HF 1500

as introduced - 87th Legislature (2011 - 2012) Posted on 04/18/2011 09:15am

A bill for an act
relating to human services; making changes to chemical and mental health
services; making rate reforms; amending Minnesota Statutes 2010, sections
245.462, subdivision 8; 245.467, subdivision 2; 245A.03, subdivision 7;
253B.02, subdivision 9; 254B.03, subdivisions 5, 9; 254B.05; 254B.12; 254B.13,
subdivision 3; 256.9693; 256B.0622, subdivision 8; 256B.0623, subdivisions 3,
8; 256B.0624, subdivisions 2, 4, 6; 256B.0625, subdivisions 23, 38; 256B.0926,
subdivision 2; 256B.0947; repealing Minnesota Statutes 2010, sections 254B.01,
subdivision 7; 256B.0622, subdivision 8a.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2010, section 245.462, subdivision 8, is amended to read:

Subd. 8.

Day treatment services.

"Day treatment," "day treatment services," or
"day treatment program" means a structured program of treatment and care provided
to an adult in or by: (1) a hospital accredited by the joint commission on accreditation
of health organizations and licensed under sections 144.50 to 144.55; (2) a community
mental health center under section 245.62; or (3) an entity that is under contract with
the county board to operate a program that meets the requirements of section 245.4712,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment
consists of group psychotherapy and other intensive therapeutic services that are provided
at least one day a week by a multidisciplinary staff under the clinical supervision of
a mental health professional. Day treatment may include education and consultation
provided to families and other individuals as part of the treatment process. The services
are aimed at stabilizing the adult's mental health status, providing mental health services,
and developing and improving the adult's independent living and socialization skills. The
goal of day treatment is to reduce or relieve mental illness and to enable the adult to live in
the community. Day treatment services are not a part of inpatient or residential treatment
services. Day treatment services are distinguished from day care by their structured
therapeutic program of psychotherapy services. The commissioner may limit medical
assistance reimbursement for day treatment to 15 hours per week per person deleted text begin instead of the
three hours per day per person specified in Minnesota Rules, part 9505.0323, subpart 15 deleted text end .

Sec. 2.

Minnesota Statutes 2010, section 245.467, subdivision 2, is amended to read:

Subd. 2.

Diagnostic assessment.

All providers of residential, acute care hospital
inpatient, and regional treatment centers must complete a diagnostic assessment for each
of their clients within five days of admission. Providers of outpatient and day treatment
services must complete a diagnostic assessment within five days after the adult's second
visit or within 30 days after intake, whichever occurs first. In cases where a diagnostic
assessment is available and has been completed within deleted text begin 180 days deleted text end new text begin three years new text end preceding
admission, only deleted text begin updating deleted text end new text begin an adult diagnostic assessment update new text end is necessary. deleted text begin "Updating" deleted text end new text begin
An "adult diagnostic assessment update" new text end means a written summary by a mental health
professional of the adult's current mental health status and service needs new text begin and includes a
face-to-face interview with the adult new text end . If the adult's mental health status has changed
markedly since the adult's most recent diagnostic assessment, a new diagnostic assessment
is required. Compliance with the provisions of this subdivision does not ensure eligibility
for medical assistance or general assistance medical care reimbursement under chapters
256B and 256D.

Sec. 3.

Minnesota Statutes 2010, section 245A.03, subdivision 7, is amended to read:

Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
and determined to be needed by the commissioner under paragraph (b);

(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center new text begin , or
restructuring of state-operated services that limits the capacity of state-operated facilities new text end ;

(4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or

(5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.

(b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area in which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.

(c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in the process of receiving an adult or child foster care license:

(1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;

(2) the provider has purchased housing or has made a financial investment in the
property;

(3) the lead agency has approved the plans, including costs for the residential setting
for each individual;

(4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and

(5) the needs of the individuals cannot be met within the existing capacity in that
county.

To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.

(d) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:

(1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;

(2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and

(3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.

Sec. 4.

Minnesota Statutes 2010, section 253B.02, subdivision 9, is amended to read:

Subd. 9.

Health officer.

"Health officer" means new text begin :
new text end

new text begin (1) new text end a licensed physician deleted text begin , deleted text end new text begin ;
new text end

new text begin (2) a new text end licensed psychologist deleted text begin , deleted text end new text begin ;
new text end

new text begin (3) a new text end licensed social worker deleted text begin , deleted text end new text begin ;
new text end

new text begin (4) a new text end registered nurse working in an emergency room of a hospital deleted text begin , or deleted text end new text begin ;
new text end

new text begin (5) a new text end psychiatric or public health nurse as defined in section 145A.02, subdivision
18 deleted text begin , or deleted text end new text begin ;
new text end

new text begin (6) new text end an advanced practice registered nurse (APRN) as defined in section 148.171,
subdivision 3 deleted text begin , and deleted text end new text begin ;
new text end

new text begin (7) a mental health professional providing mental health mobile crisis intervention
services as described under section 256B.0624; or
new text end

new text begin (8) a new text end formally designated deleted text begin members deleted text end new text begin member new text end of a prepetition screening unit
established by section 253B.07.

Sec. 5.

Minnesota Statutes 2010, section 254B.03, subdivision 5, is amended to read:

Subd. 5.

Rules; appeal.

The commissioner shall adopt rules as necessary to
implement deleted text begin Laws 1986, chapter 394, sections 8 to 20. The commissioner shall ensure that
the rules are effective on July 1, 1987 deleted text end new text begin this chapter new text end . The commissioner shall establish an
appeals process for use by recipients when services certified by the county are disputed.
The commissioner shall adopt rules and standards for the appeal process to assure
adequate redress for persons referred to inappropriate services.

Sec. 6.

Minnesota Statutes 2010, section 254B.03, subdivision 9, is amended to read:

Subd. 9.

Commissioner to select vendors and set rates.

(a) Effective July 1, 2011,
the commissioner shall:

(1) enter into agreements with eligible vendors that:

(i) meet the standards in section 254B.05, subdivision 1;

(ii) have good standing in all applicable licensure; and

(iii) have a current approved provider agreement as a Minnesota health care program
provider new text begin that contains program standards for each rate and rate enhancement defined
by the commissioner new text end ; and

(2) set rates for services reimbursed under this chapter.

(b) When setting rates, the commissioner shall consider the complexity and the
acuity of the problems presented by the client.

(c) When rates set under this section and rates set under section 254B.09, subdivision
8, apply to the same treatment placement, section 254B.09, subdivision 8, supersedes.

Sec. 7.

Minnesota Statutes 2010, section 254B.05, is amended to read:

254B.05 VENDOR ELIGIBILITY.

Subdivision 1.

Licensure required.

Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that
provide chemical dependency primary treatment, extended care, transitional residence, or
outpatient treatment services, and are licensed by tribal government are eligible vendors.
Detoxification programs are not eligible vendors. Programs that are not licensed as a
chemical dependency residential or nonresidential treatment program by the commissioner
or by tribal government new text begin or do not meet the requirements of subdivisions 1a and 1b new text end are not
eligible vendors. deleted text begin To be eligible for payment under the Consolidated Chemical Dependency
Treatment Fund, a vendor of a chemical dependency service must participate in the Drug
and Alcohol Abuse Normative Evaluation System and the treatment accountability plan.
deleted text end

new text begin Subd. 1a. new text end

new text begin Room and board provider requirements. new text end

new text begin (a) new text end Effective January 1,
2000, vendors of room and board are eligible for chemical dependency fund payment
if the vendor:

(1) has rules prohibiting residents bringing chemicals into the facility or using
chemicals while residing in the facility and provide consequences for infractions of those
rules;

deleted text begin (2) has a current contract with a county or tribal governing body;
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end is determined to meet applicable health and safety requirements;

deleted text begin (4) deleted text end new text begin (3) new text end is not a jail or prison; deleted text begin and
deleted text end

deleted text begin (5) deleted text end new text begin (4) new text end is not concurrently receiving funds under chapter 256I for the recipient deleted text begin . deleted text end new text begin ;
new text end

new text begin (5) admits individuals who are 18 years of age or older;
new text end

new text begin (6) is registered as a board and lodging or lodging establishment according to
section 157.17;
new text end

new text begin (7) has awake staff on site 24 hours per day;
new text end

new text begin (8) has staff who are at least 18 years of age and meet the requirements of Minnesota
Rules, part 9530.6450, subpart 1, item A;
new text end

new text begin (9) has emergency behavioral procedures that meet the requirements of Minnesota
Rules, part 9530.6475;
new text end

new text begin (10) meets the requirements of Minnesota Rules, part 9530.6435, subparts 3 and
4, items A and B, if administering medications to clients;
new text end

new text begin (11) meets the abuse prevention requirements of section 245A.65, including a policy
on fraternization and the mandatory reporting requirements of section 626.557;
new text end

new text begin (12) document coordination with the treatment provider to assure compliance with
section 254B.03, subdivision 2;
new text end

new text begin (13) protect client funds and ensure freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;
new text end

new text begin (14) has a grievance procedure that meets the requirements of Minnesota Rules,
part 9530.6470, subpart 2; and
new text end

new text begin (15) has sleeping and bathroom facilities for men and women separated by a door
that is locked, has an alarm, or is supervised by awake staff.
new text end

new text begin (b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (13).
new text end

new text begin Subd. 1b. new text end

new text begin Additional vendor requirements. new text end

new text begin Vendors of room and board must
comply with the following duties:
new text end

new text begin (1) maintain a provider agreement with the department;
new text end

new text begin (2) continually comply with the standards in the agreement;
new text end

new text begin (3) participate in the Drug and Alcohol Normative Evaluation System;
new text end

new text begin (4) submit an annual audit if the vendor receives $500,000 or more a year from the
consolidated chemical dependency treatment fund; and
new text end

new text begin (5) submit an annual financial statement if the vendor receives less than $500,000 or
more a year from the consolidated chemical dependency treatment fund.
new text end

Subd. 2.

Regulatory methods.

(a) Where appropriate and feasible, the
commissioner shall identify and implement alternative methods of regulation and
enforcement to the extent authorized in this subdivision. These methods shall include:

(1) expansion of the types and categories of licenses that may be granted;

(2) when the standards of an independent accreditation body have been shown to
predict compliance with the rules, the commissioner shall consider compliance with the
accreditation standards to be equivalent to partial compliance with the rules; and

(3) use of an abbreviated inspection that employs key standards that have been
shown to predict full compliance with the rules.

If the commissioner determines that the methods in clause (2) or (3) can be used in
licensing a program, the commissioner may reduce any fee set under section 254B.03,
subdivision 3, by up to 50 percent.

(b) The commissioner shall work with the commissioners of health, public
safety, administration, and education in consolidating duplicative licensing and
certification rules and standards if the commissioner determines that consolidation is
administratively feasible, would significantly reduce the cost of licensing, and would
not reduce the protection given to persons receiving services in licensed programs.
Where administratively feasible and appropriate, the commissioner shall work with the
commissioners of health, public safety, administration, and education in conducting joint
agency inspections of programs.

(c) The commissioner shall work with the commissioners of health, public safety,
administration, and education in establishing a single point of application for applicants
who are required to obtain concurrent licensure from more than one of the commissioners
listed in this clause.

Subd. 3.

Fee reductions.

If the commissioner determines that the methods in
subdivision 2, clause (2) or (3), can be used in licensing a program, the commissioner
shall reduce licensure fees by up to 50 percent. The commissioner may adopt rules to
provide for the reduction of fees when a license holder substantially exceeds the basic
standards for licensure.

Subd. 4.

Regional treatment centers.

Regional treatment center chemical
dependency treatment units are eligible vendors. The commissioner may expand the
capacity of chemical dependency treatment units beyond the capacity funded by direct
legislative appropriation to serve individuals who are referred for treatment by counties
and whose treatment will be paid for by funding under this chapter or other funding
sources. Notwithstanding the provisions of sections 254B.03 to 254B.041, payment for
any person committed at county request to a regional treatment center under chapter 253B
for chemical dependency treatment and determined to be ineligible under the chemical
dependency consolidated treatment fund, shall become the responsibility of the county.

new text begin Subd. 5. new text end

new text begin Rate requirements. new text end

new text begin (a) The commissioner shall establish rates for
chemical dependency services and service enhancements funded under this chapter.
new text end

new text begin (b) Eligible chemical dependency treatment services include:
new text end

new text begin (1) outpatient treatment services that are licensed according to Minnesota Rules,
parts 9530.6405 to 9530.6480, or applicable tribal license;
new text end

new text begin (2) medication assisted therapy services that are licensed according to Minnesota
Rules, parts 9530.6405 to 9530.6480 and 9530.6500, or applicable tribal license;
new text end

new text begin (3) medication assisted therapy plus enhanced treatment services that meet the
requirements of clause (2) and provide nine hours of clinical services each week;
new text end

new text begin (4) high, medium, and low intensity residential treatment services that are licensed
according to Minnesota Rules, parts 9530.6405 to 9530.6480 and 9530.6505, or applicable
tribal license which provide, respectively, 30, 15, and five hours of clinical services each
week;
new text end

new text begin (5) hospital-based treatment services that are licensed according to Minnesota Rules,
parts 9530.6405 to 9530.6480, or applicable tribal license and licensed as a hospital under
sections 144.50 to 144.56;
new text end

new text begin (6) adolescent treatment programs that are licensed as outpatient treatment programs
according to Minnesota Rules, parts 9530.6405 to 9530.6485, or as residential treatment
programs according to Minnesota Rules, chapter 2960, or applicable tribal license; and
new text end

new text begin (7) room and board facilities that meet the requirements of section 254B.05,
subdivision 1a.
new text end

new text begin (c) The commissioner shall establish higher rates for programs that meet the
requirements of paragraph (b) and the following additional requirements:
new text end

