HF 1250

as introduced - 91st Legislature (2019 - 2020) Posted on 02/28/2019 03:45pm

A bill for an act
relating to human services; modifying provisions governing certified community
behavioral health clinics; amending Minnesota Statutes 2018, sections 245.735,
subdivision 3; 256B.0625, subdivision 57, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2018, section 245.735, subdivision 3, is amended to read:

Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs) deleted text begin to be eligible for the prospective payment system in paragraph (f) deleted text end . Entities that
choose to be CCBHCs must:

(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals new text begin and licensed alcohol and drug counselors new text end ,
and staff who are culturally and linguistically trained to deleted text begin serve deleted text end new text begin meet new text end the needs of the deleted text begin clinic's
patient deleted text end population new text begin the clinic serves new text end ;

(3) ensure that clinic services are available and accessible to deleted text begin patients deleted text end new text begin individuals and
families new text end of all ages and genders and that crisis management services are available 24 hours
per day;

(4) establish fees for clinic services for nonmedical assistance deleted text begin patients deleted text end new text begin clients new text end using a
sliding fee scale that ensures that services to deleted text begin patients deleted text end new text begin clients new text end are not denied or limited due
to deleted text begin a patient's deleted text end new text begin a client's new text end inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;

(6) provide crisis mental health new text begin and substance use new text end services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; deleted text begin patient-centered deleted text end new text begin individual- and family-centered new text end treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veterans;

(7) provide coordination of care across settings and providers to ensure seamless
transitions for deleted text begin patients deleted text end new text begin clients new text end across the full spectrum of health services, including acute,
chronic, and behavioral needs. Care coordination may be accomplished through partnerships
or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;

(8) be certified as mental health clinics under section 245.69, subdivision 2;

deleted text begin (9) be certified to provide integrated treatment for co-occurring mental illness and
substance use disorders in adults or children under Minnesota Rules, chapter 9533, effective
July 1, 2017;
deleted text end

deleted text begin (10) deleted text end new text begin (9) new text end comply with standards relating to mental health services in Minnesota Rules,
parts 9505.0370 to 9505.0372;

deleted text begin (11) deleted text end new text begin (10) new text end be licensed to provide deleted text begin chemical dependency deleted text end new text begin substance use disorder new text end treatment
under chapter 245G;

deleted text begin (12) deleted text end new text begin (11) new text end be certified to provide children's therapeutic services and supports under section
256B.0943;

deleted text begin (13) deleted text end new text begin (12) new text end be certified to provide adult rehabilitative mental health services under section
256B.0623;

deleted text begin (14) deleted text end new text begin (13) new text end be enrolled to provide mental health crisis response services under section
256B.0624;

deleted text begin (15) deleted text end new text begin (14) new text end be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

deleted text begin (16) deleted text end new text begin (15) new text end comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926; deleted text begin and
deleted text end

deleted text begin (17) deleted text end new text begin (16) new text end provide services that comply with the evidence-based practices described in
paragraph (e) deleted text begin . deleted text end new text begin ; and
new text end

new text begin (17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), if peer services are
provided.
new text end

(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.

(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under paragraph (f) for those
services without a county contract or county approval. There is no county share when
medical assistance pays the CCBHC prospective payment. As part of the certification process
in paragraph (a), the commissioner shall require a letter of support from the CCBHC's host
county confirming that the CCBHC and the county or counties it serves have an ongoing
relationship to facilitate access and continuity of care, especially for individuals who are
uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision. new text begin For the CCBHC that is certified but not approved for
prospective payment under subdivision 5m, the commissioner may grant a variance under
this paragraph if the variance does not increase the state share of costs.
new text end

(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.

