1.1.................... moves to amend the A14-0926 amendment to H.F. No. 2402 as follows:
1.2Page 172, after line 28, insert:

1.3    "Section 1. Minnesota Statutes 2012, section 245A.155, subdivision 1, is amended to
1.4read:
1.5    Subdivision 1. Licensed foster care and respite care. This section applies to
1.6foster care agencies and licensed foster care providers who place, supervise, or care for
1.7individuals who rely on medical monitoring equipment to sustain life or monitor a medical
1.8condition that could become life-threatening without proper use of the medical equipment
1.9 in respite care or foster care.

1.10    Sec. 2. Minnesota Statutes 2012, section 245A.155, subdivision 2, is amended to read:
1.11    Subd. 2. Foster care agency requirements. In order for an agency to place an
1.12individual who relies on medical equipment to sustain life or monitor a medical condition
1.13that could become life-threatening without proper use of the medical equipment with a
1.14foster care provider, the agency must ensure that the foster care provider has received the
1.15training to operate such equipment as observed and confirmed by a qualified source,
1.16and that the provider:
1.17(1) is currently caring for an individual who is using the same equipment in the
1.18foster home; or
1.19(2) has written documentation that the foster care provider has cared for an
1.20individual who relied on such equipment within the past six months; or
1.21(3) has successfully completed training with the individual being placed with the
1.22provider.

1.23    Sec. 3. Minnesota Statutes 2012, section 245A.155, subdivision 3, is amended to read:
1.24    Subd. 3. Foster care provider requirements. A foster care provider shall not care
1.25for an individual who relies on medical equipment to sustain life or monitor a medical
2.1condition that could become life-threatening without proper use of the medical equipment
2.2 unless the provider has received the training to operate such equipment as observed and
2.3confirmed by a qualified source, and:
2.4(1) is currently caring for an individual who is using the same equipment in the
2.5foster home; or
2.6(2) has written documentation that the foster care provider has cared for an
2.7individual who relied on such equipment within the past six months; or
2.8(3) has successfully completed training with the individual being placed with the
2.9provider.

2.10    Sec. 4. Minnesota Statutes 2012, section 245A.65, subdivision 2, is amended to read:
2.11    Subd. 2. Abuse prevention plans. All license holders shall establish and enforce
2.12ongoing written program abuse prevention plans and individual abuse prevention plans as
2.13required under section 626.557, subdivision 14.
2.14(a) The scope of the program abuse prevention plan is limited to the population,
2.15physical plant, and environment within the control of the license holder and the location
2.16where licensed services are provided. In addition to the requirements in section 626.557,
2.17subdivision 14 , the program abuse prevention plan shall meet the requirements in clauses
2.18(1) to (5).
2.19(1) The assessment of the population shall include an evaluation of the following
2.20factors: age, gender, mental functioning, physical and emotional health or behavior of the
2.21client; the need for specialized programs of care for clients; the need for training of staff to
2.22meet identified individual needs; and the knowledge a license holder may have regarding
2.23previous abuse that is relevant to minimizing risk of abuse for clients.
2.24(2) The assessment of the physical plant where the licensed services are provided
2.25shall include an evaluation of the following factors: the condition and design of the
2.26building as it relates to the safety of the clients; and the existence of areas in the building
2.27which are difficult to supervise.
2.28(3) The assessment of the environment for each facility and for each site when living
2.29arrangements are provided by the agency shall include an evaluation of the following
2.30factors: the location of the program in a particular neighborhood or community; the type
2.31of grounds and terrain surrounding the building; the type of internal programming; and
2.32the program's staffing patterns.
2.33(4) The license holder shall provide an orientation to the program abuse prevention
2.34plan for clients receiving services. If applicable, the client's legal representative must be
2.35notified of the orientation. The license holder shall provide this orientation for each new
3.1person within 24 hours of admission, or for persons who would benefit more from a later
3.2orientation, the orientation may take place within 72 hours.
3.3(5) The license holder's governing body or the governing body's delegated
3.4representative shall review the plan at least annually using the assessment factors in the
3.5plan and any substantiated maltreatment findings that occurred since the last review. The
3.6governing body or the governing body's delegated representative shall revise the plan,
3.7if necessary, to reflect the review results.
3.8(6) A copy of the program abuse prevention plan shall be posted in a prominent
3.9location in the program and be available upon request to mandated reporters, persons
3.10receiving services, and legal representatives.
3.11(b) In addition to the requirements in section 626.557, subdivision 14, the individual
3.12abuse prevention plan shall meet the requirements in clauses (1) and (2).
3.13(1) The plan shall include a statement of measures that will be taken to minimize the
3.14risk of abuse to the vulnerable adult when the individual assessment required in section
3.15626.557, subdivision 14 , paragraph (b), indicates the need for measures in addition to the
3.16specific measures identified in the program abuse prevention plan. The measures shall
3.17include the specific actions the program will take to minimize the risk of abuse within
3.18the scope of the licensed services, and will identify referrals made when the vulnerable
3.19adult is susceptible to abuse outside the scope or control of the licensed services. When
3.20the assessment indicates that the vulnerable adult does not need specific risk reduction
3.21measures in addition to those identified in the program abuse prevention plan, the
3.22individual abuse prevention plan shall document this determination.
3.23(2) An individual abuse prevention plan shall be developed for each new person as
3.24part of the initial individual program plan or service plan required under the applicable
3.25licensing rule. The review and evaluation of the individual abuse prevention plan shall
3.26be done as part of the review of the program plan or service plan. The person receiving
3.27services shall participate in the development of the individual abuse prevention plan to the
3.28full extent of the person's abilities. If applicable, the person's legal representative shall be
3.29given the opportunity to participate with or for the person in the development of the plan.
3.30The interdisciplinary team shall document the review of all abuse prevention plans at least
3.31annually, using the individual assessment and any reports of abuse relating to the person.
3.32The plan shall be revised to reflect the results of this review.