new text begin (1) programs that serve parents with their children if the program meets the
additional licensing requirement in Minnesota Rules, part 9530.6490, and provides child
care that meets the requirements of section 245A.03, subdivision 2, during hours of
treatment activity;
new text end

new text begin (2) programs serving special populations if the program meets the requirements in
Minnesota Rules, part 9530.6605, subpart 13;
new text end

new text begin (3) programs that offer medical services delivered by appropriately credentialed
health care staff in an amount equal to two hours per client per week; and
new text end

new text begin (4) programs that offer services to individuals co-occurring mental health and
chemical dependency problems if:
new text end

new text begin (i) the program meets the co-occurring requirements in Minnesota Rules, part
9530.6495;
new text end

new text begin (ii) 25 percent of the counseling staff are mental health professionals, as defined in
section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under appropriate supervision preparing to become mental health professionals, except that
no more than 50 percent of the mental health staff may be students or licensing candidates;
new text end

new text begin (iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
new text end

new text begin (iv) the program has standards for multidisciplinary case review that include a
monthly review for each client; and
new text end

new text begin (v) family education is offered that addresses mental health and substance abuse
disorders and the interaction between the two.
new text end

new text begin (d) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0580 to 2960.0700, are exempt from the requirements in paragraph (c), clause
(4), items (i) to (iv).
new text end

Sec. 8.

Minnesota Statutes 2010, section 254B.12, is amended to read:

254B.12 RATE METHODOLOGY.

The commissioner shall deleted text begin , with broad-based stakeholder input, develop a
recommendation and present a report to the 2011 legislature, including proposed
legislation for a new deleted text end new text begin establish a new new text end rate methodology for the consolidated chemical
dependency treatment fund. The new methodology must replace county-negotiated rates
with a uniform statewide methodology that must include a graduated reimbursement
scale based on the patients' level of acuity and complexity. new text begin At least biennially, the
commissioner shall review the financial information provided by vendors to determine the
need for rate adjustments.
new text end

Sec. 9.

Minnesota Statutes 2010, section 254B.13, subdivision 3, is amended to read:

Subd. 3.

Program evaluation.

The commissioner shall evaluate pilot projects under
this section and report the results of the evaluation to the chairs and ranking minority
members of the legislative committees with jurisdiction over chemical health issues by
January 15, deleted text begin 2013 deleted text end new text begin 2014 new text end . Evaluation of the pilot projects must be based on outcome
evaluation criteria negotiated with the pilot projects prior to implementation.

Sec. 10.

Minnesota Statutes 2010, section 256.9693, is amended to read:

256.9693 INPATIENT TREATMENT FOR MENTAL ILLNESS.

new text begin Subdivision 1. new text end

new text begin Continuing care benefit program. new text end

The commissioner shall
establish a continuing care benefit program for deleted text begin persons deleted text end new text begin adults and children new text end with mental
illness in which deleted text begin persons deleted text end new text begin adults and children new text end with mental illness may obtain acute care
hospital inpatient treatment for mental illness for up to 45 days beyond that allowed
by section 256.969. The commissioner may authorize additional days beyond 45
based on an individual review of medical necessity. deleted text begin Persons deleted text end new text begin Adults and children new text end with
mental illness who are eligible for medical assistance may obtain inpatient treatment
under this program in hospital beds for which the commissioner contracts under this
section. The commissioner may selectively contract with hospitals to provide this benefit
through competitive bidding when reasonable geographic access by recipients can be
assured. Payments under this section shall not affect payments under section 256.969.
The commissioner may contract externally with a utilization review organization to
authorize persons with mental illness to access the continuing care benefit program. The
commissioner, as part of the contracts with hospitals, shall establish admission criteria to
allow persons with mental illness to access the continuing care benefit program. If a court
orders acute care hospital inpatient treatment for mental illness for a person, the person
may obtain the treatment under the continuing care benefit program. The commissioner
shall not require, as part of the admission criteria, any commitment or petition under
chapter 253B as a condition of accessing the program. This benefit is not available for
people who are also eligible for Medicare and who have not exhausted their annual or
lifetime inpatient psychiatric benefit under Medicare. If a recipient is enrolled in a prepaid
plan, this program deleted text begin is included in deleted text end new text begin must be covered by new text end the plan's deleted text begin coverage deleted text end new text begin capitation
payments new text end .

new text begin Subd. 2. new text end

new text begin Transfer of funds. new text end

new text begin The commissioner is authorized to transfer funds
from the child and adolescent behavioral health services appropriation for the purpose
of children and adolescent treatment under this section.
new text end

Sec. 11.

Minnesota Statutes 2010, section 256B.0622, subdivision 8, is amended to
read:

Subd. 8.

Medical assistance payment for intensive rehabilitative mental health
services.

(a) Payment for residential and nonresidential services in this section shall be
based on one daily rate per provider inclusive of the following services received by an
eligible recipient in a given calendar day: all rehabilitative services under this section,
staff travel time to provide rehabilitative services under this section, and nonresidential
crisis stabilization services under section 256B.0624.

(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each recipient for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.

(c) The deleted text begin host county shall recommend to the deleted text end commissioner new text begin shall determine new text end one rate
for each deleted text begin entity deleted text end new text begin provider new text end that will bill medical assistance for residential services under this
section and one rate for each nonresidential provider. If a single entity provides both
services, one rate is established for the entity's residential services and another rate for
the entity's nonresidential services under this section. deleted text begin In developing these rates, the host
county shall consider and document deleted text end new text begin A provider is not eligible for payment under this
section without authorization from the commissioner. The commissioner shall develop
rates using the following criteria new text end :

(1) the cost for similar services in the local trade area;

new text begin (2) the provider's cost for services, as determined as follows:
new text end

new text begin (i) the direct services portion of costs must be determined using actual costs of
salaries, benefits, payroll taxes, and training of direct service staff and service-related
transportation;
new text end

new text begin (ii) for other program costs not included in item (i), the rate must include a specified
percentage to be paid beyond the direct services costs. The percentage used shall be
determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that
provide similar services;
new text end

new text begin (iii) in situations where a provider of intensive residential services can demonstrate
actual program-related physical plant costs in excess of the group residential housing
reimbursement, the commissioner may include these costs in the program rate, so long
as the additional reimbursement does not subsidize the room and board expenses of the
program;
new text end

new text begin (iv) intensive nonresidential services physical plant costs must be reimbursed as
part of the costs described in item (ii); and
new text end

new text begin (v) up to an additional five percent of the total rate may be added to the program
rate as a return to agency quality incentive based upon the entity meeting specified
performance criteria specified by the commissioner;
new text end

deleted text begin (2) that the proposed costs incurred by entities providing the services are deleted text end new text begin (3) actual
cost is defined as costs approved by the commissioner which are new text end allowable, allocable new text begin , new text end
and reasonable, and deleted text begin are deleted text end consistent with federal reimbursement requirements deleted text begin including deleted text end new text begin
under new text end Code of Federal Regulations, title 48, chapter 1, part 31, deleted text begin as deleted text end relating to for-profit
entities, and Office of Management and Budget Circular Number A-122, deleted text begin as deleted text end relating to
nonprofit entities;

deleted text begin (3) deleted text end new text begin (4) new text end the deleted text begin intensity and frequency of services to be provided to each recipient,
including the proposed overall deleted text end number of new text begin service new text end units deleted text begin of service to be delivered deleted text end ;

deleted text begin (4) deleted text end new text begin (5) new text end the degree to which recipients will receive services other than services
under this section;

deleted text begin (5) deleted text end new text begin (6) new text end the costs of other services that will be separately reimbursed; and

deleted text begin (6) deleted text end new text begin (7) new text end input from the local planning process authorized by the adult mental health
initiative under section 245.4661, regarding recipients' service needs.

