HF 1515

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:52am

A bill for an act
relating to human services; modifying children's therapeutic services; exempting
certain programs from licensing requirements; amending Minnesota Statutes
2008, sections 157.16, by adding a subdivision; 245.4871, subdivision 10;
256B.0943, subdivisions 4, 6, 9.

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

Section 1.

Minnesota Statutes 2008, section 157.16, is amended by adding a
subdivision to read:

new text begin Subd. 5. new text end

new text begin Exemption for certain establishments. new text end

new text begin This section does not apply to
group residential facilities of ten or fewer beds licensed by the commissioner of human
services under Minnesota Rules, chapter 2960, or Minnesota Rules, parts 9520.0500
to 9520.0670, provided the facility employs or contracts with a certified food manager
under Minnesota Rules, part 4626.2015.
new text end

Sec. 2.

Minnesota Statutes 2008, section 245.4871, subdivision 10, is amended to read:

Subd. 10.

Day treatment services.

"Day treatment," "day treatment services," or
"day treatment program" means a structured program of treatment and care provided to a
child in:

(1) an outpatient hospital accredited by the Joint Commission on Accreditation of
Health Organizations and licensed under sections 144.50 to 144.55;

(2) a community mental health center under section 245.62;

(3) an entity that is under contract with the county board to operate a program that
meets the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts
9505.0170 to 9505.0475; or

(4) an entity that operates a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is
under contract with an entity that is under contract with a county board.

Day treatment consists of group psychotherapy and other intensive therapeutic
services that are provided for a minimum deleted text begin three-hour deleted text end new text begin two-hour new text end time block by a
multidisciplinary staff under the clinical supervision of a mental health professional.
Day treatment may include education and consultation provided to families and
other individuals as an extension of the treatment process. The services are aimed at
stabilizing the child's mental health status, and developing and improving the child's daily
independent living and socialization skills. Day treatment services are distinguished from
day care by their structured therapeutic program of psychotherapy services. Day treatment
services are not a part of inpatient hospital or residential treatment services. deleted text begin Day treatment
services for a child are an integrated set of education, therapy, and family interventions.
deleted text end

A day treatment service must be available to a child deleted text begin at least five days deleted text end new text begin up to 15 hours
new text end a week throughout the year and must be coordinated with, integrated with, or part of an
education program offered by the child's school.

Sec. 3.

Minnesota Statutes 2008, section 256B.0943, subdivision 4, is amended to read:

Subd. 4.

Provider entity certification.

(a) Effective July 1, 2003, the commissioner
shall establish an initial provider entity application and certification process and
recertification process to determine whether a provider entity has an administrative
and clinical infrastructure that meets the requirements in subdivisions 5 and 6. The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity that no longer meets the
requirements in this section. The county, tribe, and the commissioner shall be mutually
responsible and accountable for the county's, tribe's, and state's part of the certification,
recertification, and decertification processes.

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

(1) an Indian health services facility or a facility owned and operated by a tribe or
tribal organization operating as a 638 facility under Public Law 93-638 certified by the
state;

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

(3) a noncounty entity deleted text begin recommended for certification by the provider's host county
and deleted text end certified by the state.

Sec. 4.

Minnesota Statutes 2008, section 256B.0943, subdivision 6, is amended to read:

Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be
an eligible provider entity under this section, a provider entity must have a clinical
infrastructure that utilizes diagnostic assessment, an individualized treatment plan,
service delivery, and individual treatment plan review that are culturally competent,
child-centered, and family-driven to achieve maximum benefit for the client. The provider
entity must review new text begin , new text end and update new text begin as necessary, new text end the clinical policies and procedures every
three years and must distribute the policies and procedures to staff initially and upon
each subsequent update.

(b) The clinical infrastructure written policies and procedures must include policies
and procedures for:

(1) providing or obtaining a client's diagnostic assessment that identifies acute and
chronic clinical disorders, co-occurring medical conditions, sources of psychological
and environmental problems, deleted text begin and deleted text end new text begin including new text end a functional assessment. The functional
assessment new text begin component new text end must clearly summarize the client's individual strengths and needs;

(2) developing an individual treatment plan that is:

(i) based on the information in the client's diagnostic assessment;

(ii) developed no later than the end of the first psychotherapy session after the
completion of the client's diagnostic assessment by the mental health professional who
provides the client's psychotherapy;

(iii) developed through a child-centered, family-driven planning process that
identifies service needs and individualized, planned, and culturally appropriate
interventions that contain specific treatment goals and objectives for the client and the
client's family or foster family;

(iv) reviewed at least once every 90 days and revised, if necessary; and

(v) signed by the client or, if appropriate, by the client's parent or other person
authorized by statute to consent to mental health services for the client;

(3) developing an individual behavior plan that documents services to be provided
by the mental health behavioral aide. The individual behavior plan must include:

(i) detailed instructions on the service to be provided;

(ii) time allocated to each service;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual
treatment plan;

(4) clinical supervision of the mental health practitioner and mental health behavioral
aide. A mental health professional must document the clinical supervision the professional
provides by cosigning individual treatment plans and making entries in the client's record
on supervisory activities. Clinical supervision does not include the authority to make or
terminate court-ordered placements of the child. A clinical supervisor must be available
for urgent consultation as required by the individual client's needs or the situation. Clinical
supervision may occur individually or in a small group to discuss treatment and review
progress toward goals. The focus of clinical supervision must be the client's treatment
needs and progress and the mental health practitioner's or behavioral aide's ability to
provide services;

