STATE OF MINNESOTA

OFFICE OF ADMINISTRATIVE HEARINGS

 

FOR THE DEPARTMENT OF HUMAN SERVICES

 

 

In the matter of Proposed Rules   DEPARTMENT OF HUMAN SERVICES

Governing the Licensure of                SECOND RESPONSE TO COMMENTS

Chemical Abuse and Dependency     AND HEARING TESTIMONY

And Detoxification Programs,

Minnesota Rules, Chapter 9530

 

 

            The Minnesota Department of Human Services (Department) submits this response as its second response to written comments, hearing testimony and questions raised by the Administrative Law Judge.

 

This document is divided into three parts:

I.                 Questions raised by the Administrative Law Judge and Department’s Response

II.               Modifications to Proposed Rule Language and Department’s Rationale

III.             Department’s Response to Other Comments Received

 

 

I.            Questions raised by the Administrative Law Judge

            1.            How will the Department reconcile the proposed definition of “adolescent” at 9530.6405, subpart 2, which includes those persons under 19 years of age, with Minnesota Statutes, §245A.02, subd. 2, which defines “adult” as anyone who is 18 years old or older?

 

Response:  The Department proposes to change the definition in the proposed rules to make it consistent with Minnesota Statutes, §245A.02, subd. 2; it will define “adolescent” as anyone younger than 18 years old.

 

            2.            How will the Department reconcile counselor qualification standards in part 9530.6450 with the qualifications for licensed alcohol and drug counselors in Minnesota Statutes, §148C.04?  To what extent has the Department consulted with the Health Department concerning these requirements?  How does the Department reconcile the differing grants of authority to establish the qualifications for alcohol and drug counselors?

 

Response:  None of the ongoing training requirements in the proposed rules conflict with the licensing standards for continuing education.  Department staff met with the Director of the Health Occupations Program during the rule development process to discuss these issues.  It was agreed that the proposed language regarding counselor qualifications in the proposed rules was not inconsistent with the standard in the licensed alcohol and drug counselor (LADC) law.  The Department drafted the proposed rules with the intent of being consistent with the education and training requirements in Minnesota Statutes, Chapter 148C, the licensed alcohol and drug counselor (LADC) law. Health Department staff have been kept informed of the proposed rules throughout the rule making process.  Copies of the draft used at the public hearing were distributed to the Director of the Health Occupations Program as part of the Department’s additional notice plan.  The LADC law sets minimum standards for LADCs to practice independently, including pre-licensure education requirements and post-licensed continuing education requirements.

 

To work in a licensed facility as an alcohol and drug counselor, proposed rule part 9530.6450, subpart 5 requires that “an alcohol and drug counselor must either be licensed or exempt from licensure under Minnesota Statutes, chapter 148C” and that those who are licensed under chapter 148C “must comply with rules adopted thereunder.”  Subpart 5 requires those counselors who are exempt from licensing under chapter 148C must meet one of the education and training requirements it item B(1) – (5).

 

Proposed rule part 9530.6460, describes continuing training and education requirements for staff members.  According to subpart 2, staff who have direct client contact, including alcohol and drug counselors, must obtain training in the following areas:

a.               client confidentiality rules and regulations and client ethical boundaries (biannually);

b.               emergency procedures and client rights “as specified in part 4747.1500 and Minnesota Statutes, §§144.651 and 253B.03.” (biannually);

c.               mandatory reporting laws and obtaining client releases of information. HIV minimum standards (annually);

d.            co-occurring mental health issues (12 hours, one-time requirement);

 

            Rules promulgated under chapter 148C are found at Minnesota Rules, Chapter 4747.  Part 4747.1100 establishes the continuing education requirements for LADCs.  Part 4747.1100, subpart 1 states, in part, “[a] licensee may be given credit only for activities that directly relate to the practice of alcohol and drug counseling, the core functions, or the rules of professional conduct in part 4747.1400.”  The proposed rules are not inconsistent with this requirement.  As long as a counselor can demonstrate that the continuing education he or she obtained directly relates to the practice of alcohol and drug counseling, it can be counted for their license renewal.

 

II.            Proposed modifications to the rules and rationale

 

9530.6405  DEFINITIONS

 

Subp. 1a.  Administration of medications.  AAdministration of medications@ means performing a task to provide medications to a client, and includes the following tasks, performed in the following order:

A.   checking the client=s medication record;

B.   preparing the medication for administration;

C.   administering the medication to the client;

D.   documenting the administration, or the reason for not administering the medications as prescribed; and

E.   reporting information to a licensed practitioner or a nurse regarding problems with the administration of the medication or the client=s refusal to take the medication.

 

Rationale: Because part 9530.6435 indicates that unlicensed staff may administer medications, the procedure should be defined and the methodology made clear so the task is performed consistently according to standard medical procedure.  This language is reasonable because it is consistent with rules administered by the Minnesota Department of Health for home care, including assisted living facilities found at parts 4668.0003, subparts 2a and 21a.  The addition does not constitute a substantial change because requirements for administration of medication and medication monitoring was included in the published proposed rule.

 

Subp. 2. Adolescent. AAdolescent@ means an individual under 19 18 years of age.

 

Rationale:  This change is reasonable and necessary because it makes the use of the term consistent with statutory authority.  It is also consistent with rules governing the licensing of complementary and related services, such as Minn. Rules, Chapter 2960 and part 9530.6605.

 

Subp 7a  Chemical use problem.  “Chemical use problem” means one of the following:

                        A.   a staff member under part 9530.6450, subpart 1 receiving treatment for chemical use within the period specified in the staff qualification requirements;

            B.  chemical use that has a negative impact on the staff member’s job performance;

            C.  chemical use that affects the credibility of treatment services with clients, referral sources or other members of the community; or

            D.  symptoms of intoxication or withdrawal on the job.

 

            Rationale:  It is necessary to define the term to ensure that it has a common understanding as it is used in the rule.  This is not a substantial change because the definition was already incorporated into the language of the rule at part 9530.6460, subpart 1.E.

 

Subp. 10. Co-occurring or co-occurring client. ACo-occurring@ or Aco-occurring client@ means a diagnosis that indicates a client suffers both chemical abuse or dependency and a mental health problem, or a client who suffers from both disorders.

 

Rationale: change clarifies definition by deleting redundancy.  This is not a substantial change because it does not alter the meaning of the term.

 

Subp.  14a  Licensed practitioner.  ALicensed practitioner means a person who is authorized to prescribe as defined in Minnesota Statutes, section 151.01, subdivision 23.

 

Rationale: The proposed change is necessary to recognize that health care professionals other than physicians are authorized to prescribe medications.  The rule language here is consistent with the pharmacy law (Minn. Stat. Chapter 151).  This change does not make the rules substantially different but merely ensures the terminology used in the rule is consistent with statute.

 

Subp. 15a.  Nurse.  ANurse@ means a person licensed and currently registered to practice professional or practical nursing as defined in Minnesota Statutes, section 148.171, subdivisions 14 and 15.