3.33    Sec. 5. Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding a
3.34subdivision to read:
4.1    Subd. 37. Working day. "Working day" means Monday, Tuesday, Wednesday,
4.2Thursday, or Friday, excluding any legal holiday.

4.3    Sec. 6. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
4.4amended to read:
4.5    Subdivision 1. Health needs. (a) The license holder is responsible for meeting health
4.6service needs assigned in the coordinated service and support plan or the coordinated
4.7service and support plan addendum, consistent with the person's health needs. The license
4.8holder is responsible for promptly notifying the person's legal representative, if any, and
4.9the case manager of changes in a person's physical and mental health needs affecting
4.10health service needs assigned to the license holder in the coordinated service and support
4.11plan or the coordinated service and support plan addendum, when within 24 hours of being
4.12 discovered by the license holder, or as directed in the coordinated service and support plan
4.13or support plan addendum, unless the license holder has reason to know the change has
4.14already been reported. The license holder must document when the notice is provided.
4.15(b) If responsibility for meeting the person's health service needs has been assigned
4.16to the license holder in the coordinated service and support plan or the coordinated service
4.17and support plan addendum, the license holder must maintain documentation on how the
4.18person's health needs will be met, including a description of the procedures the license
4.19holder will follow in order to:
4.20(1) provide medication assistance or medication administration according to this
4.21chapter;
4.22(2) monitor health conditions according to written instructions from a licensed
4.23health professional;
4.24(3) assist with or coordinate medical, dental, and other health service appointments; or
4.25(4) use medical equipment, devices, or adaptive aides or technology safely and
4.26correctly according to written instructions from a licensed health professional.

4.27    Sec. 7. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b, is
4.28amended to read:
4.29    Subd. 1b. Medication assistance. If responsibility for medication assistance
4.30is assigned to the license holder in the coordinated service and support plan or the
4.31coordinated service and support plan addendum, the license holder must ensure that
4.32the requirements of subdivision 2, paragraph (b), have been met when staff provides
4.33 medication assistance must be provided to enable a person to self-administer medication
4.34or treatment when the person is capable of directing the person's own care, or when the
5.1person's legal representative is present and able to direct care for the person. For the
5.2purposes of this subdivision, "medication assistance" means any of the following:
5.3(1) bringing to the person and opening a container of previously set up medications,
5.4emptying the container into the person's hand, or opening and giving the medications in
5.5the original container to the person;
5.6(2) bringing to the person liquids or food to accompany the medication; or
5.7(3) providing reminders, in person, remotely, or through programming devices
5.8such as telephones, alarms, or medication boxes, to take regularly scheduled medication
5.9or perform regularly scheduled treatments and exercises.