(4a) CTSS certified provider entities providing day treatment programs must meet
the conditions in items (i) to (iii):

(i) the supervisor must be present and available on the premises more than 50
percent of the time in a five-working-day period during which the supervisee is providing
a mental health service;

(ii) the diagnosis and the client's individual treatment plan or a change in the
diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
by the supervisor; and

(iii) every 30 days, the supervisor must review and sign the record deleted text begin of deleted text end new text begin indicating the
supervisor has reviewed new text end the client's care for all activities in the preceding 30-day period;

(4b) for all other services provided under CTSS, clinical supervision standards
provided in items (i) to (iii) must be used:

(i) medical assistance shall reimburse a mental health practitioner who maintains a
consulting relationship with a mental health professional who accepts full professional
responsibility deleted text begin and is present on site for at least one observation during the first 12 hours
in which the mental health practitioner provides the individual, family, or group skills
training to the child or the child's family deleted text end ;

(ii) deleted text begin thereafter, deleted text end the mental health professional is required to be present on site for
observation as clinically appropriate when the mental health practitioner is providing
individual, family, or group skills training to the child or the child's family; and

(iii) new text begin when conducted, new text end the observation must be a minimum of one clinical unit. The
on-site presence of the mental health professional must be documented in the child's record
and signed by the mental health professional who accepts full professional responsibility;

(5) providing direction to a mental health behavioral aide. For entities that employ
mental health behavioral aides, the clinical supervisor must be employed by the provider
entity or other certified children's therapeutic supports and services provider entity to
ensure necessary and appropriate oversight for the client's treatment and continuity
of care. The mental health professional or mental health practitioner giving direction
must begin with the goals on the individualized treatment plan, and instruct the mental
health behavioral aide on how to construct therapeutic activities and interventions that
will lead to goal attainment. The professional or practitioner giving direction must also
instruct the mental health behavioral aide about the client's diagnosis, functional status,
and other characteristics that are likely to affect service delivery. Direction must also
include determining that the mental health behavioral aide has the skills to interact with
the client and the client's family in ways that convey personal and cultural respect and
that the aide actively solicits information relevant to treatment from the family. The aide
must be able to clearly explain the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision
and requires the professional or practitioner providing it to continuously evaluate the
mental health behavioral aide's ability to carry out the activities of the individualized
treatment plan and the individualized behavior plan. When providing direction, the
professional or practitioner must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy
and consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan,
and communicate treatment instructions and methodologies as appropriate to ensure
that treatment is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and

(v) record the results of any evaluation and corrective actions taken to modify the
work of the mental health behavioral aide;

(6) providing service delivery that implements the individual treatment plan and
meets the requirements under subdivision 9; and

(7) individual treatment plan review. The review must determine the extent to which
the services have met the goals and objectives in the previous treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the client, if appropriate, and by the client's parent or other person authorized by
statute to give consent to the mental health services for the child.

Sec. 5.

Minnesota Statutes 2008, 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; and (iii)
an entity that is under contract with the county board to operate a program that meets
the requirements of sections 245.4712, subdivision 2, and 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 deleted text begin three-hour deleted text end new text begin two-hour new text end time block. The deleted text begin three-hour deleted text end new text begin two-hour new text end time block must include
at least one hour deleted text begin , but no more than two hours, deleted text end of individual or group psychotherapy.
deleted text begin The remainder of the three-hour time block may include recreation therapy, socialization
therapy, or independent living skills therapy, but only if the therapies are included in the
client's individual treatment plan deleted text end new text begin The structured treatment program may include individual
or group psychotherapy and recreation therapy, socialization therapy, or independent
living skills therapy, if included in the client's individual treatment plan new text end . Day treatment
programs are not part of inpatient or residential treatment services; and

(4) a 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 at least one day a week for a
minimum two-hour time block. The structured treatment program may include individual
or group psychotherapy and recreation therapy, socialization therapy, or independent
living skills therapy, if included in the client's individual treatment plan.

(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) medically necessary services that are provided by a mental health behavioral
aide must be designed to improve the functioning of the child and support the family in
activities of daily and community living. A mental health behavioral aide must document
the delivery of services in written progress notes. The mental health behavioral aide
must implement goals in the treatment plan for the child's emotional disturbance that
allow the child to acquire developmentally and therapeutically appropriate daily living
skills, social skills, and leisure and recreational skills through targeted activities. These
activities may include:

(i) assisting a child as needed with skills development in dressing, eating, and
toileting;

(ii) assisting, monitoring, and guiding the child to complete tasks, including
facilitating the child's participation in medical appointments;

(iii) observing the child and intervening to redirect the child's inappropriate behavior;

(iv) assisting the child in using age-appropriate self-management skills as related
to the child's emotional disorder or mental illness, including problem solving, decision
making, communication, conflict resolution, anger management, social skills, and
recreational skills;

(v) implementing deescalation techniques as recommended by the mental health
professional;

(vi) implementing any other mental health service that the mental health professional
has approved as being within the scope of the behavioral aide's duties; or

(vii) assisting the parents to develop and use parenting skills that help the child
achieve the goals outlined in the child's individual treatment plan or individual behavioral
plan. Parenting skills must be directed exclusively to the child's treatment; and

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

(i) 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;

(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.