(d) The rate for intensive rehabilitative mental health services must exclude room
and board, as defined in section 256I.03, subdivision 6, and services not covered under
this section, such as partial hospitalization, home care, and inpatient services. Physician
services that are not separately billed may be included in the rate to the extent that a
psychiatrist is a member of the treatment team. deleted text begin The county's recommendation shall
specify the period for which the rate will be applicable, not to exceed two years.
deleted text end

(e) When services under this section are provided by an new text begin intensive nonresidential
service provider new text end assertive community team, case management functions must be an
integral part of the team.

(f) The rate for a provider must not exceed the rate charged by that provider for
the same service to other payors.

(g) deleted text begin The commissioner shall approve or reject the county's rate recommendation,
based on the commissioner's own analysis of the criteria in paragraph (c) deleted text end new text begin The rates for
existing programs must be established prospectively based upon the approved allowable
expenditures and utilization over a prior 12-month period new text end .

(h) deleted text begin Paragraph (c), clause (2), is effective for services provided on or after January
1, 2010, to December 31, 2011, and does not change contracts or agreements relating to
services provided before January 1, 2010 deleted text end new text begin Entities who discontinue providing services must
be subject to a settle-up process whereby actual costs and reimbursement for the previous
12 months are compared. In the event that the entity was paid more than the entity's
actual costs plus any applicable performance-related funding due the provider, the excess
payment must be reimbursed to the department. If a provider's revenue is less than actual
allowed costs due to lower utilization than projected, the commissioner may reimburse
the provider to recover their actual allowable costs. The resulting adjustments by the
commissioner must be proportional to the percent of total units of service reimbursed by
the commissioner new text end .

Sec. 12.

Minnesota Statutes 2010, section 256B.0623, subdivision 3, is amended to
read:

Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is age 18 or older;

(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;

(3) has substantial disability and functional impairment in three or more of the areas
listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced; and

(4) has had a recent diagnostic assessment new text begin or an adult diagnostic assessment update new text end
by a qualified professional that documents adult rehabilitative mental health services
are medically necessary to address identified disability and functional impairments and
individual recipient goals.

Sec. 13.

Minnesota Statutes 2010, section 256B.0623, subdivision 8, is amended to
read:

Subd. 8.

Diagnostic assessment.

Providers of adult rehabilitative mental health
services must complete a diagnostic assessment as defined in section 245.462, subdivision
9, within five days after the recipient's second visit or within 30 days after intake,
whichever occurs first. In cases where a diagnostic assessment is available that reflects the
recipient's current status, and has been completed within deleted text begin 180 days deleted text end new text begin three years new text end preceding
admission, an new text begin adult diagnostic assessment new text end update must be completed. An update shall
include new text begin a face-to-face interview with the recipient and new text end a written summary by a mental
health professional of the recipient's current mental health status and service needs. If the
recipient's mental health status has changed significantly since the adult's most recent
diagnostic assessment, a new diagnostic assessment is required. deleted text begin For initial implementation
of adult rehabilitative mental health services, until June 30, 2005, a diagnostic assessment
that reflects the recipient's current status and has been completed within the past three
years preceding admission is acceptable.
deleted text end

Sec. 14.

Minnesota Statutes 2010, section 256B.0624, subdivision 2, is amended to
read:

Subd. 2.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.

(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric
situation which causes an immediate need for mental health services and is consistent
with section 62Q.55.

A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or crisis mental health
practitioner with input from the recipient whenever possible.

(c) "Mental health crisis assessment" means an immediate face-to-face assessment
by a physician, a mental health professional, or mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests that the
adult may be experiencing a mental health crisis or mental health emergency situation.

(d) "Mental health mobile crisis intervention services" means face-to-face,
short-term intensive mental health services initiated during a mental health crisis or
mental health emergency to help the recipient cope with immediate stressors, identify and
utilize available resources and strengths, and begin to return to the recipient's baseline
level of functioning.

(1) This service is provided on site by a mobile crisis intervention team outside of
an inpatient hospital setting. Mental health mobile crisis intervention services must be
available 24 hours a day, seven days a week.

(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.

(3) The mobile crisis intervention team must be available to meet promptly
face-to-face with a person in mental health crisis or emergency in a community setting new text begin or
hospital emergency room new text end .

(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.

(5) The treatment plan must include recommendations for any needed crisis
stabilization services for the recipient.

(e) "Mental health crisis stabilization services" means individualized mental
health services provided to a recipient following crisis intervention services which are
designed to restore the recipient to the recipient's prior functional level. Mental health
crisis stabilization services may be provided in the recipient's home, the home of a family
member or friend of the recipient, another community setting, or a short-term supervised,
licensed residential program. Mental health crisis stabilization does not include partial
hospitalization or day treatment.

Sec. 15.

Minnesota Statutes 2010, section 256B.0624, subdivision 4, is amended to
read:

Subd. 4.

Provider entity standards.

(a) A provider entity is an entity that meets
the standards listed in paragraph (b) and:

(1) is a county board operated entity; or

(2) is a provider entity that is under contract with the county board in the county
where the potential crisis or emergency is occurring. To provide services under this
section, the provider entity must directly provide the services; or if services are
subcontracted, the provider entity must maintain responsibility for services and billing.