5.10    Sec. 8. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
5.11amended to read:
5.12    Subdivision 1. Incident response and reporting. (a) The license holder must
5.13respond to incidents under section 245D.02, subdivision 11, that occur while providing
5.14services to protect the health and safety of and minimize risk of harm to the person.
5.15(b) The license holder must maintain information about and report incidents to the
5.16person's legal representative or designated emergency contact and case manager within
5.1724 hours of an incident occurring while services are being provided, within 24 hours of
5.18discovery or receipt of information that an incident occurred, unless the license holder
5.19has reason to know that the incident has already been reported, or as otherwise directed
5.20in a person's coordinated service and support plan or coordinated service and support
5.21plan addendum. An incident of suspected or alleged maltreatment must be reported as
5.22required under paragraph (d), and an incident of serious injury or death must be reported
5.23as required under paragraph (e).
5.24(c) When the incident involves more than one person, the license holder must not
5.25disclose personally identifiable information about any other person when making the report
5.26to each person and case manager unless the license holder has the consent of the person.
5.27(d) Within 24 hours of reporting maltreatment as required under section 626.556
5.28or 626.557, the license holder must inform the case manager of the report unless there is
5.29reason to believe that the case manager is involved in the suspected maltreatment. The
5.30license holder must disclose the nature of the activity or occurrence reported and the
5.31agency that received the report.
5.32(e) The license holder must report the death or serious injury of the person as
5.33required in paragraph (b) and to the Department of Human Services Licensing Division,
5.34and the Office of Ombudsman for Mental Health and Developmental Disabilities as
5.35required under section 245.94, subdivision 2a, within 24 hours of the death or serious
6.1injury, or receipt of information that the death or serious injury occurred, unless the license
6.2holder has reason to know that the death or serious injury has already been reported.
6.3(f) When a death or serious injury occurs in a facility certified as an intermediate
6.4care facility for persons with developmental disabilities, the death or serious injury must
6.5be reported to the Department of Health, Office of Health Facility Complaints, and the
6.6Office of Ombudsman for Mental Health and Developmental Disabilities, as required
6.7under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
6.8know that the death or serious injury has already been reported.
6.9(g) The license holder must conduct an internal review of incident reports of deaths
6.10and serious injuries that occurred while services were being provided and that were not
6.11reported by the program as alleged or suspected maltreatment, for identification of incident
6.12patterns, and implementation of corrective action as necessary to reduce occurrences.
6.13The review must include an evaluation of whether related policies and procedures were
6.14followed, whether the policies and procedures were adequate, whether there is a need for
6.15additional staff training, whether the reported event is similar to past events with the
6.16persons or the services involved, and whether there is a need for corrective action by the
6.17license holder to protect the health and safety of persons receiving services. Based on
6.18the results of this review, the license holder must develop, document, and implement a
6.19corrective action plan designed to correct current lapses and prevent future lapses in
6.20performance by staff or the license holder, if any.
6.21(h) The license holder must verbally report the emergency use of manual restraint of
6.22a person as required in paragraph (b) within 24 hours of the occurrence. The license holder
6.23must ensure the written report and internal review of all incident reports of the emergency
6.24use of manual restraints are completed according to the requirements in section 245D.061.

6.25    Sec. 9. Minnesota Statutes 2013 Supplement, section 245D.07, subdivision 2, is
6.26amended to read:
6.27    Subd. 2. Service planning requirements for basic support services. (a) License
6.28holders providing basic support services or intensive support services identified in section
6.29245D.03, subdivision 1, paragraph (c), clauses (1) and (2), must meet the requirements
6.30of this subdivision.
6.31(b) Within 15 calendar days of service initiation the license holder must complete
6.32a preliminary coordinated service and support plan addendum based on the coordinated
6.33service and support plan.
6.34(c) Within 60 calendar days of service initiation the license holder must review
6.35and revise as needed the preliminary coordinated service and support plan addendum to
7.1document the services that will be provided including how, when, and by whom services
7.2will be provided, and the person responsible for overseeing the delivery and coordination
7.3of services.
7.4(d) The license holder must participate in service planning and support team
7.5meetings for the person following stated timelines established in the person's coordinated
7.6service and support plan or as requested by the person or the person's legal representative,
7.7the support team or the expanded support team.

