Minnesota Legislature
HF 2127
1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 04/12/2021 05:01pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/11/2021 | |
| 1st Engrossment | Posted on 04/12/2021 |
Current Version - 1st Engrossment
2.43 2.44
2.45 2.46 2.47 2.48 2.49 2.50 3.1 3.2 3.3 3.4 3.5 3.6
3.7
3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30
3.31
4.1 4.2 4.3 4.4 4.5
4.6
4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19
4.20
4.21 4.22 4.23 4.24 4.25 4.26 4.27
4.28
5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19
5.20
5.21 5.22 5.23 5.24 5.25
5.26
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20
6.21
6.22 6.23 6.24 6.25 6.26 6.27 6.28
6.29 6.30 6.31 7.1 7.2 7.3 7.4
7.5
7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23
7.24 7.25 7.26 7.27
7.28
8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11
8.12
8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27
8.28
8.29 8.30 8.31 8.32
9.1
9.2 9.3 9.4 9.5
9.6
9.7 9.8 9.9 9.10 9.11 9.12
9.13
9.14 9.15 9.16 9.17 9.18
9.19
9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12
10.13 10.14
10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10
11.11
11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25
11.26
11.27 11.28 11.29 11.30 11.31 12.1 12.2 12.3 12.4 12.5 12.6
12.7 12.8
12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 13.1 13.2 13.3 13.4 13.5 13.6
13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24
13.25 13.26 13.27 13.28 13.29
13.30 13.31 13.32 14.1 14.2 14.3
14.4
14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32
15.1
15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14
15.15
15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25
15.26
15.27 15.28 15.29 15.30 16.1 16.2
16.3
16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24
16.25
16.26 16.27 16.28 16.29 16.30 16.31 17.1 17.2 17.3 17.4 17.5
17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13
17.14
17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24
17.25
17.26 17.27 17.28 17.29
17.30
18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21
18.22 18.23
18.24 18.25 18.26 18.27 18.28 18.29 18.30 19.1 19.2 19.3
19.4
19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28
20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 21.1 21.2 21.3 21.4 21.5 21.6
21.7 21.8 21.9
21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16
25.17
25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32
26.1
26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 27.1 27.2
27.3
27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17
27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27
27.28 27.29 27.30 27.31 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 29.1 29.2 29.3 29.4 29.5
29.6 29.7 29.8 29.9 29.10 29.11
29.12 29.13
29.14 29.15
29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27
31.28 31.29 31.30 31.31 31.32 31.33 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20
32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 33.1 33.2
33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 34.1 34.2 34.3 34.4 34.5 34.6 34.7
34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14
35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10
36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8
37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22
37.23 37.24 37.25 37.26 37.27 37.28 37.29
38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11
38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 39.1 39.2 39.3
39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11
39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21
39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18
40.19 40.20 40.21 40.22 40.23 40.24 40.25
40.26 40.27 40.28 40.29 40.30 40.31 40.32 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17
41.18 41.19 41.20 41.21 41.22 41.23
41.24 41.25 41.26 41.27 41.28 41.29 41.30
42.1 42.2 42.3 42.4 42.5
42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 43.1 43.2
43.3 43.4
43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 44.34 45.1 45.2 45.3
45.4
45.5 45.6 45.7 45.8 45.9 45.10
45.11
45.12 45.13 45.14 45.15 45.16
45.17
45.18 45.19 45.20 45.21 45.22
45.23
45.24 45.25 45.26 45.27 45.28
45.29
46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9
46.10
46.11 46.12 46.13 46.14 46.15
46.16
46.17 46.18 46.19 46.20 46.21
46.22
46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 47.1 47.2
47.3
47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6
57.7
57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29
59.30
60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 60.32 60.33 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8
61.9
61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 63.1 63.2 63.3
63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20
63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 64.1 64.2
64.3
64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 65.33 65.34 65.35 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15
66.16
66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13
67.14
67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8
68.9
68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8
69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 70.33 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21
72.22
72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 72.32 72.33 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31
74.32
75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29
76.30
77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18
78.19
78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 81.1 81.2
81.3
81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29
81.30
82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16
82.17
82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12
85.13
85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22
85.23
85.24 85.25 85.26 85.27 85.28 85.29 85.30 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9
88.10
88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 91.1 91.2 91.3 91.4 91.5 91.6 91.7
91.8
91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 92.1 92.2 92.3 92.4 92.5
92.6
92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24
92.25
92.26 92.27 92.28 92.29 92.30 92.31 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14
93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 94.1 94.2 94.3 94.4 94.5 94.6
94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 95.1 95.2
95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18
95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26
95.27
95.28 95.29 95.30 95.31 95.32 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9
96.10 96.11 96.12 96.13
96.14 96.15
96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26
96.27 96.28
96.29 96.30 96.31 96.32 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11
97.12
97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25
98.26 98.27 98.28 98.29 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30
99.31 99.32 99.33 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13
100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 101.1 101.2 101.3 101.4 101.5 101.6
101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26
101.27
101.28 101.29 101.30 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20
102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15
103.16
103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3
104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27
104.28
105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9
105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26
106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8
106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22
108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 108.33 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10
109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24
109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 110.1 110.2 110.3 110.4
110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 112.1 112.2 112.3 112.4 112.5
112.6
112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25
113.26 113.27 113.28 113.29 113.30 113.31 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9
115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27
118.28 118.29 118.30 118.31
119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10
119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 119.34 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25
120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 121.1 121.2 121.3 121.4
121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21
121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14
122.15
122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25
122.26
122.27 122.28 122.29 122.30 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 126.1 126.2 126.3 126.4 126.5 126.6
126.7 126.8
126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17
126.18 126.19
126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30
128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29
130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11
130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10
131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29
134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 135.33 135.34 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19
137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8
139.9 139.10 139.11
139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12
140.13 140.14 140.15
140.16 140.17 140.18 140.19 140.20 140.21
140.22
140.23 140.24 140.25 140.26 140.27
140.28
141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10
141.11
141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25
142.26 142.27 142.28 142.29 142.30 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 143.34 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20
144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 145.34 146.1 146.2 146.3 146.4
146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13
146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11
147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22
147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32
148.1 148.2 148.3 148.4 148.5 148.6 148.7
148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29
149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32
150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9
150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23
150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 151.1 151.2 151.3 151.4 151.5 151.6 151.7
151.8 151.9 151.10 151.11 151.12
151.13 151.14 151.15 151.16 151.17
151.18 151.19
151.20 151.21
151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29
152.1 152.2
152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15
153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 154.33 154.34 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 156.34 156.35 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12
157.13
157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 158.34 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 161.35 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10
162.11 162.12
162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 162.33 162.34 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10
163.11 163.12 163.13
163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 163.33 163.34 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26
164.27 164.28 164.29
164.30 164.31 164.32 164.33 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23
165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 166.1 166.2
166.3
166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18
166.19
166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 168.1 168.2 168.3 168.4 168.5
168.6
168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14
168.15
168.16 168.17 168.18 168.19 168.20 168.21 168.22
168.23
168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31
169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 170.1 170.2 170.3 170.4 170.5 170.6
170.7 170.8 170.9
170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 171.1 171.2 171.3 171.4 171.5 171.6
171.7 171.8 171.9
171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22
172.23 172.24 172.25
172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 172.34 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15
173.16 173.17 173.18
173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 181.1 181.2 181.3 181.4 181.5 181.6 181.7
181.8 181.9 181.10
181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8
184.9 184.10 184.11
184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19
186.20 186.21 186.22
186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9
188.10 188.11 188.12
188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19
190.20 190.21 190.22
190.23 190.24 190.25 190.26 190.27
190.28 190.29 190.30
191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 191.33 191.34 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 192.34 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 193.34 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11
195.12
195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13
200.14 200.15 200.16
200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32
206.1 206.2 206.3
206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 206.33 206.34 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 208.1 208.2
208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 208.33 209.1 209.2 209.3 209.4
209.5
209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10
210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29
210.30
210.31 210.32 210.33 211.1 211.2 211.3 211.4 211.5 211.6 211.7
211.8 211.9 211.10
211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19
211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31
212.1 212.2 212.3 212.4
212.5 212.6 212.7 212.8
212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 213.1 213.2
213.3 213.4 213.5 213.6 213.7 213.8 213.9
213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12
214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25
214.26 214.27 214.28
214.29 214.30 214.31 215.1 215.2 215.3 215.4
215.5 215.6
215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8
217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33 217.34 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 218.34 218.35 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 219.34 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 220.33 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13
221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 222.1 222.2
222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23
227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11
228.12 228.13 228.14 228.15
228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11
229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 229.33 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4
231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 232.1 232.2 232.3 232.4 232.5 232.6 232.7
232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 234.1 234.2 234.3 234.4 234.5
234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 235.1 235.2 235.3 235.4 235.5 235.6 235.7
235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30
238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13
239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14
240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15
241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26
243.27 243.28 243.29 243.30 243.31 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15
244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15
245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11
247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21
249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28
251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 252.1 252.2
252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11
253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 254.1 254.2 254.3 254.4 254.5 254.6 254.7
254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31
255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33 255.34 255.35 256.1 256.2 256.3 256.4
256.5 256.6
256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9
260.10 260.11
260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20
260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14
262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 264.33 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28
266.29 266.30 266.31 266.32 266.33 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 268.33 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13
269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 271.33 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 275.1 275.2 275.3 275.4 275.5
275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14
278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 278.32 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3 280.4 280.5
280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26
280.27 280.28 280.29 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15
282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23
283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 288.33 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11
291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23
293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24
295.25 295.26 295.27 295.28 295.29 295.30
296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20
303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 306.33 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 307.33 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 309.33 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 313.33 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 314.33 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31
316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 319.33 319.34 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 321.32 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 326.33 326.34 326.35 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19
327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29
328.1 328.2 328.3 328.4
328.5 328.6
328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29
329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6 330.7
330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27
330.28 330.29 330.30 330.31 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 337.33 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 339.34 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16
345.17 345.18 345.19 345.20
345.21 345.22 345.23
345.24 345.25 345.26 345.27 345.28 345.29 345.30 346.1 346.2 346.3 346.4
346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19
346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 347.1 347.2
347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21
347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21
348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31
350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25
350.26 350.27 350.28 350.29 350.30 350.31 350.32 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28
351.29 351.30 351.31 351.32 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24
352.25 352.26 352.27
352.28 352.29 352.30 352.31 352.32 352.33 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10
353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30
354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 355.1 355.2 355.3
355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12
355.13 355.14 355.15 355.16 355.17
355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32
358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 359.1 359.2 359.3
359.4 359.5 359.6 359.7 359.8 359.9 359.10
359.11 359.12 359.13 359.14 359.15 359.16 359.17
359.18 359.19 359.20 359.21
359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 360.1 360.2 360.3 360.4 360.5
360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17
360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32
361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19
361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 361.33 361.34 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9
362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8
363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17
363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15
364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 364.32 364.33
365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26
365.27 365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24
366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12
367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23
367.24 367.25 367.26 367.27
367.28 367.29 367.30 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 368.33 368.34 369.1 369.2
369.3 369.4 369.5 369.6 369.7 369.8 369.9
369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25
369.26 369.27 369.28 369.29 369.30 369.31 369.32
370.1 370.2 370.3 370.4 370.5 370.6 370.7
370.8 370.9 370.10 370.11
370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26
370.27 370.28 370.29 370.30 370.31 370.32 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17
371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 371.33 371.34 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8
372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23
372.24 372.25 372.26 372.27
373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25
373.26 373.27 373.28 373.30 373.29 373.31 373.32 373.33 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 374.34 374.35 374.36 374.37 374.38 374.39 374.40 374.41 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 375.34 375.35 375.36 375.37 375.38 375.39 375.40 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 376.34 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 377.32 377.33 377.34 378.1 378.2 378.3
378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27
379.28 379.29 379.30 379.31 379.32
380.1 380.2 380.3 380.4 380.5 380.6
380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16
380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24
380.25 380.26 380.27 380.28
380.29 380.30 380.31 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8
381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19
381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 382.34 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 383.33 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10
385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15
386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 387.1 387.2 387.3 387.4 387.5 387.6 387.7
387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 387.33 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31 388.32 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13
389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 392.33 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14
393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 396.1 396.2 396.3 396.4 396.5 396.6 396.7
396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 396.33 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 397.33 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13
398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24
398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22
399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 399.32 400.1 400.2
400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26
401.27 401.28 401.29 401.30 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 404.1 404.2 404.3
404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 405.32 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10
406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24
406.25 406.26 406.27 406.28 406.29 406.30 406.31 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26
