HF 1281

1st Engrossment - 91st Legislature (2019 - 2020) Posted on 03/14/2019 03:44pm

A bill for an act
relating to human services; modifying provisions governing behavioral health
home services and medical respite health home services; appropriating money;
amending Minnesota Statutes 2018, section 256B.0757, subdivisions 1, 2, 4, 5, 8,
by adding subdivisions.

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

Section 1.

Minnesota Statutes 2018, section 256B.0757, subdivision 1, is amended to read:

Subdivision 1.

Provision of coverage.

(a) The commissioner shall provide medical
assistance coverage of health home services for eligible individuals with chronic conditions
who select a designated provider as the individual's health home.

(b) The commissioner shall implement this section in compliance with the requirements
of the state option to provide health homes for enrollees with chronic conditions, as provided
under the Patient Protection and Affordable Care Act, Public Law 111-148, sections 2703
and 3502. Terms used in this section have the meaning provided in that act.

(c) The commissioner shall establish health homes to serve populations with serious
mental illness who meet the eligibility requirements described under subdivision 2, new text begin paragraph
(b) new text end clause deleted text begin (4) deleted text end new text begin (1) new text end . The health home services provided by health homes shall focus on both
the behavioral and the physical health of these populations.

new text begin (d) The commissioner shall establish medical respite health homes to serve individuals
who are homeless and meet the eligibility requirements described under subdivision 2,
paragraph (b), clause (2). The commissioner shall work with stakeholders to develop
eligibility requirements, provider qualification requirements, and service delivery
requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
shall notify the revisor of statutes when federal approval has been obtained.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0757, subdivision 2, is amended to read:

Subd. 2.

Eligible individual.

new text begin (a) The commissioner may develop health home models
in accordance with United States Code, title 42, section 1396w-4(h)(1).
new text end

new text begin (b) new text end An individual is eligible for health home services under this section if the individual
is eligible for medical assistance under this chapter and deleted text begin has at least deleted text end :

deleted text begin (1) two chronic conditions;
deleted text end

deleted text begin (2) one chronic condition and is at risk of having a second chronic condition;
deleted text end

deleted text begin (3) one serious and persistent mental health condition; or
deleted text end

deleted text begin (4) deleted text end new text begin (1) has new text end a condition that meets the definition new text begin of serious mental illness as described new text end in
section 245.462, subdivision 20, paragraph (a), or new text begin emotional disturbance as defined in section new text end
245.4871, subdivision 15, clause (2); deleted text begin and has a current diagnostic assessment as defined in
Minnesota Rules, part 9505.0372, subpart 1, item B or C, as performed or reviewed by a
mental health professional employed by or under contract with the behavioral health home deleted text end new text begin
or
new text end

new text begin (2) the individual is homeless. For purposes of this clause, an individual is homeless if
the individual lacks a fixed, adequate night-time residence new text end .

The commissioner shall establish criteria for determining continued eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Discharge criteria. new text end

new text begin (a) An individual may be discharged from behavioral
health home services if:
new text end

new text begin (1) the behavioral health home services provider is unable to locate, contact, and engage
the individual for a period of greater than three months after persistent efforts by the
behavioral health home services provider; or
new text end

new text begin (2) the individual is unwilling to participate in behavioral health home services as
demonstrated by the individual's refusal to meet with the behavioral health home services
provider, or refusal to identify the individual's health and wellness goals or the activities or
support necessary to achieve these goals.
new text end

new text begin (b) Before discharge from behavioral health home services, the behavioral health home
services provider must offer a face-to-face meeting with the individual and the individual's
identified supports, to discuss options available to the individual, including maintaining
behavioral health home services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2018, section 256B.0757, subdivision 4, is amended to read:

Subd. 4.

Designated provider.

deleted text begin (a) deleted text end Health home services are voluntary and an eligible
individual may choose any designated provider. The commissioner shall establish designated
providers to serve as health homes and provide the services described in subdivision 3 to
individuals eligible under subdivision 2. The commissioner shall apply for grants as provided
under section 3502 of the Patient Protection and Affordable Care Act to establish health
homes and provide capitated payments to designated providers. For purposes of this section,
"designated provider" means a provider, clinical practice or clinical group practice, rural
clinic, community health center, community mental health center, or any other entity that
is determined by the commissioner to be qualified to be a health home for eligible individuals.
This determination must be based on documentation evidencing that the designated provider
has the systems and infrastructure in place to provide health home services and satisfies the
qualification standards established by the commissioner in consultation with stakeholders
and approved by the Centers for Medicare and Medicaid Services.