7.8    Sec. 10. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 1,
7.9is amended to read:
7.10    Subdivision 1. Requirements for intensive support services. Except for services
7.11identified in section 245D.03, subdivision 1, paragraph (c), clauses (1) and (2), a license
7.12holder providing intensive support services identified in section 245D.03, subdivision 1,
7.13paragraph (c), must comply with the requirements in this section and section 245D.07,
7.14subdivisions 1 and 3.

7.15    Sec. 11. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
7.16is amended to read:
7.17    Subd. 3. Assessment and initial service planning. (a) Within 15 calendar days of
7.18service initiation the license holder must complete a preliminary coordinated service and
7.19support plan addendum based on the coordinated service and support plan.
7.20(b) Within 45 calendar days of service initiation the license holder must meet with
7.21the person, the person's legal representative, the case manager, and other members of the
7.22support team or expanded support team to assess and determine the following based on the
7.23person's coordinated service and support plan and the requirements in subdivision 4 and
7.24section 245D.07, subdivision 1a:
7.25(1) the scope of the services to be provided to support the person's daily needs
7.26and activities;
7.27(2) the person's desired outcomes and the supports necessary to accomplish the
7.28person's desired outcomes;
7.29(3) the person's preferences for how services and supports are provided;
7.30(4) whether the current service setting is the most integrated setting available and
7.31appropriate for the person; and
7.32(5) how services must be coordinated across other providers licensed under this
7.33chapter serving the same person to ensure continuity of care for the person.
8.1(c) Within the scope of services, the license holder must, at a minimum, assess
8.2the following areas:
8.3(1) the person's ability to self-manage health and medical needs to maintain or
8.4improve physical, mental, and emotional well-being, including, when applicable, allergies,
8.5seizures, choking, special dietary needs, chronic medical conditions, self-administration
8.6of medication or treatment orders, preventative screening, and medical and dental
8.7appointments;
8.8(2) the person's ability to self-manage personal safety to avoid injury or accident in
8.9the service setting, including, when applicable, risk of falling, mobility, regulating water
8.10temperature, community survival skills, water safety skills, and sensory disabilities; and
8.11(3) the person's ability to self-manage symptoms or behavior that may otherwise
8.12result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7),
8.13suspension or termination of services by the license holder, or other symptoms or
8.14behaviors that may jeopardize the health and safety of the person or others.
8.15The assessments must produce information about the person that is descriptive of the
8.16person's overall strengths, functional skills and abilities, and behaviors or symptoms.

8.17    Sec. 12. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 4,
8.18is amended to read:
8.19    Subd. 4. Service outcomes and supports. (a) Within ten working days of the
8.2045-day meeting, the license holder must develop and document the service outcomes and
8.21supports based on the assessments completed under subdivision 3 and the requirements
8.22in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
8.23coordinated service and support plan addendum.
8.24(b) The license holder must document the supports and methods to be implemented
8.25to support the accomplishment of outcomes related to acquiring, retaining, or improving
8.26skills. The documentation must include:
8.27(1) the methods or actions that will be used to support the person and to accomplish
8.28the service outcomes, including information about:
8.29(i) any changes or modifications to the physical and social environments necessary
8.30when the service supports are provided;
8.31(ii) any equipment and materials required; and
8.32(iii) techniques that are consistent with the person's communication mode and
8.33learning style;
8.34(2) the measurable and observable criteria for identifying when the desired outcome
8.35has been achieved and how data will be collected;
9.1(3) the projected starting date for implementing the supports and methods and
9.2the date by which progress towards accomplishing the outcomes will be reviewed and
9.3evaluated; and
9.4(4) the names of the staff or position responsible for implementing the supports
9.5and methods.
9.6(c) Within 20 working days of the 45-day meeting, the license holder must submit
9.7to and obtain dated signatures from the person or the person's legal representative and
9.8case manager to document completion and approval of the assessment and coordinated
9.9service and support plan addendum. If, within ten working days of the submission of the
9.10assessment or coordinated service and support plan addendum, the person or the person's
9.11legal representative or case manager has not signed and returned to the license holder the
9.12assessment and coordinated service and support plan addendum or has not proposed
9.13written modifications to the license holder's submission, the submission is deemed
9.14approved and the assessment and coordinated service and support plan addendum become
9.15effective and remain in effect until the legal representative or case manager submits a
9.16written request to revise the assessment or coordinated service and support plan addendum.