(b) The adult mental health crisis response services provider entity must new text begin have the
capacity to new text end meet new text begin and carry out new text end the following standards:

(1) has the capacity to recruit, hire, and manage and train mental health professionals,
practitioners, and rehabilitation workers;

(2) has adequate administrative ability to ensure availability of services;

(3) is able to ensure adequate preservice and in-service training;

(4) is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;

(5) is able to ensure that staff are capable of implementing culturally specific
treatment identified in the individual treatment plan that is meaningful and appropriate as
determined by the recipient's culture, beliefs, values, and language;

(6) is able to ensure enough flexibility to respond to the changing intervention and
care needs of a recipient as identified by the recipient during the service partnership
between the recipient and providers;

(7) is able to ensure that mental health professionals and mental health practitioners
have the communication tools and procedures to communicate and consult promptly about
crisis assessment and interventions as services occur;

(8) is able to coordinate these services with county emergency services new text begin , community
hospitals, ambulance, transportation services, social services, law enforcement, new text end and mental
health crisis services new text begin through regularly scheduled interagency meetings new text end ;

(9) is able to ensure that mental health crisis assessment and mobile crisis
intervention services are available 24 hours a day, seven days a week;

(10) is able to ensure that services are coordinated with other mental health service
providers, county mental health authorities, or federally recognized American Indian
authorities and others as necessary, with the consent of the adult. Services must also be
coordinated with the recipient's case manager if the adult is receiving case management
services;

(11) is able to ensure that crisis intervention services are provided in a manner
consistent with sections 245.461 to 245.486;

(12) is able to submit information as required by the state;

(13) maintains staff training and personnel files;

(14) is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfaction;

(15) is able to keep records as required by applicable laws;

(16) is able to comply with all applicable laws and statutes;

(17) is an enrolled medical assistance provider; and

(18) develops and maintains written policies and procedures regarding service
provision and administration of the provider entity, including safety of staff and recipients
in high-risk situations.

Sec. 16.

Minnesota Statutes 2010, section 256B.0624, subdivision 6, is amended to
read:

Subd. 6.

Crisis assessment and mobile intervention treatment planning.

(a)
Prior to initiating mobile crisis intervention services, a screening of the potential crisis
situation must be conducted. The screening may use the resources of crisis assistance
and emergency services as defined in sections 245.462, subdivision 6, and 245.469,
subdivisions 1 and 2. The screening must gather information, determine whether a crisis
situation exists, identify parties involved, and determine an appropriate response.

(b) If a crisis exists, a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which emergency services are needed and, as time
permits, the recipient's current life situation, sources of stress, mental health problems
and symptoms, strengths, cultural considerations, support network, vulnerabilities, deleted text begin and deleted text end
current functioning new text begin , and the recipient's preferences as communicated verbally by the
recipient, or as communicated in: a health care directive as described in chapters 145C
and 253B, the treatment plan described under paragraph (d), a crisis prevention plan,
or wellness recovery action plan new text end .

(c) If the crisis assessment determines mobile crisis intervention services are needed,
the intervention services must be provided promptly. As opportunity presents during the
intervention, at least two members of the mobile crisis intervention team must confer
directly or by telephone about the assessment, treatment plan, and actions taken and
needed. At least one of the team members must be on site providing crisis intervention
services. If providing on-site crisis intervention services, a mental health practitioner must
seek clinical supervision as required in subdivision 9.

(d) The mobile crisis intervention team must develop an initial, brief crisis treatment
plan as soon as appropriate but no later than 24 hours after the initial face-to-face
intervention. The plan must address the needs and problems noted in the crisis assessment
and include measurable short-term goals, cultural considerations, and frequency and type
of services to be provided to achieve the goals and reduce or eliminate the crisis. The
treatment plan must be updated as needed to reflect current goals and services.

(e) The team must document which short-term goals have been met and when no
further crisis intervention services are required.

(f) If the recipient's crisis is stabilized, but the recipient needs a referral to other
services, the team must provide referrals to these services. If the recipient has a case
manager, planning for other services must be coordinated with the case manager.

Sec. 17.

Minnesota Statutes 2010, section 256B.0625, subdivision 23, is amended to
read:

Subd. 23.

Day treatment services.

Medical assistance covers day treatment
services as specified in sections 245.462, subdivision 8, and 245.4871, subdivision 10, that
are provided under contract with the county board. deleted text begin Notwithstanding Minnesota Rules,
part 9505.0323, subpart 15, deleted text end The commissioner may set authorization thresholds for day
treatment for adults according to subdivision 25. deleted text begin Notwithstanding Minnesota Rules, part
9505.0323, subpart 15, effective July 1, 2004, deleted text end Medical assistance covers day treatment
services for children as specified under section 256B.0943.

Sec. 18.

Minnesota Statutes 2010, section 256B.0625, subdivision 38, is amended to
read:

Subd. 38.

Payments for mental health services.

Payments for mental
health services covered under the medical assistance program that are provided by
masters-prepared mental health professionals shall be 80 percent of the rate paid to
doctoral-prepared professionals. Payments for mental health services covered under
the medical assistance program that are provided by masters-prepared mental health
professionals employed by community mental health centers shall be 100 percent of the
rate paid to doctoral-prepared professionals. deleted text begin For purposes of reimbursement of mental
health professionals under the medical assistance program, all social workers who:
deleted text end

deleted text begin (1) have received a master's degree in social work from a program accredited by the
Council on Social Work Education;
deleted text end

deleted text begin (2) are licensed at the level of graduate social worker or independent social worker;
and
deleted text end

deleted text begin (3) are practicing clinical social work under appropriate supervision, as defined by
chapter 148D; meet all requirements under Minnesota Rules, part 9505.0323, subpart
24, and shall be paid accordingly.
deleted text end

Sec. 19.

Minnesota Statutes 2010, section 256B.0926, subdivision 2, is amended to
read:

Subd. 2.

Admission review team; responsibilities; composition.

(a) Before a
person is admitted to a facility, an admission review team must assure that the provider
can meet the needs of the person as identified in the person's individual service plan
required under section 256B.092, subdivision 1 new text begin , unless authorized by the commissioner
for admittance to a state-operated services facility new text end .

(b) The admission review team must be assembled pursuant to Code of Federal
Regulations, title 42, section 483.440(b)(2). The composition of the admission review
team must meet the definition of an interdisciplinary team in Code of Federal Regulations,
title 42, section 483.440. In addition, the admission review team must meet any conditions
agreed to by the provider and the county where services are to be provided.

(c) The county in which the facility is located may establish an admission review
team which includes at least the following:

(1) a qualified developmental disability professional, as defined in Code of Federal
Regulations, title 42, section 483.440;

(2) a representative of the county in which the provider is located;

(3) at least one professional representing one of the following professions: nursing,
psychology, physical therapy, or occupational therapy; and

(4) a representative of the provider.

If the county in which the facility is located does not establish an admission review
team, the provider shall establish a team whose composition meets the definition of an
interdisciplinary team in Code of Federal Regulations, title 42, section 483.440. The
provider shall invite a representative of the county agency where the facility is located to
be a member of the admission review team.

Sec. 20.

Minnesota Statutes 2010, section 256B.0947, is amended to read:

256B.0947 INTENSIVE REHABILITATIVE MENTAL HEALTH SERVICES.

Subdivision 1.

Scope.

Effective November 1, 2011, and subject to federal approval,
medical assistance covers medically necessary, intensive nonresidential rehabilitative
mental health services as defined in subdivision 2, for recipients as defined in subdivision
3, when the services are provided by an entity meeting the standards in this section.