 

Rationale: It is reasonable and necessary to include a definition since the term is used in part 9530.6435. This change does not make the rules substantially different but merely ensures the terminology used in the rule has a standard meaning and is consistent with statute.

 

9530.6410 APPLICABILITY

 

Subp. 4.  Licensing requirements of Minnesota Rules, Chapter 2960.  Beginning July 1, 2005, residential programs providing treatment services to adolescents must be licensed as follows:

A.              A residential program licensed under parts 2960.0010 to 2960.0220 to provide services that address chemical use problems of persons who are under 21 years of age must be certified under parts 2960.0430 to 2960.0490.

B.              A residential program that addresses the chemical use problems of a person older than 15 years of age, and under 21 years of age must either be licensed under parts 2960.0010 to 2960.0220 and certified under parts 2960.0430 to 2960.0490 or be licensed under parts 9530.6405 to 9530.6495.

 

Rationale: Chapter 2960 was adopted in September, 2003 to establish the licensing standards for all out of home placement options for children. The portion of chapter 2960 governing residential treatment for children will be effective on July 1, 2005.  The above language parallels the language found at part 2960. 0440 and clarifies the applicability of each rule to residential programs addressing chemical use problems in children.  This provision is necessary to clarify the applicability of both rules and the language is reasonable because it has been duly promulgated in Chapter 2960.  Since the language here is based on existing standards and is merely a reiteration of chapter 2960, it is neither a policy change nor a substantial change to the proposed rules.    Further, since the issue of the interplay between the proposed rules and chapter 2960 was an issue raised and discussed at the public hearing, it is inherently related to the subject matter of the proposed rules and is not a substantial change. 

 

9530.6417 CAPACITY MANAGEMENT AND WAITING LIST SYSTEM COMPLIANCE

 

Alicense holder must notify the department when it has reached 90 percent of its capacity to care for clients.  A license holder need not report when capacity returns to under 90 percent capacity. The license holder must notify the placing county or tribal government when they are at 100 percent capacity and unable to accept a referral.

 

Rationale: The Department drafted the capacity management portions of the proposed rule to comply with the Federal Substance Abuse Prevention and Treatment Block Grant mandates for programs serving intravenous (“IV”) drug users and programs serving pregnant women.  In response to public comment, the Department has determined, based on its understanding of federal mandates, that the language of part 9530.6500, subpart 2 is sufficient to meet the requirements on 45 CFR 96.126 concerning programs for intravenous drug users.

 

The Department also has federally imposed capacity monitoring responsibilities withy respect to availability of programs serving pregnant women.  The federal regulations allow these responsibilities to be accomplished in a number of ways.  The Department has determined that given the flexibility offered under federal regulations and the limited populations involved, the potential burden imposed on providers by part 9530.6417 is not necessary.  The Department will develop an alternative mechanism for gathering the information necessary to monitor and manage the availability of these services.

 

9530.6425 INDIVIDUAL TREATMENT PLANS

 

Subpart 1. General. Individual treatment plans for clients in treatment must continually be updated, based on new information gathered about the client=s condition and on whether planned treatment interventions have had the intended effect. Treatment planning must include a cycle, repeating until service termination, of assessment, priority setting, planning, implementation, and reassessment based on progress, revised priorities, and revised plan. The plan must provide for the involvement of the client=s family

and those people selected by the client as being important to the success of the treatment experience at the earliest opportunity, consistent with the client=s treatment needs and written consent. The plan must be developed after completion of the comprehensive

assessment and is subject to amendment until the client=s services are discharged terminated. The client must have an opportunity to have active, direct involvement in selecting the anticipated outcomes of the treatment process and in developing the individual treatmentplan. The individual treatment plan must be signed by the client and the alcohol and drug counselor.                              

 

Rationale: The above change is necessary to be consistent with the use of the term “terminated” throughout rules.  It does not make the rules substantially different.

 

Subp. 2. Plan contents. An individual treatment plan must include:

             A. treatment goals in part 9530.6420, subpart 3, item B   9530.6422, subpart 2, item B, in which a problem has been identified;

 

Rationale: The above change provides clarification by correcting an inaccurate citiation. It does not make the rules substantially different, but simply reflect the original

intent.

 

Subp 3.  Progress notes and plan review.

(B). Treatment plan review must:

(1) Occur weekly or after each treatment service, whichever is less frequent, and

(2) Address weekly each goal in the treatment plan that has been worked on since the last review,and

                        (3) Address whether the strategies to address the goals are effective, and if not, must include changes to the treatment plan

 

            Rationale:  The above change clarifies that this provision relates to treatment plan review rather than progress notes. It also clarifies, in response to written comments received, that if treatment services are less frequent than one per week, reviews may also be less frequent. Further the change clarifies that goal review should focus on those goals that have been addressed in treatment.  It is reasonable to require the client’s individual treatment plan goals to be updated when programming is scheduled less frequently than once per week because the intention of the provision is to be flexible enough to address an individual client’s treatment needs.  The intensity of the client’s treatment needs should dictate how often treatment plan goals are addressed and updated and the addition of this language will focus on those needs. The language is not a substantial change because it simply clarifies the original intent and is consistent with the language of the SONAR. 

 

9530.6430 TREATMENT SERVICES

 

Subpart 1. Treatment services provided by license holder

            A.  A license holder must provide treatment services including:

                        (1) individual and group counseling to help the client identify and address problems related to chemical use and develop strategies to avoid inappropriate chemical use after discharge;

                        (2) client education strategies to avoid inappropriate chemical use and health problems related to chemical use and the necessary changes in lifestyle to regain and maintain health. Client education must include information concerning the human immunodeficiency virus, according to Minnesota Statutes, section 245A.19, other sexually transmitted diseases, drug and alcohol use during pregnancy, hepatitis, and tuberculosis;

                        (3) transition services to help the client integrate gains made during treatment into daily living and to reduce reliance on the license holder=s staff for support; and

                        (4) services to address issues related to co-occurring mental illness, including education for clients on basic symptoms of mental illness, the possibility of comorbidity, and the need for continued medication compliance while working on recovery from chemical abuse or dependency. At least one group per week Groups must address co-occurring mental illness issues, as needed. Whentreatment for mental health problems is indicated, it is integrated into the client=s treatment plan.

 

Rationale: If a client would not benefit from a co-occurring therapy group and would be better served by a one-to-one treatment session, the language change allows for the provider to meet that client=s needs.  The intent of this of this provision was to require these services as needed by the client.  The language “at least one group per week” created an inherent conflict.  This is not a substantial change in the rule or the policy.  The SONAR supports the language as modified. 

 

Subp. 4. Location of service provision. Except for services under subparts 2(a), 2(c), and 2(f), aA client of a license holder having multiple facility locations may only receive services at any of the license holder’s licensed locations or at the client’s home.