407.27 407.28 407.29 407.30 407.31 407.32 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24
409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 409.33 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 411.1 411.2 411.3 411.4
411.5 411.6
411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18
411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 411.32
412.1 412.2 412.3 412.4 412.5 412.6
412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19
412.20 412.21 412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8
413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27
414.28 414.29 414.30 414.31 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25
415.26 415.27 415.28 415.29 415.30 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26
416.27 416.28 416.29 416.30 416.31 416.32 416.33 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 417.33 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 418.33 418.34 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 419.33 419.34 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22
420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 421.1 421.2 421.3 421.4 421.5 421.6 421.7
421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 422.1 422.2 422.3
422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21
422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32
424.1 424.2 424.3 424.4 424.5
424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 425.33 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 426.33 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 427.33 428.1 428.2 428.3 428.4 428.5 428.6 428.7
428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 429.1 429.2 429.3 429.4 429.5 429.6
429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 429.32 429.33 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16
433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 433.32 434.1 434.2 434.3 434.4 434.5 434.6
434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29
435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 437.1 437.2 437.3 437.4 437.5 437.6 437.7
437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8
438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24
438.25 438.26 438.27 438.28 438.29 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14
440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 441.1 441.2 441.3 441.4 441.5 441.6 441.7
441.8 441.9 441.10 441.11 441.12 441.13 441.14
441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9
444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28
445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18
446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31
449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 450.33 451.1 451.2 451.3 451.4 451.5 451.6
451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27
451.28 451.29 451.30 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 454.1 454.2 454.3 454.4
454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17
454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31
455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12
455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11
456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31 456.32 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24
457.25 457.26 457.27 457.28 457.29 457.30 457.31 457.32 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8
458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26
459.27 459.28 459.29 459.30 459.31 459.32 459.33 460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 460.31 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16
461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28
462.1 462.2 462.3 462.4
462.5 462.6
462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17
462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 462.31 462.32 462.33 462.34 462.35 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18
463.19 463.20
463.21 463.22
463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 464.1 464.2 464.3 464.4
464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 464.33 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32 465.33 466.1 466.2 466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 466.31 466.32 466.33 466.34 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 467.32 467.33 467.34 467.35 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 468.33 468.34 468.35 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 469.32 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 471.33 471.34 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 472.33 472.34 472.35 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 473.35 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 474.32 474.33 474.34 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 475.33 475.34 475.35 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 476.32 476.33 476.34 476.35 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 477.33 477.34 477.35 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 478.33 478.34 478.35 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 479.33 479.34 479.35 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 480.34 480.35 480.36 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 481.33 481.34 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 482.33 482.34 482.35 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 483.32 483.33 483.34 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17
484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 484.31 484.32 484.33 484.34 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 485.32 485.33 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 486.32 486.33 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27 487.28 487.29 487.30 487.31 487.32 487.33 487.34 487.35 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 488.32 488.33 488.34 488.35 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 489.31 489.32 489.33 489.34 490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 490.34 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16
491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 491.32 491.33 491.34 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 492.33 492.34 492.35 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 493.32 493.33 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9
494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 494.31 494.32 494.33 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13
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495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22
495.23
495.24 495.25 495.26 495.27 495.28 495.29
495.30 495.31 495.32 496.2 496.1 496.3 496.4 496.6 496.5 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.17 496.16 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 496.32 496.33 496.34 496.35 496.36 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 497.33 497.34 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 498.33 498.34 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 499.33 499.34 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 500.33 500.34 501.1 501.2 501.3 501.4 501.5 501.6
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502.1 502.2 502.3 502.4
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502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 502.33
503.1 503.2 503.3 503.4 503.5 503.6
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A bill for an act
relating to human services; modifying provisions governing children and family
services, community supports, direct care and treatment, and chemical and mental
health services; making forecast adjustments; requiring reports; transferring money;
making technical and conforming changes; appropriating money; amending
Minnesota Statutes 2020, sections 62A.15, subdivision 4, by adding a subdivision;
62A.152, subdivision 3; 62A.3094, subdivision 1; 62Q.096; 119B.011, subdivision
15; 119B.025, subdivision 4; 144.0724, subdivision 4; 144.1501, subdivisions 1,
2, 3; 144.651, subdivision 2; 144D.01, subdivision 4; 144G.08, subdivision 7, as
amended; 148.90, subdivision 2; 148.911; 148B.30, subdivision 1; 148B.31;
148B.51; 148B.5301, subdivision 2; 148B.54, subdivision 2; 148E.010, by adding
a subdivision; 148E.120, subdivision 2; 148E.130, subdivision 1, by adding a
subdivision; 148F.11, subdivision 1; 245.462, subdivisions 1, 6, 8, 9, 14, 16, 17,
18, 21, 23, by adding a subdivision; 245.4661, subdivision 5; 245.4662, subdivision
1; 245.467, subdivisions 2, 3; 245.469, subdivisions 1, 2; 245.470, subdivision 1;
245.4712, subdivision 2; 245.472, subdivision 2; 245.4863; 245.4871, subdivisions
9a, 10, 11a, 17, 21, 26, 27, 29, 31, 32, 34, by adding a subdivision; 245.4876,
subdivisions 2, 3; 245.4879, subdivision 1; 245.488, subdivision 1; 245.4882,
subdivisions 1, 3; 245.4885, subdivision 1; 245.4889, subdivision 1; 245.4901,
subdivision 2; 245.62, subdivision 2; 245.735, subdivisions 3, 5, by adding a
subdivision; 245A.02, by adding subdivisions; 245A.03, subdivision 7; 245A.04,
subdivision 5; 245A.041, by adding a subdivision; 245A.043, subdivision 3;
245A.10, subdivision 4; 245A.65, subdivision 2; 245D.02, subdivision 20; 245F.04,
subdivision 2; 245G.03, subdivision 2; 246.54, subdivision 1b; 254B.01, subdivision
4a, by adding a subdivision; 254B.05, subdivision 5; 254B.12, by adding a
subdivision; 256.01, subdivision 14b; 256.0112, subdivision 6; 256.041; 256.042,
subdivisions 2, 4; 256.043, subdivision 3; 256B.0615, subdivisions 1, 5; 256B.0616,
subdivisions 1, 3, 5; 256B.0622, subdivisions 1, 2, 3a, 4, 7, 7a, 7b, 7d; 256B.0623,
subdivisions 1, 2, 3, 4, 5, 6, 9, 12; 256B.0624; 256B.0625, subdivisions 3b, 5, 5m,
19c, 20, 28a, 42, 48, 49, 56a; 256B.0757, subdivision 4c; 256B.0759, subdivisions
2, 4, by adding subdivisions; 256B.0911, subdivision 3a; 256B.092, subdivisions
4, 5, 12; 256B.0924, subdivision 6; 256B.094, subdivision 6; 256B.0941,
subdivision 1; 256B.0943, subdivisions 1, 2, 3, 4, 5, 5a, 6, 7, 9, 11; 256B.0946,
subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947, subdivisions 1, 2, 3, 3a, 5, 6, 7;
256B.0949, subdivisions 2, 4, 5a; 256B.097, by adding subdivisions; 256B.25,
subdivision 3; 256B.439, by adding subdivisions; 256B.49, subdivisions 11, 11a,
17, by adding a subdivision; 256B.4914, subdivisions 5, 6, 7, 8, 9, by adding a
subdivision; 256B.69, subdivision 5a; 256B.761; 256B.763; 256B.85, subdivisions
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 11b, 12, 12b, 13, 13a, 15, 17a, 18a, 20b, 23, 23a, by
adding subdivisions; 256D.03, by adding a subdivision; 256D.051, by adding
subdivisions; 256D.0515; 256D.0516, subdivision 2; 256E.34, subdivision 1;
256I.03, subdivision 13; 256I.04, subdivision 3; 256I.05, subdivisions 1a, 1c, 11;
256I.06, subdivisions 6, 8; 256J.08, subdivisions 15, 71, 79; 256J.10; 256J.21,
subdivisions 3, 4, 5; 256J.24, subdivision 5; 256J.30, subdivision 8; 256J.33,
subdivisions 1, 2, 4; 256J.37, subdivisions 1, 1b, 3, 3a; 256J.626, subdivision 1;
256J.95, subdivision 9; 256N.25, subdivisions 2, 3; 256N.26, subdivisions 11, 13;
256P.01, subdivisions 3, 6a, by adding a subdivision; 256P.04, subdivisions 4, 8;
256P.06, subdivisions 2, 3; 256P.07; 256S.18, subdivision 7; 256S.20, subdivision
1; 260.761, subdivision 2; 260C.007, subdivisions 6, 14, 26c, 31; 260C.157,
subdivision 3; 260C.212, subdivisions 1a, 13; 260C.4412; 260C.452; 260C.704;
260C.706; 260C.708; 260C.71; 260C.712; 260C.714; 260D.01; 260D.05; 260D.06,
subdivision 2; 260D.07; 260D.08; 260D.14; 260E.01; 260E.02, subdivision 1;
260E.03, subdivision 22, by adding subdivisions; 260E.06, subdivision 1; 260E.14,
subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20, subdivision 2;
260E.24, subdivisions 2, 7; 260E.31, subdivision 1; 260E.33, subdivision 1, by
adding a subdivision; 260E.35, subdivision 6; 260E.36, by adding a subdivision;
295.50, subdivision 9b; 325F.721, subdivision 1; Laws 2019, First Special Session
chapter 9, article 14, section 3, as amended; Laws 2020, First Special Session
chapter 7, section 1, subdivision 2, as amended; Laws 2020, Fifth Special Session
chapter 3, article 10, section 3; proposing coding for new law in Minnesota Statutes,
chapters 245; 245A; 254B; 256B; 256P; proposing coding for new law as Minnesota
Statutes, chapter 245I; repealing Minnesota Statutes 2020, sections 16A.724,
subdivision 2; 245.462, subdivision 4a; 245.4871, subdivision 32a; 245.4879,
subdivision 2; 245.62, subdivisions 3, 4; 245.69, subdivision 2; 245.735,
subdivisions 1, 2, 4; 256B.0596; 256B.0615, subdivision 2; 256B.0616, subdivision
2; 256B.0622, subdivisions 3, 5a; 256B.0623, subdivisions 7, 8, 10, 11; 256B.0625,
subdivisions 5l, 35a, 35b, 61, 62, 65; 256B.0916, subdivisions 2, 3, 4, 5, 8, 11, 12;
256B.0943, subdivisions 8, 10; 256B.0944; 256B.0946, subdivision 5; 256B.097,
subdivisions 1, 2, 3, 4, 5, 6; 256B.49, subdivisions 26, 27; 256D.051, subdivisions
1, 1a, 2, 2a, 3, 3a, 3b, 6b, 6c, 7, 8, 9, 18; 256D.052, subdivision 3; 256J.08,
subdivisions 10, 53, 61, 62, 81, 83; 256J.21, subdivisions 1, 2; 256J.30, subdivisions
5, 7, 8; 256J.33, subdivisions 3, 4, 5; 256J.34, subdivisions 1, 2, 3, 4; 256J.37,
subdivision 10; Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372;
9520.0010; 9520.0020; 9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070;
9520.0080; 9520.0090; 9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140;
9520.0150; 9520.0160; 9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210;
9520.0230; 9520.0750; 9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800;
9520.0810; 9520.0820; 9520.0830; 9520.0840; 9520.0850; 9520.0860; 9520.0870;
9530.6800; 9530.6810.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
ECONOMIC SUPPORTS
Section 1.
Minnesota Statutes 2020, section 119B.011, subdivision 15, is amended to read:
Subd. 15.
Income.
"Income" means earned income as defined under section 256P.01,
subdivision 3, unearned income as defined under section 256P.01, subdivision 8, and public
assistance cash benefits, including the Minnesota family investment program, diversionary
work program, work benefit, Minnesota supplemental aid, general assistance, refugee cash
assistance, at-home infant child care subsidy payments, and child support and maintenance
distributed to deleted text begin thedeleted text end new text begin anew text end family under section 256.741, subdivision 2anew text begin , and nonrecurring income
over $60 per quarter unless earmarked and used for the purpose for which it was intendednew text end .
The following are deducted from income: funds used to pay for health insurance premiums
for family members, and child or spousal support paid to or on behalf of a person or persons
who live outside of the household. Income sources new text begin that are new text end not included in this subdivision
and section 256P.06, subdivision 3, are not countednew text begin as incomenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.025, subdivision 4, is amended to read:
Subd. 4.
Changes in eligibility.
(a) The county shall process a change in eligibility
factors according to paragraphs (b) to (g).
(b) A family is subject to the reporting requirements in section 256P.07new text begin , subdivision 6new text end .
(c) If a family reports a change or a change is known to the agency before the family's
regularly scheduled redetermination, the county must act on the change. The commissioner
shall establish standards for verifying a change.
(d) A change in income occurs on the day the participant received the first payment
reflecting the change in income.
(e) During a family's 12-month eligibility period, if the family's income increases and
remains at or below 85 percent of the state median income, adjusted for family size, there
is no change to the family's eligibility. The county shall not request verification of the
change. The co-payment fee shall not increase during the remaining portion of the family's
12-month eligibility period.
(f) During a family's 12-month eligibility period, if the family's income increases and
exceeds 85 percent of the state median income, adjusted for family size, the family is not
eligible for child care assistance. The family must be given 15 calendar days to provide
verification of the change. If the required verification is not returned or confirms ineligibility,
the family's eligibility ends following a subsequent 15-day adverse action notice.
(g) Notwithstanding Minnesota Rules, parts 3400.0040, subpart 3, and 3400.0170,
subpart 1, if an applicant or participant reports that employment ended, the agency may
accept a signed statement from the applicant or participant as verification that employment
ended.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256D.03, is amended by adding a subdivision to
read:
new text begin Subd. 2b. new text end
new text begin Budgeting and reporting. new text end
new text begin
County agencies shall determine eligibility and
calculate benefit amounts for general assistance according to the provisions in sections
256P.06, 256P.07, 256P.09, and 256P.10.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin SNAP employment and training. new text end
new text begin
The commissioner shall implement a
Supplemental Nutrition Assistance Program (SNAP) employment and training program
that meets the SNAP employment and training participation requirements of the United
States Department of Agriculture governed by Code of Federal Regulations, title 7, section
273.7. The commissioner shall operate a SNAP employment and training program in which
SNAP recipients elect to participate. In order to receive SNAP assistance beyond the time
limit, unless residing in an area covered by a time-limit waiver governed by Code of Federal
Regulations, title 7, section 273.24, nonexempt SNAP recipients who do not meet federal
SNAP work requirements must participate in an employment and training program. In
addition to county and tribal agencies that administer SNAP, the commissioner may contract
with third-party providers for SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin County and tribal agency duties. new text end
new text begin
County or tribal agencies that administer
SNAP shall inform adult SNAP recipients about employment and training services and
providers in the recipient's area. County or tribal agencies that administer SNAP may elect
to subcontract with a public or private entity approved by the commissioner to provide
SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Duties of commissioner. new text end
new text begin
In addition to any other duties imposed by law, the
commissioner shall:
new text end
new text begin
(1) supervise the administration of SNAP employment and training services to county,
tribal, and contracted agencies under this section and Code of Federal Regulations, title 7,
section 273.7;
new text end
new text begin
(2) disburse money allocated and reimbursed for SNAP employment and training services
to county, tribal, and contracted agencies;
new text end
new text begin
(3) accept and supervise the disbursement of any funds that may be provided by the
federal government or other sources for SNAP employment and training services;
new text end
new text begin
(4) cooperate with other agencies, including any federal agency or agency of another
state, in all matters concerning the powers and duties of the commissioner under this section;
new text end
new text begin
(5) coordinate with the commissioner of employment and economic development to
deliver employment and training services statewide;
new text end
new text begin
(6) work in partnership with counties, tribes, and other agencies to enhance the reach
and services of a statewide SNAP employment and training program; and
new text end
new text begin
(7) identify eligible nonfederal funds to earn federal reimbursement for SNAP
employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 23. new text end
new text begin Recipient duties. new text end
new text begin
Unless residing in an area covered by a time-limit waiver,
nonexempt SNAP recipients must meet federal SNAP work requirements to receive SNAP
assistance beyond the time limit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Program funding. new text end
new text begin
(a) The United States Department of Agriculture annually
allocates SNAP employment and training funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(b) The United States Department of Agriculture authorizes the disbursement of SNAP
employment and training reimbursement funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(c) Except for funds allocated for state program development and administrative purposes
or designated by the United States Department of Agriculture for a specific project, the
commissioner of human services shall disburse money allocated for federal SNAP
employment and training to counties and tribes that administer SNAP based on a formula
determined by the commissioner that includes but is not limited to the county's or tribe's
proportion of adult SNAP recipients as compared to the statewide total.
new text end
new text begin
(d) The commissioner of human services shall disburse federal funds that the
commissioner receives as reimbursement for SNAP employment and training costs to the
state agency, county, tribe, or contracted agency that incurred the costs being reimbursed.
new text end
new text begin
(e) The commissioner of human services may reallocate unexpended money disbursed
under this section to county, tribal, or contracted agencies that demonstrate a need for
additional funds.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256D.0515, is amended to read:
256D.0515 ASSET LIMITATIONS FOR SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM HOUSEHOLDS.
All Supplemental Nutrition Assistance Program (SNAP) households must be determined
eligible for the benefit discussed under section 256.029. SNAP households must demonstrate
that their gross income is equal to or less than deleted text begin 165deleted text end new text begin 200new text end percent of the federal poverty
guidelines for the same family size.
Sec. 10.
Minnesota Statutes 2020, section 256D.0516, subdivision 2, is amended to read:
Subd. 2.
SNAP reporting requirements.
The commissioner of human services shall
implement simplified reporting as permitted under the Food and Nutrition Act of 2008, as
amended, and the SNAP regulations in Code of Federal Regulations, title 7, part 273. SNAP
benefit recipient households required to report periodically shall not be required to report
more often than one time every six months. deleted text begin This provision shall not apply to households
receiving food benefits under the Minnesota family investment program waiver.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256E.34, subdivision 1, is amended to read:
Subdivision 1.
Distribution of appropriation.
The commissioner must distribute funds
appropriated to the commissioner by law for that purpose to Hunger Solutions, a statewide
association of food shelves organized as a nonprofit corporation as defined under section
501(c)(3) of the Internal Revenue Code of 1986, to distribute to qualifying food shelves. A
food shelf qualifies under this section if:
(1) it is a nonprofit corporation, or is affiliated with a nonprofit corporation, as defined
in section 501(c)(3) of the Internal Revenue Code of 1986new text begin or a federally recognized tribal
nationnew text end ;
(2) it distributes standard food orders without charge to needy individuals. The standard
food order must consist of at least a two-day supply or six pounds per person of nutritionally
balanced food items;
(3) it does not limit food distributions to individuals of a particular religious affiliation,
race, or other criteria unrelated to need or to requirements necessary to administration of a
fair and orderly distribution system;
(4) it does not use the money received or the food distribution program to foster or
advance religious or political views; and
(5) it has a stable address and directly serves individuals.