9.17    Sec. 13. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 5,
9.18is amended to read:
9.19    Subd. 5. Progress reviews. (a) The license holder must give the person or the
9.20person's legal representative and case manager an opportunity to participate in the ongoing
9.21review and development of the methods used to support the person and accomplish
9.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
9.23the person's support team or expanded support team, must meet with the person, the
9.24person's legal representative, and the case manager, and participate in progress review
9.25meetings following stated timelines established in the person's coordinated service and
9.26support plan or coordinated service and support plan addendum or within 30 days of a
9.27written request by the person, the person's legal representative, or the case manager,
9.28at a minimum of once per year.
9.29(b) The license holder must summarize the person's progress toward achieving the
9.30identified outcomes and make recommendations and identify the rationale for changing,
9.31continuing, or discontinuing implementation of supports and methods identified in
9.32subdivision 4 in a written report sent to the person or the person's legal representative and
9.33case manager five working days prior to the review meeting, unless the person, the person's
9.34legal representative, or the case manager requests to receive the in a report available at
9.35the time of the progress review meeting. The report must be sent five working days prior
10.1to the progress review meeting if requested by the team in the coordinated service and
10.2support plan or coordinated service and support plan addendum. Within 60 calendar days
10.3of service initiation, the license holder must document the preference of the person or the
10.4person's legal representative and the case manager regarding receiving written reports. The
10.5license holder must document changes to those preferences when changes are requested.
10.6(c) Within ten working days of the progress review meeting, the license holder
10.7must obtain dated signatures from the person or the person's legal representative and
10.8the case manager to document approval of any changes to the coordinated service and
10.9support plan addendum.
10.10(d) If, within ten working days of the submission of the changes to the coordinated
10.11service and support plan addendum, the person or the person's legal representative or case
10.12manager has not signed and returned to the license holder the coordinated service and
10.13support plan addendum or has not proposed written modifications to the license holder's
10.14submission, the submission is deemed approved and the coordinated service and support
10.15plan addendum becomes effective and remains in effect until the legal representative or
10.16case manager submits a written request to revise the coordinated service and support plan.

10.17    Sec. 14. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 3, is
10.18amended to read:
10.19    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
10.20direct support, or staff who have responsibilities related to supervising or managing the
10.21provision of direct support service, are competent as demonstrated through skills and
10.22knowledge training, experience, and education to meet the person's needs and additional
10.23requirements as written in the coordinated service and support plan or coordinated
10.24service and support plan addendum, or when otherwise required by the case manager or
10.25the federal waiver plan. The license holder must verify and maintain evidence of staff
10.26competency, including documentation of:
10.27(1) education and experience qualifications relevant to the job responsibilities
10.28assigned to the staff and the needs of the general population of persons served by the
10.29program, including a valid degree and transcript, or a current license, registration, or
10.30certification, when a degree or licensure, registration, or certification is required by this
10.31chapter or in the coordinated service and support plan or coordinated service and support
10.32plan addendum;
10.33(2) demonstrated competency in the orientation and training areas required under
10.34this chapter, and when applicable, completion of continuing education required to
10.35maintain professional licensure, registration, or certification requirements. Competency in
11.1these areas is determined by the license holder through knowledge testing and or observed
11.2skill assessment conducted by the trainer or instructor; and
11.3(3) except for a license holder who is the sole direct support staff, periodic
11.4performance evaluations completed by the license holder of the direct support staff
11.5person's ability to perform the job functions based on direct observation.
11.6(b) Staff under 18 years of age may not perform overnight duties or administer
11.7medication.

