1.1    .................... moves to amend H. F. No. 908 as follows:
1.2Page 2, after line 25, insert:

1.6    Subdivision 1. Scope. In order to improve the quality of services provided to
1.7Minnesotans with disabilities, a statewide quality assurance and improvement system
1.8for Minnesotans receiving disability services is established. The disability services
1.9included are the home and community-based services waiver programs for persons with
1.10developmental disabilities, under section 256B.092, subdivision 4, traumatic brain injury,
1.11and for those who qualify for nursing facility or hospital levels of care under section
1.12256B.49; home care services under section 256B.0651; family support grant under section
1.13252.32; consumer support grant under section 256.476; and semi-independent living
1.14services under section 252.275. The statewide quality assurance and improvement system
1.15shall include a state quality commission, six regional quality councils, an outcome based
1.16quality review component, and a comprehensive system for effective incident reporting,
1.17investigation, analysis, and follow-up.
1.18    Subd. 2. State Quality Commission. (a) The commissioner shall appoint the
1.19members of the State Quality Commission, including representatives from the following
1.20groups: disability service recipients, at least one member from each regional quality
1.21council, disability service providers, disability advocacy groups, county human service
1.22agencies, and state agency staff from the Departments of Human Services, Health, and the
1.23Office of the Ombudsman for Mental Health and Developmental Disabilities.
1.24    (b) The State Quality Commission shall assist the Departments of Human Services
1.25and Health in fulfilling federally mandated obligations by monitoring disability service
1.26quality and quality assurance and improvement practices in Minnesota, establishing state
2.1quality improvement priorities with methods for achieving results, and providing an
2.2annual report to the legislative committees with jurisdiction over policy and funding of
2.3disability services on the outcomes, improvement priorities, and activities undertaken by
2.4the commission during the previous state fiscal year.
2.5    Subd. 3. Regional quality councils. (a) The commissioner shall establish six
2.6regional quality councils of key stakeholders including regional representatives of
2.7disability service recipients, disability service providers, disability advocacy groups,
2.8county government, and state agency regional staff from human services, health, and the
2.9Office of the Ombudsman for Mental Health and Developmental Disabilities who are
2.10appointed by the State Quality Commission.
2.11    (b) The regional councils shall:
2.12    (1) direct and monitor outcome-based quality assurance programs;
2.13    (2) analyze and review quality outcomes and critical incident data;
2.14    (3) provide information and training programs for persons with disabilities, including
2.15service recipients and their caregivers, on service options and quality expectations;
2.16    (4) disseminate information and resources developed to other regional quality
2.18    (5) respond to state level priorities;
2.19    (6) establish regional priorities for quality improvement;
2.20    (7) submit an annual report to the State Quality Commission on the status, outcomes,
2.21and improvement priorities and activities in the region;
2.22    (8) choose a representative to participate on the State Quality Commission; and
2.23    (9) assume other responsibilities consistent with the priorities of the State Quality
2.25    (c) The regional councils shall maintain staff and manage resources needed,
2.26consistent with funding and direction from the commissioner in consultation with the
2.27State Quality Commission.
2.28    Subd. 4. Annual survey of service recipients. The commissioner, in consultation
2.29with the State Quality Commission, shall conduct an annual independent statewide survey
2.30of at least five to ten percent of service recipients, randomly selected, to determine the
2.31effectiveness and quality of disability services. The survey shall be consistent with the
2.32system performance expectations of the Centers for Medicare and Medicaid Services
2.33(CMS) Quality Framework and analyze whether desired outcomes for persons with
2.34different demographic, diagnostic, health, and functional needs, receiving different types
2.35of services, in different settings, with different costs have been achieved. Annual statewide
3.1and regional reports of the results will be published for use by regions, counties, and
3.2providers to plan and measure the impact of quality improvement activities.
3.3    Subd. 5. Outcome-based quality review. The state commission shall designate an
3.4outcome-based quality review program to assure that quality assessment and licensing
3.5practices are founded on valid, reliable assessments in areas consistent with the CMS
3.6Quality Framework. The outcome-based quality review process shall:
3.7    (1) be designed and implemented based on the work of the State Quality Commission
3.8and Regional Councils, information from the statewide service user survey, and the
3.9incident reporting data;
3.10    (2) cover both licensed and unlicensed services;
3.11    (3) include outcome-based interviews of a sufficient sample of individuals and
3.12caregivers served by an agency to provide reliable information which can be used to
3.13determine the level of service quality, issue program licenses as needed, recommend
3.14remedial activities, and determine the need for general and specific training, technical
3.15assistance, consumer education, and other service improvement activities; and
3.16    (4) be available for use by regional councils for an alternative quality assurance
3.17program should counties in a region seek to develop an alternative to the state licensure
3.18system pursuant to the process established under sections 256B.095 to 256B.0955.
3.19    Subd. 6. Incident reporting, investigation, analysis, and follow-up
3.20improvements. (a) The commissioner shall improve the system of incident reporting,
3.21including reports made under the Maltreatment of Minors and Vulnerable Adults Acts,
3.22investigation, analysis, and follow-up for disability services to assure that incidents
3.23that may have jeopardized safety, health, civil and human rights, service-related
3.24assurances, and other protections to prevent abuse, neglect, and exploitation are reviewed,
3.25investigated, and acted upon in a timely manner.
3.26    (b) Information, data, and analysis from the reporting system shall be used at the
3.27provider, county, and regional levels to improve services for recipients and shall be
3.28provided in a standardized format on a regular basis to regional quality councils, the State
3.29Quality Commission, and appropriate state and county agencies.
3.30    Subd. 7. Effective date. (a) Subdivisions 1 through 4 and 6 are effective July 1,
3.312007, subject to the following phased implementation:
3.32    (1) the State Quality Commission and at least two regional quality councils, one
3.33in southeastern Minnesota and the other to be designated by the commissioner, shall
3.34begin July 1, 2008;
3.35    (2) two additional regional councils must be established by January 1, 2010;
4.1    (3) the remaining two regional councils must be established by July 1, 2011;
4.2    (4) the statewide survey of service recipients shall be developed beginning July
4.31, 2007, and field-tested during calendar year 2008 with implementation beginning on
4.4or before January 31, 2009; and
4.5    (5) beginning July 1, 2007, in consultation with a stakeholder workgroup, the
4.6commissioner shall develop, design, and make recommendations for improvements in the
4.7incident reporting, analysis, and data systems.
4.8    (b) Subdivision 5 is effective July 1, 2009. The outcome-based quality review
4.9process shall be designed and implemented based on the work of the State Quality
4.10Commission and regional councils, information from the statewide service user survey,
4.11and the incident reporting data, as funding allows after July 1, 2009."
4.12Page 2, line 27, before "$" insert "(a)"
4.13Page 2, after line 28, insert:
4.14    "(b) $....... is appropriated from the general fund to the commissioner of human
4.15services for fiscal year 2008, to develop and establish the quality assurance and
4.16improvement system according to the schedule set forth under Minnesota Statutes, section
4.17256B.096, subdivision 7. Federal Medicaid match obtained for this purpose shall be
4.18dedicated to the commissioner for this purpose.
4.19    (c) $....... in fiscal year 2008 and $....... in fiscal year 2009 is appropriated from
4.20the general fund to the commissioner of human services for the implementation of the
4.21quality assurance and improvement system. Federal Medicaid match obtained for this
4.22purpose shall be dedicated to the commissioner for this purpose. This appropriation is
4.23added to the agency's base."
4.24Renumber the sections in sequence and correct the internal references
4.25Amend the title accordingly