Sec. 12.
Minnesota Statutes 2020, section 256I.03, subdivision 13, is amended to read:
Subd. 13.
Prospective budgeting.
"Prospective budgeting" deleted text begin means estimating the amount
of monthly income a person will have in the payment monthdeleted text end new text begin has the meaning given in
section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256I.06, subdivision 6, is amended to read:
Subd. 6.
Reports.
Recipients must report changes in circumstances according to section
256P.07 deleted text begin that affect eligibility or housing support payment amounts, other than changes in
earned income, within ten days of the changedeleted text end . Recipients with countable earned income
must complete a household report form at least once every six monthsnew text begin according to section
256P.10new text end . deleted text begin If the report form is not received before the end of the month in which it is due,
the county agency must terminate eligibility for housing support payments. The termination
shall be effective on the first day of the month following the month in which the report was
due. If a complete report is received within the month eligibility was terminated, the
individual is considered to have continued an application for housing support payment
effective the first day of the month the eligibility was terminated.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 1c, paragraph (d).
deleted text begin
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256J.08, subdivision 15, is amended to read:
Subd. 15.
Countable income.
"Countable income" means earned and unearned income
that is deleted text begin not excluded under section 256J.21, subdivision 2deleted text end new text begin described in section 256P.06,
subdivision 3new text end , or disregarded under section 256J.21, subdivision 3new text begin , or section 256P.03new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256J.08, subdivision 71, is amended to read:
Subd. 71.
Prospective budgeting.
"Prospective budgeting" deleted text begin means a method of
determining the amount of the assistance payment in which the budget month and payment
month are the samedeleted text end new text begin has the meaning given in section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256J.08, subdivision 79, is amended to read:
Subd. 79.
Recurring income.
"Recurring income" means a form of income which is:
(1) received periodically, and may be received irregularly when receipt can be anticipated
even though the date of receipt cannot be predicted; and
(2) from the same source or of the same type that is received and budgeted in a
prospective month deleted text begin and is received in one or both of the first two retrospective monthsdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256J.10, is amended to read:
256J.10 MFIP ELIGIBILITY REQUIREMENTS.
To be eligible for MFIP, applicants must meet the general eligibility requirements in
sections 256J.11 to 256J.15, the property limitations in section 256P.02, and the income
limitations in deleted text begin sectiondeleted text end new text begin sectionsnew text end 256J.21new text begin and 256P.06new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256J.21, subdivision 3, is amended to read:
Subd. 3.
Initial income test.
The agency shall determine initial eligibility by considering
all earned and unearned income deleted text begin that is not excluded under subdivision 2deleted text end new text begin as defined in section
256P.06new text end . To be eligible for MFIP, the assistance unit's countable income minus the earned
income disregards in paragraph (a) and section 256P.03 must be below the family wage
level according to section 256J.24new text begin , subdivision 7,new text end for that size assistance unit.
(a) The initial eligibility determination must disregard the following items:
(1) the earned income disregard as determined in section 256P.03;
(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older;
(3) all payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household shall be disregarded from the income
of the person with the legal obligation to pay support; and
(4) an allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver according to section 256J.36.
(b) deleted text begin After initial eligibility is established,deleted text end new text begin The income test is for a six-month period.new text end The
assistance payment calculation is based on deleted text begin the monthly income testdeleted text end new text begin prospective budgeting
according to section 256P.09new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, except for the
amendments in subdivision 3, paragraph (b), which are effective March 1, 2023.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256J.21, subdivision 4, is amended to read:
Subd. 4.
deleted text begin Monthlydeleted text end Income test and determination of assistance payment.
deleted text begin The county
agency shall determine ongoing eligibility and the assistance payment amount according
to the monthly income test.deleted text end To be eligible for MFIP, the result of the computations in
paragraphs (a) to (e) new text begin applied to prospective budgeting new text end must be at least $1.
(a) Apply an income disregard as defined in section 256P.03, to gross earnings and
subtract this amount from the family wage level. If the difference is equal to or greater than
the MFIP transitional standard, the assistance payment is equal to the MFIP transitional
standard. If the difference is less than the MFIP transitional standard, the assistance payment
is equal to the difference. The earned income disregard in this paragraph must be deducted
every month there is earned income.
(b) All payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household must be disregarded from the income
of the person with the legal obligation to pay support.
(c) An allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver must be made according to section 256J.36.
(d) Subtract unearned income dollar for dollar from the MFIP transitional standard to
determine the assistance payment amount.
(e) When income is both earned and unearned, the amount of the assistance payment
must be determined by first treating gross earned income as specified in paragraph (a). After
determining the amount of the assistance payment under paragraph (a), unearned income
must be subtracted from that amount dollar for dollar to determine the assistance payment
amount.
deleted text begin
(f) When the monthly income is greater than the MFIP transitional standard after
deductions and the income will only exceed the standard for one month, the county agency
must suspend the assistance payment for the payment month.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256J.21, subdivision 5, is amended to read:
Subd. 5.
Distribution of income.
new text begin (a) new text end The income of all members of the assistance unit
must be counted. Income may also be deemed from ineligible persons to the assistance unit.
Income must be attributed to the person who earns it or to the assistance unit according to
paragraphs deleted text begin (a) todeleted text end new text begin (b) andnew text end (c).
deleted text begin
(a) Funds distributed from a trust, whether from the principal holdings or sale of trust
property or from the interest and other earnings of the trust holdings, must be considered
income when the income is legally available to an applicant or participant. Trusts are
presumed legally available unless an applicant or participant can document that the trust is
not legally available.
deleted text end
(b) Income from jointly owned property must be divided equally among property owners
unless the terms of ownership provide for a different distribution.
(c) Deductions are not allowed from the gross income of a financially responsible
household member or by the members of an assistance unit to meet a current or prior debt.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256J.24, subdivision 5, is amended to read:
Subd. 5.
MFIP transitional standard.
(a) The MFIP transitional standard is based on
the number of persons in the assistance unit eligible for both food and cash assistance. The
amount of the transitional standard is published annually by the Department of Human
Services.
(b) The amount of the MFIP cash assistance portion of the transitional standard is
increased $100 per month per household. This increase shall be reflected in the MFIP cash
assistance portion of the transitional standard published annually by the commissioner.
new text begin
(c) On October 1 of each year, the commissioner of human services shall adjust the cash
assistance portion under paragraph (a) for inflation based on the CPI-U for the prior calendar
year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for the fiscal year beginning on July 1,
2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256J.30, subdivision 8, is amended to read:
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the
reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the
county agency must immediately deleted text begin return the incomplete form and clearly state what the
caregiver must do for the form to be completedeleted text end new text begin contact the caregiver by phone or in writing
to acquire the necessary information to complete the formnew text end .
(c) The automated eligibility system must send a notice of proposed termination of
assistance to the assistance unit if a complete MFIP household report form is not received
by a county agency. The automated notice must be mailed to the caregiver by approximately
the 16th of the month. When a caregiver submits an incomplete form on or after the date a
notice of proposed termination has been sent, the termination is valid unless the caregiver
submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered
to have continued its application for assistance if a complete MFIP household report form
is received within a calendar month after the month in which the form was due and assistance
shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements
under subdivision 5 when any of the following factors cause a caregiver to fail to provide
the county agency with a completed MFIP household report form before the end of the
month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form
when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the
part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable
care which prevents the caregiver from providing a completed MFIP household report form
before the end of the month in which the form is due.
Sec. 24.
Minnesota Statutes 2020, section 256J.33, subdivision 1, is amended to read:
Subdivision 1.
Determination of eligibility.
new text begin (a)new text end A county agency must determine MFIP
eligibility prospectively deleted text begin for a payment monthdeleted text end based on deleted text begin retrospectivelydeleted text end assessing income
and the county agency's best estimate of the circumstances that will exist in the payment
month.
deleted text begin Except as described in section 256J.34, subdivision 1, when prospective eligibility exists,deleted text end
new text begin (b)new text end A county agency must calculate the amount of the assistance payment using deleted text begin retrospectivedeleted text end new text begin
prospectivenew text end budgeting. To determine MFIP eligibility and the assistance payment amount,
a county agency must apply countable income, described in deleted text begin sectiondeleted text end new text begin sections 256P.06 andnew text end
256J.37, subdivisions 3 to deleted text begin 10deleted text end new text begin 9new text end , received by members of an assistance unit or by other
persons whose income is counted for the assistance unit, described under sections
deleted text begin anddeleted text end 256J.37, subdivisions 1 to 2new text begin , and 256P.06, subdivision 1new text end .
new text begin (c)new text end This income must be applied to the MFIP standard of need or family wage level
subject to this section and sections 256J.34 to 256J.36. new text begin Countablenew text end income received deleted text begin in a
calendar month and not otherwise excluded under section deleted text end deleted text begin 256J.21, subdivision 2deleted text end deleted text begin ,deleted text end must be
applied to the needs of an assistance unit.
new text begin
(d) An assistance unit is not eligible when the countable income equals or exceeds the
MFIP standard of need or the family wage level for the assistance unit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective March 1, 2023. Paragraph (b) is effective
March 1, 2023, except the amendment striking section 256J.21 and inserting section 256P.06
is effective August 1, 2021. Paragraph (c) is effective August 1, 2021, except the amendment
striking "in a calendar month" is effective March 1, 2023. Paragraph (d) is effective March
1, 2023.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256J.33, subdivision 2, is amended to read:
Subd. 2.
Prospective eligibility.
An agency must determine whether the eligibility
requirements that pertain to an assistance unit, including those in sections 256J.11 to 256J.15
and 256P.02, will be met prospectively for the payment deleted text begin monthdeleted text end new text begin periodnew text end . deleted text begin Except for the
provisions in section 256J.34, subdivision 1,deleted text end The income test will be applied deleted text begin retrospectivelydeleted text end new text begin
prospectivelynew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256J.33, subdivision 4, is amended to read:
Subd. 4.
Monthly income test.
A county agency must apply the monthly income test
retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when
the countable income equals or exceeds the MFIP standard of need or the family wage level
for the assistance unit. The income applied against the monthly income test must include:
(1) gross earned income from employmentnew text begin as described in chapter 256Pnew text end , prior to
mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after
the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36deleted text begin ,
unless the employment income is specifically excluded under section 256J.21, subdivision
2deleted text end ;
(2) gross earned income from self-employment less deductions for self-employment
expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or
business state and federal income taxes, personal FICA, personal health and life insurance,
and after the disregards in section 256J.21, subdivision 4, and the allocations in section
256J.36;
(3) unearned income new text begin as described in section 256P.06, subdivision 3, new text end after deductions
for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36deleted text begin ,
unless the income has been specifically excluded in section 256J.21, subdivision 2deleted text end ;
(4) gross earned income from employment as determined under clause (1) which is
received by a member of an assistance unit who is a minor child or minor caregiver and
less than a half-time student;
(5) child support received by an assistance unit, excluded under deleted text begin section 256J.21,
subdivision 2, clause (49), ordeleted text end section 256P.06, subdivision 3, clause (2), item (xvi);
(6) spousal support received by an assistance unit;
(7) the income of a parent when that parent is not included in the assistance unit;
(8) the income of an eligible relative and spouse who seek to be included in the assistance
unit; and
(9) the unearned income of a minor child included in the assistance unit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256J.37, subdivision 1, is amended to read:
Subdivision 1.
Deemed income from ineligible assistance unit members.
The income
of ineligible assistance unit membersnew text begin , except individuals identified in section 256J.24,
subdivision 3, paragraph (a), clause (1),new text end must be deemed after allowing the following
disregards:
(1) an earned income disregard as determined under section 256P.03;
(2) all payments made by the ineligible person according to a court order for spousal
support or the support of children not living in the assistance unit's household; and
(3) an amount for the unmet needs of the ineligible persons who live in the household
who, if eligible, would be assistance unit members under section 256J.24, subdivision 2 or
4, paragraph (b). This amount is equal to the difference between the MFIP transitional
standard when the ineligible persons are included in the assistance unit and the MFIP
transitional standard when the ineligible persons are not included in the assistance unit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256J.37, subdivision 1b, is amended to read:
Subd. 1b.
Deemed income from parents of minor caregivers.
In households where
minor caregivers live with a parent or parents new text begin or a stepparent new text end who do not receive MFIP for
themselves or their minor children, the income of the parents new text begin or a stepparent new text end must be deemed
after allowing the following disregards:
(1) income of the parents equal to 200 percent of the federal poverty guideline for a
family size not including the minor parent and the minor parent's child in the household
deleted text begin according to section 256J.21, subdivision 2, clause (43)deleted text end ; and
(2) all payments made by parents according to a court order for spousal support or the
support of children not living in the parent's household.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256J.37, subdivision 3, is amended to read:
Subd. 3.
Earned income of wage, salary, and contractual employees.
The agency
must include gross earned income less any disregards in the initial deleted text begin and monthlydeleted text end income
test. Gross earned income received by persons employed on a contractual basis must be
prorated over the period covered by the contract even when payments are received over a
lesser period of time.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256J.37, subdivision 3a, is amended to read:
Subd. 3a.
Rental subsidies; unearned income.
(a) Effective July 1, 2003, the agency
shall count $50 of the value of public and assisted rental subsidies provided through the
Department of Housing and Urban Development (HUD) as unearned income to the cash
portion of the MFIP grant. The full amount of the subsidy must be counted as unearned
income when the subsidy is less than $50. The income from this subsidy shall be budgeted
according to section deleted text begin 256J.34deleted text end new text begin 256P.09new text end .
(b) The provisions of this subdivision shall not apply to an MFIP assistance unit which
includes a participant who is:
(1) age 60 or older;
(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
certified by a qualified professional when the illness, injury, or incapacity is expected to
continue for more than 30 days and severely limits the person's ability to obtain or maintain
suitable employment; or
(3) a caregiver whose presence in the home is required due to the illness or incapacity
of another member in the assistance unit, a relative in the household, or a foster child in the
household when the illness or incapacity and the need for the participant's presence in the
home has been certified by a qualified professional and is expected to continue for more
than 30 days.
(c) The provisions of this subdivision shall not apply to an MFIP assistance unit where
the parental caregiver is an SSI participant.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256J.626, subdivision 1, is amended to read:
Subdivision 1.
Consolidated fund.
The consolidated fund is established to support
counties and tribes in meeting their duties under this chapter. Counties and tribes must use
funds from the consolidated fund to develop programs and services that are designed to
improve participant outcomes as measured in section 256J.751, subdivision 2. Counties new text begin and
tribes that administer MFIP eligibility new text end may use the funds for any allowable expenditures
under subdivision 2, including case management. Tribes new text begin that do not administer MFIP
eligibility new text end may use the funds for any allowable expenditures under subdivision 2, including
case management, except those in subdivision 2, paragraph (a), clauses (1) and (6). new text begin All
payments made through the MFIP consolidated fund to support a caregiver's pursuit of
greater economic stability does not count when determining a family's available income.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256J.95, subdivision 9, is amended to read:
Subd. 9.
Property and income limitations.