11.8    Sec. 15. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4, is
11.9amended to read:
11.10    Subd. 4. Orientation to program requirements. Except for a license holder
11.11who does not supervise any direct support staff, within 60 calendar days of hire, unless
11.12stated otherwise, the license holder must provide and ensure completion of ten hours of
11.13orientation for direct support staff providing basic services and 30 hours of orientation
11.14for direct support staff providing intensive services that combines supervised on-the-job
11.15training with review of and instruction in the following areas:
11.16(1) the job description and how to complete specific job functions, including:
11.17(i) responding to and reporting incidents as required under section 245D.06,
11.18subdivision 1; and
11.19(ii) following safety practices established by the license holder and as required in
11.20section 245D.06, subdivision 2;
11.21(2) the license holder's current policies and procedures required under this chapter,
11.22including their location and access, and staff responsibilities related to implementation
11.23of those policies and procedures;
11.24(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
11.25federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
11.26responsibilities related to complying with data privacy practices;
11.27(4) the service recipient rights and staff responsibilities related to ensuring the
11.28exercise and protection of those rights according to the requirements in section 245D.04;
11.29(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
11.30reporting and service planning for children and vulnerable adults, and staff responsibilities
11.31related to protecting persons from maltreatment and reporting maltreatment. This
11.32orientation must be provided within 72 hours of first providing direct contact services and
11.33annually thereafter according to section 245A.65, subdivision 3;
12.1(6) the principles of person-centered service planning and delivery as identified in
12.2section 245D.07, subdivision 1a, and how they apply to direct support service provided
12.3by the staff person; and
12.4(7) the safe and correct use of manual restraint on an emergency basis according to
12.5the requirements in section 245D.061 and what constitutes the use of restraints, time out,
12.6and seclusion, including chemical restraint;
12.7(8) staff responsibilities related to prohibited procedures under section 245D.06,
12.8subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
12.9or undesired behavior, and why such procedures are not safe;
12.10(9) basic first aid; and
12.11(10) other topics as determined necessary in the person's coordinated service and
12.12support plan by the case manager or other areas identified by the license holder.

12.13    Sec. 16. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4a,
12.14is amended to read:
12.15    Subd. 4a. Orientation to individual service recipient needs. (a) Before having
12.16unsupervised direct contact with a person served by the program, or for whom the staff
12.17person has not previously provided direct support, or any time the plans or procedures
12.18identified in paragraphs (b) to (f) (e) are revised, the staff person must review and receive
12.19instruction on the requirements in paragraphs (b) to (f) (e) as they relate to the staff
12.20person's job functions for that person.
12.21(b) For community residential services, training and competency evaluations must
12.22include the following, if identified in the coordinated service and support plan:
12.23(1) appropriate and safe techniques in personal hygiene and grooming, including
12.24hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
12.25daily living (ADLs) as defined under section 256B.0659, subdivision 1;
12.26(2) an understanding of what constitutes a healthy diet according to data from the
12.27Centers for Disease Control and Prevention and the skills necessary to prepare that diet; and
12.28(3) skills necessary to provide appropriate support in instrumental activities of daily
12.29living (IADLs) as defined under section 256B.0659, subdivision 1; and
12.30(4) demonstrated competence in providing first aid.
12.31(c) The staff person must review and receive instruction on the person's coordinated
12.32service and support plan or coordinated service and support plan addendum as it relates
12.33to the responsibilities assigned to the license holder, and when applicable, the person's
12.34individual abuse prevention plan, to achieve and demonstrate an understanding of the
12.35person as a unique individual, and how to implement those plans.
13.1(d) The staff person must review and receive instruction on medication
13.2administration procedures established for the person when medication administration is
13.3assigned to the license holder according to section 245D.05, subdivision 1, paragraph
13.4(b). Unlicensed staff may administer medications only after successful completion of a
13.5medication administration training, from a training curriculum developed by a registered
13.6nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
13.7practitioner, physician's assistant, or physician. The training curriculum must incorporate
13.8an observed skill assessment conducted by the trainer to ensure staff demonstrate the
13.9ability to safely and correctly follow medication procedures.
13.10Medication administration must be taught by a registered nurse, clinical nurse
13.11specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
13.12service initiation or any time thereafter, the person has or develops a health care condition
13.13that affects the service options available to the person because the condition requires:
13.14(1) specialized or intensive medical or nursing supervision; and
13.15(2) nonmedical service providers to adapt their services to accommodate the health
13.16and safety needs of the person.
13.17(e) The staff person must review and receive instruction on the safe and correct
13.18operation of medical equipment used by the person to sustain life or to monitor a medical
13.19condition that could become life-threatening without proper use of the medical equipment,
13.20including but not limited to ventilators, feeding tubes, or endotracheal tubes. The training
13.21must be provided by a licensed health care professional or a manufacturer's representative
13.22and incorporate an observed skill assessment to ensure staff demonstrate the ability to
13.23safely and correctly operate the equipment according to the treatment orders and the
13.24manufacturer's instructions.
13.25(f) The staff person must review and receive instruction on what constitutes use of
13.26restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
13.27related to the prohibitions of their use according to the requirements in section 245D.06,
13.28subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
13.29or undesired behavior and why they are not safe, and the safe and correct use of manual
13.30restraint on an emergency basis according to the requirements in section 245D.061.
13.31(g) In the event of an emergency service initiation, the license holder must ensure
13.32the training required in this subdivision occurs within 72 hours of the direct support staff
13.33person first having unsupervised contact with the person receiving services. The license
13.34holder must document the reason for the unplanned or emergency service initiation and
13.35maintain the documentation in the person's service recipient record.
14.1(h) (g) License holders who provide direct support services themselves must
14.2complete the orientation required in subdivision 4, clauses (3) to (7) (10).