 

Rationale: The change here, in response to comments received, clarifies the intent of the provision, which is to allow flexibility in the location of treatment services for those providers who do not have multiple facility locations.  This flexibility is especially important for rural providers.  It allows treatment to take place in a client=s home if it is consistent with the individual=s treatment plan and it is in the client=s best interest.  This is not a substantial change to the rule, merely a clarification.  As the SONAR indicates, the above changes are consistent with original intent of the provision as published. 

 

9530.6435 MEDICAL HEALTH CARE SERVICES

 

Subpart 1. Medical Health care services description. An applicant or license holder must maintain a complete description of the medical health care services, offered by the license holder including nursing services, dietary services, and emergency physician services offered by the license holder. An applicant must include a written copy of a medical services description with the license application.

 

            Rationale:  The above changes are in response to comments and are made for the purpose of clarification.  The terminology more accurately reflects the types of services which the license holder is required to offer.  This is not a substantial change to the rule.  It is consistent with the SONAR and merely a clarification of the published rule language.

 

Subpart. 2. Consultation services. In addition to the requirements under subpart 1, the applicant or license holder must have a written procedure approved by the medical director a physician licensed under chapter 147 for obtaining medical interventions when needed for any client. The license holder must have access to and document the availability of a mental health professional to provide diagnostic assessment and treatment planning assistance.

 

Rationale:  This was the only provision in the rule which indicated the need for a medical director.  The department determined that it is unnecessary to require treatment programs to engage the services of a medical director for this single function.  The language change will allow providers to meet the requirement through the review and approval of a licensed physician.  This is not a substantial change to the rule.  In both instances the procedures must be approved by a physician.

 

Subp. 3. Administration of prescription medication  and assistance with self-medication.  A license holder must meet the following requirements if services include medication administration:

A. a staff member, other than a physician, licensed practitioner, registered nurse, or licensed practical nurse, who is responsible delegated by a licensed practitioner or a  registered nurse the task of administration of medication or medication assistance with self medication must:

             (1) certificate that  document the staff member’s completion of a trained medication aide medication administration training program for unlicensed personnel through a Minnesota post-secondary educational institution; or

             (2) be trained according to a formalized training program which is taught and supervised by a registered nurse and offered by the license holder. Completion of the course must be documented in writing and placed in the staff member’s personnel records; or

                        (3) demonstrate to a registered nurse competency to perform the delegated activity.

 

B.             A registered nurse must provide consultation and review the license holder’s procedures for administration of medication at least monthly.  be employed or contracted to develop the policies and procedures for medication administration and or assistance with self-administration of medication.  A registered nurse must provide supervision as defined in Minnesota Rules part 6321.0100.  The registered nurse supervision must include onsite supervision at least monthly or more often as warranted by the health needs of the clients.  The policies and procedures must include:

(1)          delegations of administration of medication is limited to administration of those medications which are oral, suppository, eye drops, ear drops, inhalant, or topical;

(2)           a requirement that each client’s file must include documentation indicating whether staff will be administering medication or the client will be doing self-administration or a combination of both;

(3)         a provision that clients may carry emergency medication such as nitroglycerin as instructed by their physician;

(4)         a provision for medication to be self-administered when a client is scheduled not to be at the facility;

(5)         a provision that if medication is to be self-administered at a time when the client  is present in the facility, medication will be self-administered under observation of a trained staff person;

(6)         a provision that if the license holder serves clients who are parents with children, the parent must administer medication to the child under staff supervision;  

(7)            requirements for recording the client’s use of medication, including staff signatures with date and time;

(8)            guidelines regarding when to inform a registered nurse of problems with self-administration and medication administration, including failure to administer, client refusal of a medication , adverse reactions, or errors; and

(9)            procedures for acceptance, documentation, and implementation of prescriptions, whether written, verbal, telephonic, or electronic.

 

Rationale:  The changes to this subpart, in response to comments received and evidence regarding the issue of medication errors, provides more guidance to the license holder and staff to develop a health care delivery system that is consistent with national and state standards for client care. 

 

The changes to this subpart are necessary to ensure that the license holder and staff understand that medication administration is a delegated medical function that may only be delegated by a licensed practitioner or a registered nurse.  Without such a delegation, unlicensed staff members have no authority to administer medications to the client.  The language changes also specify the nature of the required training for unlicensed staff. The language replaces the undefined term “trained medication aide” with specifics regarding the training that is required.

 

The proposed changes establish limits on the medications that may be administered and detailed policies and procedures to assure client safety.  The limits and procedures are consistent with standards taught in medication administration courses for unlicensed staff.  The proposed change are also consistent with standards used by the Minnesota Department of Health in rules concerning non-health settings in which health care is comparable to the care provided in chemical dependency and detoxification programs. See Minn. Rules 4668.0855. 

 

The changes also address comments concerning off site administration of medications and allow for the development of procedures to govern off-site administration. 

 

The proposed changes are not a substantial change to the rules.  Health care services and procedures governing medication administration are addressed in the rules as published and the SONAR.  These changes merely clarify the requirements and offer more direction to ensure consistency with other state laws.

 

            Subp. 4. Medication monitoring.   A license holder who monitors clients taking prescription medication must have a written procedure for medication monitoring that includes staff observation of the client taking the medication, locked medication storage, requirements that medication be in its original container labeled by a pharmacist, and a record of the resident=s use of medication that is signed by staff, with the time and date. The procedure must be approved by an individual licensed to practice medicine or

nursing under Minnesota Statutes, chapter 148. If the license holder serves clients who are parents with children, the parent must administer medication to the child under staff supervision.

 

Rationale:  This subpart becomes unnecessary due to the prior modifications.

 

Subp. 4.  Control of Drugs.  A license holder must have in place and implement written policies and procedures developed by a registered nurse that contains the following provisions:

            A.   a requirement that all drugs must be stored in a locked compartment.  Schedule II drugs, as defined in Minnesota Statutes, section 152.02, must be stored in a separately locked compartment, permanently affixed to the physical plant or medication cart;

B.     a system which accounts for all scheduled drugs each shift;

C.              a procedure for recording the client’s use of medication, including the signatures of the administrator of the medication with time and date;

D.              a procedure for destruction of discontinued, outdated or deteriorated medications;

E.               a statement that only authorized personnel are permitted to have access to the keys to the locked drug compartments; and

F.               a statement that no legend drug supply for one client will be given to another client.

 

            Rationale:  The above changes are more specific and guide the license holder regarding controlling access to all drugs.  These changes are needed to address the issue of secure storage in an environment where there may be a heightened risk of drug theft.  The above language is reasonable because it is consistent with Department of Health regulations for facilities in which medications are administered and scheduled drugs are stored.  The language does not represent a substantial change.  The proposed rule, as published, addressed the issue of drug control and contained a requirement for locked storage of drugs. 

