HF 506

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:38am

A bill for an act
relating to human services; including licensed mental health professional
counselors as a qualified provider under medical assistance; amending Minnesota
Statutes 2008, sections 245.462, subdivision 18; 245.470, subdivision 1;
245.4871, subdivision 27; 245.488, subdivision 1; 256B.0622, subdivision 2;
256B.0623, subdivision 5; 256B.0624, subdivisions 5, 8; 256B.0625, subdivision
42; 256B.0943, subdivision 1; 256J.08, subdivision 73a.

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

Section 1.

Minnesota Statutes 2008, section 245.462, subdivision 18, is amended to
read:

Subd. 18.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the treatment of mental illness who is qualified in at
least one of the following ways:

(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171
to 148.285; and:

(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or

(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;

(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;

(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;

(4) in psychiatry: a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry;

(5) in marriage and family therapy: the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness; deleted text begin or
deleted text end

(6) new text begin in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301 with at least
4,000 hours of postmaster's supervised experience in the delivery of clinical services in
the treatment of mental illness; or
new text end

new text begin (7) new text end in allied fields: a person with a master's degree from an accredited college or
university in one of the behavioral sciences or related fields, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness.

Sec. 2.

Minnesota Statutes 2008, section 245.470, subdivision 1, is amended to read:

Subdivision 1.

Availability of outpatient services.

(a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of adults
with mental illness residing in the county. Services may be provided directly by the
county through county-operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with privately
operated mental health centers or mental health clinics approved by the commissioner
under section 245.69, subdivision 2; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a licensed mental health professional as defined in section 245.462,
subdivision 18, clauses (1) to deleted text begin (4) deleted text end new text begin (6) new text end . Clients may be required to pay a fee according to
section 245.481. Outpatient services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating an adult's mental health needs through therapy;

(6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication; and

(7) preventing placement in settings that are more intensive, costly, or restrictive
than necessary and appropriate to meet client needs.

(b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the client can best be served outside the
county.

Sec. 3.

Minnesota Statutes 2008, section 245.4871, subdivision 27, is amended to read:

Subd. 27.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the diagnosis and treatment of children's emotional
disorders. A mental health professional must have training and experience in working with
children consistent with the age group to which the mental health professional is assigned.
A mental health professional must be qualified in at least one of the following ways:

(1) in psychiatric nursing, the mental health professional must be a registered nurse
who is licensed under sections 148.171 to 148.285 and who is certified as a clinical
specialist in child and adolescent psychiatric or mental health nursing by a national nurse
certification organization or who has a master's degree in nursing or one of the behavioral
sciences or related fields from an accredited college or university or its equivalent, with
at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of mental illness;

(2) in clinical social work, the mental health professional must be a person licensed
as an independent clinical social worker under chapter 148D, or a person with a master's
degree in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders;

(3) in psychology, the mental health professional must be an individual licensed by
the board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;

(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American board of psychiatry and neurology or eligible
for board certification in psychiatry;

(5) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; deleted text begin or
deleted text end

(6) new text begin in licensed professional clinical counseling, the mental health professional shall
be a licensed professional clinical counselor under section 148B.5301 with at least 4,000
hours of postmaster's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; or
new text end

new text begin (7) new text end in allied fields, the mental health professional must be a person with a master's
degree from an accredited college or university in one of the behavioral sciences or related
fields, with at least 4,000 hours of post-master's supervised experience in the delivery of
clinical services in the treatment of emotional disturbances.

Sec. 4.

Minnesota Statutes 2008, section 245.488, subdivision 1, is amended to read:

Subdivision 1.

Availability of outpatient services.

(a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of each
child with emotional disturbance residing in the county and the child's family. Services
may be provided directly by the county through county-operated mental health centers or
mental health clinics approved by the commissioner under section 245.69, subdivision 2;
by contract with privately operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with hospital
mental health outpatient programs certified by the Joint Commission on Accreditation
of Hospital Organizations; or by contract with a licensed mental health professional as
defined in section 245.4871, subdivision 27, clauses (1) to deleted text begin (4) deleted text end new text begin (6) new text end . A child or a child's
parent may be required to pay a fee based in accordance with section 245.481. Outpatient
services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating the child's mental health needs through therapy; and

(6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication.

