State Advocacy Team Summary - Minnesota

The Minnesota (MN) state advocacy team was led by chapter lead Justin Nelson-Deering, Interim Clinic Manager at Children’s Cancer and Bloods Disorder Program and Director of Ambulatory Services; and Miranda Solem, Director of Community & Residential Services at Sanford Behavioral Health. The team was also supported by members Amy K. Wilson, Licensed Clinical Social Worker, Center for Bleeding and Clotting Disorders, M Health Fairview, University of Minnesota Medical Center; Bill Robie, Senior Director of Government Relations with the National Bleeding Disorders Foundation, and Dr. Mark Reding, Director of the Center for Bleeding and Clotting Disorders at the University of Minnesota Medical Center and Associate Professor of Medicine in the Division of Hematology, Oncology, and Transplantation at the University of Minnesota.

Summary of Achievements

In their first year, the BD SUMHAC MN team successfully:

  1. Engaged with state officials from MN Department of Health Services (DHS) and the MN Hospital Association.

  2. Identified a state champion with MN DHS.

  3. Mapped the regulatory landscape of SUD facilities and residential MH facilities, with particular attention to policies related to:

    1. Self-administration of infusion and injection medications

    2. Staff assisted administration of infusion and injection medications

    3. External provider assisted administration of infusion and /injection medications

    4. Patients’ ability to bring in their prescribed medications from home (i.e., brown bagging) or from a third party pharmacy (i.e., white bagging)

    5. Patient cherry-picking

  4. Has been invited to present a Spark Session at the 2024 Minnesota Association of Resources for Recovery and Chemical Health (MARRCH) conference. MARRCH is a professional association of addiction treatment professionals and organizations striving to raise awareness about addiction and the power of recovery.

  5. Expanded by adding its newest member, Amy K. Wilson, LICSW, University of Minnesota Health Hemophilia Program.

Regulatory Landscape Mapping

Sorted by landscape area. All regulatory Information is as of August 2024

SUD Facility Information

Self-infusions/ injections

  • MN Statute 245G.08: Medical Services.

    § Subd. 5. Administration of medication and assistance with self-medication. 

    (2) a provision that each client's file must include documentation indicating whether staff must conduct the administration of medication or the client must self-administer medication, 

    (5) a provision that if a client self-administers medication when the client is present in the facility, the client must self-administer medication under the observation of a trained staff member.

    MN Statute 245G.07: Treatment Service.

    “Residential and nonresidential treatment programs… must offer all treatment services in clauses (1) to (5): 

    (4) a service to address issues related to co-occurring disorders, including client education on continued medication compliance.”

  • Self-administration of infusion and injection medications is permitted in SUD facilities, so long as there is documentation that the client is able to self-administer and the facility has trained staff that are available to assist and observe the individual when they are self-administering.

Staff-assisted infusions/ injections

  • MN Statute 245G.07: Treatment Service.

    Residential and nonresidential treatment programs… must offer all treatment services in clauses (1) to (5): 

    (4) a service to address issues related to co-occurring disorders, including client education on continued medication compliance

    (5) (ii) Treatment coordination services include: assistance in coordination with and follow up for medical services as identified in the treatment plan.

    MN Statute 245G.08: Medical Services.

    § Subd. 5. Administration of medication and assistance with self-medication. 

    (2) a provision that each client's file must include documentation indicating whether staff must conduct the administration of medication or the client must self-administer medication.

  • If a client requires injection or infusion medication and they are unable to self-administer, SUD facilities are required to coordinate with medical services to ensure that the client can continue compliance with medication. This can include permitting a trained staff member to administer an infusion/subcutaneous injection, as long as it's within their scope of practice (i.e. an LPN, or RN).

External provider-assisted infusions/injections

  • MN Statute 245G.07: Treatment Service.

    Residential and nonresidential treatment programs… must offer all treatment services in clauses (1) to (5): 

    (4) a service to address issues related to co-occurring disorders, including client education on continued medication compliance

    (5) (ii) Treatment coordination services include: assistance in coordination with and follow up for medical services as identified in the treatment plan.

  • If a patient requires injection or infusion medication and cannot self-administer, residential SUD facilities are required to coordinate with medical services to ensure that the client can continue compliance with their medication. This can include coordinating with an external provider to administer the infusion/ injection in the facility and/or coordinating with an external provider to administer to infusion/ injection off-site (e.g., in an Emergency Department).

Policies to prevent cherry-picking

  • Current SUD regulations do not prevent facilities from admitting or denying patients based on perceived medical complexity. 

