HF 4021

1st Division Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/21/2022 09:53am

A bill for an act
relating to human services; establishing residential treatment admission
requirements for children experiencing a mental health crisis; establishing additional
requirements for licensed children's residential mental health facilities when treating
children experiencing a mental health crisis; amending Minnesota Statutes 2020,
section 245.4882, by adding a subdivision; Minnesota Statutes 2021 Supplement,
section 245.4885, subdivision 1; proposing coding for new law in Minnesota
Statutes, chapter 245A.

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

Section 1.

Minnesota Statutes 2020, section 245.4882, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Crisis admissions and stabilization. new text end

new text begin (a) A child may be referred for residential
treatment services under this section for the purpose of crisis stabilization by:
new text end

new text begin (1) a mental health professional as defined in section 245I.04, subdivision 2;
new text end

new text begin (2) a physician licensed under chapter 147 who is assessing a child in an emergency
department; or
new text end

new text begin (3) a member of a mobile crisis team who meets the qualifications under section
256B.0624, subdivision 5 new text end new text begin .
new text end

new text begin (b) A provider making a referral under paragraph (a) must conduct an assessment of the
child's mental health needs and make a determination that the child is experiencing a mental
health crisis and is in need of residential treatment services under this section.
new text end

new text begin (c) A child may receive services under this subdivision for up to 30 days and must be
subject to the screening and admissions criteria and processes under section 245.4885
thereafter new text end new text begin .
new text end

new text begin (d) For a child eligible for medical assistance, the commissioner shall reimburse counties
for all costs incurred for the child receiving children's residential crisis stabilization services,
including room and board costs.
new text end

Sec. 2.

Minnesota Statutes 2021 Supplement, section 245.4885, subdivision 1, is amended
to read:

Subdivision 1.

Admission criteria.

(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a treatment foster care setting, residential treatment facility, or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if county funds are used to pay for the child's services. new text begin An emergency includes when
a child is in need of and has been referred for crisis stabilization services under section
245.4882, subdivision 6. A child who has been referred to residential treatment for crisis
stabilization services in a residential treatment center is not required to undergo an assessment
under this section.
new text end

(b) The county board shall determine the appropriate level of care for a child when
county-controlled funds are used to pay for the child's residential treatment under this
chapter, including residential treatment provided in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d. When a county board does not have
responsibility for a child's placement and the child is enrolled in a prepaid health program
under section 256B.69, the enrolled child's contracted health plan must determine the
appropriate level of care for the child. When Indian Health Services funds or funds of a
tribally owned facility funded under the Indian Self-Determination and Education Assistance
Act, Public Law 93-638, are used for the child, the Indian Health Services or 638 tribal
health facility must determine the appropriate level of care for the child. When more than
one entity bears responsibility for a child's coverage, the entities shall coordinate level of
care determination activities for the child to the extent possible.

(c) The child's level of care determination shall determine whether the proposed treatment:

(1) is necessary;

(2) is appropriate to the child's individual treatment needs;

(3) cannot be effectively provided in the child's home; and

(4) provides a length of stay as short as possible consistent with the individual child's
needs.

(d) When a level of care determination is conducted, the county board or other entity
may not determine that a screening of a child, referral, or admission to a residential treatment
facility is not appropriate solely because services were not first provided to the child in a
less restrictive setting and the child failed to make progress toward or meet treatment goals
in the less restrictive setting. The level of care determination must be based on a diagnostic
assessment of a child that evaluates the child's family, school, and community living
situations; and an assessment of the child's need for care out of the home using a validated
tool which assesses a child's functional status and assigns an appropriate level of care to the
child. The validated tool must be approved by the commissioner of human services and
may be the validated tool approved for the child's assessment under section 260C.704 if the
juvenile treatment screening team recommended placement of the child in a qualified
residential treatment program. If a diagnostic assessment has been completed by a mental
health professional within the past 180 days, a new diagnostic assessment need not be
completed unless in the opinion of the current treating mental health professional the child's
mental health status has changed markedly since the assessment was completed. The child's
parent shall be notified if an assessment will not be completed and of the reasons. A copy
of the notice shall be placed in the child's file. Recommendations developed as part of the
level of care determination process shall include specific community services needed by
the child and, if appropriate, the child's family, and shall indicate whether these services
are available and accessible to the child and the child's family. The child and the child's
family must be invited to any meeting where the level of care determination is discussed
and decisions regarding residential treatment are made. The child and the child's family
may invite other relatives, friends, or advocates to attend these meetings.

(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual family
community support plan is being developed by the case manager, if assigned.

(f) The level of care determination, placement decision, and recommendations for mental
health services must be documented in the child's record and made available to the child's
family, as appropriate.

