HF 2926

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 03/22/2010 10:18am

A bill for an act
relating to human services; amending children's mental health policy provisions;
making a technical change to community health workers; amending Minnesota
Statutes 2008, sections 256B.761; 260C.157, subdivision 3; Minnesota Statutes
2009 Supplement, sections 245.4885, subdivisions 1, 1a; 254B.05, subdivision 1;
256B.0625, subdivision 49; 256B.0943, subdivision 9.

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

Section 1.

Minnesota Statutes 2009 Supplement, section 245.4885, subdivision 1,
is amended to read:

Subdivision 1.

Admission criteria.

(a) Prior to admission, except in the case of
emergency admission, all children referred for treatment of severe emotional disturbance
in a treatment foster care setting, residential treatment facility, or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level
of care if public funds are used to pay for the services.

(b) The county board shall determine the appropriate level of care when
county-controlled funds are used to pay for the services. When the child is enrolled in
a prepaid health program under section 256B.69, the enrolled child's contracted health
plan must determine the appropriate level of care. new text begin When Indian Health Services funds
or funds of a tribally owned facility funded under the Indian Self-Determination and
Education Assistance Act, Public Law 93-638, are to be used, the Indian Health Services
or 638 tribal health facility must determine the appropriate level of care. new text end When more than
one entity bears responsibility for coverage, the entities shall coordinate level of care
determination activities to the extent possible.

(c) The level of care determination shall determine whether the proposed treatment:

(1) is necessary;

(2) is appropriate to the child's individual treatment needs;

(3) cannot be effectively provided in the child's home; and

(4) provides a length of stay as short as possible consistent with the individual
child's need.

(d) When a level of care determination is conducted, the responsible entity may
not determine that referral or admission to a treatment foster care setting or residential
treatment facility is not appropriate solely because services were not first provided to the
child in a less restrictive setting and the child failed to make progress toward or meet
treatment goals in the less restrictive setting. The level of care determination must be
based on a diagnostic assessment that includes a functional assessment which evaluates
family, school, and community living situations; and an assessment of the child's need
for care out of the home using a validated tool which assesses a child's functional status
and assigns an appropriate level of care. The validated tool must be approved by the
commissioner of human services. If a diagnostic assessment including a functional
assessment has been completed by a mental health professional within the past 180 days,
a new diagnostic assessment need not be completed unless in the opinion of the current
treating mental health professional the child's mental health status has changed markedly
since the assessment was completed. The child's parent shall be notified if an assessment
will not be completed and of the reasons. A copy of the notice shall be placed in the
child's file. Recommendations developed as part of the level of care determination process
shall include specific community services needed by the child and, if appropriate, the
child's family, and shall indicate whether or not these services are available and accessible
to the child and family.

(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual
family community support plan is being developed by the case manager, if assigned.

(f) The level of care determination shall comply with section 260C.212. The parent
shall be consulted in the process, unless clinically detrimental to the child.

(g) The level of care determination, and placement decision, and recommendations
for mental health services must be documented in the child's record.

Sec. 2.

Minnesota Statutes 2009 Supplement, section 245.4885, subdivision 1a,
is amended to read:

Subd. 1a.

Emergency admission.

Effective July 1, 2006, if a child is admitted to
a treatment foster care setting, residential treatment facility, deleted text begin or acute care hospital for
emergency treatment deleted text end or held for emergency care by a regional treatment center under
section 253B.05, subdivision 1, the level of care determination must occur within five
working days of admission.

Sec. 3.

Minnesota Statutes 2009 Supplement, section 254B.05, subdivision 1, is
amended to read:

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 deleted text begin located on
federally recognized tribal lands deleted text end 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 are not eligible vendors.
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.

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;

(2) has a current contract with a county or tribal governing body;

(3) is determined to meet applicable health and safety requirements;

(4) is not a jail or prison; and

(5) is not concurrently receiving funds under chapter 256I for the recipient.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 49,
is amended to read:

Subd. 49.

Community health worker.

(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if
the community health worker has:

(1) received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculum; or

(2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end , and section 245.4871, subdivision 27,
clauses (1) to (5), or dentist, or at least five years of supervised experience by a certified
public health nurse operating under the direct authority of an enrolled unit of government.

Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.

(b) Community health workers must work under the supervision of a medical
assistance enrolled physician, registered nurse, advanced practice registered nurse, mental
health professional as defined in section 245.462, subdivision 18, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end ,
and section 245.4871, subdivision 27, clauses (1) to (5), or dentist, or work under the
supervision of a certified public health nurse operating under the direct authority of an
enrolled unit of government.

