HF 1047

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 04/02/2013 12:14pm

A bill for an act
relating to state government; requiring development of outreach, public
education, and screening for maternal depression; expanding medical assistance
eligibility for pregnant women and infants; requiring the commissioner of human
services to provide technical assistance related to maternal depression screening
and referrals; adding parenting skills to adult rehabilitative mental health
services; expanding Minnesota health care program outreach; requiring reports;
appropriating money; amending Minnesota Statutes 2012, sections 145.906;
145A.17, subdivision 1; 214.12, by adding a subdivision; 256B.04, by adding a
subdivision; 256B.055, subdivisions 5, 6; 256B.057, subdivision 1; 256B.0623,
subdivision 2; proposing coding for new law in Minnesota Statutes, chapter 145.

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

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2012, section 145.906, is amended to read:

145.906 POSTPARTUM DEPRESSION EDUCATION AND INFORMATION.

(a) The commissioner of health shall work with health care facilities, licensed health
and mental health care professionals, the women, infants, and children (WIC) program,
mental health advocates, consumers, and families in the state to develop materials and
information about postpartum depression, including treatment resources, and develop
policies and procedures to comply with this section.

(b) Physicians, traditional midwives, and other licensed health care professionals
providing prenatal care to women must have available to women and their families
information about postpartum depression.

(c) Hospitals and other health care facilities in the state must provide departing new
mothers and fathers and other family members, as appropriate, with written information
about postpartum depression, including its symptoms, methods of coping with the illness,
and treatment resources.

(d) Information about postpartum depression, including its symptoms, potential
impact on families, and treatment resources, must be available at WIC sites.

new text begin (e) The commissioner of health, in collaboration with the commissioner of human
services, shall reduce the racial disparity gap in knowledge of maternal and postpartum
depression, as measured by the Pregnancy Risk Assessment and Monitoring System
(PRAMS) and other survey data collected by the commissioner of health, to the extent
that it is available.
new text end

Sec. 2.

new text begin [145.907] MATERNAL DEPRESSION; DEFINITION.
new text end

new text begin "Maternal depression" means depression or other perinatal mood or anxiety disorder
experienced by a woman during pregnancy or during the first year following the birth of
her child.
new text end

Sec. 3.

Minnesota Statutes 2012, section 145A.17, subdivision 1, is amended to read:

Subdivision 1.

Establishment; goals.

The commissioner shall establish a program
to fund family home visiting programs designed to foster healthy beginnings, improve
pregnancy outcomes, promote school readiness, prevent child abuse and neglect, reduce
juvenile delinquency, promote positive parenting and resiliency in children, and promote
family health and economic self-sufficiency for children and families. The commissioner
shall promote partnerships, collaboration, and multidisciplinary visiting done by teams of
professionals and paraprofessionals from the fields of public health nursing, social work,
and early childhood education. A program funded under this section must serve families
at or below 200 percent of the federal poverty guidelines, and other families determined
to be at risk, including but not limited to being at risk for child abuse, child neglect, or
juvenile delinquency. Programs must begin prenatally whenever possible and must be
targeted to families with:

(1) adolescent parents;

(2) a history of alcohol or other drug abuse;

(3) a history of child abuse, domestic abuse, or other types of violence;

(4) a history of domestic abuse, rape, or other forms of victimization;

(5) reduced cognitive functioning;

(6) a lack of knowledge of child growth and development stages;

(7) low resiliency to adversities and environmental stresses;

(8) insufficient financial resources to meet family needs;

(9) a history of homelessness;

(10) a risk of long-term welfare dependence or family instability due to employment
barriers; deleted text begin or
deleted text end

new text begin (11) a serious mental health disorder, including maternal depression as defined in
section 145.907; or
new text end

deleted text begin (11) deleted text end new text begin (12) new text end other risk factors as determined by the commissioner.

Sec. 4.

Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
to read:

new text begin Subd. 22. new text end

new text begin Maternal depression screening and referral. new text end

new text begin (a) The commissioner
shall provide technical assistance to health care providers to improve maternal depression
screening and referral rates for medical assistance and MinnesotaCare enrollees. The
technical assistance must include, but is not limited to, the provision of information on
culturally competent practice, administrative and legal liability issues, and best practices
for discussing mental health issues with patients.
new text end

new text begin (b) The commissioner, in consultation with the commissioners of health and
education, shall monitor: (1) maternal depression screening, to the extent possible, and
referral rates based on medical assistance and MinnesotaCare claims and Pregnancy
Risk Assessment Monitoring System (PRAMS) survey findings; and (2) the impact of
improved screening.
new text end

new text begin (c) For purposes of this subdivision, "maternal depression" has the meaning provided
in section 145.907.
new text end

Sec. 5.

Minnesota Statutes 2012, section 256B.055, subdivision 5, is amended to read:

Subd. 5.

Pregnant women; dependent unborn child.

Medical assistance may be
paid for a pregnant woman who has written verification of a positive pregnancy test from
a physician or licensed registered nurse, who meets the other eligibility criteria of this
section and who would be categorically eligible for assistance under the state's AFDC
plan in effect as of July 16, 1996, as required by the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193, if the child
had been born and was living with the woman. For purposes of this subdivision, a woman
is considered pregnant for deleted text begin 60 days deleted text end new text begin the first year new text end postpartum.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013, or upon federal
approval, whichever is later.
new text end

Sec. 6.

Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:

Subd. 6.

Pregnant women; needy unborn child.

Medical assistance may be paid
for a pregnant woman who has written verification of a positive pregnancy test from a
physician or licensed registered nurse, who meets the other eligibility criteria of this
section and whose unborn child would be eligible as a needy child under subdivision 10 if
born and living with the woman. For purposes of this subdivision, a woman is considered
pregnant for deleted text begin 60 days deleted text end new text begin the first year new text end postpartum.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013, or upon federal
approval, whichever is later.
new text end

Sec. 7.

Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year of
age or a pregnant woman who has written verification of a positive pregnancy test from
a physician or licensed registered nurse is eligible for medical assistance if countable
family income is equal to or less than 275 percent of the federal poverty guideline for the
same family size. For purposes of this subdivision, "countable family income" means the
amount of income considered available using the methodology of the AFDC program
under the state's AFDC plan as of July 16, 1996, as required by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193,
except for the earned income disregard and employment deductions.

(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to the effective date for any months in the six-month budget period before
that date and the income standards and methodologies in effect on the effective date for
any months in the six-month budget period on or after that date. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
2003, and the income standards and methodologies in effect on the expiration date for any
months in the six-month budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(3) An amount equal to the amount of earned income exceeding 275 percent of
the federal poverty guideline, up to a maximum of the amount by which the combined
total of 185 percent of the federal poverty guideline plus the earned income disregards
and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
pregnant women and infants less than one year of age.

(c) Dependent care and child support paid under court order shall be deducted from
the countable income of pregnant women.

(d) An infant born to a woman who was eligible for and receiving medical assistance
on the date of the child's birth shall continue to be eligible for medical assistance without
redetermination until the child's deleted text begin first deleted text end new text begin second new text end birthday.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013, or upon federal
approval, whichever is later.
new text end

Sec. 8.

Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:

Subd. 2.

Definitions.

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

(a) "Adult rehabilitative mental health services" means mental health services
which are rehabilitative and enable the recipient to develop and enhance psychiatric
stability, social competencies, personal and emotional adjustment, deleted text begin and deleted text end independent living new text begin ,
parenting skills, new text end and community skills, when these abilities are impaired by the symptoms
of mental illness. Adult rehabilitative mental health services are also appropriate when
provided to enable a recipient to retain stability and functioning, if the recipient would
be at risk of significant functional decompensation or more restrictive service settings
without these services.

(1) Adult rehabilitative mental health services instruct, assist, and support the
recipient in areas such as: interpersonal communication skills, community resource
utilization and integration skills, crisis assistance, relapse prevention skills, health care
directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
and nutrition skills, transportation skills, medication education and monitoring, mental
illness symptom management skills, household management skills, employment-related
skills, new text begin parenting skills, new text end and transition to community living services.