deleted text begin (f) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by certified
community behavioral health clinics, in accordance with guidance issued by the Centers
for Medicare and Medicaid Services. During the operation of the demonstration project,
payments shall comply with federal requirements for an enhanced federal medical assistance
percentage. The commissioner may include quality bonus payment in the prospective
payment system based on federal criteria and on a clinic's provision of the evidence-based
practices in paragraph (e). The prospective payment system does not apply to MinnesotaCare.
Implementation of the prospective payment system is effective July 1, 2017, or upon federal
approval, whichever is later.
deleted text end

deleted text begin (g) The commissioner shall seek federal approval to continue federal financial
participation in payment for CCBHC services after the federal demonstration period ends
for clinics that were certified as CCBHCs during the demonstration period and that continue
to meet the CCBHC certification standards in paragraph (a). Payment for CCBHC services
shall cease effective July 1, 2019, if continued federal financial participation for the payment
of CCBHC services cannot be obtained.
deleted text end

deleted text begin (h) The commissioner may certify at least one CCBHC located in an urban area and at
least one CCBHC located in a rural area, as defined by federal criteria. To the extent allowed
by federal law, the commissioner may limit the number of certified clinics so that the
projected claims for certified clinics will not exceed the funds budgeted for this purpose.
The commissioner shall give preference to clinics that:
deleted text end

deleted text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated; and
deleted text end

deleted text begin (2) enhance the state's ability to meet the federal priorities to be selected as a CCBHC
demonstration state.
deleted text end

deleted text begin (i) deleted text end new text begin (f) new text end The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 5m. new text end

new text begin Certified community behavioral health clinic services. new text end

new text begin (a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
new text end

new text begin (b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by a CCBHC, in
accordance with guidance issued by the Centers for Medicare and Medicaid Services. The
commissioner may include a quality bonus payment in the prospective payment system
based on federal criteria and on a CCBHC's provision of the evidence-based practices in
section 245.735, subdivision 3, paragraph (e). The prospective payment system does not
apply to MinnesotaCare.
new text end

new text begin (c) To the extent allowed by federal law, the commissioner may limit the number of
CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected
claims do not exceed the money appropriated for this purpose. The commissioner shall
apply the following priorities, in the order listed, to give preference to clinics that:
new text end

new text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated;
new text end

new text begin (2) are certified as CCBHCs during the federal CCBHC demonstration period;
new text end

new text begin (3) receive CCBHC grants from the United States Department of Health and Human
Services; or
new text end

new text begin (4) focus on serving individuals in tribal areas and other underserved communities.
new text end

new text begin (d) Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal CCBHC
demonstration, except:
new text end

new text begin (1) the commissioner shall rebase CCBHC rates at least every two years;
new text end

new text begin (2) the commissioner shall provide for a 90-day appeals process of the rebasing;
new text end

new text begin (3) the commissioner shall reimburse a CCBHC for allowable costs, including direct
patient care costs and patient-related support services. These costs include but are not limited
to the costs of:
new text end

new text begin (i) acquisition, implementation, and maintenance of electronic health records and patient
management systems;
new text end

new text begin (ii) care coordination;
new text end

new text begin (iii) a new CCBHC service that is not incorporated in the baseline prospective payment
system rate, or a deletion of a CCBHC service that is incorporated in the baseline rate;
new text end

new text begin (iv) a change in service due to amended regulatory requirements or rules;
new text end

new text begin (v) a change in operating costs attributable to capital expenditures associated with a
modification of the services, including new or expanded service facilities, regulatory
compliance, or changes in technology or medical practices at the clinic;
new text end

new text begin (vi) a change in types of services due to a change in applicable technology and medical
practice utilized by the clinic; and
new text end

new text begin (vii) a change in the scope of a project approved by the federal Substance Abuse and
Mental Health Services Administration or the commissioner; and
new text end

new text begin (4) the prospective payment rate under this section does not apply for services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:

Subd. 57.

Payment for Part B Medicare crossover claims.

(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.

(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.

(c) Excluded from this limitation are payments to federally qualified health centers deleted text begin and deleted text end new text begin , new text end
rural health clinics new text begin , and CCBHCs subject to the prospective payment system under
subdivision 5m new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end