HF 3793

as introduced - 91st Legislature (2019 - 2020) Posted on 02/26/2020 02:40pm

A bill for an act
relating to human services; changing definition relating to children's mental health
crisis response services; modifying intensive rehabilitative mental health services
requirements; amending Minnesota Statutes 2018, sections 256B.0944, subdivision
1; 256B.0947, subdivisions 2, 3, 4, 5, 6.

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

Section 1.

Minnesota Statutes 2018, section 256B.0944, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

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

(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation
that, but for the provision of crisis response services to the child, would likely result in
significantly reduced levels of functioning in primary activities of daily living, an emergency
situation, or the child's placement in a more restrictive setting, including, but not limited
to, inpatient hospitalization.

(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric
situation that causes an immediate need for mental health services and is consistent with
section 62Q.55. A physician, mental health professional, or crisis mental health practitioner
determines a mental health crisis or emergency for medical assistance reimbursement with
input from the client and the client's family, if possible.

(c) "Mental health crisis assessment" means an immediate face-to-face assessment by
a physician, mental health professional, or mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests the child
may be experiencing a mental health crisis or mental health emergency situation.

(d) "Mental health mobile crisis intervention services" means face-to-face, short-term
intensive mental health services initiated during a mental health crisis or mental health
emergency. Mental health mobile crisis services must help the recipient cope with immediate
stressors, identify and utilize available resources and strengths, and begin to return to the
recipient's baseline level of functioning. Mental health mobile services must be provided
on site by a mobile crisis intervention team outside of deleted text begin an emergency room, urgent care, or deleted text end
an inpatient hospital setting.

(e) "Mental health crisis stabilization services" means individualized mental health
services provided to a recipient following crisis intervention services that are designed to
restore the recipient to the recipient's prior functional level. The individual treatment plan
recommending mental health crisis stabilization must be completed by the intervention team
or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services
may be provided in the recipient's home, the home of a family member or friend of the
recipient, schools, another community setting, or a short-term supervised, licensed residential
program if the service is not included in the facility's cost pool or per diem. Mental health
crisis stabilization is not reimbursable when provided as part of a partial hospitalization or
day treatment program.

Sec. 2.

Minnesota Statutes 2018, section 256B.0947, 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 child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20 deleted text end new text begin eight years of age or older and under 26 new text end with a serious mental
illness or co-occurring mental illness and substance abuse addiction who require intensive
services to prevent admission to an inpatient psychiatric hospital or placement in a residential
treatment facility or who require intensive services to step down from inpatient or residential
care to community-based care.

(b) "Co-occurring mental illness and substance abuse addiction" means a dual diagnosis
of at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.

(c) "Diagnostic assessment" has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1, and for this section must incorporate a determination of
the youth's necessary level of care using a standardized functional assessment instrument
approved and periodically updated by the commissioner.

(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.

(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.

(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.

(g) "Medication education services" means services provided individually or in groups,
which focus on:

(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;

(2) the role and effects of medications in treating symptoms of mental illness; and

(3) 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, or
registered nurses with certification in psychiatric and mental health care.

(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer who:

(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;

(2) assists younger peers to identify and achieve specific life goals;

(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;

(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;

(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and

(6) meets the following criteria:

(i) is at least 22 years of age;

(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;

(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;

(iv) has at least a high school diploma or equivalent;

(v) has successfully completed training requirements determined and periodically updated
by the commissioner;

(vi) is willing to disclose the individual's own mental health history to team members
and clients; and

(vii) must be free of substance use problems for at least one year.

(i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.

(j) "Substance use disorders" means one or more of the disorders defined in the diagnostic
and statistical manual of mental disorders, current edition.

(k) "Transition services" means:

(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;

(2) providing the client with knowledge and skills needed posttransition;

(3) establishing communication between sending and receiving entities;

(4) supporting a client's request for service authorization and enrollment; and

(5) establishing and enforcing procedures and schedules.

A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.

(l) "Treatment team" means all staff who provide services to recipients under this section.

new text begin (m) "Family peer specialist" means a staff person qualified under section 256B.0616.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0947, subdivision 3, is amended to read:

Subd. 3.

Client eligibility.

An eligible recipient is an individual who:

(1) is deleted text begin age 16, 17, 18, 19, or 20 deleted text end new text begin eight years of age or older and under 26 new text end ; deleted text begin and
deleted text end

(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
abuse addiction, for which intensive nonresidential rehabilitative mental health services are
needed;

(3) has received a level-of-care determination, using an instrument approved by the
commissioner, that indicates a need for intensive integrated intervention without 24-hour
medical monitoring and a need for extensive collaboration among multiple providers;

(4) has a functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; deleted text begin or
deleted text end

new text begin (5) new text end who is likely to need services from the adult mental health system deleted text begin within the next
two years deleted text end new text begin in adulthood new text end ; and

deleted text begin (5) deleted text end new text begin (6) new text end has had a recent diagnostic assessment, as provided in Minnesota Rules, part
9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.

Sec. 4.

