HF 3404

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/03/2022 06:45pm

A bill for an act
relating to human services; modifying intensive treatment in foster care; providing
various directions to the commissioner of human services; requiring a report;
appropriating money; amending Minnesota Statutes 2020, section 256B.0946, as
amended.

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

Section 1.

Minnesota Statutes 2020, section 256B.0946, as amended by Laws 2021, chapter
30, article 17, sections 91 to 96 and 113, and Laws 2021, First Special Session chapter 7,
article 11, sections 27 and 28, is amended to read:

256B.0946 INTENSIVE TREATMENT deleted text begin IN FOSTER CARE deleted text end new text begin FOR FAMILIES IN
THE COMMUNITY new text end .

Subdivision 1.

Required covered service components.

(a) Subject to federal approval,
medical assistance covers medically necessary intensive treatment services when the services
are provided by a provider entity certified under and meeting the standards in this section.
The provider entity must make reasonable and good faith efforts to report individual client
outcomes to the commissioner, using instruments and protocols approved by the
commissioner.

(b) Intensive treatment services to children with mental illness deleted text begin residing in foster family
settings that comprise specific required service components provided in clauses (1) to (6) deleted text end
are reimbursed by medical assistance when they meet the following standards:

(1) psychotherapy provided by a mental health professional or a clinical trainee;

(2) crisis planning;

(3) individual, family, and group psychoeducation services provided by a mental health
professional or a clinical trainee;

(4) clinical care consultation provided by a mental health professional or a clinical
trainee;

(5) individual treatment plan development as defined in Minnesota Rules, part 9505.0371,
subpart 7; and

(6) service delivery payment requirements as provided under subdivision 4.

Subd. 1a.

Definitions.

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

(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.

(b) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.

(c) "Crisis planning" has the meaning given in section 245.4871, subdivision 9a.

(d) "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influences into interventions as a way to maximize resiliency
factors and utilize cultural strengths and resources to promote overall wellness.

(e) "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.

(f) "Standard diagnostic assessment" means the assessment described in section 245I.10,
subdivision 6.

(g) "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.

deleted text begin (h) "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text end

deleted text begin (i) "Foster family setting" means the foster home in which the license holder resides.
deleted text end

deleted text begin (j) deleted text end new text begin (h) new text end "Individual treatment plan" means the plan described in section 245I.10,
subdivisions 7 and 8.

deleted text begin (k) deleted text end new text begin (i) new text end "Mental health certified family peer specialist" means a staff person who is
qualified according to section 245I.04, subdivision 12.

deleted text begin (l) deleted text end new text begin (j) new text end "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.

deleted text begin (m) deleted text end new text begin (k) new text end "Mental illness" has the meaning given in section 245I.02, subdivision 29.

deleted text begin (n) deleted text end new text begin (l) new text end "Parent" has the meaning given in section 260C.007, subdivision 25.

deleted text begin (o) deleted text end new text begin (m) new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.

deleted text begin (p) deleted text end new text begin (n) new text end "Psychotherapy" means the treatment described in section 256B.0671, subdivision
11.

deleted text begin (q) deleted text end new text begin (o) new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.

deleted text begin (r) deleted text end new text begin (p) new text end "Trauma" has the meaning given in section 245I.02, subdivision 38.

deleted text begin (s) deleted text end new text begin (q) new text end "Treatment supervision" means the supervision described under section 245I.06.

Subd. 2.

Determination of client eligibility.

An eligible recipient is an individual, from
birth through age 20, who deleted text begin is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota Tribe, and deleted text end has received: (1) a
standard diagnostic assessment within 180 days before the start of service that documents
that intensive treatment services are medically necessary deleted text begin within a foster family setting deleted text end to
ameliorate identified symptoms and functional impairments; and (2) a level of care
assessment as defined in section 245I.02, subdivision 19, that demonstrates that the individual
requires intensive intervention without 24-hour medical monitoring, and a functional
assessment as defined in section 245I.02, subdivision 17. deleted text begin The level of care assessment and
the functional assessment must include information gathered from the placing county, Tribe,
or case manager.
deleted text end

Subd. 3.