Sec. 3.

new text begin [245A.26] CHILDREN'S RESIDENTIAL FACILITY CRISIS
STABILIZATION SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end

new text begin (b) "Clinical trainee" means a staff person who is qualified under section 245I.04,
subdivision 6.
new text end

new text begin (c) "License holder" means an individual, organization, or government entity that was
issued a license by the commissioner of human services under this chapter for residential
mental health treatment for children with emotional disturbance according to Minnesota
Rules, parts 2960.0010 to 2960.0220 and 2960.0580 to 2960.0700, or shelter care services
according to Minnesota Rules, parts 2960.0010 to 2960.0120 and 2960.0510 to 2960.0530.
new text end

new text begin (d) "Mental health professional" means an individual who is qualified under section
245I.04, subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Scope and applicability. new text end

new text begin (a) This section establishes additional licensing
requirements for a children's residential facility to provide children's residential crisis
stabilization services to a child who is experiencing a mental health crisis and is in need of
residential treatment services.
new text end

new text begin (b) A children's residential facility may provide residential crisis stabilization services
only if the facility is licensed to provide:
new text end

new text begin (1) residential mental health treatment for children with emotional disturbance according
to Minnesota Rules, parts 2960.0010 to 2960.0220 and 2960.0580 to 2960.0700; or
new text end

new text begin (2) shelter care services according to Minnesota Rules, parts 2960.0010 to 2960.0120
and 2960.0510 to 2960.0530.
new text end

new text begin (c) If a child receives residential crisis stabilization services for 35 days or fewer in a
facility licensed according to paragraph (b), clause (1), the facility is not required to complete
a diagnostic assessment or treatment plan under Minnesota Rules, part 2960.0180, subpart
2, and part 2960.0600.
new text end

new text begin (d) If a child receives residential crisis stabilization services for 35 days or fewer in a
facility licensed according to paragraph (b), clause (2), the facility is not required to develop
a plan for meeting the child's immediate needs under Minnesota Rules, part 2960.0520,
subpart 3.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility for services. new text end

new text begin An individual is eligible for children's residential crisis
stabilization services if the individual is under 19 years of age and meets the eligibility
criteria for crisis services under section 256B.0624, subdivision 3.
new text end

new text begin Subd. 4. new text end

new text begin Required services; providers. new text end

new text begin (a) A license holder providing residential crisis
stabilization services must continually follow a child's individual crisis treatment plan to
improve the child's functioning.
new text end

new text begin (b) The license holder must offer and have the capacity to directly provide the following
treatment services to a child:
new text end

new text begin (1) crisis stabilization services as described in section 256B.0624, subdivision 7;
new text end

new text begin (2) mental health services as specified in the child's individual crisis treatment plan,
according to the child's treatment needs;
new text end

new text begin (3) health services and medication administration, if applicable; and
new text end

new text begin (4) referrals for the child to community-based treatment providers and support services
for the child's transition from residential crisis stabilization to another treatment setting.
new text end

new text begin (c) Children's residential crisis stabilization services must be provided by a qualified
staff person listed in section 256B.0624, subdivision 8, according to the scope of practice
for the individual staff person's position.
new text end

new text begin Subd. 5. new text end

new text begin Assessment and treatment planning. new text end

new text begin (a) Within 24 hours of a child's admission
for residential crisis stabilization, the license holder must assess the child and document the
child's immediate needs, including the child's:
new text end

new text begin (1) health and safety, including the need for crisis assistance; and
new text end

new text begin (2) need for connection to family and other natural supports.
new text end

new text begin (b) Within 24 hours of a child's admission for residential crisis stabilization, the license
holder must complete a crisis treatment plan for the child, according to the requirements
for a crisis treatment plan under section 256B.0624, subdivision 11. The license holder must
base the child's crisis treatment plan on the child's referral information and the assessment
of the child's immediate needs under paragraph (a). A mental health professional or a clinical
trainee under the supervision of a mental health professional must complete the crisis
treatment plan. A crisis treatment plan completed by a clinical trainee must contain
documentation of approval, as defined in section 245I.02, subdivision 2, by a mental health
professional within five business days of initial completion by the clinical trainee.
new text end

new text begin (c) A mental health professional must review a child's crisis treatment plan each week
and document the weekly reviews in the child's client file.
new text end

new text begin (d) For a client receiving children's residential crisis stabilization services who is 18
years of age or older, the license holder must complete an individual abuse prevention plan
for the client, pursuant to section 245A.65, subdivision 2, as part of the client's crisis
treatment plan.
new text end

new text begin Subd. 6. new text end

new text begin Staffing requirements. new text end

new text begin Staff members of facilities providing services under
this section must have access to a mental health professional or clinical trainee within 30
minutes, either in person or by telephone. The license holder must maintain a current schedule
of available mental health professionals or clinical trainees and include contact information
for each mental health professional or clinical trainee. The schedule must be readily available
to all staff members.
new text end