The asset limits and exclusions in section
256P.02 apply to applicants and participants of DWP. All payments, deleted text begin unless excluded in
section 256J.21deleted text end new text begin as described in section 256P.06, subdivision 3new text end , must be counted as income
to determine eligibility for the diversionary work program. The agency shall treat income
as outlined in section 256J.37, except for subdivision 3a. The initial income test and the
disregards in section 256J.21, subdivision 3, shall be followed for determining eligibility
for the diversionary work program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256P.01, subdivision 3, is amended to read:
Subd. 3.
Earned income.
"Earned income" means deleted text begin cash or in-kinddeleted text end income earned through
the receipt of wages, salary, commissions, bonuses, tips, gratuities, profit from employment
activities, net profit from self-employment activities, payments made by an employer for
regularly accrued vacation or sick leave, severance pay based on accrued leave time,
deleted text begin payments from training programs at a rate at or greater than the state's minimum wage,deleted text end
royalties, honoraria, or other profit from activity that results from the client's work, deleted text begin service,deleted text end
effort, or labornew text begin for purposes other than student financial assistance, rehabilitation programs,
student training programs, or service programs such as AmeriCorpsnew text end . The income must be
in return for, or as a result of, legal activity.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256P.01, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Prospective budgeting. new text end
new text begin
"Prospective budgeting" means estimating the amount
of monthly income that an assistance unit will have in the payment month.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256P.04, subdivision 4, is amended to read:
Subd. 4.
Factors to be verified.
(a) The agency shall verify the following at application:
(1) identity of adults;
(2) age, if necessary to determine eligibility;
(3) immigration status;
(4) income;
(5) spousal support and child support payments made to persons outside the household;
(6) vehicles;
(7) checking and savings accounts;
(8) inconsistent information, if related to eligibility;
(9) residence;new text begin and
new text end
(10) Social Security numberdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
deleted text end
(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, deleted text begin clause (7)deleted text end new text begin clauses (8) and (9)new text end , are not required to
verify the information in paragraph (a), clause (10). When a Social Security number is not
provided to the agency for verification, this requirement is satisfied when each member of
the assistance unit cooperates with the procedures for verification of Social Security numbers,
issuance of duplicate cards, and issuance of new numbers which have been established
jointly between the Social Security Administration and the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023, except for paragraph (b),
which is effective July 1, 2021.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256P.04, subdivision 8, is amended to read:
Subd. 8.
Recertification.
The agency shall recertify eligibility deleted text begin in an annual interview
with the participant. The interview may be conducted by telephone, by Internet telepresence,
or face-to-face in the county office or in another location mutually agreed upon. A participant
must be given the option of a telephone interview or Internet telepresence to recertify
eligibilitydeleted text end new text begin annuallynew text end . During deleted text begin the interviewdeleted text end new text begin recertification and reporting under section 256P.10new text end ,
the agency shall verify the following:
(1) income, unless excluded, including self-employment earnings;
(2) assets when the value is within $200 of the asset limit; and
(3) inconsistent information, if related to 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. 37.
Minnesota Statutes 2020, section 256P.06, subdivision 2, is amended to read:
Subd. 2.
deleted text begin Exempted individualsdeleted text end new text begin Exemptionsnew text end .
(a) The following members of an assistance
unit under chapters 119B and 256J are exempt from having their earned income count
deleted text begin towardsdeleted text end new text begin towardnew text end the income of an assistance unit:
(1) children under six years old;
(2) caregivers under 20 years of age enrolled at least half-time in school; and
(3) minors enrolled in school full time.
(b) The following members of an assistance unit are exempt from having their earned
and unearned income count deleted text begin towardsdeleted text end new text begin towardnew text end the income of an assistance unit for 12
consecutive calendar months, beginning the month following the marriage date, for benefits
under chapter 256J if the household income does not exceed 275 percent of the federal
poverty guideline:
(1) a new spouse to a caretaker in an existing assistance unit; and
(2) the spouse designated by a newly married couple, both of whom were already
members of an assistance unit under chapter 256J.
(c) If members identified in paragraph (b) also receive assistance under section 119B.05,
they are exempt from having their earned and unearned income count deleted text begin towardsdeleted text end new text begin towardnew text end the
income of the assistance unit if the household income prior to the exemption does not exceed
67 percent of the state median income for recipients for 26 consecutive biweekly periods
beginning the second biweekly period after the marriage date.
new text begin
(d) For individuals who are members of an assistance unit under chapters 256I and 256J,
the assistance standard effective in January 2020 for a household of one under chapter 256J
shall be counted as income under chapter 256I, and any subsequent increases to unearned
income under chapter 256J shall be exempt.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256P.06, subdivision 3, is amended to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winningsnew text begin according to guidance provided for the Supplemental
Nutrition Assistance Programnew text end ;
(vii) unemployment insurance incomenew text begin that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
new text end
new text begin
(A) 18 years of age and enrolled in a secondary school; or
new text end
new text begin (B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-timenew text end ;
(viii) retirement, survivors, and disability insurance payments;
deleted text begin
(ix) nonrecurring income over $60 per quarter unless earmarked and used for the purpose
for which it is intended. Income and use of this income is subject to verification requirements
under section 256P.04;
deleted text end
deleted text begin (x)deleted text end new text begin (ix)new text end retirement benefits;
deleted text begin (xi)deleted text end new text begin (x)new text end cash assistance benefits, as defined by each program in chapters 119B, 256D,
256I, and 256J;
deleted text begin (xii)deleted text end new text begin (xi)new text end tribal per capita payments unless excluded by federal and state law;
deleted text begin (xiii)deleted text end new text begin (xii)new text end income and payments from service and rehabilitation programs that meet or
exceed the state's minimum wage rate;
deleted text begin (xiv)deleted text end new text begin (xiii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;
deleted text begin (xv)deleted text end new text begin (xiv)new text end all child support payments for programs under chapters 119B, 256D, and 256I;
deleted text begin (xvi)deleted text end new text begin (xv)new text end the amount of child support received that exceeds $100 for assistance units
with one child and $200 for assistance units with two or more children for programs under
chapter 256J; deleted text begin and
deleted text end
deleted text begin (xvii)deleted text end new text begin (xvi)new text end spousal supportdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(xvii) workers' compensation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023, except subdivision 3,
clause (2), item (vii), which is effective the day following final enactment and subdivision
3, clause (2), item (xvii), which is effective August 1, 2021.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256P.07, is amended to read:
256P.07 REPORTING OF deleted text begin INCOME ANDdeleted text end CHANGES.
Subdivision 1.
Exempted programs.
Participants who new text begin receive Supplemental Security
Income and new text end qualify for Minnesota supplemental aid under chapter 256D deleted text begin anddeleted text end new text begin ornew text end for housing
support under chapter 256I deleted text begin on the basis of eligibility for Supplemental Security Incomedeleted text end are
exempt from deleted text begin this sectiondeleted text end new text begin reporting incomenew text end .
new text begin Subd. 1a. new text end
new text begin Child care assistance programs. new text end
new text begin
Participants who qualify for child care
assistance programs under chapter 119B are exempt from this section except for the reporting
requirements in subdivision 6.
new text end
Subd. 2.
Reporting requirements.
An applicant or participant must provide information
on an application and any subsequent reporting forms about the assistance unit's
circumstances that affect eligibility or benefits. An applicant or assistance unit must report
changes identified in deleted text begin subdivisiondeleted text end new text begin subdivisionsnew text end 3new text begin , 4, 5, 7, 8, and 9 during the application
period or by the tenth of the month following the month that the change occurrednew text end . When
information is not accurately reported, both an overpayment and a referral for a fraud
investigation may result. When information or documentation is not provided, the receipt
of any benefit may be delayed or denied, depending on the type of information required
and its effect on eligibility.
Subd. 3.
Changes that must be reported.
deleted text begin
An assistance unit must report the changes
or anticipated changes specified in clauses (1) to (12) within ten days of the date they occur,
at the time of recertification of eligibility under section 256P.04, subdivisions 8 and 9, or
within eight calendar days of a reporting period, whichever occurs first. An assistance unit
must report other changes at the time of recertification of eligibility under section 256P.04,
subdivisions 8 and 9, or at the end of a reporting period, as applicable. When an agency
could have reduced or terminated assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (12) had not occurred, the agency must
determine whether a timely notice could have been issued on the day that the change
occurred. When a timely notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error overpayment under section
119B.11, subdivision 2a, or 256P.08. Changes in circumstances that must be reported within
ten days must also be reported for the reporting period in which those changes occurred.
Within ten days, an assistance unit must report:
deleted text end
deleted text begin
(1) a change in earned income of $100 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(2) a change in unearned income of $50 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(3) a change in employment status and hours with the exception of a program under
chapter 119B;
deleted text end
deleted text begin
(4) a change in address or residence;
deleted text end
deleted text begin
(5) a change in household composition with the exception of programs under chapter
256I;
deleted text end
deleted text begin
(6) a receipt of a lump-sum payment with the exception of a program under chapter
119B;
deleted text end
deleted text begin
(7) an increase in assets if over $9,000 with the exception of programs under chapter
119B;
deleted text end
deleted text begin
(8) a change in citizenship or immigration status;
deleted text end
deleted text begin
(9) a change in family status with the exception of programs under chapter 256I;
deleted text end
deleted text begin
(10) a change in disability status of a unit member, with the exception of programs under
chapter 119B;
deleted text end
deleted text begin
(11) a new rent subsidy or a change in rent subsidy with the exception of a program
under chapter 119B; and
deleted text end
deleted text begin
(12) a sale, purchase, or transfer of real property with the exception of a program under
chapter 119B.
deleted text end
new text begin
An assistance unit must report changes or anticipated changes as described
in this section.
new text end
new text begin
(a) An assistance unit must report:
new text end
new text begin
(1) a change in eligibility for Supplemental Security Income, Retirement Survivors
Disability Insurance, or another federal income support;
new text end
new text begin
(2) a change in address or residence;
new text end
new text begin
(3) a change in household composition with the exception of programs under chapter
256I;
new text end
new text begin
(4) cash prizes and winnings according to guidance provided for the Supplemental
Nutrition Assistance Program;
new text end
new text begin
(5) a change in citizenship or immigration status;
new text end
new text begin
(6) a change in family status with the exception of programs under chapter 256I; and
new text end
new text begin
(7) assets when the value is at or above the asset limit.
new text end
new text begin
(b) When an agency could have reduced or terminated assistance for one or more payment
months if a delay in reporting a change specified in clauses (1) to (7) had not occurred, the
agency must determine whether a timely notice could have been issued on the day that the
change occurred. When a timely notice could have been issued, each month's overpayment
subsequent to the notice must be considered a client error overpayment under section
256P.08.
new text end
Subd. 4.
MFIP-specific reporting.
In addition to subdivision 3, an assistance unit under
chapter 256J, deleted text begin within ten days of the change,deleted text end must report:
(1) a pregnancy not resulting in birth when there are no other minor children; deleted text begin and
deleted text end
(2) a change in school attendance of a parent under 20 years of age deleted text begin or of an employed
child.deleted text end new text begin ; and
new text end
new text begin
(3) an individual who is 18 or 19 years of age attending high school who graduates or
drops out of school.
new text end
Subd. 5.
DWP-specific reporting.
In addition to subdivisions 3 and 4, an assistance
unit participating in the diversionary work program under section 256J.95 must report on
an application:
(1) shelter expenses; and
(2) utility expenses.
Subd. 6.
Child care assistance programs-specific reporting.
(a) deleted text begin In addition to
subdivision 3,deleted text end An assistance unit under chapter 119B, within ten days of the change, must
report:
(1) a change in a parentally responsible individual's custody schedule for any child
receiving child care assistance program benefits;
(2) a permanent end in a parentally responsible individual's authorized activity; deleted text begin and
deleted text end
(3) if the unit's family's annual included income exceeds 85 percent of the state median
income, adjusted for family sizedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) a change in address or residence;
new text end
new text begin
(5) a change in household composition;
new text end
new text begin
(6) a change in citizenship or immigration status; and
new text end
new text begin
(7) a change in family status.
new text end
(b) An assistance unit subject to section 119B.095, subdivision 1, paragraph (b), must
report a change in the unit's authorized activity status.
(c) An assistance unit must notify the county when the unit wants to reduce the number
of authorized hours for children in the unit.
Subd. 7.
Minnesota supplemental aid-specific reporting.
new text begin (a) new text end In addition to subdivision
3new text begin and notwithstanding the exemption in subdivision 1new text end , an assistance unit participating in
the Minnesota supplemental aid program under deleted text begin section 256D.44, subdivision 5, paragraph
(g), within ten days of the change,deleted text end new text begin chapter 256Dnew text end must report deleted text begin shelter expenses.deleted text end new text begin :
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater.
new text end
new text begin
(b) An assistance unit receiving housing assistance under section 256D.44, subdivision
5, paragraph (g), including assistance units who also receive Supplemental Security Income,
must report:
new text end
new text begin
(1) a change in shelter expenses; and
new text end
new text begin
(2) a new rent subsidy or a change in a rent subsidy.
new text end
new text begin Subd. 8. new text end
new text begin Housing support-specific reporting. new text end
new text begin
(a) In addition to subdivision 3, an
assistance unit participating in the housing support program under chapter 256I must report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater, with the exception of
participants already subject to six-month reporting requirements in section 256P.10.
new text end
new text begin
(b) Notwithstanding the exemptions in subdivisions 1 and 3, an assistance unit receiving
housing support under chapter 256I, including an assistance unit that receives Supplemental
Security Income, must report:
new text end
new text begin
(1) a new rent subsidy or a change in a rent subsidy;
new text end
new text begin
(2) a change in the disability status of a unit member; and
new text end
new text begin
(3) a change in household composition if the assistance unit is a participant in housing
support under section 256I.04, subdivision 3, paragraph (a), clause (3).
new text end
new text begin Subd. 9. new text end
new text begin General assistance-specific reporting. new text end
new text begin
In addition to subdivision 3, an
assistance unit participating in the general assistance program under chapter 256D must
report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater;
new text end
new text begin
(2) a change in earned income of $100 per month or greater, with the exception of
participants who are already subject to six-month reporting requirements in section 256P.10;
and
new text end
new text begin
(3) changes in any condition that would result in the loss of a basis for eligibility in
section 256D.05, subdivision 1, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 40.
new text begin
[256P.09] PROSPECTIVE BUDGETING OF BENEFITS.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units who qualify for child care
assistance programs under chapter 119B; housing support assistance units under chapter
256I who are not subject to reporting under section 256P.10; and assistance units who
qualify for Minnesota Supplemental Aid under chapter 256D are exempt from this section.
new text end
new text begin Subd. 2. new text end
new text begin Prospective budgeting of benefits. new text end
new text begin
An agency must use prospective budgeting
to calculate an assistance payment amount.
new text end
new text begin Subd. 3. new text end
new text begin Income changes. new text end
new text begin
Prospective budgeting must be used to determine the amount
of the assistance unit's benefit for the following six-month period. An increase in income
shall not affect an assistance unit's eligibility or benefit amount until the next case review
unless otherwise required by section 256P.07. A decrease in income shall be effective on
the date that the change occurs if the change is reported by the tenth of the month following
the month when the change occurred. If the decrease in income is not reported by the tenth
of the month following the month when the change occurred, the change in income shall
be effective the month following the month when the change is reported.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 41.
new text begin
[256P.10] SIX-MONTH REPORTING.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units who qualify for child care
assistance programs under chapter 119B; assistance units who qualify for Minnesota
Supplemental Aid under chapter 256D; and assistance units who qualify for housing support
under chapter 256I and also receive Supplemental Security Income are exempt from this
section.
new text end
new text begin Subd. 2. new text end
new text begin Reporting. new text end
new text begin
(a) Every six months, an assistance unit that qualifies for the
Minnesota family investment program under chapter 256J; an assistance unit that qualifies
for general assistance under chapter 256D with earned income of $100 per month or greater;
or an assistance unit that qualifies for housing support under chapter 256I with earned
income of $100 per month or greater is subject to six month case reviews. The initial
reporting period may be shorter than six months in order to align with other program reporting
periods.
new text end
new text begin
(b) An assistance unit that qualifies for the Minnesota family investment program and
an assistance unit that qualifies for general assistance as described in paragraph (a) must
complete household report forms as prescribed by the commissioner for redetermination of
benefits.
new text end
new text begin
(c) An assistance unit that qualifies for housing support as described in paragraph (a)
must complete household report forms as prescribed by the commissioner to provide
information about earned income.
new text end
new text begin
(d) An assistance unit that qualifies for housing support and also receives assistance
through the Minnesota family investment program shall be subject to the requirements of
this section for purposes of the Minnesota family investment program but not for housing
support.
new text end
new text begin
(e) An assistance unit must submit a household report form in compliance with the
provisions in section 256P.04, subdivision 11.
new text end
new text begin
(f) An assistance unit may choose to report changes under this section at any time.
new text end
new text begin Subd. 3. new text end
new text begin When to terminate assistance. new text end
new text begin
(a) An agency must terminate benefits when
the participant fails to submit the household report form before the end of the six month
review period. If the participant submits the household report form within 30 days of the
termination of benefits, benefits must be reinstated and made available retroactively for the
full benefit month.
new text end
new text begin
(b) When an assistance unit is determined to be ineligible for assistance according to
this section and chapter 256D, 256I, or 256J, the agency must terminate assistance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 42.
Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
new text begin Subd. 5. new text end
new text begin Waivers and modifications. new text end
new text begin
When the peacetime emergency declared by the
governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by
the proper authority, the following waivers and modifications to human services programs
issued by the commissioner of human services pursuant to Executive Orders 20-12 and
20-42, including any amendments to the waivers or modifications issued before the peacetime
emergency expires, shall remain in effect until December 31, 2021, unless necessary federal
approval is not received at any time for a waiver or modification:
new text end
new text begin
(1) Executive Order 21-15: when determining eligibility for cash assistance programs,
not counting as income any emergency economic relief provided through the American
Rescue Plan Act of 2021; and
new text end
new text begin
(2) CV.04.A4: waiving interviews for annual eligibility recertifications of households
receiving cash assistance in which all necessary information has been submitted and verified.
new text end
Sec. 43. new text begin DIRECTION TO COMMISSIONER; LONG-TERM HOMELESS
SUPPORTIVE SERVICES REPORT.
new text end
new text begin
(a) No later than January 15, 2023, the commissioner of human services shall produce
a report which shows the projects funded under Minnesota Statutes, section 256K.26, and
provide a copy of the report to the chairs and ranking minority members of the legislative
committees with jurisdiction over services for persons experiencing homelessness.
new text end
new text begin
(b) This report must be updated annually for two additional years and the commissioner
must provide copies of the updated reports to the chairs and ranking minority members of
the legislative committees with jurisdiction over services for persons experiencing
homelessness by January 15, 2024, and January 15, 2025.
new text end
Sec. 44. new text begin 2021 REPORT TO LEGISLATURE ON RUNAWAY AND HOMELESS
YOUTH.
new text end
new text begin Subdivision 1. new text end
new text begin Report development. new text end
new text begin
The commissioner of human services is exempt
from preparing the report required under Minnesota Statutes, section 256K.45, subdivision
2, in 2023 and shall instead update the information in the 2007 legislative report on runaway
and homeless youth. In developing the updated report, the commissioner must use existing
data, studies, and analysis provided by state, county, and other entities including:
new text end
new text begin
(1) Minnesota Housing Finance Agency analysis on housing availability;
new text end
new text begin
(2) the Minnesota state plan to end homelessness;
new text end
new text begin
(3) the continuum of care counts of youth experiencing homelessness and assessments
as provided by Department of Housing and Urban Development (HUD) required coordinated
entry systems;
new text end
new text begin
(4) the biannual Department of Human Services report on the Homeless Youth Act;
new text end
new text begin
(5) the Wilder Research homeless study;
new text end
new text begin
(6) the Voices of Youth Count sponsored by Hennepin County; and
new text end
new text begin
(7) privately funded analysis, including:
new text end
new text begin
(i) nine evidence-based principles to support youth in overcoming homelessness;
new text end
new text begin
(ii) the return on investment analysis conducted for YouthLink by Foldes Consulting;
and
new text end
new text begin
(iii) the evaluation of Homeless Youth Act resources conducted by Rainbow Research.
new text end
new text begin Subd. 2. new text end
new text begin Key elements; due date. new text end
new text begin
(a) The report must include three key elements where
significant learning has occurred in the state since the 2007 report, including:
new text end
new text begin
(1) the unique causes of youth homelessness;
new text end
new text begin
(2) targeted responses to youth homelessness, including the significance of positive
youth development as fundamental to each targeted response; and
new text end
new text begin
(3) recommendations based on existing reports and analysis on how to end youth
homelessness.
new text end
new text begin
(b) To the extent that data is available, the report must include:
new text end
new text begin
(1) a general accounting of the federal and philanthropic funds leveraged to support
homeless youth activities;
new text end
new text begin
(2) a general accounting of the increase in volunteer responses to support youth
experiencing homelessness; and
new text end
new text begin
(3) a data-driven accounting of geographic areas or distinct populations that have gaps
in service or are not yet served by homeless youth responses.
new text end
new text begin
(c) The commissioner of human services shall consult with and incorporate the expertise
of community-based providers of homeless youth services and other expert stakeholders to
complete the report. The commissioner shall submit the report to the chairs and ranking
minority members of the legislative committees with jurisdiction over youth homelessness
by December 15, 2022.
new text end
Sec. 45. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b,
6c, 7, 8, 9, and 18; 256D.052, subdivision 3; and 256J.21, subdivisions 1 and 2,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256J.08, subdivisions 10, 53, 61, 62, 81, and 83;
256J.30, subdivisions 5, 7, and 8; 256J.33, subdivisions 3, 4, and 5; 256J.34, subdivisions
1, 2, 3, and 4; and 256J.37, subdivision 10,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective August 1, 2021. Paragraph (b) is effective
March 1, 2023.
new text end
ARTICLE 2
CHILD PROTECTION
Section 1.
Minnesota Statutes 2020, section 256N.25, subdivision 2, is amended to read:
Subd. 2.
Negotiation of agreement.
(a) When a child is determined to be eligible for
Northstar kinship assistance or adoption assistance, the financially responsible agency, or,
if there is no financially responsible agency, the agency designated by the commissioner,
must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
the caregiver and agency reach concurrence as to the terms of the agreement, both parties
shall sign the agreement. The agency must submit the agreement, along with the eligibility
determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
the commissioner for final review, approval, and signature according to subdivision 1.
(b) A monthly payment is provided as part of the adoption assistance or Northstar kinship
assistance agreement to support the care of children unless the child is eligible for adoption
assistance and determined to be an at-risk child, in which case no payment will be made
unless and until the caregiver obtains written documentation from a qualified expert that
the potential disability upon which eligibility for the agreement was based has manifested
itself.
(1) The amount of the payment made on behalf of a child eligible for Northstar kinship
assistance or adoption assistance is determined through agreement between the prospective
relative custodian or the adoptive parent and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, using the
assessment tool established by the commissioner in section 256N.24, subdivision 2, and the
associated benefit and payments outlined in section 256N.26. Except as provided under
section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes the monthly
benefit level for a child under foster care. The monthly payment under a Northstar kinship
assistance agreement or adoption assistance agreement may be negotiated up to the monthly
benefit level under foster care. In no case may the amount of the payment under a Northstar
kinship assistance agreement or adoption assistance agreement exceed the foster care
maintenance payment which would have been paid during the month if the child with respect
to whom the Northstar kinship assistance or adoption assistance payment is made had been
in a foster family home in the state.
(2) The rate schedule for the agreement is determined based on the age of the child on
the date that the prospective adoptive parent or parents or relative custodian or custodians
sign the agreement.
(3) The income of the relative custodian or custodians or adoptive parent or parents must
not be taken into consideration when determining eligibility for Northstar kinship assistance
or adoption assistance or the amount of the payments under section 256N.26.
(4) With the concurrence of the relative custodian or adoptive parent, the amount of the
payment may be adjusted periodically using the assessment tool established by the
commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
subdivision 3 when there is a change in the child's needs or the family's circumstances.
(5) An adoptive parent of an at-risk child with an adoption assistance agreement may
request a reassessment of the child under section 256N.24, subdivision 10, and renegotiation
of the adoption assistance agreement under subdivision 3 to include a monthly payment, if
the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner.
(c) For Northstar kinship assistance agreements:
(1) the initial amount of the monthly Northstar kinship assistance payment must be
equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less any
offsets under section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective relative custodian and specified in that agreement, unless the Northstar
kinship assistance agreement is entered into when a child is under the age of six; and
(2) the amount of the monthly payment for a Northstar kinship assistance agreement for
a child who is under the age of six must be as specified in section 256N.26, subdivision 5.
(d) For adoption assistance agreements:
(1) for a child in foster care with the prospective adoptive parent immediately prior to
adoptive placement, the initial amount of the monthly adoption assistance payment must
be equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less
any offsets in section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective adoptive parents and specified in that agreement, unless the child is
identified as at-risk or the adoption assistance agreement is entered into when a child is
under the age of six;
(2) for an at-risk child who must be assigned level A as outlined in section 256N.26, no
payment will be made unless and until the potential disability manifests itself, as documented
by an appropriate professional, and the commissioner authorizes commencement of payment
by modifying the agreement accordingly;
(3) the amount of the monthly payment for an adoption assistance agreement for a child
under the age of six, other than an at-risk child, must be as specified in section 256N.26,
subdivision 5;
(4) for a child who is in the Northstar kinship assistance program immediately prior to
adoptive placement, the initial amount of the adoption assistance payment must be equivalent
to the Northstar kinship assistance payment in effect at the time that the adoption assistance
agreement is signed or a lesser amount if agreed to by the prospective adoptive parent and
specified in that agreement, unless the child is identified as an at-risk child; and
(5) for a child who is not in foster care placement or the Northstar kinship assistance
program immediately prior to adoptive placement or negotiation of the adoption assistance
agreement, the initial amount of the adoption assistance agreement must be determined
using the assessment tool and process in this section and the corresponding payment amount
outlined in section 256N.26.
Sec. 2.
Minnesota Statutes 2020, section 256N.25, subdivision 3, is amended to read:
Subd. 3.
Renegotiation of agreement.
(a) A relative custodian or adoptive parent of a
child with a Northstar kinship assistance or adoption assistance agreement may request
renegotiation of the agreement when there is a change in the needs of the child or in the
family's circumstances. When a relative custodian or adoptive parent requests renegotiation
of the agreement, a reassessment of the child must be completed consistent with section
256N.24, subdivisions 10 and 11. If the reassessment indicates that the child's level has
changed, the financially responsible agency or, if there is no financially responsible agency,
the agency designated by the commissioner or the commissioner's designee, and the caregiver
must renegotiate the agreement to include a payment with the level determined through the
reassessment process. The agreement must not be renegotiated unless the commissioner,
the financially responsible agency, and the caregiver mutually agree to the changes. The
effective date of any renegotiated agreement must be determined by the commissioner.
(b) An adoptive parent of an at-risk child with an adoption assistance agreement may
request renegotiation of the agreement to include a monthly payment under section 256N.26
if the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner. Prior
to renegotiating the agreement, a reassessment of the child must be conducted as outlined
in section 256N.24, subdivision 10. The reassessment must be used to renegotiate the
agreement to include an appropriate monthly payment. The agreement must not be
renegotiated unless the commissioner, the financially responsible agency, and the caregiver
mutually agree to the changes. The effective date of any renegotiated agreement must be
determined by the commissioner.
deleted text begin
(c) Renegotiation of a Northstar kinship assistance or adoption assistance agreement is
required when one of the circumstances outlined in section 256N.26, subdivision 13, occurs.
deleted text end
Sec. 3.
Minnesota Statutes 2020, section 256N.26, subdivision 11, is amended to read:
Subd. 11.
Child income or income attributable to the child.
(a) A monthly Northstar
kinship assistance or adoption assistance payment must be considered as income and
resources attributable to the child. Northstar kinship assistance and adoption assistance are
exempt from garnishment, except as permissible under the laws of the state where the child
resides.
(b) When a child is placed into foster care, any income and resources attributable to the
child are treated as provided in sections 252.27 and 260C.331, or 260B.331, as applicable
to the child being placed.
(c) deleted text begin Consideration of income and resources attributable to the child must be part of the
negotiation process outlined in section 256N.25, subdivision 2. In some circumstances, the
receipt of other income on behalf of the child may impact the amount of the monthly payment
received by the relative custodian or adoptive parent on behalf of the child through Northstar
Care for Children.deleted text end Supplemental Security Income (SSI), retirement survivor's disability
insurance (RSDI), veteran's benefits, railroad retirement benefits, and black lung benefits
are considered income and resources attributable to the child.
Sec. 4.
Minnesota Statutes 2020, section 256N.26, subdivision 13, is amended to read:
Subd. 13.
Treatment of retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, and black lung benefits.
deleted text begin (a)deleted text end If a child placed in foster care
receives retirement survivor's disability insurance, veteran's benefits, railroad retirement
benefits, or black lung benefits at the time of foster care placement or subsequent to
placement in foster care, the financially responsible agency may apply to be the payee for
the child for the duration of the child's placement in foster care. If it is anticipated that a
child will be eligible to receive retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, or black lung benefits after finalization of the adoption or
assignment of permanent legal and physical custody, the permanent caregiver shall apply
to be the payee of those benefits on the child's behalf. deleted text begin The monthly amount of the other
benefits must be considered an offset to the amount of the payment the child is determined
eligible for under Northstar Care for Children.
deleted text end
deleted text begin
(b) If a child becomes eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits, after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the other benefits must be considered an offset to the amount of the
payment the child is determined eligible for under Northstar Care for Children.
deleted text end
deleted text begin
(c) If a child ceases to be eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the payment under Northstar Care for Children must be the amount the
child was determined to be eligible for prior to consideration of any offset.
deleted text end
deleted text begin
(d) If the monthly payment received on behalf of the child under retirement survivor's
disability insurance, veteran's benefits, railroad retirement benefits, or black lung benefits
changes after the adoption assistance or Northstar kinship assistance agreement is finalized,
the permanent caregiver shall notify the commissioner as to the new monthly payment
amount, regardless of the amount of the change in payment. If the monthly payment changes
by $75 or more, even if the change occurs incrementally over the duration of the term of
the adoption assistance or Northstar kinship assistance agreement, the monthly payment
under Northstar Care for Children must be adjusted without further consent to reflect the
amount of the increase or decrease in the offset amount. Any subsequent change to the
payment must be reported and handled in the same manner. A change of monthly payments
of less than $75 is not a permissible reason to renegotiate the adoption assistance or Northstar
kinship assistance agreement under section 256N.25, subdivision 3. The commissioner shall
review and revise the limit at which the adoption assistance or Northstar kinship assistance
agreement must be renegotiated in accordance with subdivision 9.
deleted text end
Sec. 5.
Minnesota Statutes 2020, section 260.761, subdivision 2, is amended to read:
Subd. 2.
Agency and court notice to tribes.
