult foster care home during normal sleeping 76.24 hours to allow for alternative methods of overnight supervision. The commissioner may 76.25 grant the variance if the local county licensing agency recommends the variance and the 76.26 county recommendation includes documentation verifying that: 76.27 (1) the county has approved the license holder's plan for alternative methods of 76.28 providing overnight supervision and determined the plan protects the residents' health, 76.29 safety, and rights; 76.30 (2) the license holder has obtained written and signed informed consent from 76.31 each resident or each resident's legal representative documenting the resident's or legal 76.32 representative's agreement with the alternative method of overnight supervision; and 76.33 (3) the alternative method of providing overnight supervision, which may include 76.34 the use of technology, is specified for each resident in the resident's: (i) individualized 77.1 plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if 77.2 required; or (iii) individual resident placement agreement under Minnesota Rules, part 77.3 9555.5105, subpart 19, if required. 77.4 (b) To be eligible for a variance under paragraph (a), the adult foster care license 77.5 holder must not have had a l i c e n s i n g a c t i o n conditional license issued under section 77.6 245A.06 or any other licensing sanction issued under section 245A.07 during the prior 24 77.7 months based on failure to provide adequate supervision, health care services, or resident 77.8 safety in the adult foster care home. 77.9 (c) A license holder requesting a variance under this subdivision to utilize 77.10 technology as a component of a plan for alternative overnight supervision may request 77.11 the commissioner's review in the absence of a county recommendation. Upon receipt of 77.12 such a request from a license holder, the commissioner shall review the variance request 77.13 with the county. 58.17 Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The 58.18 commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts 58.19 requiring a caregiver to be present in an adult foster care home during normal sleeping 58.20 hours to allow for alternative methods of overnight supervision. The commissioner may 58.21 grant the variance if the local county licensing agency recommends the variance and the 58.22 county recommendation includes documentation verifying that: 58.23 (1) the county has approved the license holder's plan for alternative methods of 58.24 providing overnight supervision and determined the plan protects the residents' health, 58.25 safety, and rights; 58.26 (2) the license holder has obtained written and signed informed consent from 58.27 each resident or each resident's legal representative documenting the resident's or legal 58.28 representative's agreement with the alternative method of overnight supervision; and 58.29 (3) the alternative method of providing overnight supervision, which may include 58.30 the use of technology, is specified for each resident in the resident's: (i) individualized 58.31 plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if 58.32 required; or (iii) individual resident placement agreement under Minnesota Rules, part 58.33 9555.5105, subpart 19, if required. 58.34 (b) To be eligible for a variance under paragraph (a), the adult foster care license 58.35 holder must not have had a l i c e n s i n g a c t i o n conditional license issued under section 59.1 245A.06, or any other licensing sanction issued under section 245A.07 during the prior 24 59.2 months based on failure to provide adequate supervision, health care services, or resident 59.3 safety in the adult foster care home. 59.4 (c) A license holder requesting a variance under this subdivision to utilize 59.5 technology as a component of a plan for alternative overnight supervision may request 59.6 the commissioner's review in the absence of a county recommendation. Upon receipt of 59.7 such a request from a license holder, the commissioner shall review the variance request 59.8 with the county. 59.9 Sec. 9. Minnesota Statutes 2010, section 245A.11, subdivision 7a, is amended to read: PAGE R11
59.10 Subd. 7a. Alternate overnight supervision technology; adult foster care license. 59.11 (a) The commissioner may grant an applicant or license holder an adult foster care license 59.12 for a residence that does not have a caregiver in the residence during normal sleeping 59.13 hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses 59.14 monitoring technology to alert the license holder when an incident occurs that may 59.15 jeopardize the health, safety, or rights of a foster care recipient. The applicant or license 59.16 holder must comply with all other requirements under Minnesota Rules, parts 9555.5105 59.17 to 9555.6265, and the requirements under this subdivision. The license printed by the 59.18 commissioner must state in bold and large font: 59.19 (1) that the facility is under electronic monitoring; and 59.20 (2) the telephone number of the county's common entry point for making reports of 59.21 suspected maltreatment of vulnerable adults under section 626.557, subdivision 9. 