 

9530.6445 STAFFING REQUIREMENTS

 

Subp. 5. Unusual occurrences. When clients are present, a license holder must have at least one staff person on the premises who has a current American Red Cross standard first aid certificate or equivalent certification and at least one staff person on the premises who has a current American Red Cross community CPR, American Heart Association or equivalent CPR certification. certificate. A single staff person with both certifications satisfies this requirement.

 

Rationale:  The above changes, made in response to written comments, reflects the availability of qualified CPR certifications from sources other than the American Red Cross.  This is not a substantial change in policy, as the certifications are still required to be equivalent to that offered by the American Red Cross.

 

9530.6450 STAFF QUALIFICATIONS

 

Subp. 4. Alcohol and drug counselor supervisor qualifications. In addition to meeting the requirements of subpart 1, an alcohol and drug counselor supervisor must meet the following qualifications:

             A. the individual is competent in the areas specified in subpart 5, with documented competency according to subpart 6 or 7;

             Rationale:  The above change deletes an inaccurate reference to subparts 6 and 7.  This is not a substantial change to the rule but an editorial correction.  This language was erroneously held over from an earlier draft of the rule in which the qualifications of the alcohol and drug counselor were contained in 3 separate subparts.

 

9530.6485 ADDITIONAL REQUIREMENTS FOR LICENSE HOLDERS SERVING ADOLESCENTS

 

Subpart 1. License holders serving adolescents.   A residential treatment program that provides treatment services to serves persons under 19 18 years of age must be licensed as a residential program for children in out-of-home placement by the department unless the license holder is exempt under Minnesota Statutes, section 245A.03, subdivision 2. License holders providing residential treatment services must also obtain any additional certifications required by the department for those programs.

 

Rationale:  The above change conforms to the change to the definition of “adolescent” in part 9530.6405, subpart 2. 

 

9530.6510 DEFINITIONS

 

Subp. 1a.  Administration of medications.  AAdministration of medications@ means performing a task to provide medications to a client, and includes the following tasks, performed in the following order:

A.   checking the client=s medication record;

B.   preparing the medication for administration;

C.   administering the medication to the client;

D.   documenting the administration, or the reason for not administering the medications as prescribed; and

E.   reporting information to a licensed practitioner or a nurse regarding problems with the administration of the medication or the client=s refusal to take the medication.

 

Rationale: Because part 9530.6555 indicates that unlicensed staff may administer medications, the procedure should be defined and the methodology made clear so the task is performed consistently according to standard medical procedure.  This language is reasonable as it is consistent with rules administered by the Minnesota Department of Health for home care, including assisted living facilities found at parts 4668.0003, subparts 2a and 21a.  The addition does not constitute a substantial change because the administration of medication and medication monitoring was included in the published proposed rule.

 

Subp 3a.  Chemical use problem.  “Chemical use problem” means one of the following:

                        A.   receiving treatment for chemical use within the period specified in the staff qualification requirements;

            B.  chemical use that has a negative impact on the staff member’s job performance;

            C.  chemical use that affects the credibility of treatment services with clients, referral sources or other members of the community; and

D.    symptoms of intoxication or withdrawal on the job.

 

Rationale: It is necessary to define the term to ensure that it has a common understanding as it is used in the rule.  This is not a substantial change because the definition was already incorporated into the language of the rule at part 9530.6570, subpart 1.D.

 

Subp.  8a. Licensed practitioner.  ALicensed practitioner means a person who is authorized to prescribe as defined in Minnesota Statutes, section 151.01, subdivision 23.

 

            Rationale: The proposed changes is necessary to recognize that health care professionals other than physicians are authorized to prescribe medications.  The rule language here is consistent with the pharmacy law (MS Ch 151).  This change does not make the rules substantially different but merely ensures the terminology used in the rule is consistent with statute.

 

Subp. 9. Medical director. AMedical director@ means the individual, licensed under Minnesota Statutes, chapter 148   147, and employed or contracted by the license holder to direct and supervise health care for clients of a program licensed under parts

9530.6510 to 9530.6590.

 

Subp. 10. Nurse. ANurse@ means a person licensed and currently registered to practice professional or practical nursing as defined in Minnesota Statutes, section 148.171, subdivisions 8 and 20 14 and 15.

 

Rationale:  The above changes are necessary to correct citations.  They do not substantially change the rules, but merely ensure that the applicable law is correctly referenced.

 

9530.6555 MEDICATIONS

 

In addition to the medication administration procedures in chapter 4665, a license holder must meet the requirements in items A and B.   A license holder must meet the following requirements if services include medication administration:

             A. A staff member other than a physician licensed practitioner, registered nurse, or licensed practical nurse who is responsible delegated by a licensed practitioner or a registered nurse the tasks of administration of medications or for assistance  with self medications medication administration must either :

                        (1) provide a certificate  document which must be placed in the staff member’ personnel records verifying successful completion of a trained medication aide  medication administration training program through an accredited, Minnesota post-secondary educational institution. Completion of the course must be documented and placed in the staff member=s personnel records; or

                        (2) be trained according to a formalized training program offered by the license holder that is taught and supervised by a registered nurse. Completion of the course must be documented and placed in the staff member=s personnel records; or

                        (3)  demonstrate to a registered nurse competency to perform the delegated activity.

             B. A registered nurse must provide consultation and review the license holder=s procedure for administration of medication at least weekly.    Be employed or contracted to develop the policies and procedures for medication administration.  A registered nurse must provide supervision as defined in Minnesota Rules, part 6321.0100.  The registered nurse supervision must include onsite supervision at least monthly or more often as warranted by the health needs of the clients.  The policies and procedures must include:

                        (1)   a requirement that delegations of administration of medications is limited to administration of those medicatioons which are oral, suppository, eye drops, ear drops, inhalant or topical;

                        (2)   a provision that clients may carry emergency medications such as nitroglycerin as instructed by their physician;

                                    (3)   requirements for recording a client’s use of medication, including staff signatures with date and time;

                                    (4)   guidelines regarding when to inform a registered nurse of problems with medication administration, including failure to administer, client refusal of a medication, adverse reactions or errors; and

(5)            procedures for acceptance, documentation and implementation of prescriptions, whether written, verbal, telephonic or electronic.

 

Rationale:  The above provisions were added to provide consistency between the licensing of treatment programs and detoxification facilities.  As with treatment programs it is necessary to provide more specific guidelines regarding the use of unlicensed staff in the administration of medications.  It is also reasonable to make these provisions consistent with standards applied by the Department of Health and standard established by the Board of Nursing.    These changes are not a substantial change in the rule, but simply provide greater specificity to a area already addressed in the published draft. 