(a) When a local social services agency
has information that a family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking
assessmentnew text end being conducted may involve an Indian child, the local social services agency
shall notify the Indian child's tribe of the family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver
sex trafficking assessmentnew text end according to section 260E.18.new text begin The local social services agency
shall providenew text end initial notice deleted text begin shall be provideddeleted text end by telephone and by e-mail or facsimile. The
local social services agency shall request that the tribe or a designated tribal representative
participate in evaluating the family circumstances, identifying family and tribal community
resources, and developing case plans.
(b) When a local social services agency has information that a child receiving services
may be an Indian child, the local social services agency shall notify the tribe by telephone
and by e-mail or facsimile of the child's full name and date of birth, the full names and dates
of birth of the child's biological parents, and, if known, the full names and dates of birth of
the child's grandparents and of the child's Indian custodian. This notification must be provided
deleted text begin sodeleted text end new text begin fornew text end the tribe deleted text begin candeleted text end new text begin tonew text end determine if the child is enrolled in the tribe or eligible for new text begin tribal
new text end membership, and deleted text begin must be provideddeleted text end new text begin the agency must provide this notification to the tribenew text end
within seven daysnew text begin of receiving information that the child may be an Indian childnew text end . If
information regarding the child's grandparents or Indian custodian is not available within
the seven-day period, the local social services agency shall continue to request this
information and shall notify the tribe when it is received. Notice shall be provided to all
tribes to which the child may have any tribal lineage. If the identity or location of the child's
parent or Indian custodian and tribe cannot be determined, the local social services agency
shall provide the notice required in this paragraph to the United States secretary of the
interior.
(c) In accordance with sections 260C.151 and 260C.152, when a court has reason to
believe that a child placed in emergency protective care is an Indian child, the court
administrator or a designee shall, as soon as possible and before a hearing takes place, notify
the tribal social services agency by telephone and by e-mail or facsimile of the date, time,
and location of the emergency protective case hearing. The court shall make efforts to allow
appearances by telephone for tribal representatives, parents, and Indian custodians.
(d) A local social services agency must provide the notices required under this subdivision
at the earliest possible time to facilitate involvement of the Indian child's tribe. Nothing in
this subdivision is intended to hinder the ability of the local social services agency and the
court to respond to an emergency situation. Lack of participation by a tribe shall not prevent
the tribe from intervening in services and proceedings at a later date. A tribe may participate
new text begin in a case new text end at any time. At any stage of the local social services agency's involvement with
an Indian child, the agency shall provide full cooperation to the tribal social services agency,
including disclosure of all data concerning the Indian child. Nothing in this subdivision
relieves the local social services agency of satisfying the notice requirements in the Indian
Child Welfare Act.
Sec. 6.
Minnesota Statutes 2020, section 260C.007, subdivision 14, is amended to read:
Subd. 14.
Egregious harm.
"Egregious harm" means the infliction of bodily harm to a
child or neglect of a child which demonstrates a grossly inadequate ability to provide
minimally adequate parental care. deleted text begin Thedeleted text end Egregious harm deleted text begin needdeleted text end new text begin mustnew text end not have occurred in the
state or in the county where a termination of parental rights action deleted text begin is otherwise properly
venueddeleted text end new text begin has proper venuenew text end . Egregious harm includes, but is not limited to:
(1) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes a violation of sections 609.185 to
609.2114, 609.222, subdivision 2, 609.223, or any other similar law of any other state;
(2) the infliction of "substantial bodily harm" to a child, as defined in section 609.02,
subdivision 7a;
(3) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony malicious punishment of a
child under section 609.377;
(4) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony unreasonable restraint of a
child under section 609.255, subdivision 3;
(5) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony neglect or endangerment of
a child under section 609.378;
(6) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes assault under section 609.221, 609.222,
or 609.223;
(7) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes new text begin sex trafficking, new text end solicitation,
inducement, deleted text begin ordeleted text end promotion of, or receiving profit derived from prostitution under section
609.322;
(8) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes murder or voluntary manslaughter
as defined by United States Code, title 18, section 1111(a) or 1112(a);
(9) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes aiding or abetting, attempting,
conspiring, or soliciting to commit a murder or voluntary manslaughter that constitutes a
violation of United States Code, title 18, section 1111(a) or 1112(a); or
(10) conduct toward a child that constitutes criminal sexual conduct under sections
609.342 to 609.345.
Sec. 7.
Minnesota Statutes 2020, section 260E.01, is amended to read:
260E.01 POLICY.
(a) The legislature hereby declares that the public policy of this state is to protect children
whose health or welfare may be jeopardized through maltreatment. While it is recognized
that most parents want to keep their children safe, sometimes circumstances or conditions
interfere with their ability to do so. When this occurs, the health and safety of the children
must be of paramount concern. Intervention and prevention efforts must address immediate
concerns for child safety and the ongoing risk of maltreatment and should engage the
protective capacities of families. In furtherance of this public policy, it is the intent of the
legislature under this chapter to:
(1) protect children and promote child safety;
(2) strengthen the family;
(3) make the home, school, and community safe for children by promoting responsible
child care in all settings; and
(4) provide, when necessary, a safe temporary or permanent home environment for
maltreated children.
(b) In addition, it is the policy of this state to:
(1) require the reporting of maltreatment of children in the home, school, and community
settings;
(2) provide for deleted text begin thedeleted text end voluntary reporting of maltreatment of children;
(3) require an investigation when the report alleges sexual abuse or substantial child
endangermentnew text begin , except when the report alleges sex trafficking by a noncaregiver sex traffickernew text end ;
(4) provide a family assessment, if appropriate, when the report does not allege sexual
abuse or substantial child endangerment; deleted text begin and
deleted text end
(5) new text begin provide a noncaregiver sex trafficking assessment when the report alleges sex
trafficking by a noncaregiver sex trafficker; and
new text end
new text begin (6) new text end provide protective, family support, and family preservation services when needed
in appropriate cases.
Sec. 8.
Minnesota Statutes 2020, section 260E.02, subdivision 1, is amended to read:
Subdivision 1.
Establishment of team.
A county shall establish a multidisciplinary
child protection team that may include, but new text begin is new text end not deleted text begin bedeleted text end limited to, the director of the local
welfare agency or designees, the county attorney or designees, the county sheriff or designees,
representatives of health and education, representatives of mental healthnew text begin , representatives of
agencies providing specialized services or responding to youth who experience or are at
risk of experiencing sex trafficking or sexual exploitation,new text end or other appropriate human
services or community-based agencies, and parent groups. As used in this section, a
"community-based agency" may include, but is not limited to, schools, social services
agencies, family service and mental health collaboratives, children's advocacy centers, early
childhood and family education programs, Head Start, or other agencies serving children
and families. A member of the team must be designated as the lead person of the team
responsible for the planning process to develop standards for the team's activities with
battered women's and domestic abuse programs and services.
Sec. 9.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision to
read:
new text begin Subd. 15a. new text end
new text begin Noncaregiver sex trafficker. new text end
new text begin
"Noncaregiver sex trafficker" means an
individual who is alleged to have engaged in the act of sex trafficking a child, who is not a
person responsible for the child's care, who does not have a significant relationship with
the child as defined in section 609.341, and who is not a person in a current or recent position
of authority as defined in section 609.341, subdivision 10.
new text end
Sec. 10.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision
to read:
new text begin Subd. 15b. new text end
new text begin Noncaregiver sex trafficking assessment. new text end
new text begin
"Noncaregiver sex trafficking
assessment" is a comprehensive assessment of child safety, the risk of subsequent child
maltreatment, and strengths and needs of the child and family. The local welfare agency
shall only perform a noncaregiver sex trafficking assessment when a maltreatment report
alleges sex trafficking of a child by someone other than the child's caregiver. A noncaregiver
sex trafficking assessment does not include a determination of whether child maltreatment
occurred. A noncaregiver sex trafficking assessment includes a determination of a family's
need for services to address the safety of the child or children, the safety of family members,
and the risk of subsequent child maltreatment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 260E.03, subdivision 22, is amended to read:
Subd. 22.
Substantial child endangerment.
"Substantial child endangerment" means
that a person responsible for a child's care, by act or omission, commits or attempts to
commit an act against a child deleted text begin under theirdeleted text end new text begin in the person'snew text end care that constitutes any of the
following:
(1) egregious harm under subdivision 5;
(2) abandonment under section 260C.301, subdivision 2;
(3) neglect under subdivision 15, paragraph (a), clause (2), that substantially endangers
the child's physical or mental health, including a growth delay, which may be referred to
as failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
(4) murder in the first, second, or third degree under section 609.185, 609.19, or 609.195;
(5) manslaughter in the first or second degree under section 609.20 or 609.205;
(6) assault in the first, second, or third degree under section 609.221, 609.222, or 609.223;
(7) new text begin sex trafficking, new text end solicitation, inducement, deleted text begin anddeleted text end new text begin ornew text end promotion of prostitution under
section 609.322;
(8) criminal sexual conduct under sections 609.342 to 609.3451;
(9) solicitation of children to engage in sexual conduct under section 609.352;
(10) malicious punishment or neglect or endangerment of a child under section 609.377
or 609.378;
(11) use of a minor in sexual performance under section 617.246; or
(12) parental behavior, status, or condition deleted text begin that mandates thatdeleted text end new text begin requiringnew text end the county
attorneynew text begin tonew text end file a termination of parental rights petition under section 260C.503, subdivision
2.
Sec. 12.
Minnesota Statutes 2020, section 260E.14, subdivision 2, is amended to read:
Subd. 2.
Sexual abuse.
(a) The local welfare agency is the agency responsible for
investigating an allegation of sexual abuse if the alleged offender is the parent, guardian,
sibling, or an individual functioning within the family unit as a person responsible for the
child's care, or a person with a significant relationship to the child if that person resides in
the child's household.
(b) The local welfare agency is also responsible for new text begin assessing or new text end investigating when a
child is identified as a victim of sex trafficking.
Sec. 13.
Minnesota Statutes 2020, section 260E.14, subdivision 5, is amended to read:
Subd. 5.
Law enforcement.
(a) The local law enforcement agency is the agency
responsible for investigating a report of maltreatment if a violation of a criminal statute is
alleged.
(b) Law enforcement and the responsible agency must coordinate their investigations
or assessments as required under this chapter when deleted text begin thedeleted text end new text begin : (1) anew text end report alleges maltreatment
that is a violation of a criminal statute by a person who is a parent, guardian, sibling, person
responsible for the child's care deleted text begin functioningdeleted text end within the family unit, ornew text begin by anew text end person who lives
in the child's household and who has a significant relationship to the childdeleted text begin ,deleted text end in a setting other
than a facility as defined in section 260E.03new text begin ; or (2) a report alleges sex trafficking of a childnew text end .
Sec. 14.
Minnesota Statutes 2020, section 260E.17, subdivision 1, is amended to read:
Subdivision 1.
Local welfare agency.
(a) Upon receipt of a report, the local welfare
agency shall determine whether to conduct a family assessment deleted text begin ordeleted text end new text begin ,new text end an investigationnew text begin , or a
noncaregiver sex trafficking assessmentnew text end as appropriate to prevent or provide a remedy for
maltreatment.
(b) The local welfare agency shall conduct an investigation when the report involves
sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
(c) The local welfare agency shall begin an immediate investigation deleted text begin if,deleted text end at any time when
the local welfare agency is deleted text begin usingdeleted text end new text begin responding withnew text end a family assessment deleted text begin response,deleted text end new text begin andnew text end the
local welfare agency determines that there is reason to believe that sexual abuse deleted text begin ordeleted text end new text begin ,new text end substantial
child endangermentnew text begin ,new text end or a serious threat to the child's safety exists.
(d) The local welfare agency may conduct a family assessment for reports that do not
allege sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
In determining that a family assessment is appropriate, the local welfare agency may consider
issues of child safety, parental cooperation, and the need for an immediate response.
(e) The local welfare agency may conduct a family assessment deleted text begin ondeleted text end new text begin fornew text end a report that was
initially screened and assigned for an investigation. In determining that a complete
investigation is not required, the local welfare agency must document the reason for
terminating the investigation and notify the local law enforcement agency if the local law
enforcement agency is conducting a joint investigation.
new text begin
(f) The local welfare agency shall conduct a noncaregiver sex trafficking assessment
when a maltreatment report alleges sex trafficking of a child and the alleged offender is a
noncaregiver sex trafficker as defined by section 260E.03, subdivision 15a.
new text end
new text begin
(g) During a noncaregiver sex trafficking assessment, the local welfare agency shall
initiate an immediate investigation if there is reason to believe that a child's parent, caregiver,
or household member allegedly engaged in the act of sex trafficking a child or was alleged
to have engaged in any conduct requiring the agency to conduct an investigation.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260E.18, is amended to read:
260E.18 NOTICE TO CHILD'S TRIBE.
The local welfare agency shall provide immediate notice, according to section 260.761,
subdivision 2, to an Indian child's tribe when the agency has reason to believe new text begin that new text end the family
assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking assessmentnew text end may involve an
Indian child. For purposes of this section, "immediate notice" means notice provided within
24 hours.
Sec. 16.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall deleted text begin conduct adeleted text end new text begin havenew text end face-to-face contact with the child reported to be maltreated
and with the child's primary caregiver sufficient to complete a safety assessment and ensure
the immediate safety of the child.
(b) new text begin Except in a noncaregiver sex trafficking assessment, new text end thenew text begin local welfare agency shall
havenew text end face-to-face contact with the child and primary caregiver deleted text begin shall occurdeleted text end immediately if
sexual abuse or substantial child endangerment is alleged and within five calendar days for
all other reports. If the alleged offender was not already interviewed as the primary caregiver,
the local welfare agency shall also conduct a face-to-face interview with the alleged offender
in the early stages of the assessment or investigationnew text begin , except in a noncaregiver sex trafficking
assessmentnew text end .
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.new text begin
In a noncaregiver sex trafficking assessment, the local child welfare agency is not required
to interview the alleged offender.
new text end
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statementnew text begin , except
in a noncaregiver sex trafficking assessment where the local welfare agency may rely on
law enforcement datanew text end . The alleged offender may submit supporting documentation relevant
to the assessment or investigation.
Sec. 17.
Minnesota Statutes 2020, section 260E.24, subdivision 2, is amended to read:
Subd. 2.
Determination after family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
After conducting a family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end , the local welfare agency shall determine whether child protective services are
needed to address the safety of the child and other family members and the risk of subsequent
maltreatment.
Sec. 18.
Minnesota Statutes 2020, section 260E.24, subdivision 7, is amended to read:
Subd. 7.
Notification at conclusion of family assessmentnew text begin or a noncaregiver sex
trafficking assessmentnew text end .
Within ten working days of the conclusion of a family assessmentnew text begin
or a noncaregiver sex trafficking assessmentnew text end , the local welfare agency shall notify the parent
or guardian of the child of the need for services to address child safety concerns or significant
risk of subsequent maltreatment. The local welfare agency and the family may also jointly
agree that family support and family preservation services are needed.
Sec. 19.
Minnesota Statutes 2020, section 260E.33, subdivision 1, is amended to read:
Subdivision 1.
Followingnew text begin anew text end family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
Administrative reconsideration is not applicable to a family assessment new text begin or
noncaregiver sex trafficking assessment new text end since no determination concerning maltreatment
is made.
Sec. 20.
Minnesota Statutes 2020, section 260E.35, subdivision 6, is amended to read:
Subd. 6.
Data retention.
(a) Notwithstanding sections 138.163 and 138.17, a record
maintained or a record derived from a report of maltreatment by a local welfare agency,
agency responsible for assessing or investigating the report, court services agency, or school
under this chapter shall be destroyed as provided in paragraphs (b) to (e) by the responsible
authority.