(b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.

(c) Outpatient services offered by the county board to prevent placement must be at
the level of treatment appropriate to the child's diagnostic assessment.

Sec. 5.

Minnesota Statutes 2008, section 256B.0622, subdivision 2, is amended to read:

Subd. 2.

Definitions.

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

(a) "Intensive nonresidential rehabilitative mental health services" means adult
rehabilitative mental health services as defined in section 256B.0623, subdivision 2,
paragraph (a), except that these services are provided by a multidisciplinary staff using
a total team approach consistent with assertive community treatment, the Fairweather
Lodge treatment model, as defined by the standards established by the National Coalition
for Community Living, and other evidence-based practices, and directed to recipients with
a serious mental illness who require intensive services.

(b) "Intensive residential rehabilitative mental health services" means short-term,
time-limited services provided in a residential setting to recipients who are in need of
more restrictive settings and are at risk of significant functional deterioration if they do
not receive these services. Services are designed to develop and enhance psychiatric
stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more
independent setting. Services must be directed toward a targeted discharge date with
specified client outcomes and must be consistent with the Fairweather Lodge treatment
model as defined in paragraph (a), and other evidence-based practices.

(c) "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.

(d) "Overnight staff" means a member of the intensive residential rehabilitative
mental health treatment team who is responsible during hours when recipients are
typically asleep.

(e) "Treatment team" means all staff who provide services under this section to
recipients. At a minimum, this includes the clinical supervisor, mental health professionals
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 ; mental health
practitioners as defined in section 245.462, subdivision 17; mental health rehabilitation
workers under section 256B.0623, subdivision 5, clause (3); and certified peer specialists
under section 256B.0615.

Sec. 6.

Minnesota Statutes 2008, section 256B.0623, subdivision 5, is amended to read:

Subd. 5.

Qualifications of provider staff.

Adult rehabilitative mental health
services must be provided by qualified individual provider staff of a certified provider
entity. Individual provider staff must be qualified under one of the following criteria:

(1) a 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 . If the recipient has a current diagnostic assessment by a licensed
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 , recommending receipt of adult mental health rehabilitative services, the definition of
mental health professional for purposes of this section includes a person who is qualified
under section 245.462, subdivision 18, clause deleted text begin (6) deleted text end new text begin (7) new text end , and who holds a current and valid
national certification as a certified rehabilitation counselor or certified psychosocial
rehabilitation practitioner;

(2) a mental health practitioner as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professional;

(3) a certified peer specialist under section 256B.0615. The certified peer specialist
must work under the clinical supervision of a mental health professional; or

(4) a mental health rehabilitation worker. A mental health rehabilitation worker
means a staff person working under the direction of a mental health practitioner or mental
health professional and under the clinical supervision of a mental health professional in
the implementation of rehabilitative mental health services as identified in the recipient's
individual treatment plan who:

(i) is at least 21 years of age;

(ii) has a high school diploma or equivalent;

(iii) has successfully completed 30 hours of training during the past two years in all
of the following areas: recipient rights, recipient-centered individual treatment planning,
behavioral terminology, mental illness, co-occurring mental illness and substance abuse,
psychotropic medications and side effects, functional assessment, local community
resources, adult vulnerability, recipient confidentiality; and

(iv) meets the qualifications in subitem (A) or (B):

(A) has an associate of arts degree in one of the behavioral sciences or human
services, or is a registered nurse without a bachelor's degree, or who within the previous
ten years has:

(1) three years of personal life experience with serious and persistent mental illness;

(2) three years of life experience as a primary caregiver to an adult with a serious
mental illness or traumatic brain injury; or

(3) 4,000 hours of supervised paid work experience in the delivery of mental health
services to adults with a serious mental illness or traumatic brain injury; or

(B)(1) is fluent in the non-English language or competent in the culture of the
ethnic group to which at least 20 percent of the mental health rehabilitation worker's
clients belong;

(2) receives during the first 2,000 hours of work, monthly documented individual
clinical supervision by a mental health professional;

(3) has 18 hours of documented field supervision by a mental health professional
or practitioner during the first 160 hours of contact work with recipients, and at least six
hours of field supervision quarterly during the following year;

(4) has review and cosignature of charting of recipient contacts during field
supervision by a mental health professional or practitioner; and

(5) has 40 hours of additional continuing education on mental health topics during
the first year of employment.