deleted text begin (b) The commissioner shall develop and implement certification standards for designated
providers under this subdivision.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 4a. new text end

new text begin Behavioral health home services provider requirements. new text end

new text begin A behavioral
health home services provider must:
new text end

new text begin (1) be an enrolled Minnesota Health Care Programs provider;
new text end

new text begin (2) provide a medical assistance covered primary care or behavioral health service;
new text end

new text begin (3) utilize an electronic health record;
new text end

new text begin (4) utilize an electronic patient registry that contains the data elements required by the
commissioner;
new text end

new text begin (5) demonstrate the organization's capacity to administer screenings approved by the
commissioner for substance use disorder or alcohol and tobacco use;
new text end

new text begin (6) demonstrate the organization's capacity to refer an individual to resources appropriate
to the individual's screening results;
new text end

new text begin (7) have policies and procedures to track referrals to ensure that the referral met the
individual's needs;
new text end

new text begin (8) conduct a brief needs assessment when an individual begins receiving behavioral
health home services. The brief needs assessment must be completed with input from the
individual and the individual's identified supports. The brief needs assessment must address
the individual's immediate safety and transportation needs and potential barriers to
participating in behavioral health home services;
new text end

new text begin (9) conduct a health wellness assessment within 60 days after intake that contains all
required elements identified by the commissioner;
new text end

new text begin (10) conduct a health action plan that contains all required elements identified by the
commissioner. The plan must be completed within 90 days after intake and must be updated
at least once every six months, or more frequently if significant changes to an individual's
needs or goals occur;
new text end

new text begin (11) agree to cooperate with and participate in the state's monitoring and evaluation of
behavioral health home services; and
new text end

new text begin (12) obtain the individual's written consent to begin receiving behavioral health home
services using a form approved by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 4b. new text end

new text begin Behavioral health home provider training and practice transformation
requirements. new text end

new text begin (a) The behavioral health home services provider must ensure that all staff
delivering behavioral health home services receive adequate preservice and ongoing training,
including:
new text end

new text begin (1) training approved by the commissioner that describes the goals and principles of
behavioral health home services; and
new text end

new text begin (2) training on evidence-based practices to promote an individual's ability to successfully
engage with medical, behavioral health, and social services to achieve the individual's health
and wellness goals.
new text end

new text begin (b) The behavioral health home services provider must ensure that staff are capable of
implementing culturally responsive services, as determined by the individual's culture,
beliefs, values, and language as identified in the individual's health wellness assessment.
new text end

new text begin (c) The behavioral health home services provider must participate in the department's
practice transformation activities to support continued skill and competency development
in the provision of integrated medical, behavioral health, and social services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 4c. new text end

new text begin Behavioral health home staff qualifications. new text end

new text begin (a) A behavioral health home
services provider must maintain staff with required professional qualifications appropriate
to the setting.
new text end

new text begin (b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.
new text end

new text begin (c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6).
new text end

new text begin (d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner as defined
in section 245.462, subdivision 17, or a community health worker as defined in section
256B.0625, subdivision 49.
new text end

new text begin (e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
new text end

new text begin (1) a peer support specialist as defined in section 256B.0615;
new text end

new text begin (2) a family peer support specialist as defined in section 256B.0616;
new text end

new text begin (3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
new text end

new text begin (4) a mental health rehabilitation worker as defined in section 256B.0623, subdivision
5, clause (4);
new text end

new text begin (5) a community paramedic as defined in section 144E.28, subdivision 9;
new text end

new text begin (6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
new text end

new text begin (7) a community health worker as defined in section 256B.0625, subdivision 49.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 4d. new text end

new text begin Behavioral health home service delivery standards. new text end

new text begin (a) A behavioral health
home services provider must meet the following service delivery standards:
new text end

new text begin (1) establish and maintain processes to support the coordination of an individual's primary
care, behavioral health, and dental care;
new text end

new text begin (2) maintain a team-based model of care, including regular coordination and
communication between behavioral health home services team members;
new text end

new text begin (3) use evidence-based practices that recognize and are tailored to the medical, social,
economic, behavioral health, functional impairment, cultural, and environmental factors
affecting the individual's health and health care choices;
new text end

new text begin (4) use person-centered planning practices to ensure the individual's health action plan
accurately reflects the individual's preferences, goals, resources, and optimal outcomes for
the individual and the individual's identified supports;
new text end

new text begin (5) use the patient registry to identify individuals and population subgroups requiring
specific levels or types of care and provide or refer the individual to needed treatment,
intervention, or services;
new text end

new text begin (6) utilize the Department of Human Services Partner Portal to identify past and current
treatment or services and identify potential gaps in care;
new text end

new text begin (7) deliver services consistent with the standards for frequency and face-to-face contact
required by the commissioner;
new text end

new text begin (8) ensure that a diagnostic assessment is completed for each individual receiving
behavioral health home services within six months of the start of behavioral health home
services;
new text end

new text begin (9) deliver services in locations and settings that meet the needs of the individual;
new text end

new text begin (10) provide a central point of contact to ensure that individuals and the individual's
identified supports can successfully navigate the array of services that impact the individual's
health and well-being;
new text end

new text begin (11) have capacity to assess an individual's readiness for change and the individual's
capacity to integrate new health care or community supports into the individual's life;
new text end

new text begin (12) offer or facilitate the provision of wellness and prevention education on
evidenced-based curriculums specific to the prevention and management of common chronic
conditions;
new text end

new text begin (13) help an individual set up and prepare for medical, behavioral health, social service,
or community support appointments, including accompanying the individual to appointments
as appropriate, and providing follow-up with the individual after these appointments;
new text end