 

            Subp. 4.  Control of drugs.  A license holder must have in place and implement written policies and procedures developed by a registered nurse that contains the following provisions:     

                        A.   a requirement that all drugs must be stored in a locked compartment.  Schedule II drugs, as defined in Minnesota Statutes, section 152.02, must be stored in a separately locked compartment, permanently affixed to the physical plant or medication cart;

                        B.  a system for accounting for all scheduled drugs each shift;

                        C.  a procedure for recording the client’s use of medication, including staff signatures with time and date;

                        D.  a procedure for destruction of discontinued, outdated or deteriorated medications;

                        E.  a statement that only authorized personnel are permitted to have access to the keys to the locked drug compartments; and

                        F.  a statement that no legend drug supply for one client will be given to another client.

 

                        Rationale:  In response to comments received, the Department added this subpart because it agrees that there must be adequate procedures governing secure storage for drugs, especially in a setting where scheduled drugs are likely to be misappropriated.  The additional language is consistent with Department of Health regulations already in place for facilities in which medications are administered by staff and scheduled drugs are stored.  It is reasonable to require chemical dependency and detoxification programs to have similar provisions specified in the rule to lessen the risk of drug theft, particularly scheduled drugs.

 

9530.6565 STAFF QUALIFICATIONS

 

Subp. 6. Personal relationships. A.A license holder must have a written policy addressing personal relationships between clients and unlicensed staff who have direct client contact. The policy must:

             A. prohibit direct contact between a client and unlicensed  a staff member if the unlicensed staff member has had a personal relationship with the client within two years of the client=s admission to the program;

             B. prohibit access to a client=s clinical records by an unlicensed  a staff member who has had a personal relationship with the client within two years of prior to the client=s admission, unless the client consents in writing; and

             C. prohibit a clinical relationship between an unlicensed a staff member and a client if the unlicensed staff member has had a personal relationship with the client within two years of prior to the client=s admission.  If a personal relationship exists, the employee must report the relationship to their supervisor and recuse themselves from the clinical relationship with that client.

 

Rationale:  These changes are in response to comments by the Board of Nursing regarding the expectation of both licensed and unlicensed staff to maintain professional boundaries with clients.  Although licensed staff may have additional ethical requirements regarding client relationships, it is reasonable to ensure that all staff, regardless of licensure, report personal relationships with clients to a supervisor to ensure the safety of the client.   This is not a substantial change to the rule. The issue of personal relationships with clients was addressed in the proposed language as published.  Further the justification provided in the SONAR would apply to both licensed and unlicensed staff.

 

 

 

III.            Department’s Response to Comments Received Not Addressed in Parts I or II

 

 

RULE PART

 

9530.6405  DEFINITIONS 

Subpart 2.  Adolescent.

Comment:  Many who commented suggested the legal age of majority in Minnesota is 18, and that defining the term to include those persons up to age 19 is not only legally incorrect, but that such a definition places a burden on programs who have relied upon the legal standard of age 18 being the age of majority. 

Response:  The Department will modify the rule to define adolescent as a person under the age of 18 years.

 

Subpart 12.  Direct client contact.

Comment:  A question was raised whether the definition cited the correct statutory citation (Minnesota Statutes, section 245C.02, subdivision 11)

Response:  The citation is correct, passed during the 2003 legislative session at 2003 laws, ch. 15, art. 1, s 2.

 

Subpart 17.  Program serving intravenous drug abusers. 

Comment:  A comment was received suggesting the Department consider changing the term to “Program serving narcotic (or opiate) drug abusers with medication assisted therapy.”  The rationale for this suggestion was that the term would be consistent with the last sentence of the definition, and would clarify the fact that the definition is specific to programs commonly known as methadone programs, as opposed to residential or other outpatient treatment programs.

Response:  Since these standards are a federal mandate, the department intends to maintain the language used federally so that these standards are described in a common language and clearly stated to meet the federal compliance standards.

 

Subpart 19.  Treatment.

Comment:  Some comments asked for clarification whether a license holder must provide all of the elements of the definition.

Response:  The Department will respond in its final response on December 11, 2003.

 

9530.6410 APPLICABILITY

            Comment:  Some comments indicated that subpart 2 (Activities exempt from license requirement) is not clear.

            Response:  This subpart is needed to clarify those organizational functions that are closely related to treatment services, but are not subject to licensing under the proposed rule.  It is consistent with statute to specify in the proposed rules those activities where treatment services may be provided but are not the primary function of the activities.

            This subpart also is needed to clarify that some licensed professionals who provide treatment services are not subject to licensing under the proposed rule.  In order to access reimbursement through the Consolidated Chemical Dependency Treatment Fund, a provider must be licensed under the proposed rules.  If a licensed professional in private practice provides treatment services and does not access the fund to pay for those services, the proposed rule gives them an exemption from the proposed rules.

 

9530.6415 LICENSING REQUIREMENTS

            Comment:  One comment suggested that subpart 2 (Contents of application) gives too much power to the county regarding new or expanded programs.

            Response:  The language in subpart 2 is a continuation of existing rule language.  The Department and the counties jointly establish a need for any provider expansion to ensure an objective and uniform decision-making process.  The basis of the establishment of need should be the recommendation of the county board of commissioners of the county in which the applicant’s program will be located.  The county board is in the best position to know what the local needs exist for the applicant’s program.  Further, consideration of the county board’s recommendation is consistent with the responsibility of county boards to “coordinate all alcohol and other drug abuse services conducted by local agencies” under Minnesota Statutes, §254A.07, subdivision 1.

 

            Comment:  With respect to subpart 3 (Changes in license term), a comment suggested that reporting every minor treatment services changes should not be required because it would be unduly burdensome. 

            Response:  A change in treatment services provided may alter the type of services license holders deliver to clients.  Unreported changes could result in a license holder’s straying inadvertently from compliance with the rules as a whole.  The Department relies on the statement of need and reasonableness to support the proposed language.

 

9530.6420    INITIAL SERVICES PLAN

Comment:  a comment suggested that the term “first treatment session” could be narrowly interpreted to mean a “group” led by a counselor.

Response:  The Department does not believe the term “treatment session” is likely to be interpreted as a therapy group.  “Treatment service” means a therapeutic intervention or a series of interventions, which seems to be a rather broad interpretation.

 

9530.6422 COMPREHENSIVE ASSESSMENT

            Comment:             Language should be added to subpart 1 (Comprehensive assessment of client’s chemical use problems) to include not only alcohol and drug counselors but also “other qualified licensed professionals” as staff qualified to coordinate the comprehensive assessment.  The rationale given for this suggestion was that a licensed psychologist, social worker or nurse with specific training in substance abuse is qualified to coordinate the assessment process.”  

            Response:  To be addressed in the Department’s final proposal on December 11, 2003.

 

Comment:  One comment stated concern regarding subpart 1, item N and suggested that the language in that item be changed to “a determination whether a client’s needs exceed the scope of the agency abuse prevention plan.  An individual abuse prevention plan is required for all clients who meet this determination.”  The rationale for this suggestion was that clients in a residential treatment program are, by definition, vulnerable adults.  The agency abuse prevention plan is designed to minimize the risk of abuse to the general population and is sufficient for many clients.  Completing an individual plan for every client in a residential program is unnecessary.