Subd. 2.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, deleted text begin or other evidence-based practices deleted text end new text begin as adapted for
youth new text end , and new text begin are new text end directed to recipients new text begin ages 16 to 21 new text end with a serious mental illness new text begin or
co-occurring mental illness and substance abuse addiction new text end who require intensive services new text begin
to prevent admission to an inpatient psychiatric hospital or placement in a residential
treatment facility or who require intensive services to step down from inpatient or
residential care to community-based care new text end .

(b) deleted text begin "Evidence-based practices" are nationally recognized mental health services that
are proven by substantial research to be effective in helping individuals with serious
mental illness obtain specific treatment goals deleted text end new text begin "Co-occurring mental illness and substance
abuse addiction" means a dual diagnosis of at least one form of mental illness and at least
one substance use disorder. Substance use disorders include alcohol or drug abuse or
dependence, excluding nicotine use new text end .

new text begin (c) "Diagnostic assessment" has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1, and for this section must incorporate a determination of
the youth's necessary level of care using a standardized functional assessment instrument
approved and periodically updated by the commissioner.
new text end

new text begin (d) "Education specialist" means an individual with knowledge and experience
working with youth regarding special education requirements and goals, special education
plans, and coordination of educational activities with health care activities.
new text end

new text begin (e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
new text end

new text begin (f) "Integrated dual disorders treatment" means the integrated treatment of
co-occurring mental illness and substance use disorders by a team of cross-trained
clinicians within the same program, and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each
stage of treatment.
new text end

new text begin (g) "Medication education services" means services provided individually or in
groups, which focus on:
new text end

new text begin (1) educating the client and client's family or significant nonfamilial supporters
about mental illness and symptoms;
new text end

new text begin (2) the role and effects of medications in treating symptoms of mental illness; and
new text end

new text begin (3) the side effects of medications.
new text end

new text begin Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
new text end

new text begin (h) "Peer specialist" means an employed team member who is a certified peer
specialist and also a former children's mental health consumer who:
new text end

new text begin (1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
new text end

new text begin (2) assists younger peers to identify and achieve specific life goals;
new text end

new text begin (3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
new text end

new text begin (4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
new text end

new text begin (5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
new text end

new text begin (6) meets the following criteria:
new text end

new text begin (i) is at least 22 years of age;
new text end

new text begin (ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part
9505.0370, subpart 20, or co-occurring mental illness and substance abuse addiction;
new text end

new text begin (iii) is a former consumer of child and adolescent mental health services, or a former
or current consumer of adult mental health services;
new text end

new text begin (iv) has at least a high school diploma or equivalent;
new text end

new text begin (v) has successfully completed training requirements determined and periodically
updated by the commissioner; and
new text end

new text begin (vi) is willing to disclose the individual's own mental health history to team members
and clients.
new text end

new text begin (i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
new text end

new text begin (j) "Substance use disorders" means one or more of the disorders defined in the
diagnostic and statistical manual of mental disorders, current edition, that include:
new text end

new text begin (1) alcohol or drug abuse, which is indicated by harmful effects on a person's life
including work, relationship, and legal problems; and
new text end

new text begin (2) dependence on drugs or alcohol which is indicated by tolerance, withdrawal, or
inability to reduce using more than intended.
new text end

new text begin (k) "Transition services" means:
new text end

new text begin (1) activities, materials, consultation, and coordination that ensures continuity of
the client's care in advance of and in preparation for the client's move from one stage of
care or life to another by maintaining contact with the client and assisting the client to
establish provider relationships;
new text end

new text begin (2) providing the client with knowledge and skills needed posttransition;
new text end

new text begin (3) establishing communication between sending and receiving entities;
new text end

new text begin (4) supporting a client's request for service authorization and enrollment; and
new text end

new text begin (5) establishing and enforcing procedures and schedules.
new text end

new text begin A youth's transition from the children's mental health system and services to
the adult mental health system and services and return to the client's home and entry
or re-entry into community-based mental health services following discharge from an
out-of-home placement or inpatient hospital stay.
new text end

deleted text begin (c) deleted text end new text begin (l) new text end "Treatment team" means all staff who provide services to recipients under this
section. deleted text begin At a minimum, this includes the clinical supervisor, mental health professionals,
mental health practitioners, mental health behavioral aides, and a school representative
familiar with the recipient's individual education plan (IEP) if applicable.
deleted text end

Subd. 3.

new text begin Client new text end eligibility.

An eligible recipient deleted text begin under the age of 18 deleted text end is an individual
who:

(1) is age 16 deleted text begin or deleted text end new text begin , new text end 17 new text begin , 18, 19, or 20 new text end ; new text begin and
new text end

(2) is diagnosed with a deleted text begin medical condition, such as an emotional disturbance or
traumatic brain injury deleted text end new text begin serious mental illness or co-occurring mental illness and substance
abuse addiction new text end , for which intensive nonresidential rehabilitative mental health services
are needed;

new text begin (3) has received a level-of-care determination, using an instrument approved by the
commissioner, that indicates a need for intensive integrated intervention without 24-hour
medical monitoring and a need for extensive collaboration among multiple providers;
new text end

deleted text begin (3) deleted text end new text begin (4) new text end has deleted text begin substantial disability and deleted text end new text begin a new text end functional impairment deleted text begin in three or more of the
areas listed in section 245.462, subdivision 11a, so that self-sufficiency upon adulthood or
emancipation is unlikely deleted text end new text begin and a history of difficulty in functioning safely and successfully
in the community, school, home, or job; or who is likely to need services from the adult
mental health system within the next two years new text end ; and

deleted text begin (4) deleted text end new text begin (5) new text end has had a recent diagnostic assessment new text begin , as provided in Minnesota Rules,
part 9505.0372, subpart 1, new text end by a deleted text begin qualified deleted text end new text begin mental health new text end professional new text begin who is qualified
under Minnesota Rules, part 9505.0371, subpart 5, item A, new text end that documents that intensive
nonresidential rehabilitative mental health services are medically necessary to deleted text begin address deleted text end new text begin
ameliorate new text end identified deleted text begin disability and deleted text end new text begin symptoms and new text end functional impairments and new text begin to achieve new text end
individual deleted text begin recipient deleted text end new text begin transition new text end goals.

new text begin Subd. 3a. new text end

new text begin Required service components. new text end

new text begin (a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5
to an eligible client under subdivision 3.
new text end

new text begin (b) Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities covered by the single daily rate per client must include the following,
as needed by the individual client:
new text end

new text begin (1) individual, family, and group psychotherapy;
new text end

new text begin (2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (p);
new text end

new text begin (3) crisis assistance as defined in section 245.4871, subdivision 9a, which includes
recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944;
new text end

new text begin (4) medication management provided by a physician or an advanced practice
registered nurse with certification in psychiatric and mental health care;
new text end

new text begin (5) mental health case management as provided in section 256B.0625, subdivision
20;
new text end

new text begin (6) medication education services as defined in this section;
new text end

new text begin (7) care coordination by a client-specific lead worker assigned by and responsible to
the treatment team;
new text end

new text begin (8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;
new text end

new text begin (9) clinical consultation to a client's employer or school or to other service agencies
or to the courts to assist in managing the mental illness or co-occurring disorder and to
develop client support systems;
new text end

new text begin (10) coordination with, or performance of, crisis intervention and stabilization
services as defined in section 256B.0944;
new text end

new text begin (11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
new text end

new text begin (12) transition services as defined in this section;
new text end

new text begin (13) integrated dual disorders treatment as defined in this section; and
new text end

new text begin (14) housing access support.
new text end

new text begin (c) The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:
new text end

new text begin (1) client access to crisis intervention services, as defined in section 256B.0944, and
available 24 hours per day and seven days per week;
new text end

new text begin (2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
new text end

new text begin (3) determination of the client's needed level of care using an instrument approved
and periodically updated by the commissioner.
new text end

Subd. 4.