14.3    Sec. 17. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 5, is
14.4amended to read:
14.5    Subd. 5. Annual training. A license holder must provide annual training to direct
14.6support staff on the topics identified in subdivision 4, clauses (3) to (7), and subdivision
14.74a (10). A license holder must provide a minimum of 24 hours of annual training to
14.8direct service staff with providing intensive services and having fewer than five years
14.9of documented experience and 12 hours of annual training to direct service staff with
14.10 providing intensive services and having five or more years of documented experience in
14.11topics described in subdivisions 4 and 4a, paragraphs (a) to (h) (g). Training on relevant
14.12topics received from sources other than the license holder may count toward training
14.13requirements. A license holder must provide a minimum of 12 hours of annual training
14.14to direct service staff providing basic services and having fewer than five years of
14.15documented experience and six hours of annual training to direct service staff providing
14.16basic services and having five or more years of documented experience.

14.17    Sec. 18. Minnesota Statutes 2013 Supplement, section 245D.095, subdivision 3,
14.18is amended to read:
14.19    Subd. 3. Service recipient record. (a) The license holder must maintain a record of
14.20current services provided to each person on the premises where the services are provided
14.21or coordinated. When the services are provided in a licensed facility, the records must
14.22be maintained at the facility, otherwise the records must be maintained at the license
14.23holder's program office. The license holder must protect service recipient records against
14.24loss, tampering, or unauthorized disclosure according to the requirements in sections
14.2513.01 to 13.10 and 13.46.
14.26(b) The license holder must maintain the following information for each person:
14.27(1) an admission form signed by the person or the person's legal representative
14.28that includes:
14.29(i) identifying information, including the person's name, date of birth, address,
14.30and telephone number; and
14.31(ii) the name, address, and telephone number of the person's legal representative, if
14.32any, and a primary emergency contact, the case manager, and family members or others as
14.33identified by the person or case manager;
15.1(2) service information, including service initiation information, verification of the
15.2person's eligibility for services, documentation verifying that services have been provided
15.3as identified in the coordinated service and support plan or coordinated service and support
15.4plan addendum according to paragraph (a), and date of admission or readmission;
15.5(3) health information, including medical history, special dietary needs, and
15.6allergies, and when the license holder is assigned responsibility for meeting the person's
15.7health service needs according to section 245D.05:
15.8(i) current orders for medication, treatments, or medical equipment and a signed
15.9authorization from the person or the person's legal representative to administer or assist in
15.10administering the medication or treatments, if applicable;
15.11(ii) a signed statement authorizing the license holder to act in a medical emergency
15.12when the person's legal representative, if any, cannot be reached or is delayed in arriving;
15.13(iii) medication administration procedures;
15.14(iv) a medication administration record documenting the implementation of the
15.15medication administration procedures, and the medication administration record reviews,
15.16including any agreements for administration of injectable medications by the license
15.17holder according to the requirements in section 245D.05; and
15.18(v) a medical appointment schedule when the license holder is assigned
15.19responsibility for assisting with medical appointments;
15.20(4) the person's current coordinated service and support plan or that portion of the
15.21plan assigned to the license holder;
15.22(5) copies of the individual abuse prevention plan and assessments as required under
15.23section 245D.071, subdivisions 2 and subdivision 3;
15.24(6) a record of other service providers serving the person when the person's
15.25coordinated service and support plan or coordinated service and support plan addendum
15.26identifies the need for coordination between the service providers, that includes a contact
15.27person and telephone numbers, services being provided, and names of staff responsible for
15.28coordination;
15.29(7) documentation of orientation to service recipient rights according to section
15.30245D.04, subdivision 1 , and maltreatment reporting policies and procedures according to
15.31section 245A.65, subdivision 1, paragraph (c);
15.32(8) copies of authorizations to handle a person's funds, according to section 245D.06,
15.33subdivision 4, paragraph (a);
15.34(9) documentation of complaints received and grievance resolution;
15.35(10) incident reports involving the person, required under section 245D.06,
15.36subdivision 1;
16.1(11) copies of written reports regarding the person's status when requested according
16.2to section 245D.07, subdivision 3, progress review reports as required under section
16.3245D.071, subdivision 5 , progress or daily log notes that are recorded by the program,
16.4and reports received from other agencies involved in providing services or care to the
16.5person; and
16.6(12) discharge summary, including service termination notice and related
16.7documentation, when applicable.