59.22 (b) Applications for a license under this section must be submitted directly to 59.23 the Department of Human Services licensing division. The licensing division must 59.24 immediately notify the host county and lead county contract agency and the host county 59.25 licensing agency. The licensing division must collaborate with the county licensing 59.26 agency in the review of the application and the licensing of the program. 59.27 (c) Before a license is issued by the commissioner, and for the duration of the 59.28 license, the applicant or license holder must establish, maintain, and document the 59.29 implementation of written policies and procedures addressing the requirements in 59.30 paragraphs (d) through (f). 59.31 (d) The applicant or license holder must have policies and procedures that: 59.32 (1) establish characteristics of target populations that will be admitted into the home, 59.33 and characteristics of populations that will not be accepted into the home; 60.1 (2) explain the discharge process when a foster care recipient requires overnight 60.2 supervision or other services that cannot be provided by the license holder due to the 60.3 limited hours that the license holder is on site; 60.4 (3) describe the types of events to which the program will respond with a physical 60.5 presence when those events occur in the home during time when staff are not on site, and 60.6 how the license holder's response plan meets the requirements in paragraph (e), clause 60.7 (1) or (2); 60.8 (4) establish a process for documenting a review of the implementation and 60.9 effectiveness of the response protocol for the response required under paragraph (e), 60.10 clause (1) or (2). The documentation must include: 60.11 (i) a description of the triggering incident; 60.12 (ii) the date and time of the triggering incident; PAGE R12
60.13 (iii) the time of the response or responses under paragraph (e), clause (1) or (2); 60.14 (iv) whether the response met the resident's needs; 60.15 (v) whether the existing policies and response protocols were followed; and 60.16 (vi) whether the existing policies and protocols are adequate or need modification. 60.17 When no physical presence response is completed for a three-month period, the 60.18 license holder's written policies and procedures must require a physical presence response 60.19 drill to be conducted for which the effectiveness of the response protocol under paragraph 60.20 (e), clause (1) or (2), will be reviewed and documented as required under this clause; and 60.21 (5) establish that emergency and nonemergency phone numbers are posted in a 60.22 prominent location in a common area of the home where they can be easily observed by a 60.23 person responding to an incident who is not otherwise affiliated with the home. 60.24 (e) The license holder must document and include in the license application which 60.25 response alternative under clause (1) or (2) is in place for responding to situations that 60.26 present a serious risk to the health, safety, or rights of people receiving foster care services 60.27 in the home: 60.28 (1) response alternative (1) requires only the technology to provide an electronic 60.29 notification or alert to the license holder that an event is underway that requires a response. 60.30 Under this alternative, no more than ten minutes will pass before the license holder will be 60.31 physically present on site to respond to the situation; or 60.32 (2) response alternative (2) requires the electronic notification and alert system 60.33 under alternative (1), but more than ten minutes may pass before the license holder is 60.34 present on site to respond to the situation. Under alternative (2), all of the following 60.35 conditions are met: 61.1 (i) the license holder has a written description of the interactive technological 61.2 applications that will assist the license holder in communicating with and assessing the 61.3 needs related to the care, health, and safety of the foster care recipients. This interactive 61.4 technology must permit the license holder to remotely assess the well being of the foster 61.5 care recipient without requiring the initiation of the foster care recipient. Requiring the 61.6 foster care recipient to initiate a telephone call does not meet this requirement; 61.7 (ii) the license holder documents how the remote license holder is qualified and 61.8 capable of meeting the needs of the foster care recipients and assessing foster care 61.9 recipients' needs under item (i) during the absence of the license holder on site; 61.10 (iii) the license holder maintains written procedures to dispatch emergency response 61.11 personnel to the site in the event of an identified emergency; and PAGE R13