            Response:  There must be an assessment for each client who meets the definition of a vulnerable adult because it is required by statute.  The assessment of each client’s susceptibility to abuse in order to protect the client while delivering treatment services.  Item N will encompass a plan for clients determined under Minnesota Statutes, §626.5572 to be vulnerable adults and who receive treatment, even if they do not receive room and board at the site because, as vulnerable adults, they require additional protection from harm. 

 

Comment:  A number of comments indicated that the requirement in subpart 2 (Assessment summary) that the assessment summary be completed within three calendar days of service initiation was too short, or, at the very least, needs to include an exclusion for holidays and weekends.  Three days is not adequate because it does not allow the counselor to consider acuity of detoxification or medical problems.  Perhaps seven days with the ability to amend the assessment if necessary would be more reasonable.

Another comment noted that subpart 2B, items 1, 2 and 3 states that the counselor must include in the assessment acute intoxication and withdrawal potential, biomedical conditions and complications, and emotional and behavioral conditions and complications.  The comment stated that these areas are beyond the scope of alcohol and drug counseling.  These are medical conditions that LADCs are not trained to identify.

            Another comment indicated that subpart 2 should give programs options to formulate their own assessment domains as long as relevant information is gathered and suggested adding  language like “or similarly constructed assessment domains that capture equivalent information relevant to treatment planning.”  Mandated format forces programs to adhere to a set of terms that may not actually capture the relevant information.  The language suggests the information considered relevant could be added but does not provide the option of replacing the mandated titles with what the program believes is most relevant.

            Response:  The Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  The Department believes that the three day requirement is reasonable.  If a client is in a licensed program receiving treatment services over holidays or weekends,  

the assessment summary should be in place to guide those services.  Additionally, the rule allows license holders to delay the completion of the summary, as long as the basis for the delay is documented.

             Subpart 2 is designed to foster uniformity in both format and language.  Uniformity will allow the information to be commonly understood and utilized by a variety of treatment professionals in a variety of treatment settings.

            The rule does not require LADCs to diagnose medical conditions in completing the summary.  The rule language allows them to rely on information provided by other sources and to incorporate that information, when available, into the summary.  

 

            Comment:  Subpart 3B should be modified.

            Response:  See modifications in part II.

 

9530.6425 INDIVIDUAL TREATMENT PLANS

            Comment:  This part reads like a policy statement, not a rule.  Programs should have the autonomy to address this issue.   “Monitoring of any physical and mental health problems” should not include things like taking blood pressure, etc.  Documenting affect is OK, but not requiring counselors to screen for mental health.  Item C states that late entries must be clearly labeled “late entry.”  This is a supervision issue, not a rule issue, to be addressed by individual agencies.

            Comment:  The term “discharged” in subpart 1 (General) should be changed to “terminated.”

            Response:  See language modification in part II of this document.

 

            Comment:  The term “immediately” in subpart 3 (Progress notes and plan review), paragraph A, item 1, is vague.

 

            Comment:  The five day time frame in subpart 4 is too short; seven days would be more reasonable given staff workloads.

 

            Comment:  Electronic record keeping should be determined to be in compliance with this part.

Response:  The department is reviewing the issue of electronic records and signatures to determine if additional language should be added to address this concern.  The department will include any proposed changes or a further response in its final filing.

 

Except for the modifications proposed above, the department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

9530.6430 TREATMENT SERVICES

            Comment:  The term “group” in subpart 1 (Treatment services provided by license holder) should be changed to “session,” to be consistent with part 9530.6422. 

           

Comment:  With respect to subpart 1, item A, item 2, education on pregnancy issues should not be required for programs with male clients only.

            Response:  The Department believes that the issue of drug and alcohol use information during pregnancy is a common health concern among chemical abusers.  The education enables clients to make informed decisions to protect the health and safety of people receiving treatment services, as well as family and friends.

 

Comment:  The term “as needed” in subpart 1, paragraph A, item (4) is vague and inconsistent with “at least one group per week”.

A requirement for one group per week on co-occurring illnesses is arbitrary.

Too much emphasis on mental health issues.

            Response:  See language modification to subpart 1, paragraph A, item (4) in part II of this document.

 

            Comment:  Subpart 1B should be modified to say “must demonstrate a sensitivity to cultural differences and address the specific needs of all clients”

            Response:  This part of the proposed rules goes beyond merely stating that someone is culturally sensitive.  The proposed language better states that treatment services must address cultural issues and special needs because each client is culturally unique.  The client’s cultural background is an important factor in determining whether a particular provider is able to meet the client’s specific needs.  Treatment completion rates is significantly higher for clients treated in culturally-specific programs compared with clients of the same race or ethnicity treated in programs open to clients of all races.

 

Comment:  Subpart 2 (Additional Treatment Services), uses the term “may,” which is unclear.

Comment:  Subpart 2 (Additional Treatment Services), paragraph C appears to conflict with subpart 3 (Counselors to provide treatment services).  Paraprofessionals should be able, under supervision of an LADC, carry out functions like therapeutic recreation.  Activities must be recognized with respect to certain drug use behaviors as a valued treatment service.

Response:  In order to receive reimbursement for recreational activities, there must be a distinction between therapeutic recreation and planned leisure activities because the latter are not presented in a therapeutic context.  In order to identify therapeutic recreation as a professional treatment service, those providing the service must meet the accepted standards of the therapeutic recreation therapy field.

 

Comment:  Subpart 4 (Location of service provision) is not clear

Response:  See language modification is part II of this document.  The change is this subpart will clarify the intent of the provision and continue to allow flexibility in the location of treatment services for those providers who do not have multiple facility locations and especially for those providers in rural areas.  It will include the client’s home as a location of where treatment services may be provided, as long as it is consistent with the client’s individual treatment plan and in the client’s best interest.

 

Except for the modifications proposed above, the department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

9530.6435              MEDICAL SERVICES

            NOTE:  See part II of this document for specific rule modifications.

 

            Comments:  A number of suggestions were made for this part of the proposed rules to clarify policies governing medication administration and handling, as well as the need for and duties of a registered nurse.  Other comments suggested allowing clients to self administer medication under certain parameters.

 

            Response: The Department must assure that persons qualified to provide those services address the medical needs and does not require the provider to provide medical services on site, only that there is a plan to address those services. 

Subpart 1 reflects a policy requirement that the licensed provider must determine the nature of the medical services that will be provided to ensure that staff and procedures are in place for those services. The license holder must maintain a description of the medical services offered in order to assure compliance with applicable rule parts, and to inform clients and their families of services that will be available to the client.  The license provider must submit a description of a proposed medical services plan to demonstrate a good faith effort to show it has access to such services.

Subpart 2 determines the need for mental health consultation services to provide diagnostic assessment and treatment planning assistance.  This determination will be made by the clinician with training and education, fulfilled by the department’s training requirement for those with co-occurring disorders.  Through the training and education, the clinician should have the knowledge and expertise to make an appropriate referral for mental health problems.  The documentation of the consultation services should be part of the provider policy and procedures manual.  