16.8    Sec. 19. Minnesota Statutes 2013 Supplement, section 245D.22, subdivision 4, is
16.9amended to read:
16.10    Subd. 4. First aid must be available on site. (a) A staff person trained in first
16.11aid must be available on site and, when required in a person's coordinated service and
16.12support plan or coordinated service and support plan addendum, be able to provide
16.13cardiopulmonary resuscitation, whenever persons are present and staff are required to be
16.14at the site to provide direct service. The CPR training must include in-person instruction,
16.15hands-on practice, and an observed skills assessment under the direct supervision of a
16.16CPR instructor.
16.17(b) A facility must have first aid kits readily available for use by, and that meet
16.18the needs of, persons receiving services and staff. At a minimum, the first aid kit must
16.19be equipped with accessible first aid supplies including bandages, sterile compresses,
16.20scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
16.21adhesive tape, and first aid manual.

16.22    Sec. 20. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 3, is
16.23amended to read:
16.24    Subd. 3. Staff ratio requirement for each person receiving services. The case
16.25manager, in consultation with the interdisciplinary team, must determine at least once each
16.26year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
16.27services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
16.28assigned each person and the documentation of how the ratio was arrived at must be kept
16.29in each person's individual service plan. Documentation must include an assessment of the
16.30person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
16.31assessment form required by the commissioner.

16.32    Sec. 21. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 4, is
16.33amended to read:
17.1    Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
17.2staff ratio requirement of one to four if:
17.3(1) on a daily basis the person requires total care and monitoring or constant
17.4hand-over-hand physical guidance to successfully complete at least three of the following
17.5activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
17.6taking appropriate action for self-preservation under emergency conditions; or
17.7(2) the person engages in conduct that poses an imminent risk of physical harm to
17.8self or others at a documented level of frequency, intensity, or duration requiring frequent
17.9daily ongoing intervention and monitoring as established in the person's coordinated
17.10service and support plan or coordinated service and support plan addendum.

17.11    Sec. 22. Minnesota Statutes 2013 Supplement, section 245D.31, subdivision 5, is
17.12amended to read:
17.13    Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
17.14staff ratio requirement of one to eight if:
17.15(1) the person does not meet the requirements in subdivision 4; and
17.16(2) on a daily basis the person requires verbal prompts or spot checks and minimal
17.17or no physical assistance to successfully complete at least four three of the following
17.18activities: toileting, communicating basic needs, eating, or ambulating, or taking
17.19appropriate action for self-preservation under emergency conditions."
17.20Page 184, delete section 15 and insert:

17.21    "Sec. 15. REPEALER.
17.22(a) Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 2, is
17.23repealed.
17.24(b) Laws 2011, First Special Session chapter 9, article 6, section 95, subdivisions 1,
17.252, 3, and 4, are repealed effective the day following final enactment."
17.26Renumber the sections in sequence and correct the internal references
17.27Amend the title accordingly