(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.

Sec. 5.

Minnesota Statutes 2009 Supplement, section 256B.0943, subdivision 9,
is amended to read:

Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a
certified provider entity must ensure that:

(1) each individual provider's caseload size permits the provider to deliver services
to both clients with severe, complex needs and clients with less intensive needs. The
provider's caseload size should reasonably enable the provider to play an active role in
service planning, monitoring, and delivering services to meet the client's and client's
family's needs, as specified in each client's individual treatment plan;

(2) site-based programs, including day treatment and preschool programs, provide
staffing and facilities to ensure the client's health, safety, and protection of rights, and that
the programs are able to implement each client's individual treatment plan;

(3) a day treatment program is provided to a group of clients by a multidisciplinary
team under the clinical supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections
144.50 to 144.55; (ii) a community mental health center under section 245.62; or (iii)
an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4712, subdivision 2, or 245.4884, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
stabilize the client's mental health status while developing and improving the client's
independent living and socialization skills. The goal of the day treatment program must
be to reduce or relieve the effects of mental illness and provide training to enable the
client to live in the community. The program must be available at least one day a week
for a two-hour time block. The two-hour time block must include at least one hour of
individual or group psychotherapy. The remainder of the structured treatment program
may include individual or group psychotherapy deleted text begin and recreation therapy, socialization
therapy, or independent living skills therapy deleted text end , and individual or group skills training, if
included in the client's individual treatment plan. Day treatment programs are not part of
inpatient or residential treatment services. A day treatment program may provide fewer
than the minimally required hours for a particular child during a billing period in which
the child is transitioning into, or out of, the program; and

(4) a therapeutic preschool program is a structured treatment program offered
to a child who is at least 33 months old, but who has not yet reached the first day of
kindergarten, by a preschool multidisciplinary team in a day program licensed under
Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available two
hours per day, five days per week, and 12 months of each calendar year. The structured
treatment program may include individual or group psychotherapy and individual or
group skills training, if included in the client's individual treatment plan. A therapeutic
preschool program may provide fewer than the minimally required hours for a particular
child during a billing period in which the child is transitioning into, or out of, the program.

(b) A provider entity must deliver the service components of children's therapeutic
services and supports in compliance with the following requirements:

(1) individual, family, and group psychotherapy must be delivered as specified in
Minnesota Rules, part 9505.0323;

(2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who has a consulting relationship with a
mental health professional who accepts full professional responsibility for the training;

(3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
through arrangements for direct intervention and support services to the child and the
child's family. Crisis assistance must utilize resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family as evidenced by
a sudden change in behavior with negative consequences for well being, a loss of usual
coping mechanisms, or the presentation of danger to self or others;

(4) mental health behavioral aide services must be medically necessary treatment
services, identified in the child's individual treatment plan and individual behavior plan,
which are performed minimally by a paraprofessional qualified according to subdivision
7, paragraph (b), clause (3), and which are designed to improve the functioning of the
child in the progressive use of developmentally appropriate psychosocial skills. Activities
involve working directly with the child, child-peer groupings, or child-family groupings
to practice, repeat, reintroduce, and master the skills defined in subdivision 1, paragraph
(p), as previously taught by a mental health professional or mental health practitioner
including:

(i) providing cues or prompts in skill-building peer-to-peer or parent-child
interactions so that the child progressively recognizes and responds to the cues
independently;

(ii) performing as a practice partner or role-play partner;

(iii) reinforcing the child's accomplishments;

(iv) generalizing skill-building activities in the child's multiple natural settings;

(v) assigning further practice activities; and

(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.

A mental health behavioral aide must document the delivery of services in written
progress notes. The mental health behavioral aide must implement treatment strategies
in the individual treatment plan and the individual behavior plan. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies; and

(5) direction of a mental health behavioral aide must include the following:

(i) deleted text begin a total of one hour of on-site observation by a mental health professional during
the first 12 hours of service provided to a child deleted text end new text begin a clinical supervision plan approved by
the responsible mental health professional new text end ;

(ii) ongoing on-site observation by a mental health professional or mental health
practitioner for at least a total of one hour during every 40 hours of service provided
to a child; and

(iii) immediate accessibility of the mental health professional or mental health
practitioner to the mental health behavioral aide during service provision.

Sec. 6.