  • SUD facilities are allowed to admit or deny patients based on perceived medical complexity. This means that if SUD facility staff are not comfortable or do not feel equipped to support someone with a bleeding disorder, they can be denied admission. However, the updated federal regulation Section 504 guideline now applies to medical settings and prohibits discrimination on the basis of a disability. Medical facilities are not allowed to deny access based solely on the presence of a diagnosis, such as a bleeding disorder. Providers are required to conduct an individualized inquiry to determine whether the facility can meet the individual’s specific needs.

MH Facility Information

Self-infusions/injections

  • MN Statute 245I.11: Health Services and Medications.

    Subdivision 1.

    Generally. If a license holder is licensed as a residential program, stores or administers client medications, or observes clients self-administer medications, the license holder must ensure that a staff person who is a registered nurse or licensed prescriber is responsible for overseeing storage and administration of client medications and observing as a client self-administers medications, including training according to section 245I.05, subdivision 6, and documenting the occurrence according to section 245I.08, subdivision 5.

    MN Statute 245I.11: Health Services and Medications.

    Subd. 5. Medication administration.

    (1) assess and document each client's ability to self-administer medication. In the assessment, the license holder must evaluate the client's ability to: (i) comply with prescribed medication regimens; and (ii) store the client's medications safely and in a manner that protects other individuals in the facility. Through the assessment process, the license holder must assist the client in developing the skills necessary to safely self-administer medication

  • Self-administration of infusion and injection medications are permitted in residential MH facilities. However, facilities have their own internal policies on self-administration of infusion and injection medications. Residential SUD facilities have a registered nurse on staff who is responsible for regulating medication policies and procedures, including assessing whether an individual is able to safely self-administer their medications. This nurses’ license is attached to medication management and he/she/they is allowed to determine if self-administration of medications is permitted in the facility. If the nurse does not feel comfortable with monitoring and assisting individuals with self-infusion or injection medications, the facility is allowed to deny a person based on this preference. Facility staff must be trained to observe self-administration of medications. The language is unclear but presumably in order for a facility to permit monitoring of self-infusions, the staff must be trained to monitor self-infusions.   

Staff assisted infusions/ injections

  • MN Statute 245I.11: Health Services and Medications.

    Subdivision 1. Generally. If a license holder is licensed as a residential program, stores or administers client medications, or observes clients self-administer medications, the license holder must ensure that a staff person who is a registered nurse or licensed prescriber is responsible for overseeing storage and administration of client medications and observing as a client self-administers medications, including training according to section 245I.05, subdivision 6, and documenting the occurrence according to section 245I.08,

  • Residential MH facility staff are permitted to administer infusion or injection medication, as long as they are appropriately trained. 

External provider assisted infusions/injections

  • Waiting on the specific regulatory language/ reference from Minnesota DHS

  • According to DHS staff, external provider assisted infusions/injections are allowed but their requirements are different depending on if the patient is an adult or a child.

    If the patient is an adult, there is no special training required for external providers and no contract requirements. External providers can come into the facility and provide this service. However, the facility/program may have their own rules. External providers will need to comply with background checks and other requirements in order to enter a pediatric facility.

White bagging and brown bagging

  • MN Statute 245I.11: Health Services and Medications.

    Subd. 3. Storing and accounting for medications. (7) Record each incident when a staff person accepts a supply of client medications and destroy discontinued, outdated, or deteriorated client medications.

  • Individuals are permitted to bring in medications from home into residential MH facilities, including injection and infusion medications. Facility staff are required to keep a record of all client medications brought into the facility.

Policies to prevent cherry-picking

  • Current residential MH regulations do not prevent facilities from admitting or denying patients based on perceived medical complexity.

  • The current regulations permit residential MH facilities to admit or deny patients based on perceived medical complexity. There is nothing in the current MN regulations that protect individuals from facility cherry-picking. This means that if a facility does not want to accept a person who has a bleeding disorder or someone who uses infusion medication, there is nothing that would prevent them from denying that person admission.

    However,  facilities that accept federal assistance do have to comply with federal requirements such as Section 504 and provide reasonable accommodations.

Next Steps for Advocacy

The MN team has determined the following goals for Phase 2:

  1. Gain increased clarity and map the regulatory landscape of inpatient MH facilities. The team will engage with state officials from the MN Department of Health (DOH) who regulate these facilities across the state.

  2. Present at the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH) conference in October 2024. Team members Miranda Solem and Justin Nelson-Deering will present on the local advocacy work of BD SUMHAC and the current regulations behavioral health providers should be aware of when working with patients with bleeding disorders.

  3. Continue to engage with the Minnesota Hospital Association on ways to provide education to behavioral health facilities and resources on ways to increase support for individuals with bleeding disorders in these facilities.

  4. Expand the team. The MN team is actively looking to increase membership to continue its local advocacy work across the state.

More State Advocacy Resources

Step-By-Step Guide to State Advocacy

Tools for Advocacy