Sec. 7.

Minnesota Statutes 2008, section 256B.0624, subdivision 5, is amended to read:

Subd. 5.

Mobile crisis intervention staff qualifications.

For provision of adult
mental health mobile crisis intervention services, a mobile crisis intervention team is
comprised of at least two mental health professionals 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 , or a combination of at least one mental health
professional and one mental health practitioner as defined in section 245.462, subdivision
17, with the required mental health crisis training and under the clinical supervision of
a mental health professional on the team. The team must have at least two people with
at least one member providing on-site crisis intervention services when needed. Team
members must be experienced in mental health assessment, crisis intervention techniques,
and clinical decision-making under emergency conditions and have knowledge of local
services and resources. The team must recommend and coordinate the team's services
with appropriate local resources such as the county social services agency, mental health
services, and local law enforcement when necessary.

Sec. 8.

Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to read:

Subd. 8.

Adult crisis stabilization staff qualifications.

(a) Adult mental health
crisis stabilization services must be provided by qualified individual staff of a qualified
provider entity. Individual provider staff must have the following qualifications:

(1) be a 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 ;

(2) be a mental health practitioner as defined in section 245.462, subdivision 17.
The mental health practitioner must work under the clinical supervision of a mental health
professional; or

(3) be a mental health rehabilitation worker who meets the criteria in section
256B.0623, subdivision 5, clause (3); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professional.

(b) Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during
the past two years.

Sec. 9.

Minnesota Statutes 2008, section 256B.0625, subdivision 42, is amended to
read:

Subd. 42.

Mental health professional.

Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall include a person
who is qualified as specified in section 245.462, subdivision 18, deleted text begin clause deleted text end new text begin clauses new text end (5) new text begin and (6) new text end ;
or 245.4871, subdivision 27, deleted text begin clause deleted text end new text begin clauses new text end (5) new text begin and (6) new text end , for the purpose of this section and
Minnesota Rules, parts 9505.0170 to 9505.0475.

Sec. 10.

Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to
read:

Subdivision 1.

Definitions.

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

(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

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

(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.

(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).

(k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.

(l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

(m) "Mental health professional" means an individual as defined in section 245.4871,
subdivision 27, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end , or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

(n) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

(o) "Skills training" means individual, family, or group training designed to improve
the basic functioning of the child with emotional disturbance and the child's family in the
activities of daily living and community living, and to improve the social functioning of the
child and the child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual, family, and group skills training must:

(1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;

(2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and

(3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.

Sec. 11.

Minnesota Statutes 2008, section 256J.08, subdivision 73a, is amended to read:

Subd. 73a.

Qualified professional.

(a) For physical illness, injury, or incapacity,
a "qualified professional" means a licensed physician, a physician's assistant, a nurse
practitioner, or a licensed chiropractor.

(b) For developmental disability and intelligence testing, a "qualified professional"
means an individual qualified by training and experience to administer the tests necessary
to make determinations, such as tests of intellectual functioning, assessments of adaptive
behavior, adaptive skills, and developmental functioning. These professionals include
licensed psychologists, certified school psychologists, or certified psychometrists working
under the supervision of a licensed psychologist.

(c) For learning disabilities, a "qualified professional" means a licensed psychologist
or school psychologist with experience determining learning disabilities.

(d) For mental health, a "qualified professional" means a licensed physician or a
qualified mental health professional. A "qualified mental health professional" means:

(1) for children, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in child
and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences
or related fields from an accredited college or university or its equivalent, with at least
4,000 hours of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness;

(2) for adults, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in adult psychiatric
and mental health nursing by a national nurse certification organization or who has a
master's degree in nursing or one of the behavioral sciences or related fields from an
accredited college or university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness;

(3) in clinical social work, a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;

(4) in psychology, an individual licensed by the Board of Psychology under sections
148.88 to 148.98, who has stated to the Board of Psychology competencies in the
diagnosis and treatment of mental illness;

(5) in psychiatry, a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry; deleted text begin and
deleted text end

(6) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39, with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness new text begin ; and
new text end

new text begin (7) in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301 with at least
4,000 hours of postmaster's supervised experience in the delivery of clinical services in
the treatment of mental illness new text end .