Minnesota Statutes 2008, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day
treatment services, home-based mental health services, and family community support
services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
50th percentile of 1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
1993, with at least 33 percent of the clients receiving rehabilitation services in the most
recent calendar year who are medical assistance recipients, will be increased by 38 percent,
when those services are provided within the comprehensive outpatient rehabilitation
facility and provided to residents of nursing facilities owned by the entity.

new text begin (c) The commissioner shall establish three levels of payment for mental health
diagnostic assessment, based on three levels of complexity. The aggregate payment under
the tiered rates must not exceed the projected aggregate payments for mental health
diagnostic assessment under the previous single rate. The new rate structure is effective
January 1, 2011, or upon federal approval, whichever is later.
new text end

Sec. 7.

Minnesota Statutes 2008, section 260C.157, subdivision 3, is amended to read:

Subd. 3.

Juvenile treatment screening team.

(a) The responsible social services
agency shall establish a juvenile treatment screening team to conduct screenings and
prepare case plans under this subdivision. The team, which may be the team constituted
under section 245.4885 or 256B.092 or Minnesota Rules, parts 9530.6600 to 9530.6655,
shall consist of social workers, juvenile justice professionals, and persons with expertise
in the treatment of juveniles who are emotionally disabled, chemically dependent, or have
a developmental disability. The team shall involve parents or guardians in the screening
process as appropriate. The team may be the same team as defined in section 260B.157,
subdivision 3.

new text begin (b) The social services agency shall determine whether a child brought to its
attention for the purposes described in this section is an Indian child, as defined in section
260C.007, subdivision 21, and shall determine the identity of the Indian child's tribe, as
defined in section 260.755, subdivision 9. When a child to be evaluated is an Indian child,
the team provided in paragraph (a) shall include a designated representative of the Indian
child's tribe, unless the child's tribal authority declines to appoint a representative. The
Indian child's tribe may delegate its authority to represent the child to any other federally
recognized Indian tribe, as defined in section 260.755, subdivision 12.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end If the court, prior to, or as part of, a final disposition, proposes to place a child:

(1) for the primary purpose of treatment for an emotional disturbance, a
developmental disability, or chemical dependency in a residential treatment facility out
of state or in one which is within the state and licensed by the commissioner of human
services under chapter 245A; or

(2) in any out-of-home setting potentially exceeding 30 days in duration, including a
postdispositional placement in a facility licensed by the commissioner of corrections or
human services, the court new text begin shall ascertain whether the child is an Indian child and new text end shall
notify the county welfare agency new text begin and, if the child is an Indian child, shall notify the Indian
child's tribe new text end . The county's juvenile treatment screening team must either: (i) screen and
evaluate the child and file its recommendations with the court within 14 days of receipt
of the notice; or (ii) elect not to screen a given case and notify the court of that decision
within three working days.

deleted text begin (c) deleted text end new text begin (d) new text end If the screening team has elected to screen and evaluate the child, the child
may not be placed for the primary purpose of treatment for an emotional disturbance, a
developmental disability, or chemical dependency, in a residential treatment facility out of
state nor in a residential treatment facility within the state that is licensed under chapter
245A, unless one of the following conditions applies:

(1) a treatment professional certifies that an emergency requires the placement
of the child in a facility within the state;

(2) the screening team has evaluated the child and recommended that a residential
placement is necessary to meet the child's treatment needs and the safety needs of the
community, that it is a cost-effective means of meeting the treatment needs, and that it
will be of therapeutic value to the child; or

(3) the court, having reviewed a screening team recommendation against placement,
determines to the contrary that a residential placement is necessary. The court shall state
the reasons for its determination in writing, on the record, and shall respond specifically
to the findings and recommendation of the screening team in explaining why the
recommendation was rejected. The attorney representing the child and the prosecuting
attorney shall be afforded an opportunity to be heard on the matter.

new text begin (e) When the county's juvenile treatment screening team has elected to screen and
evaluate a child determined to be an Indian child, the team shall provide notice to the
tribe or tribes that accept jurisdiction for the Indian child or that recognize the child as a
member of the tribe or as a person eligible for membership in the tribe, and permit the
tribe's representative to participate in the screening team.
new text end

new text begin (f) When the Indian child's tribe or tribal health care services provider or Indian
Health Services provider proposes to place a child for the primary purpose of treatment
for an emotional disturbance, a developmental disability, or co-occurring emotional
disturbance and chemical dependency, the Indian child's tribe or the tribe delegated by
the child's tribe shall submit necessary documentation to the county juvenile treatment
screening team, which must invite the Indian child's tribe to designate a representative to
the screening team.
new text end