(b) For a report alleging maltreatment that was not accepted for new text begin an new text end assessment or new text begin an
new text end investigation, a family assessment case, new text begin a noncaregiver sex trafficking assessment case, new text end and
a case where an investigation results in no determination of maltreatment or the need for
child protective services, the record must be maintained for a period of five years after the
datenew text begin thatnew text end the report was not accepted for assessment or investigation or the date of the final
entry in the case record. A record of a report that was not accepted must contain sufficient
information to identify the subjects of the report, the nature of the alleged maltreatment,
and the reasons deleted text begin as todeleted text end why the report was not accepted. Records under this paragraph may
not be used for employment, background checks, or purposes other than to assist in future
screening decisions and risk and safety assessments.
(c) All records relating to reports that, upon investigation, indicate deleted text begin eitherdeleted text end maltreatment
or a need for child protective services shall be maintained for ten years after the date of the
final entry in the case record.
(d) All records regarding a report of maltreatment, including a notification of intent to
interview that was received by a school under section 260E.22, subdivision 7, shall be
destroyed by the school when ordered to do so by the agency conducting the assessment or
investigation. The agency shall order the destruction of the notification when other records
relating to the report under investigation or assessment are destroyed under this subdivision.
(e) Private or confidential data released to a court services agency under subdivision 3,
paragraph (d), must be destroyed by the court services agency when ordered to do so by the
local welfare agency that released the data. The local welfare agency or agency responsible
for assessing or investigating the report shall order destruction of the data when other records
relating to the assessment or investigation are destroyed under this subdivision.
ARTICLE 3
CHILD PROTECTION POLICY
Section 1.
Minnesota Statutes 2020, 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 public funds are used to pay for the new text begin child's new text end services.
(b) The responsible social services agency shall determine the appropriate level of care
for a child when county-controlled funds are used to pay for the child's services or placement
in a qualified residential treatment facility under chapter 260C and licensed by the
commissioner under chapter 245A. In accordance with section 260C.157, a juvenile treatment
screening team shall conduct a screeningnew text begin of a childnew text end before the team may recommend whether
to place a child in a qualified residential treatment program as defined in section 260C.007,
subdivision 26d. When a social services agency 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 carenew text begin for the
childnew text end . 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 to be
usednew text begin for a childnew text end , the Indian Health Services or 638 tribal health facility must determine the
appropriate level of carenew text begin for the childnew text end . When more than one entity bears responsibility fornew text begin
a child'snew text end coverage, the entities shall coordinate level of care determination activitiesnew text begin for the
childnew text end to the extent possible.
(c) The responsible social services agency must make thenew text begin child'snew text end level of care
determination available to thenew text begin child'snew text end juvenile treatment screening team, as permitted under
chapter 13. The level of care determination shall inform the juvenile treatment screening
team process and the assessment in section 260C.704 when considering whether to place
the child in a qualified residential treatment program. When the responsible social services
agency is not involved in determining a child's placement, 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
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the responsible social services
agency or other entity may not determine that a screeningnew text begin of a childnew text end under section 260C.157
or referral or admission to a treatment foster care setting or 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 assessmentnew text begin
of a childnew text end that includes a functional assessment which evaluatesnew text begin the child'snew text end 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 carenew text begin to the childnew text end . The validated tool must be approved by the
commissioner of human servicesnew text begin 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 programnew text end . If a diagnostic assessment
including a functional 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 deleted text begin or notdeleted text end these services are available and accessible
to the child andnew text begin the child'snew text end family.
(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) When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 new text begin and chapter
260Dnew text end unless a court terminates the parent's rights or court orders restrict the parent from
participating in case planning, visitation, or parental responsibilities.
(g) The level of care determination, deleted text begin anddeleted text end placement decision, and recommendations for
mental health services must be documented in the child's record, as required in deleted text begin chapterdeleted text end
new text begin chaptersnew text end 260Cnew text begin and 260Dnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin
At risk of becoming a victim of sex trafficking or commercial sexual
exploitation.
new text end
new text begin
For the purposes of section 245A.25, a youth who is "at risk of becoming a
victim of sex trafficking or commercial sexual exploitation" means a youth who meets the
criteria established by the commissioner of human services for this purpose.
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. 3.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Children's residential facility. new text end
new text begin
"Children's residential facility" is defined as
a residential program licensed under this chapter or chapter 241 according to the applicable
standards in Minnesota Rules, parts 2960.0010 to 2960.0710.
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 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6d. new text end
new text begin Foster family setting. new text end
new text begin
"Foster family setting" has the meaning given in
Minnesota Rules, chapter 2960.3010, subpart 23, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
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. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6e. new text end
new text begin Foster residence setting. new text end
new text begin
"Foster residence setting" has the meaning given
in Minnesota Rules, chapter 2960.3010, subpart 26, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
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 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 18a. new text end
new text begin Trauma. new text end
new text begin
For the purposes of section 245A.25, "trauma" means an event,
series of events, or set of circumstances experienced by an individual as physically or
emotionally harmful or life-threatening and has lasting adverse effects on the individual's
functioning and mental, physical, social, emotional, or spiritual well-being. Trauma includes
the cumulative emotional or psychological harm of group traumatic experiences transmitted
across generations within a community that are often associated with racial and ethnic
population groups that have suffered major intergenerational losses.
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 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Victim of sex trafficking or commercial sexual exploitation. new text end
new text begin
For the purposes
of section 245A.25, "victim of sex trafficking or commercial sexual exploitation" means a
person who meets the definitions in section 260C.007, subdivision 31, clauses (4) and (5).
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 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 24. new text end
new text begin Youth. new text end
new text begin
For the purposes of section 245A.25, "youth" means a "child" as
defined in section 260C.007, subdivision 4, and includes individuals under 21 years of age
who are in foster care pursuant to section 260C.451.
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. 9.
Minnesota Statutes 2020, section 245A.041, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin
First date of working in a facility or setting; documentation
requirements.
new text end
new text begin
Children's residential facility and foster residence setting license holders
must document the first date that a person who is a background study subject begins working
in the license holder's facility or setting. If the license holder does not maintain documentation
of each background study subject's first date of working in the facility or setting in the
license holder's personnel files, the license holder must provide documentation to the
commissioner that contains the first date that each background study subject began working
in the license holder's program upon the commissioner's request.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 10.
new text begin
[245A.25] RESIDENTIAL PROGRAM CERTIFICATIONS FOR
COMPLIANCE WITH THE FAMILY FIRST PREVENTION SERVICES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Certification scope and applicability. new text end
new text begin
(a) This section establishes the
requirements that a children's residential facility or child foster residence setting must meet
to be certified for the purposes of Title IV-E funding requirements as:
new text end
new text begin
(1) a qualified residential treatment program;
new text end
new text begin
(2) a residential setting specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) a residential setting specializing in providing prenatal, postpartum, or parenting
support for youth; or
new text end
new text begin
(4) a supervised independent living setting for youth who are 18 years of age or older.
new text end
new text begin
(b) This section does not apply to a foster family setting in which the license holder
resides in the foster home.
new text end
new text begin
(c) Children's residential facilities licensed as detention settings according to Minnesota
Rules, parts 2960.0230 to 2960.0290, or secure programs according to Minnesota Rules,
parts 2960.0300 to 2960.0420, may not be certified under this section.
new text end
new text begin
(d) For purposes of this section, "license holder" means an individual, organization, or
government entity that was issued a children's residential facility or foster residence setting
license by the commissioner of human services under this chapter or by the commissioner
of corrections under chapter 241.
new text end
new text begin
(e) Certifications issued under this section for foster residence settings may only be
issued by the commissioner of human services and are not delegated to county or private
licensing agencies under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Program certification types and requests for certification. new text end
new text begin
(a) By July 1,
2021, the commissioner of human services must offer certifications to license holders for
the following types of programs:
new text end
new text begin
(1) qualified residential treatment programs;
new text end
new text begin
(2) residential settings specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) residential settings specializing in providing prenatal, postpartum, or parenting
support for youth; and
new text end
new text begin
(4) supervised independent living settings for youth who are 18 years of age or older.
new text end
new text begin
(b) An applicant or license holder must submit a request for certification under this
section on a form and in a manner prescribed by the commissioner of human services. The
decision of the commissioner of human services to grant or deny a certification request is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Trauma-informed care. new text end
new text begin
(a) Programs certified under subdivisions 4 or 5 must
provide services to a person according to a trauma-informed model of care that meets the
requirements of this subdivision, except that programs certified under subdivision 5 are not
required to meet the requirements of paragraph (e).
new text end
new text begin
(b) For the purposes of this section, "trauma-informed care" is defined as care that:
new text end
new text begin
(1) acknowledges the effects of trauma on a person receiving services and on the person's
family;
new text end
new text begin
(2) modifies services to respond to the effects of trauma on the person receiving services;
new text end
new text begin
(3) emphasizes skill and strength-building rather than symptom management; and
new text end
new text begin
(4) focuses on the physical and psychological safety of the person receiving services
and the person's family.
new text end
new text begin
(c) The license holder must have a process for identifying the signs and symptoms of
trauma in a youth and must address the youth's needs related to trauma. This process must
include:
new text end
new text begin
(1) screening for trauma by completing a trauma-specific screening tool with each youth
upon the youth's admission or obtaining the results of a trauma-specific screening tool that
was completed with the youth within 30 days prior to the youth's admission to the program;
and
new text end
new text begin
(2) ensuring that trauma-based interventions targeting specific trauma-related symptoms
are available to each youth when needed to assist the youth in obtaining services. For
qualified residential treatment programs, this must include the provision of services in
paragraph (e).
new text end
new text begin
(d) The license holder must develop and provide services to each youth according to the
principles of trauma-informed care including:
new text end
new text begin
(1) recognizing the impact of trauma on a youth when determining the youth's service
needs and providing services to the youth;
new text end
new text begin
(2) allowing each youth to participate in reviewing and developing the youth's
individualized treatment or service plan;
new text end
new text begin
(3) providing services to each youth that are person-centered and culturally responsive;
and
new text end
new text begin
(4) adjusting services for each youth to address additional needs of the youth.
new text end
new text begin
(e) In addition to the other requirements of this subdivision, qualified residential treatment
programs must use a trauma-based treatment model that includes:
new text end
new text begin
(1) assessing each youth to determine if the youth needs trauma-specific treatment
interventions;
new text end
new text begin
(2) identifying in each youth's treatment plan how the program will provide
trauma-specific treatment interventions to the youth;
new text end
new text begin
(3) providing trauma-specific treatment interventions to a youth that target the youth's
specific trauma-related symptoms; and
new text end
new text begin
(4) training all clinical staff of the program on trauma-specific treatment interventions.
new text end
new text begin
(f) At the license holder's program, the license holder must provide a physical, social,
and emotional environment that:
new text end
new text begin
(1) promotes the physical and psychological safety of each youth;
new text end
new text begin
(2) avoids aspects that may be retraumatizing;
new text end
new text begin
(3) responds to trauma experienced by each youth and the youth's other needs; and
new text end
new text begin
(4) includes designated spaces that are available to each youth for engaging in sensory
and self-soothing activities.
new text end
new text begin
(g) The license holder must base the program's policies and procedures on
trauma-informed principles. In the program's policies and procedures, the license holder
must:
new text end
new text begin
(1) describe how the program provides services according to a trauma-informed model
of care;
new text end
new text begin
(2) describe how the program's environment fulfills the requirements of paragraph (f);
new text end
new text begin
(3) prohibit the use of aversive consequences for a youth's violation of program rules
or any other reason;
new text end
new text begin
(4) describe the process for how the license holder incorporates trauma-informed
principles and practices into the organizational culture of the license holder's program; and
new text end
new text begin
(5) if the program is certified to use restrictive procedures under Minnesota Rules, part
2960.0710, describe how the program uses restrictive procedures only when necessary for
a youth in a manner that addresses the youth's history of trauma and avoids causing the
youth additional trauma.
new text end
new text begin
(h) Prior to allowing a staff person to have direct contact, as defined in section 245C.02,
subdivision 11, with a youth and annually thereafter, the license holder must train each staff
person about:
new text end
new text begin
(1) concepts of trauma-informed care and how to provide services to each youth according
to these concepts; and
new text end
new text begin
(2) impacts of each youth's culture, race, gender, and sexual orientation on the youth's
behavioral health and traumatic experiences.
new text end
new text begin Subd. 4. new text end
new text begin Qualified residential treatment programs; certification requirements. new text end
new text begin
(a)
To be certified as a qualified residential treatment program, a license holder must meet:
new text end
new text begin
(1) the definition of a qualified residential treatment program in section 260C.007,
subdivision 26d;
new text end
new text begin
(2) the requirements for providing trauma-informed care and using a trauma-based
treatment model in subdivision 3; and
new text end
new text begin
(3) the requirements of this subdivision.
new text end
new text begin
(b) For each youth placed at the license holder's program, the license holder must
collaborate with the responsible social services agency and other appropriate parties to
implement the youth's out-of-home placement plan and the youth's short-term and long-term
mental health and behavioral health goals in the assessment required by sections 260C.212,
subdivision 1; 260C.704; and 260C.708.
new text end
new text begin
(c) A qualified residential treatment program must use a trauma-based treatment model
that meets all of the requirements of subdivision 3 that is designed to address the needs,
including clinical needs, of youth with serious emotional or behavioral disorders or
disturbances. The license holder must develop, document, and review a treatment plan for
each youth according to the requirements of Minnesota Rules, parts 2960.0180, subpart 2,
item B; and 2960.0190, subpart 2.
new text end
new text begin
(d) The following types of staff must be on-site according to the program's treatment
model and must be available 24 hours a day and seven days a week to provide care within
the scope of their practice:
new text end
new text begin
(1) a registered nurse or licensed practical nurse licensed by the Minnesota Board of
Nursing to practice professional nursing or practical nursing as defined in section 148.171,
subdivisions 14 and 15; and
new text end
new text begin
(2) other licensed clinical staff to meet each youth's clinical needs.
new text end
new text begin
(e) A qualified residential treatment program must be accredited by one of the following
independent, not-for-profit organizations:
new text end
new text begin
(1) the Commission on Accreditation of Rehabilitation Facilities (CARF);
new text end
new text begin
(2) the Joint Commission;
new text end
new text begin
(3) the Council on Accreditation (COA); or
new text end
new text begin
(4) another independent, not-for-profit accrediting organization approved by the Secretary
of the United States Department of Health and Human Services.
new text end
new text begin
(f) The license holder must facilitate participation of a youth's family members in the
youth's treatment program, consistent with the youth's best interests and according to the
youth's out-of-home placement plan required by sections 260C.212, subdivision 1; and
260C.708.
new text end
new text begin
(g) The license holder must contact and facilitate outreach to each youth's family
members, including the youth's siblings, and must document outreach to the youth's family
members in the youth's file, including the contact method and each family member's contact
information. In the youth's file, the license holder must record and maintain the contact
information for all known biological family members and fictive kin of the youth.
new text end
new text begin
(h) The license holder must document in the youth's file how the program integrates
family members into the treatment process for the youth, including after the youth's discharge
from the program, and how the program maintains the youth's connections to the youth's
siblings.
new text end
new text begin
(i) The program must provide discharge planning and family-based aftercare support to
each youth for at least six months after the youth's discharge from the program. When
providing aftercare to a youth, the program must have monthly contact with the youth and
the youth's caregivers to promote the youth's engagement in aftercare services and to regularly
evaluate the family's needs. The program's monthly contact with the youth may be
face-to-face, by telephone, or virtual.
new text end
new text begin
(j) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (b) to (i).