new text begin (14) offer or facilitate the provision of health coaching related to chronic disease
management and the navigation of complex systems of care to the individual, the individual's
family, and identified supports;
new text end

new text begin (15) connect the individual, the individual's family, and identified supports to appropriate
support services that help the individual overcome access or service barriers, increase
self-sufficiency skills, and improve overall health;
new text end

new text begin (16) provide effective referrals and timely access to services; and
new text end

new text begin (17) establish a continuous quality improvement process for providing behavioral health
home services.
new text end

new text begin (b) The behavioral health home services provider must also create a plan, in partnership
with the individual and the individual's identified supports, to support the individual after
discharge from a hospital, residential treatment program, or other setting. The plan must
include protocols for:
new text end

new text begin (1) maintaining contact between the behavioral health home services team member, the
individual, and the individual's identified supports during and after discharge;
new text end

new text begin (2) linking the individual to new resources as needed;
new text end

new text begin (3) reestablishing the individual's existing services and community and social supports;
and
new text end

new text begin (4) following up with appropriate entities to transfer or obtain the individual's service
records as necessary for continued care.
new text end

new text begin (c) If the individual is enrolled in a managed care plan, a behavioral health home services
provider must:
new text end

new text begin (1) notify the behavioral health home services contact designated by the managed care
plan within 30 days of when the individual begins behavioral health home services; and
new text end

new text begin (2) adhere to the managed care plan communication and coordination requirements
described in the behavioral health home services manual.
new text end

new text begin (d) Before terminating behavioral health home services, the behavioral health home
services provider must:
new text end

new text begin (1) provide a 60-day notice of termination of behavioral health home services to all
individuals receiving behavioral health home services, the commissioner, and managed care
plans, if applicable; and
new text end

new text begin (2) refer individuals receiving behavioral health home services to a new behavioral
health home services provider.
new text end

Sec. 9.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 4e. new text end

new text begin Behavioral health home provider variances. new text end

new text begin (a) The commissioner may
grant a variance to specific requirements under subdivisions 4a, 4b, 4c, or 4d for a behavioral
health home services provider according to this subdivision.
new text end

new text begin (b) The commissioner may grant a variance if the commissioner finds that:
new text end

new text begin (1) failure to grant the variance would result in hardship or injustice to the applicant;
new text end

new text begin (2) the variance would be consistent with the public interest; and
new text end

new text begin (3) the variance would not reduce the level of services provided to individuals served
by the organization.
new text end

new text begin (c) The commissioner may grant a variance from one or more requirements to permit
an applicant to offer behavioral health home services of a type or in a manner that is
innovative, if the commissioner finds that the variance does not impede the achievement of
the criteria in subdivisions 4a, 4b, 4c, or 4d and may improve the behavioral health home
services provided by the applicant.
new text end

new text begin (d) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 10.

Minnesota Statutes 2018, section 256B.0757, subdivision 5, is amended to read:

Subd. 5.

Payments.

new text begin (a) new text end The commissioner shall deleted text begin make payments to each designated
provider for the provision of health home services described in subdivision 3 to each eligible
individual under subdivision 2 that selects the health home as a provider deleted text end new text begin establish a single,
statewide reimbursement rate for behavioral health home services described in subdivisions
4a to 4d new text end .

new text begin (b) The commissioner shall establish a single, statewide reimbursement rate for medical
respite health home services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
shall notify the revisor of statutes when federal approval has been obtained.
new text end

Sec. 11.

Minnesota Statutes 2018, section 256B.0757, subdivision 8, is amended to read:

Subd. 8.

Evaluation and continued development.

(a) For continued certification under
this section, new text begin behavioral new text end health homes new text begin and medical respite health homes new text end must meet process,
outcome, and quality standards developed and specified by the commissioner. The
commissioner shall collect data from health homes as necessary to monitor compliance with
certification standards.

(b) The commissioner may contract with a private entity to evaluate patient and family
experiences, health care utilization, and costs.

(c) The commissioner shall utilize findings from the implementation of deleted text begin behavioral deleted text end health
homes to determine populations to serve under subsequent health home models for individuals
with chronic conditions.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 12. new text begin REQUIREMENTS, STANDARDS, AND QUALIFICATIONS FOR
MEDICAL RESPITE HEALTH HOMES.
new text end

new text begin The commissioner of human services, in consultation with stakeholders, shall develop
requirements, service standards, and qualifications for medical respite health homes.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 13. new text begin APPROPRIATION.
new text end

new text begin $....... in fiscal year 2020 and $....... in fiscal year 2021 are appropriated from the general
fund to the commissioner of human services for grants to providers of medical respite health
home services. Grants may be used by providers to pay for the cost of medical respite health
home services delivered during the period in which the medical assistance benefit is being
developed and federal approval is being sought. Grants shall be awarded to organizations
delivering medical respite services, as of January 1, 2019, to individuals experiencing
homelessness. Grantees must agree to work toward becoming certified as a medical respite
health home. This is a onetime appropriation and is available until expended.
new text end