Positive supports rule frequently asked questions

The positive supports rule is a new Minnesota law that requires all DHS license holders to use person-centered principles and positive support strategies when they provide services for people of all age with developmental disabilities or related conditions. In addition, the rule both prohibits and limits certain restrictive interventions.

A “positive support strategy” is a strengths-based strategy based on an individual assessment with the person. It emphasizes teaching a person productive and self-determined skills or alternative strategies and behaviors without the use of restrictive interventions.

The positive supports rule supports several goals that represent the latest developments in the field of disability services. These goals exist to:

• Promote community participation, person-centeredness & inclusion in the most integrated setting
• Focus on creating quality environments
• Ensure collaborative development of positive support strategies
• Increase skills and self-determination of people receiving services
• Improve the quality of life of people receiving services
• Ensure people are free from humiliating and demeaning procedures
• Eliminate the use of aversive and deprivation procedures
• Create a consistent set of standards for providers across service settings.

The rule became effective on Aug. 31, 2015.

The rule applies to all DHS license holders who provide services to a person or child with a “developmental disability or related condition.”

The positive supports rule uses the definitions for these terms in Minn. Rule 9525.0016, subpart 2. The law governs case management services for people with developmental disabilities. Please read those definitions to become familiar with what health conditions the rule covers.

In general, for a person to have a “developmental disability,” there must be a diagnosis of an intellectual disability that substantially limits cognitive functioning and other skills, including communication and self-care. This diagnosis must be before their 22nd birthday.

In general, for a person to have a “related condition,” they must have a condition that closely resembles a “developmental disability” and require treatments or services similar to those required for people with developmental disabilities. Examples of closely related conditions include:

• Autism spectrum disorder
• Cerebral palsy
• Prader-Willi syndrome.

Minnesota statute (Minn. Stat., §245.462, subd. 20) does not define mental illness or an emotional disturbance as a “related condition.” For example, attention deficit hyperactivity disorder (ADHD) is not a “related condition.” However, a person might have multiple diagnoses (chronic mental illness and autism), so the rule would apply to him or her.

If you provide services to someone under a 245D or home and community-based services license, then that person automatically is covered by the rule, regardless of their diagnosis. All services your program provides to that person must comply with the positive supports rule.

If you deliver services to someone under any other DHS license, there are several possible ways you might know if he/she meets the definition:

• The person, or their legal guardian, may have told you. If you provide services to a child, the parent or legal guardian may have told you.
• You know that the adult or child who receives services from you is on a Developmental Disabilities (DD) Waiver or has a DD case manager.
• There may be medical or health information in the adult or child’s client/service file, treatment plan, Individual Service Plan, or Individualized Education Plan (IEP) that indicates the adult or child may have a “developmental disability or related condition.”

In general, if you have information that suggests a person you serve meets the definition of “developmental disability or related condition,” as defined in Minn. Rule 9525.0016, 2 , you should follow up with the person (or their legal guardian). You should discuss the positive supports rule and these definitions with them. You then should document the outcome of that discussion. Include whether the person meets the definition of “developmental disability or related condition.”

Yes. The staff person also should document whether, because of the assessment, the person meets the definition of “developmental disability or related condition” so that your program can comply with the positive supports rule, if applicable.

If you serve a child or adult with developmental disabilities or a related condition, then there are requirements for your program for:

• Compliance and reporting
• Documentation
• Interactions with the person/child
• Staff training.

The requirements of the rule are at Minn. Rules, Ch. 9544

In general, there are seven key requirements license holders must follow. They must:

• Develop and document positive support strategies for every person to whom the rule applies
• Ensure certain staff qualifications and training requirements are met
• Maintain a policy on the emergency use of manual restraint
• Prohibit the use of restrictive interventions
• Report certain incidents using the behavior intervention report form
• Conduct functional behavior assessments
• Develop positive support transition plans.

DHS recognizes license holders will need time to learn about the positive supports rule and to develop a plan to comply with the rule as soon as possible.

If you currently serve someone with a “developmental disability or related condition,” the PSR applies to that service. You must comply with the rule in entirety and as soon as possible.

If you are not currently serving someone with a “developmental disability or related condition,” you must comply with the positive supports rule before you begin to provide services to him or her.

Remember, if you provide services under a 245D HCBS license, then the rule covers each person you provide services to. You must comply with the positive supports rule in its entirety and as soon as possible.

Yes.

As stated above, DHS recognizes that license holders will need time to learn about the rule and to develop a plan to comply with the rule as soon as possible. DHS Licensing staff will review license holder records to assure the program has a plan in place to comply with the training, documentation and programming requirements of the rule and that reasonable progress is being made.

No. DHS will not grant a variance to allow the use of a prohibited procedure as defined in the rule. Other variances will be considered on an individualized basis and consistent with DHS authority and guidance provided in statute. For example, Minn. Stat. §245A.04, subd. 9 allows the DHS commissioner to grant variances for rules that do not affect the health or safety of people in a licensed program under certain conditions.

Use the DHS Variance Request form, DHS-3141 (PDF) to submit a request for a variance.

• DHS Partners and Providers: Positive supports page.
• Minn. Rules, Ch. 9544.
• College of Direct Support page (for online training related to the rule).

If you have specific questions, email positivesupports@state.mn.us