Provider deleted text begin certification and deleted text end contract requirements.

(a) The intensive
nonresidential rehabilitative mental health services provider deleted text begin must: deleted text end new text begin agency shall
new text end

deleted text begin (1) deleted text end have a contract with the deleted text begin host county deleted text end new text begin commissioner new text end to provide intensive transition
youth rehabilitative mental health services deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (2) be certified by the commissioner as being in compliance with this section and
section 256B.0943.
deleted text end

(b) The commissioner shall develop deleted text begin procedures deleted text end new text begin administrative and clinical contract
standards and performance evaluation criteria new text end for deleted text begin counties and deleted text end providers new text begin , including county
providers, and may require applicants new text end to submit deleted text begin contracts and other deleted text end documentation as
needed to allow the commissioner to determine whether the standards deleted text begin in this section deleted text end are
met.

Subd. 5.

Standards for new text begin intensive new text end nonresidential new text begin rehabilitative new text end providers.

(a)
Services must be provided by a deleted text begin certified deleted text end provider entity as deleted text begin defined in section 256B.0943,
subdivision 4 that meets the requirements in section 245B.0943, subdivisions 5 and 6 deleted text end new text begin
provided in subdivision 4 new text end .

new text begin (b) The treatment team for intensive nonresidential rehabilitative mental health
services comprises both permanently employed core team members and client-specific
team members as follows:
new text end

new text begin (1) The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical
responsibility for clients. Based on professional qualifications and client needs, clinically
qualified core team members are assigned on a rotating basis as the client's lead worker to
coordinate a client's care. The core team must comprise at least four full-time equivalent
direct care staff and must include, but is not limited to:
new text end

new text begin (i) an independently licensed mental health professional, qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, who serves as team leader to provide
administrative direction and clinical supervision to the team;
new text end

new text begin (ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must
be credentialed to prescribe medications;
new text end

new text begin (iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
new text end

new text begin (iv) a peer specialist as defined in subdivision 2, paragraph (h).
new text end

new text begin (2) The core team may also include any of the following:
new text end

new text begin (i) additional mental health professionals;
new text end

new text begin (ii) a vocational specialist;
new text end

new text begin (iii) an educational specialist;
new text end

new text begin (iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
new text end

new text begin (v) a mental health practitioner, as defined in section 245.4871, subdivision 26;
new text end

new text begin (vi) a mental health manager, as defined in section 245.4871, subdivision 4; and
new text end

new text begin (vii) a housing access specialist.
new text end

new text begin (3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
new text end

new text begin (i) the mental health professional treating the client prior to placement with the
treatment team;
new text end

new text begin (ii) the client's current substance abuse counselor, if applicable;
new text end

new text begin (iii) a lead member of the client's individual education planning team or school-based
mental health provider, if applicable;
new text end

new text begin (iv) a representative from the client's health care home or primary care clinic, as
needed to ensure integration of medical and behavioral health care;
new text end

new text begin (v) the client's probation officer or other juvenile justice representative, if applicable;
and
new text end

new text begin (vi) the client's current vocational or employment counselor, if applicable.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The clinical supervisor deleted text begin must deleted text end new text begin shall new text end be an active member of the treatment team new text begin
and shall function as a practicing clinician at least on a part-time basis new text end . The treatment team
deleted text begin must deleted text end new text begin shall new text end meet with the clinical supervisor at least weekly to discuss recipients' progress
and make rapid adjustments to meet recipients' needs. The team meeting deleted text begin shall deleted text end new text begin must new text end
include deleted text begin recipient-specific deleted text end new text begin client-specific new text end case reviews and general treatment discussions
among team members. deleted text begin Recipient-specific deleted text end new text begin Client-specific new text end case reviews and planning must
be documented in the individual deleted text begin recipient's deleted text end new text begin client's new text end treatment record.

new text begin (d) The staffing ratio must not exceed ten clients to one full-time equivalent
treatment team position.
new text end

new text begin (e) The treatment team shall serve no more than 80 clients at any one time. Should
local demand exceed the team's capacity, an additional team must be established rather
than exceed this limit.
new text end

deleted text begin (c) treatment deleted text end new text begin (f) Nonclinical new text end staff deleted text begin must deleted text end new text begin shall new text end have prompt access in person or by
telephone to a mental health practitioner or mental health professional. The provider deleted text begin must deleted text end new text begin
shall new text end have the capacity to promptly and appropriately respond to emergent needs and make
any necessary staffing adjustments to assure the health and safety of deleted text begin recipients deleted text end new text begin clients new text end .

deleted text begin (d) The initial functional assessment must be completed within ten days of intake
and updated at least every three months or prior to discharge from the service, whichever
comes first.
deleted text end

deleted text begin (e) The initial individual treatment plan must be completed within ten days of intake
and reviewed and updated at least monthly with the recipient.
deleted text end

new text begin (g) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT)
model as conducted by the commissioner, including the collection and reporting of data
and the reporting of performance measures as specified by contract with the commissioner.
new text end

new text begin (h) A regional treatment team may serve multiple counties.
new text end

Subd. 6.

deleted text begin Additional deleted text end new text begin Service new text end standards.

The standards in this subdivision apply to
intensive nonresidential rehabilitative mental health services.

deleted text begin (1) deleted text end new text begin (a) new text end The treatment team deleted text begin must deleted text end new text begin shall new text end use team treatment, not an individual treatment
model.

deleted text begin (2) The clinical supervisor must function as a practicing clinician at least on a
part-time basis.
deleted text end

deleted text begin (3) The staffing ratio must not exceed ten recipients to one full-time equivalent
treatment team position.
deleted text end

deleted text begin (4) deleted text end new text begin (b) new text end Services must be available at times that meet client needs.