Minnesota Statutes 2018, section 256B.0947, subdivision 4, is amended to read:

Subd. 4.

Provider contract requirements.

(a) The intensive nonresidential rehabilitative
mental health services provider agency shall have a contract with the commissioner to
provide intensive transition youth rehabilitative mental health services.

(b) The commissioner shall develop deleted text begin administrative and clinical contract standards and deleted text end
performance evaluation criteria for providers, including county providers, and may require
applicants new text begin and providers new text end to submit documentation as needed to allow the commissioner to
determine whether the deleted text begin standards deleted text end new text begin criteria new text end are met.

Sec. 5.

Minnesota Statutes 2018, section 256B.0947, subdivision 5, is amended to read:

Subd. 5.

Standards for intensive nonresidential rehabilitative providers.

(a) Services
must be provided by a provider entity as provided in subdivision 4.

new text begin (b) The treatment team must have specialized training in the specific age group they
serve. An individual treatment team must either serve youth between eight years of age or
older and under 16, or 14 years of age or older and under 26.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The treatment team for intensive nonresidential rehabilitative mental health
services comprises both permanently employed core team members and client-specific team
members as follows:

(1) The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients. Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must include, but is not limited to:

(i) an independently licensed mental health professional, qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, who serves as team leader to provide administrative
direction and clinical supervision to the team;

(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;

(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and

(iv) a peer specialist as defined in subdivision 2, paragraph (h).

(2) The core team may also include any of the following:

(i) additional mental health professionals;

(ii) a vocational specialist;

(iii) an educational specialist;

(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;

(v) a mental health practitioner, as defined in section 245.4871, subdivision 26;

(vi) a deleted text begin mental health manager deleted text end new text begin case management service provider new text end , as defined in section
245.4871, subdivision 4; and

(vii) a housing access specialist.

(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:

(i) the mental health professional treating the client prior to placement with the treatment
team;

(ii) the client's current substance abuse counselor, if applicable;

(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;

(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;

(v) the client's probation officer or other juvenile justice representative, if applicable;
and

(vi) the client's current vocational or employment counselor, if applicable.

deleted text begin (c) deleted text end new text begin (d) new text end The clinical supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the clinical supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.

deleted text begin (d) deleted text end new text begin (e) new text end The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.

deleted text begin (e) deleted text end new text begin (f) new text end The treatment team shall serve no more than 80 clients at any one time. Should
local demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.

deleted text begin (f) deleted text end new text begin (g) new text end Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider shall have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to deleted text begin assure deleted text end new text begin ensure new text end the health and safety of clients.

deleted text begin (g) deleted text end new text begin (h) new text end The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.

deleted text begin (h) deleted text end new text begin (i) new text end A regional treatment team may serve multiple counties.

Sec. 6.

Minnesota Statutes 2018, section 256B.0947, subdivision 6, is amended to read:

Subd. 6.

Service standards.

The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.

(a) The treatment team deleted text begin shall deleted text end new text begin must new text end use team treatment, not an individual treatment model.

(b) Services must be available at times that meet client needs.

new text begin (c) Services must be age-appropriate and meet the specific needs of the client.
new text end

deleted text begin (c) deleted text end new text begin (d) new text end The initial functional assessment must be completed within ten days of intake
and updated at least every deleted text begin three deleted text end new text begin six new text end months or prior to discharge from the service, whichever
comes first.

deleted text begin (d) deleted text end new text begin (e) new text end An individual treatment plan must deleted text begin be completed for each client, according to
criteria specified in section 256B.0943, subdivision 6, paragraph (b), clause (2), and,
additionally, must deleted text end :

new text begin (1) be based on the information in the client's diagnostic assessment and baselines;
new text end

new text begin (2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
new text end

new text begin (3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
new text end

new text begin (4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
new text end

new text begin (5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
new text end

new text begin (6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
new text end

deleted text begin (1) deleted text end new text begin (7) new text end be completed in consultation with the client's current therapist and key providers
and provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community new text begin . For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan new text end ;

deleted text begin (2) deleted text end new text begin (8) new text end if a need for substance use disorder treatment is indicated by validated assessment:

(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;

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

deleted text begin (3) deleted text end new text begin (9) new text end be signed by the clinical supervisor and by the client and, if the client is a minor,
by the client's parent or other person authorized by statute to consent to mental health
treatment and substance use disorder treatment for the client; and

deleted text begin (4) deleted text end new text begin (10) new text end provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" services.

deleted text begin (e) deleted text end new text begin (f) new text end The treatment team shall actively and assertively engage the client's family
members and significant others by establishing communication and collaboration with the
family and significant others and educating the family and significant others about the
client's mental illness, symptom management, and the family's role in treatment, unless the
team knows or has reason to suspect that the client has suffered or faces a threat of suffering
any physical or mental injury, abuse, or neglect from a family member or significant other.

deleted text begin (f) deleted text end new text begin (g) new text end For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.

deleted text begin (g) deleted text end new text begin (h) new text end The treatment team shall provide interventions to promote positive interpersonal
relationships.