 

Except for the modifications proposed in part II of this document, the department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

9530.6440 CLIENT RECORDS

            Comment:  Regarding subpart 3 (Client records, contents), one comment suggested that the Department add a requirement for new prescriptions.

 

            Response:  The Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  Further, the Department believes that the concerns raised here have been adequately addressed by the proposed modifications to part 9530.6435.

 

9530.6445 STAFFING REQUIREMENTS

            Comment:  The rule should include a requirement for a  registered nurse.

            Response:  The Department believes the statement of need and reasonableness  adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  Registered nurses are required for certain activities.  The department intends to allow license holders the flexibility to determine whether or not they need a registered nurse on staff.

 

            Comment:  Unless intended, the language in subpart 4 should not be construed as meaning the state supports 16 clients actively participating in a group with one LADC.

            Response:  The Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  The Department intends to allow flexibility in the determination of group size, based upon client needs.  The group size of 16 is established as the maximum number, not as a standard.

 

            Comment:  A comment suggested changes to subpart 2 to read: “Clinical supervision should be provided by a qualified individual versed in the 12 core functions.”  The requirement is too restrictive as it relates to the FTE’s that are imposed.  Small programs are adversely impacted by this level of restriction.

 

Comment:  A comment suggested changing subpart 4 to read as follows:  “A counselor in a program treating intravenous drug abusers must not supervise more than an average of 50 clients.”

            Comment:  A comment suggested adding the following language: “At least 25 percent of a .5 FTE or greater”, and striking that a counseling group shall not exceed an average of 16 clients.

            Response: The established guidelines for the size of counseling group will ensure the effectiveness of the group and the individual attention that is given to each client.  The existing rule does not specify a maximum group size but does regulate the ratio of clients to counselors.   By using an average of 16 clients in a group, the license holder has the flexibility to determine group size based upon the individual needs of the clients and the skill and experience of the counselor.  At the same time, this ensures that license holders will not exceed their capacity to provide quality treatment services and individual attention to clients.  The group size should depend on the client’s severity of need and can only be determined when the assessment is completed.  The license holder must exercise professional discretion to determine the needs of clients receiving treatment services at any given time since those needs vary and cannot be anticipated in this rule.  The Department relies on the statement of need and reasonableness to support the language as proposed.

 

 

Comment:  A comment suggested that subpart 5 (Unusual occurrences) should be renamed “Medical emergencies.” A number of comments suggested that the requirement of a staff person to have CPR training by the American Red Cross-community CPR certificate is too restrictive.   Another suggestion was to make a language change to read “current American Red Cross community CPR certificate or equivalent” and that the requirement be moved to medical emergencies section.

Response:  This section is separate from the provider emergency plan because it requires that the provider employ staff with the ability to perform basic first aid procedures to ensure the health and safety of clients receiving treatment services.  The staff needs to be prepared to deal with many unforeseen circumstances and first aid training enables them to deal with them effectively.  See language modification in part II of this document.

 

            Comment:  Why is CPR certification necessary in an outpatient program? 

            Response:  It may be necessary for outpatient staff to perform CPR on a client in the same way residential staff may need to perform it on a residential client.  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

            Except for what is stated above, Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

9530.6450 STAFF QUALIFICATIONS

            Comment:  The requirement in subpart 1 (Qualifications of all staff members with direct client contact) for directors, counselors, supervisors and nurses is two years from chemical use problems, while that for paraprofessionals and others with direct client contact is one year Requirement needs to be consistent for any employee with client contact.  Need to define “chemical use problems”

            Response:  Given that professionals have a greater responsibility for helping clients overcome abuse and dependency, they must show a higher degree and a longer term of sobriety than do paraprofessionals.  Professionals must demonstrate that they have been able to control their own chemical use issues.  Paraprofessionals are allowed to work with clients with less time chemically free because they do not have as much responsibility as professionals do, but they still serve as role models for clients who look to them for guidance in recovery.  This provision is intended to recognize that there may be a shortage of licensed professionals in some areas of the state and the use of paraprofessionals is necessary.  It also recognizes that individuals in recovery may serve as role models and may reinforce their own efforts. 

            The department feels that this requirement should be maintained so that treatment directors, supervisors, nurses, counselors and any other professional persons who have direct client contact serve as direct role models for clients in the programs as well as paraprofessional staff members.  Two years of chemical free experience provides some assurance that the individuals have addressed their own chemical use issues.

 

Comment:  With respect to subpart 2, it is not clear on how long a staff person who experiences chemical use problems after their employment date must refrain from direct client contact.  Does the department require that such an individual be free of problems for two years before they can resume direct contact?  Such a requirement would be consistent with other language in this section.

Response:  Continuing freedom from chemical use problems employment requirement.  Chemical use problems is defined in 9530.6460, subpart 1, E. 1- 4.

 

Comment:  Subpart 5 should be deleted as defined in the rule because it is an anachronism and is an unnecessary process requirement.  Outcomes, in the form of minimum treatment standards are already established by the rule.  How the license holder needs the license holder and not the State properly determine those standards, in terms of establishment of supervisory positions.  It is the responsibility of the director to establish appropriate mechanism for supervision of counseling staff.

Response:  The Department will respond to this comment in its final proposal on December 11, 2003.

 

Comment:  Subpart 5, item Bcontains no definition of competent; no methods of documenting competence

Response:  The department has defined competence by stating the number of hours required for each subject area established in Minnesota Statutes, Chapter 148C for an alcohol and drug counselor licensing requirements. Chapter 148C does not place educational requirements on exempt alcohol and drug practitioners.  However, this proposed rule requires exempt persons to meet the educational requirements of this subpart if they are not licensed under Chapter 148C. 

 

 Comment:  Subpart 6 is not clear with respect to who can admit, transfer or discharge a client.  Also it does not specify when admission occurs

Comment:  Subpart 7.  Volunteers.  This provision is not clear.

Comment:  Subpart 8.  Interns.  The provision is unclear

Response:  In the chemical dependency treatment field treatment is often provided by individuals who are recovering from addiction or abuse and who have no formal training other than their own experience.   Such treatment is common in this field and is recognized to benefit the client as well as reinforcing the continued abstinence of the former addict or abuser.  The license holder must have a staff member with the knowledge, training and skill in the areas monitoring volunteers to ensure the health and safety of clients.

After reviewing subparts 6, 7 or 8, the Department doesn’t see a conflict in the amendments to MS Chapter 148C.  The only subpart that might give us concern is subpart 5, Alcohol and drug counselor requirements.  This subpart begins with a requirement that, in addition to meeting the requirements in subpart 1, an alcohol and drug counselor working in a DHS licensed facility must be "either licensed or exempt from licensure under Minnesota Statutes, chapter 148C."  Right now, the only persons truly "exempted" from licensing (that is, who have no licensing authority over them but who can practice legally) are those counselors employed by hospitals or by state or local governments.  Section 148C.11 addresses "exceptions" to the license requirements, and basically states that nothing in MS Chapter 148C should be read to restrict members of other professions from performing functions for which they are qualified or licensed.  