(2) These services shall be provided to the recipient on a one-to-one basis in the
recipient's home or another community setting or in groups.

(b) "Medication education services" means services provided individually or in
groups which focus on educating the recipient about mental illness and symptoms; the role
and effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians,
pharmacists, physician's assistants, or registered nurses.

(c) "Transition to community living services" means services which maintain
continuity of contact between the rehabilitation services provider and the recipient and
which facilitate discharge from a hospital, residential treatment program under Minnesota
Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
living services are not intended to provide other areas of adult rehabilitative mental health
services.

ARTICLE 2

MISCELLANEOUS

Section 1.

Minnesota Statutes 2012, section 214.12, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Parental depression. new text end

new text begin The health-related licensing boards that regulate
professions that serve caregivers at risk of depression, or their children, including
behavioral health and therapy, chiropractic, marriage and family therapy, medical practice,
nursing, psychology, and social work, shall provide educational materials on the subject of
parental depression and its potential effects on children if unaddressed, including how to:
new text end

new text begin (1) screen mothers for depression;
new text end

new text begin (2) identify children who are affected by their mother's depression; and
new text end

new text begin (3) provide treatment or referral information on needed services.
new text end

Sec. 2. new text begin INSTRUCTIONS TO COMMISSIONERS; PLAN.
new text end

new text begin (a) By September 1, 2014, the commissioners of human services, health, and
education shall develop a joint plan to reduce the prevalence of parental depression and
other serious mental illness and the potential impact of unaddressed parental mental
illness on children. The plan must include specific goals, outcomes, and recommended
measures to determine the impact of interventions on the incidence of parental depression
and child well-being, including early childhood screening and the school readiness of
high-risk children. The plan shall address ways to encourage a multigenerational approach
to adult mental health and child well-being in public health, health care, adult and child
mental health, child welfare, and other relevant programs and policies, and include
recommendations to increase public awareness about untreated parental depression and
its potential harmful impact on children.
new text end

new text begin (b) To identify key goals and objectives to be included in the plan, the commissioners
may consult with multisector, multidisciplinary stakeholders including, but not limited
to, local public health agencies, health providers, mental health providers, researchers,
early childhood professionals, and advocates. The commissioners may use the findings
and recommendations of the visible child work group established in Laws 2012, chapter
247, article 3, section 27, in developing its recommendations.
new text end

new text begin (c) Jointly prepared biennial reports must be submitted to the legislature beginning
December 15, 2015. The reports must address progress on plan implementation, budget
and policy recommendations, and data on access to relevant services and resources
reported by race, geography, and income. The reports must address progress in achieving
goals established by Minnesota Milestones or other relevant statewide goals.
new text end

new text begin (d) The Department of Human Services, Children's Mental Health Division, is the
lead agency and is responsible for compiling data; coordinating development of joint
performance measures; and convening the agencies and divisions in order to implement
the plan developed under paragraph (a), aimed at reducing the prevalence of maternal
depression and its adverse impact on child development. The Children's Mental Health
Division is responsible for submitting the initial and biennial plans.
new text end

ARTICLE 3

APPROPRIATIONS

Section 1. new text begin MENTAL HEALTH CONSULTATION.
new text end

new text begin $....... in fiscal year 2014 and $....... in fiscal year 2015 are appropriated from the
general fund to the commissioner of human services to provide mental health consultation
to early Head Start and Head Start programs, child care centers, family day care providers,
and legally unlicensed family child care providers in order to reduce the number of children
expelled from these programs due to behavioral, emotional, and developmental issues.
new text end

Sec. 2. new text begin CHILDREN'S MENTAL HEALTH GRANTS.
new text end

new text begin $....... in fiscal year 2014 and $....... in fiscal year 2015 are appropriated from the
general fund to the commissioner of human services for children's mental health grants.
new text end

Sec. 3. new text begin HOME VISITING PROGRAMS.
new text end

new text begin $....... in fiscal year 2014 and $....... in fiscal year 2015 are appropriated from the
general fund to the commissioner of health for grants to local public health agencies to
implement evidence-based family home visiting programs for high-risk families under
Minnesota Statutes, section 145A.17.
new text end