Eligible mental health services providers.

(a) Eligible providers for intensive
deleted text begin children's mental health services in a foster family setting deleted text end new text begin treatment for families in the
community new text end must be certified by the state and have a service provision contract with a county
board or a reservation tribal council and must be able to demonstrate the ability to provide
all of the services required in this section and meet the standards in chapter 245I, as required
in section 245I.011, subdivision 5.

(b) For purposes of this section, a provider agency must be:

(1) a county-operated entity certified by the state;

(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or

(3) a noncounty entity.

(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.

(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.

Subd. 4.

Service delivery payment requirements.

(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment deleted text begin in foster care deleted text end new text begin for families in the community new text end , consistent with subdivision
1, paragraph (b), and comply with the following requirements in paragraphs (b) to (n).

(b) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
standard diagnostic assessment and team consultation and treatment planning review process.

(c) Each client receiving treatment must be assessed for a trauma history, and the client's
treatment plan must document how the results of the assessment will be incorporated into
treatment.

(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.

(e) Each client receiving treatment services must have an individual treatment plan that
is reviewed, evaluated, and approved every 90 days using the team consultation and treatment
planning process.

(f) Clinical care consultation must be provided in accordance with the client's individual
treatment plan.

(g) Each client must have a crisis plan within ten days of initiating services and must
have access to clinical phone support 24 hours per day, seven days per week, during the
course of treatment. The crisis plan must demonstrate coordination with the local or regional
mobile crisis intervention team.

(h) Services must be deleted text begin delivered and deleted text end documented deleted text begin at least three days per week deleted text end , deleted text begin equaling deleted text end new text begin
must total new text end at least six hours of treatment per week new text begin , and may be billed in increments other
than two-hour increments of time new text end . If the mental health professional, client, and family agree,
service units may be temporarily reduced for a period of no more than 60 days in order to
meet the needs of the client and family, or as part of transition or on a discharge plan to
another service or level of care. The reasons for service reduction must be identified,
documented, and included in the treatment plan. Billing and payment are prohibited for
days on which no services are delivered and documented.

(i) Location of service delivery must be in the client's home, day care setting, school, or
other community-based setting that is specified on the client's individualized treatment plan.

(j) Treatment must be developmentally and culturally appropriate for the client.

(k) Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.

(l) Parents, siblings, foster parents, and members of the child's permanency plan must
be involved in treatment and service delivery unless otherwise noted in the treatment plan.

(m) Transition planning for the child must be conducted starting with the first treatment
plan and must be addressed throughout treatment to support the child's permanency plan
and postdischarge mental health service needs.

(n) In order for a provider to receive the daily per-client encounter rate, at least one of
the services listed in subdivision 1, paragraph (b), clauses (1) to (3), must be provided. The
services listed in subdivision 1, paragraph (b), clauses (4) and (5), may be included as part
of the daily per-client encounter rate.

Subd. 5.

Service authorization.

The commissioner will administer authorizations for
services under this section in compliance with section 256B.0625, subdivision 25.

Subd. 6.

Excluded services.

(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment deleted text begin in foster care services deleted text end new text begin for families in the community new text end , but may be billed separately:

(1) inpatient psychiatric hospital treatment;

(2) mental health targeted case management;

(3) partial hospitalization;

(4) medication management;

deleted text begin (5) children's mental health day treatment services;
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end crisis response services under section 256B.0624;

deleted text begin (7) deleted text end new text begin (6) new text end transportation; and

deleted text begin (8) deleted text end new text begin (7) new text end mental health certified family peer specialist services under section 256B.0616.

(b) Children receiving intensive treatment deleted text begin in foster care services deleted text end are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment deleted text begin in foster care deleted text end :

(1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0943;

(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph (l);

(3) home and community-based waiver services;

(4) mental health residential treatment; and

(5) room and board costs as defined in section 256I.03, subdivision 6.