 

9530.6460 PERSONNEL POLICIES AND PROCEDURES

Comment:  For a person to be a licensed psychologist in MN, a PhD is required and a postdoctoral work.  Other pro licenses require a minimum of a master’s degree.  Requiring LADCs to have 12 hours (9530.6460, subp 2E) continuing education to work with mental health issues is irresponsible and unethical.  Mental health issues require years of education and supervision to treat appropriately. 

Response:   The Department does not propose that alcohol and drug counselors become mental health counselors, but only that they be trained to look for mental health symptoms which would allow the counselor to make an informed referral to a mental health professional.

 

Comment:  Subpart 2A and Subpart 2E conflict with LADC licensing rules, which state every third reporting period.

Response:  The proposed rules are silent as to reporting training for renewing a personal license.  The proposed rule only requires that the training be obtained every two years for staff employed in a program licensed under these rules.

 

Comment:  If DHS simply wants the staff member experiencing chemical use problems to not be exposed to the clients, why not end part after subp. 1?  DHS causes program to define condition that is “required” to be addressed by DHS, making rule part nebulous.  Rule part requires program to make up a condition and regulate it as you understand the rule except that your definition must adhere to what DHS thinks the condition might be.  Again, “chemical use problem” must be defined.

            Items E1 - E4 suggest that DHS has some idea of what “chemical use problems” means, but it is unreasonable to hold programs to a standard that is not sufficiently defined to keep program out of harms way.  This rule part should be stricken.

           

Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  Further, chemical use problems will not be uniformly manifested.  Therefore, it is necessary to define the condition broadly to encompass a variety of scenarios.

           

Subpart 2.  Staff development.

Comment:  The time frame for training should be extended for two years, at least to end of calendar year 2005.

Response:  The Department proposes that the rules become effective on September 1, 2004.  Prior to that date, the Department intends to assist programs by providing training in this area.

           

            Comment: One comment recommend that psychotherapy be included in the definition section 9530.6405.  The proposed rule does not define psychotherapy in any of the sections.  Treatment programs provide therapeutic services that may not qualify as group, individual, or family therapy yet are not purely didactic in nature.  If a counselor is hired solely to provide such services it would not be clear if Chapter 148A applied.

 

Responses:  A comment suggested a language change on subpart 1, E to “receiving treatment for active chemical use” from “receiving treatment for chemical use”.  The current language does not prevent the provider personnel policy to contain a statement referring to an employee receiving treatment for relapse prevention.  If the employee is not actively using chemicals, the two-year requirement which refers to freedom from chemical use problems as a staff qualification, would be maintained and not grounds for discipline or dismissal.   

 

            There were several comments referring to the co-occurring training requirement in subpart 2, item E.  The department is adopting standards of care for persons in primary chemical dependency treatment programs to address mental health problems.  Those standards of care will present unique issues that must be recognized and addressed to achieve a successful treatment outcome for those with chemical abuse or dependency and mental health issues. Staff cannot effectively identify and address these issues, unless they have developed a knowledge base from training and education and are able to demonstrate competency in screening and education of mental health disorders.  This will assure linkage is provided to access mental health treatment for those clients who need mental health services beyond the capabilities of the chemical dependency treatment provider.  For some clients, psychiatric disorders and symptoms do not subside within a reasonable length of time in chemical dependency treatment and it becomes evident that co-morbidity exists.  The training and education mandate will ensure procedures or tools are followed and used competently when co-morbidity exists.  The license holder may grant credit for relevant training obtained prior to the effective date of this rule.

 

A comment recommended that psychotherapy be included in the definition section of the rule.  For purposes of subpart 3, C, Chapter 148A defines “psychotherapy”.  “Psychotherapy” means the professional treatment, assessment, or counseling of a mental or emotional illness, symptom, or condition.  The provider can make an informed decision about this subpart by referring to Chapter 148A.

 

9530.6480 EVALUATION

            Comment:  The part needs clarification regarding  DAANES participation and possible violations of federal law.

            Response:  The Department does not believe there is a conflict with federal law requirements and participation in DAANES.  The department is continuing to review this matter and will provide additional comment in its final response.

 

9530.6485 ADDITIONAL REQUIREMENTS FOR LICENSE HOLDERS SERVING ADOLESCENTS

 

            There were a number of comments on this section, including questions about the reasonableness of the rule part, its clarity, and access to relevant information for programs.

 

            Comment:  What other “additional certifications required by the department for those programs?  Makes it easy for DHS to attach any sort of certification requirements without due process.

            Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

Comment:  Subpart 2.  There should be a statement that the LADC who does not have 150 hours of supervised experience as an adolescent counselor may engage in alcohol and drug counseling with adolescents if under direct supervision of an LADC.  What is definition of “classroom hours?”  Does inservice training count?

Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

Comment:  Subpart 4.  Potential conflicts between state and federal law.

Response:  The Department does not believe there is a conflict in the law.  The department is continuing to review this matter and will provide additional comment in its final response.

 

9530.6495 ADDITIONAL REQUIREMENTS FOR LICENSE HOLDERS WHO SPECIALIZE IN TREATMENT OF PERSONS WITH CHEMICAL ABUSE OR DEPENDENCY AND MENTAL HEALTH DISORDERS

            Comment:  Substitute “disorders” for “problems” wherever used in this part.

            Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

            Comment:  consider replacing “of Persons with Chemical Abuse or Dependency and Mental Health Disorders” with “Of Persons with Chemical Abuse and Mental Health Disorders or Chemical Dependency and Mental Health Disorders”

            Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.

 

9530.6500 ADDITIONAL REQUIREMENTS FOR METHADONE PROGRANMS SERVING INTRAVENOUS DRUG ABUSERS

            Comment:  DHS attempts to make the definition of “client” commonly referred to as “patient” less restrictive than is mandated in federal law by providing language that causes a federally assisted program to not consider an applicant engaged in interim services a client.  This increases the vulnerability of individuals applying for services from a confidentiality perspective.  There is no definition of “interim services”

            Response:  Department believes the statement of need and reasonableness (SONAR) adequately explains the rationale for this part of the proposed rule and no clarification or modification is necessary.  Further, the rule definition is solely for purposes of applying the requirements of the rule parts indicated.  The definition does not alter rights the client or patient has under federal law. 

            Comment:  Subpart 6 conflicts with federal law.  Disclosure to central registry cannot be made without permission for disclosure from client; no reference to federal law that assures client that consent is required; item F is explicitly against federal law.  What MN law creates a Central Registry?  How would the public benefit from a Central Registry.  Must DHS follow fed law in 42 CFR Part III?

            Response:  The department does not believe there is a conflict with federal law requirements and these rule requirements.  The department is continuing to review this matter and will provide additional comment in its final response.

 

 

The Department will respond to all remaining comments in its final response on December 11, 2003.