new text begin (c) The initial functional assessment must be completed within ten days of intake
and updated at least every three months or prior to discharge from the service, whichever
comes first.
new text end

new text begin (d) An individual treatment plan must be completed for each client, according to
criteria specified in section 256B.0943, subdivision 6, paragraph (b), clause (2), and,
additionally, must:
new text end

new text begin (1) be completed in consultation with the client's current therapist and key providers
and provide for ongoing consultation with the client's current therapist to ensure
therapeutic continuity and to facilitate the client's return to the community;
new text end

new text begin (2) if a need for substance use disorder treatment is indicated by validated
assessment:
new text end

new text begin (i) identify goals, objectives, and strategies of substance use disorder treatment;
develop a schedule for accomplishing treatment goals and objectives; and identify the
individuals responsible for providing treatment services and supports;
new text end

new text begin (ii) be reviewed at least once every 90 days and revised, if necessary;
new text end

new text begin (3) be signed by the clinical supervisor and by the client and, if the client is a minor,
by the client's parent or other person authorized by statute to consent to mental health
treatment and substance use disorder treatment for the client; and
new text end

new text begin (4) provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" services.
new text end

deleted text begin (5) deleted text end new text begin (e) new text end The treatment team deleted text begin must deleted text end new text begin shall new text end actively and assertively engage deleted text begin and reach
out to deleted text end the deleted text begin recipient's deleted text end new text begin client's new text end family members and significant others deleted text begin , after obtaining the
recipient's permission deleted text end new text begin by establishing communication and collaboration with the family
and significant others and educating the family and significant others about the client's
mental illness, symptom management, and the family's role in treatment, unless the team
knows or has reason to suspect that the client has suffered or faces a threat of suffering any
physical or mental injury, abuse, or neglect from a family member or significant other new text end .

new text begin (f) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the
client, the protected health information directly relevant to such person's involvement with
the client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If
the client is present, the treatment team shall obtain the client's agreement, provide the
client with an opportunity to object, or reasonably infer from the circumstances, based
on the exercise of professional judgment, that the client does not object. If the client is
not present or is unable, by incapacity or emergency circumstances, to agree or object,
the treatment team may, in the exercise of professional judgment, determine whether
the disclosure is in the best interests of the client and, if so, disclose only the protected
health information that is directly relevant to the family member's, relative's, friend's,
or client-identified person's involvement with the client's health care. The client may
orally agree or object to the disclosure and may prohibit or restrict disclosure to specific
individuals.
new text end

deleted text begin (6) The treatment team must establish ongoing communication and collaboration
between the team, family, and significant others and educate the family and significant
others about mental illness, symptom management, and the family's role in treatment.
deleted text end

deleted text begin (7) deleted text end new text begin (g) new text end The treatment team deleted text begin must deleted text end new text begin shall new text end provide interventions to promote positive
interpersonal relationships.

Subd. 7.

Medical assistance payment new text begin and rate setting new text end .

(a) Payment for
deleted text begin nonresidential deleted text end services in this section deleted text begin shall deleted text end new text begin must new text end be based on one daily new text begin encounter new text end rate per
provider inclusive of the following services received by an eligible deleted text begin recipient deleted text end new text begin client new text end in a
given calendar day: all rehabilitative services new text begin , supports, and ancillary activities new text end under
this section, staff travel time to provide rehabilitative services under this section, and
deleted text begin nonresidential deleted text end crisis deleted text begin stabilization deleted text end new text begin response new text end services under section 256B.0944.

(b) deleted text begin Except as indicated in paragraph (c), deleted text end Payment deleted text begin will deleted text end new text begin must new text end not be made to more than
one entity for each deleted text begin recipient deleted text end new text begin client new text end for services provided under this section on a given day.
If services under this section are provided by a team that includes staff from more than one
entity, the team deleted text begin must deleted text end new text begin shall new text end determine how to distribute the payment among the members.

(c) The deleted text begin host county shall recommend to the deleted text end commissioner deleted text begin one rate for each entity deleted text end new text begin
shall establish regional cost-based rates for entities new text end that will bill medical assistance for
nonresidential intensive rehabilitative mental health services. In developing these rates,
the deleted text begin host county deleted text end new text begin commissioner new text end shall consider deleted text begin and document deleted text end :

(1) the cost for similar services in the deleted text begin local deleted text end new text begin health care new text end trade area;

(2) actual costs incurred by entities providing the services;

(3) the intensity and frequency of services to be provided to each deleted text begin recipient deleted text end new text begin client new text end ;

(4) the degree to which deleted text begin recipients deleted text end new text begin clients new text end will receive services other than services
under this section; and

(5) the costs of other services that will be separately reimbursed.

(d) new text begin The rate for a provider must not exceed the rate charged by that provider for
the same service to other payors.
new text end

new text begin Subd. 7a. new text end

new text begin Noncovered services. new text end

new text begin (a) new text end The rate for intensive rehabilitative mental
health services must exclude medical assistance deleted text begin room and board rate, as defined in section
256I.03, subdivision 6, and deleted text end new text begin payment for new text end services not covered under this section deleted text begin , such as
partial hospitalization and inpatient services deleted text end . deleted text begin Physician deleted text end Services deleted text begin are deleted text end not deleted text begin a component of
the treatment team and deleted text end new text begin covered under this section new text end may be billed separately. deleted text begin The county's
recommendation shall specify the period for which the rate will be applicable, not to
exceed two years.
deleted text end

deleted text begin (e) When services under this section are provided by an assertive community team,
case management functions must be an integral part of the team.
deleted text end

deleted text begin (f) The rate for a provider must not exceed the rate charged by that provider for
the same service to other payors.
deleted text end

deleted text begin (g) The commissioner shall approve or reject the county's rate recommendation,
based on the commissioner's own analysis of the criteria in paragraph (c).
deleted text end

new text begin (b) The following services are not covered under this section and are not eligible for
medical assistance payment under the per-client, per-day payment:
new text end

new text begin (1) inpatient psychiatric hospital treatment;
new text end

new text begin (2) mental health residential treatment;
new text end

new text begin (3) partial hospitalization;
new text end

new text begin (4) physician services outside of care provided by a psychiatrist serving as a member
of the treatment team;
new text end

new text begin (5) room and board costs, as defined in section 256I.03, subdivision 6;
new text end

new text begin (6) children's mental health day treatment services; and
new text end

new text begin (7) mental health behavioral aide services, as defined in section 256B.0943,
subdivision 1, paragraph (m).
new text end

Subd. 8.

new text begin Provider new text end enrollment deleted text begin and rate setting deleted text end .

deleted text begin Counties that employ their
own staff to provide services under this section deleted text end new text begin The commissioner shall establish and
administer treatment teams with consideration given to regional distribution. Providers new text end
shall apply directly to the commissioner for enrollment and deleted text begin rate setting deleted text end new text begin must be reimbursed
at rates established by contract new text end . deleted text begin In this case, a county contract is not required and deleted text end The
commissioner shall perform the program review deleted text begin and rate setting duties which would
otherwise be required of counties under this section deleted text end .

new text begin Subd. 9. new text end

new text begin Service authorization. new text end

new text begin The commissioner shall publish prior authorization
criteria and standards to be used for intensive nonresidential rehabilitative mental health
services, as provided in section 256B.0625, subdivision 25.
new text end

Sec. 21. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2010, sections 254B.01, subdivision 7; and 256B.0622,
subdivision 8a, new text end new text begin are repealed.
new text end