Subd. 7.

Medical assistance payment and rate setting.

new text begin (a) new text end The commissioner shall
establish a single daily per-client encounter rate for intensive treatment deleted text begin in foster care services deleted text end new text begin
for families in the community new text end . The rate must be constructed to cover only eligible services
delivered to an eligible recipient by an eligible provider, as prescribed in subdivision 1,
paragraph (b).

new text begin (b) Beginning July 1, 2022, the commissioner shall increase the rate established under
paragraph (a) by 25 percent. Providers must use the rate increase to provide increased wages
to staff in order to recruit and retain quality staff.
new text end

Sec. 2. new text begin DIRECTION TO COMMISSIONER; COLLABORATIVE INTENSIVE
BRIDGING SERVICES.
new text end

new text begin No later than June 30, 2025, the commissioner of human services shall request additional
federal funds from the Centers for Medicare and Medicaid Services to support collaborative
intensive bridging services. The commissioner shall use all available supporting data and
consult with counties, service providers, and evaluators in making the request.
new text end

Sec. 3. new text begin DIRECTION TO COMMISSIONER; HIGH-FIDELITY WRAPAROUND
SERVICES.
new text end

new text begin The commissioner of human services shall add an enhanced targeted case management
Medicaid reimbursement request into the ongoing targeted case management redesign to
fund recognized evidence-based, high-fidelity wraparound services models that are
family-centered. The commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over human services policy and finance by
......., 2023, on the anticipated timing of submission of a Medicaid state plan amendment,
or other request for federal approval, to the Centers for Medicare and Medicaid Services.
new text end

Sec. 4. new text begin DIRECTION TO COMMISSIONER; INTEGRATED THERAPEUTIC
SERVICES MODEL.
new text end

new text begin No later than February 1, 2023, the commissioner of human services shall report to the
legislative committees and divisions with jurisdiction over human services policy and finance
on a plan for the integrated therapeutic services model to be established as a service model
that will be covered under Medicaid to serve children, youth, and families who demonstrate
eligibility for this level of care. The commissioner shall consult with school districts and
integrated therapeutic services model service providers in creating the plan. The report shall
describe existing funding streams that can support the original demonstration model, describe
key service elements that require funding strategies for a final model, and include a timeline
to develop the fiscal and service analysis to submit a state plan amendment to the Centers
for Medicare and Medicaid Services to receive federal Medicaid matching money for the
integrated therapeutic services model. The report shall include applicable evaluation data
obtained from the ongoing demonstration of the integrated therapeutic services model.
new text end

Sec. 5. new text begin APPROPRIATIONS; COLLABORATIVE INTENSIVE BRIDGING
SERVICES.
new text end

new text begin $....... in fiscal year 2023 is appropriated from the general fund to the commissioner of
human services for grants to sustain existing mental health infrastructure. The grant shall
include money for:
new text end

new text begin (1) maintaining current levels of collaborative intensive bridging services and evaluation;
new text end

new text begin (2) limited expansions of collaborative intensive bridging services and evaluation;
new text end

new text begin (3) training and technical assistance by an expert contractor with experience in
collaborative intensive bridging services to counties and service providers on maintaining
fidelity to the collaborative intensive bridging service model.
new text end

new text begin The base appropriation is $....... in fiscal year 2024, $....... in fiscal year 2025, and $0 in
fiscal year 2026.
new text end

Sec. 6. new text begin APPROPRIATIONS; HIGH-FIDELITY WRAPAROUND SERVICES.
new text end

new text begin $....... in fiscal year 2023 is appropriated from the general fund to the commissioner of
human services for grants to sustain existing mental health infrastructure. The grant shall
be used to maintain current service levels and evaluation practices of system of care
contracted, nationally certified high-fidelity wraparound services sites. The grant shall also
fund limited expansion of high-fidelity wraparound services. The base appropriation is
$....... in fiscal year 2024 and $0 in fiscal year 2025.
new text end