new text end
new text begin Subd. 5. new text end
new text begin
Residential settings specializing in providing care and supportive services
for youth who have been or are at risk of becoming victims of sex trafficking or
commercial sexual exploitation; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing care and supportive services for youth who have
been or are at risk of becoming victims of sex trafficking or commercial sexual exploitation,
a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) Settings certified according to this subdivision are exempt from the requirements of
section 245A.04, subdivision 11, paragraph (b).
new text end
new text begin
(c) The program must use a trauma-informed model of care that meets all of the applicable
requirements of subdivision 3, and that is designed to address the needs, including emotional
and mental health needs, of youth who have been or are at risk of becoming victims of sex
trafficking or commercial sexual exploitation.
new text end
new text begin
(d) The program must provide high quality care and supportive services for youth who
have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation and must:
new text end
new text begin
(1) offer a safe setting to each youth designed to prevent ongoing and future trafficking
of the youth;
new text end
new text begin
(2) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(3) assist each youth with accessing medical, mental health, legal, advocacy, and family
services based on the youth's individual needs;
new text end
new text begin
(4) provide each youth with relevant educational, life skills, and employment supports
based on the youth's individual needs;
new text end
new text begin
(5) offer a trafficking prevention education curriculum and provide support for each
youth at risk of future sex trafficking or commercial sexual exploitation; and
new text end
new text begin
(6) engage with the discharge planning process for each youth and the youth's family.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (c) and (d).
new text end
new text begin
(f) The license holder must ensure that each staff person who has direct contact, as
defined in section 245C.02, subdivision 11, with a youth served by the license holder's
program completes a human trafficking training approved by the Department of Human
Services' Children and Family Services Administration before the staff person has direct
contact with a youth served by the program and annually thereafter. For programs certified
prior to January 1, 2022, the license holder must ensure that each staff person at the license
holder's program completes the initial training by January 1, 2022.
new text end
new text begin Subd. 6. new text end
new text begin
Residential settings specializing in providing prenatal, postpartum, or
parenting supports for youth; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing prenatal, postpartum, or parenting supports for
youth, a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) The license holder must collaborate with the responsible social services agency and
other appropriate parties to implement each youth's out-of-home placement plan required
by section 260C.212, subdivision 1.
new text end
new text begin
(c) The license holder must specialize in providing prenatal, postpartum, or parenting
supports for youth and must:
new text end
new text begin
(1) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(2) assist each youth with accessing postpartum services during the same period of time
that a woman is considered pregnant for the purposes of medical assistance eligibility under
section 256B.055, subdivision 6, including providing each youth with:
new text end
new text begin
(i) sexual and reproductive health services and education; and
new text end
new text begin
(ii) a postpartum mental health assessment and follow-up services; and
new text end
new text begin
(3) discharge planning that includes the youth and the youth's family.
new text end
new text begin
(d) On or before the date of a child's initial physical presence at the facility, the license
holder must provide education to the child's parent related to safe bathing and reducing the
risk of sudden unexpected infant death and abusive head trauma from shaking infants and
young children. The license holder must use the educational material developed by the
commissioner of human services to comply with this requirement. At a minimum, the
education must address:
new text end
new text begin
(1) instruction that: (i) a child or infant should never be left unattended around water;
(ii) a tub should be filled with only two to four inches of water for infants; and (iii) an infant
should never be put into a tub when the water is running; and
new text end
new text begin
(2) the risk factors related to sudden unexpected infant death and abusive head trauma
from shaking infants and young children and means of reducing the risks, including the
safety precautions identified in section 245A.1435 and the risks of co-sleeping.
new text end
new text begin
The license holder must document the parent's receipt of the education and keep the
documentation in the parent's file. The documentation must indicate whether the parent
agrees to comply with the safeguards described in this paragraph. If the parent refuses to
comply, program staff must provide additional education to the parent as described in the
parental supervision plan. The parental supervision plan must include the intervention,
frequency, and staff responsible for the duration of the parent's participation in the program
or until the parent agrees to comply with the safeguards described in this paragraph.
new text end
new text begin
(e) On or before the date of a child's initial physical presence at the facility, the license
holder must document the parent's capacity to meet the health and safety needs of the child
while on the facility premises considering the following factors:
new text end
new text begin
(1) the parent's physical and mental health;
new text end
new text begin
(2) the parent being under the influence of drugs, alcohol, medications, or other chemicals;
new text end
new text begin
(3) the child's physical and mental health; and
new text end
new text begin
(4) any other information available to the license holder indicating that the parent may
not be able to adequately care for the child.
new text end
new text begin
(f) The license holder must have written procedures specifying the actions that staff shall
take if a parent is or becomes unable to adequately care for the parent's child.
new text end
new text begin
(g) If the parent refuses to comply with the safeguards described in paragraph (d) or is
unable to adequately care for the child, the license holder must develop a parental supervision
plan in conjunction with the parent. The plan must account for any factors in paragraph (e)
that contribute to the parent's inability to adequately care for the child. The plan must be
dated and signed by the staff person who completed the plan.
new text end
new text begin
(h) The license holder must have written procedures addressing whether the program
permits a parent to arrange for supervision of the parent's child by another youth in the
program. If permitted, the facility must have a procedure that requires staff approval of the
supervision arrangement before the supervision by the nonparental youth occurs. The
procedure for approval must include an assessment of the nonparental youth's capacity to
assume the supervisory responsibilities using the criteria in paragraph (e). The license holder
must document the license holder's approval of the supervisory arrangement and the
assessment of the nonparental youth's capacity to supervise the child and must keep this
documentation in the file of the parent whose child is being supervised by the nonparental
youth.
new text end
new text begin
(i) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (h).
new text end
new text begin Subd. 7. new text end
new text begin
Supervised independent living settings for youth 18 years of age or older;
certification requirements.
new text end
new text begin
(a) To be certified as a supervised independent living setting
for youth who are 18 years of age or older, a license holder must meet the requirements of
this subdivision.
new text end
new text begin
(b) A license holder must provide training, counseling, instruction, supervision, and
assistance for independent living, to meet the needs of the youth being served.
new text end
new text begin
(c) A license holder may provide services to assist the youth with locating housing,
money management, meal preparation, shopping, health care, transportation, and any other
support services necessary to meet the youth's needs and improve the youth's ability to
conduct such tasks independently.
new text end
new text begin
(d) The service plan for the youth must contain an objective of independent living skills.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (d).
new text end
new text begin Subd. 8. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) For a program licensed by the commissioner
of human services, the commissioner of human services may review a program's compliance
with certification requirements by conducting an inspection, a licensing review, or an
investigation of the program. The commissioner may issue a correction order to the license
holder for a program's noncompliance with the certification requirements of this section.
For a program licensed by the commissioner of human services, a license holder must make
a request for reconsideration of a correction order according to section 245A.06, subdivision
2.
new text end
new text begin
(b) For a program licensed by the commissioner of corrections, the commissioner of
human services may review the program's compliance with the requirements for a certification
issued under this section biennially and may issue a correction order identifying the program's
noncompliance with the requirements of this section. The correction order must state the
following:
new text end
new text begin
(1) the conditions that constitute a violation of a law or rule;
new text end
new text begin
(2) the specific law or rule violated; and
new text end
new text begin
(3) the time allowed for the program to correct each violation.
new text end
new text begin
(c) For a program licensed by the commissioner of corrections, if a license holder believes
that there are errors in the correction order of the commissioner of human services, the
license holder may ask the Department of Human Services to reconsider the parts of the
correction order that the license holder alleges are in error. To submit a request for
reconsideration, the license holder must send a written request for reconsideration by United
States mail to the commissioner of human services. The request for reconsideration must
be postmarked within 20 calendar days of the date that the correction order was received
by the license holder and must:
new text end
new text begin
(1) specify the parts of the correction order that are alleged to be in error;
new text end
new text begin
(2) explain why the parts of the correction order are in error; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
A request for reconsideration does not stay any provisions or requirements of the correction
order. The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin
(d) Nothing in this subdivision prohibits the commissioner of human services from
decertifying a license holder according to subdivision 9 prior to issuing a correction order.
new text end
new text begin Subd. 9. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner of human services may rescind a
certification issued under this section if a license holder fails to comply with the certification
requirements in this section.
new text end
new text begin
(b) The license holder may request reconsideration of a decertification by notifying the
commissioner of human services by certified mail or personal service. The license holder
must request reconsideration of a decertification in writing. If the license holder sends the
request for reconsideration of a decertification by certified mail, the license holder must
send the request by United States mail to the commissioner of human services and the
request must be postmarked within 20 calendar days after the license holder received the
notice of decertification. If the license holder requests reconsideration of a decertification
by personal service, the request for reconsideration must be received by the commissioner
of human services within 20 calendar days after the license holder received the notice of
decertification. When submitting a request for reconsideration of a decertification, the license
holder must submit a written argument or evidence in support of the request for
reconsideration.
new text end
new text begin
(c) The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 10. new text end
new text begin Variances. new text end
new text begin
The commissioner of human services may grant variances to the
requirements in this section that do not affect a youth's health or safety or compliance with
federal requirements for Title IV-E funding if the conditions in section 245A.04, subdivision
9, are met.
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. 11.
Minnesota Statutes 2020, section 256.01, subdivision 14b, is amended to read:
Subd. 14b.
American Indian child welfare projects.
(a) The commissioner of human
services may authorize projects to initiate tribal delivery of child welfare services to American
Indian children and their parents and custodians living on the reservation. The commissioner
has authority to solicit and determine which tribes may participate in a project. Grants may
be issued to Minnesota Indian tribes to support the projects. The commissioner may waive
existing state rules as needed to accomplish the projects. The commissioner may authorize
projects to use alternative methods of (1) screening, investigating, and assessing reports of
child maltreatment, and (2) administrative reconsideration, administrative appeal, and
judicial appeal of maltreatment determinations, provided the alternative methods used by
the projects comply with the provisions of section 256.045 and chapter 260E that deal with
the rights of individuals who are the subjects of reports or investigations, including notice
and appeal rights and data practices requirements. The commissioner shall only authorize
alternative methods that comply with the public policy under section 260E.01. The
commissioner may seek any federal approval necessary to carry out the projects as well as
seek and use any funds available to the commissioner, including use of federal funds,
foundation funds, existing grant funds, and other funds. The commissioner is authorized to
advance state funds as necessary to operate the projects. Federal reimbursement applicable
to the projects is appropriated to the commissioner for the purposes of the projects. The
projects must be required to address responsibility for safety, permanency, and well-being
of children.
(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.
(c) In order to qualify for an American Indian child welfare project, a tribe must:
(1) be one of the existing tribes with reservation land in Minnesota;
(2) have a tribal court with jurisdiction over child custody proceedings;
(3) have a substantial number of children for whom determinations of maltreatment have
occurred;
(4)(i) have capacity to respond to reports of abuse and neglect under chapter 260E; or
(ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
(5) provide a wide range of services to families in need of child welfare services; deleted text begin and
deleted text end
(6) have a tribal-state title IV-E agreement in effectdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) enter into host Tribal contracts pursuant to section 256.0112, subdivision 6.
new text end
(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:
(1) assessment and prevention of child abuse and neglect;
(2) family preservation;
(3) facilitative, supportive, and reunification services;
(4) out-of-home placement for children removed from the home for child protective
purposes; and
(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.
(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under chapter 260E for those children during the time within
which the tribal project is in effect and funded. The commissioner shall work with tribes
and affected counties to develop procedures for data collection, evaluation, and clarification
of ongoing role and financial responsibilities of the county and tribe for child welfare services
prior to initiation of the project. Children who have not been identified by the tribe as
participating in the project shall remain the responsibility of the county. Nothing in this
section shall alter responsibilities of the county for law enforcement or court services.
(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:
(1) the child must be receiving child protective services;
(2) the child must be in foster care; or
(3) the child's parents must have had parental rights suspended or terminated.
Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.
(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.
(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.
(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.
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.
Minnesota Statutes 2020, section 256.0112, subdivision 6, is amended to read:
Subd. 6.
Contracting within and across county lines; lead county contractsnew text begin ; lead
tribal contractsnew text end .
Paragraphs (a) to (e) govern contracting within and across county lines
and lead county contracts.new text begin Paragraphs (a) to (e) govern contracting within and across
reservation boundaries and lead tribal contracts for initiative tribes under section 256.01,
subdivision 14b. For purposes of this subdivision, "local agency" includes a tribe or a county
agency.
new text end
(a) Once a local agency and an approved vendor execute a contract that meets the
requirements of this subdivision, the contract governs all other purchases of service from
the vendor by all other local agencies for the term of the contract. The local agency that
negotiated and entered into the contract becomes the leadnew text begin tribe ornew text end county for the contract.
(b) When the local agency in the county new text begin or reservation new text end where a vendor is located wants
to purchase services from that vendor and the vendor has no contract with the local agency
or any othernew text begin tribe ornew text end county, the local agency must negotiate and execute a contract with
the vendor.
(c) When a local agency deleted text begin in one countydeleted text end wants to purchase services from a vendor located
in another countynew text begin or reservationnew text end , it must notify the local agency in the countynew text begin or reservationnew text end
where the vendor is located. Within 30 days of being notified, the local agency in the vendor's
countynew text begin or reservationnew text end must:
(1) if it has a contract with the vendor, send a copy to the inquiring new text begin local new text end agency;
(2) if there is a contract with the vendor for which another local agency is the leadnew text begin tribe
ornew text end county, identify the lead new text begin tribe or new text end county to the inquiring agency; or
(3) if no local agency has a contract with the vendor, inform the inquiring agency whether
it will negotiate a contract and become the lead new text begin tribe or new text end county. If the agency where the
vendor is located will not negotiate a contract with the vendor because of concerns related
to clients' health and safety, the agency must share those concerns with the inquiring new text begin local
new text end agency.
(d) If the local agency in the county where the vendor is located declines to negotiate a
contract with the vendor or fails to respond within 30 days of receiving the notification
under paragraph (c), the inquiring agency is authorized to negotiate a contract and must
notify the local agency that declined or failed to respond.
(e) When the inquiring deleted text begin countydeleted text end new text begin local agencynew text end under paragraph (d) becomes the leadnew text begin tribe
ornew text end county for a contract and the contract expires and needs to be renegotiated, that new text begin tribe or
new text end county must again follow the requirements under paragraph (c) and notify the local agency
where the vendor is located. The local agency where the vendor is located has the option
of becoming the leadnew text begin tribe ornew text end county for the new contract. If the local agency does not
exercise the option, paragraph (d) applies.
(f) This subdivision does not affect the requirement to seek county concurrence under
section 256B.092, subdivision 8a, when the services are to be purchased for a person with
a developmental disability or under section 245.4711, subdivision 3, when the services to
be purchased are for an adult with serious and persistent mental illness.
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.
Minnesota Statutes 2020, section 260C.007, subdivision 6, is amended to read:
Subd. 6.
Child in need of protection or services.
"Child in need of protection or
services" means a child who is in need of protection or services because the child:
(1) is abandoned or without parent, guardian, or custodian;
(2)(i) has been a victim of physical or sexual abuse as defined in section 260E.03,
subdivision 18 or 20, (ii) resides with or has resided with a victim of child abuse as defined
in subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or child
abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment as
defined in subdivision 15;
(3) is without necessary food, clothing, shelter, education, or other required care for the
child's physical or mental health or morals because the child's parent, guardian, or custodian
is unable or unwilling to provide that care;
(4) is without the special care made necessary by a physical, mental, or emotional
condition because the child's parent, guardian, or custodian is unable or unwilling to provide
that care;
(5) is medically neglected, which includes, but is not limited to, the withholding of
medically indicated treatment from an infant with a disability with a life-threatening
condition. The term "withholding of medically indicated treatment" means the failure to
respond to the infant's life-threatening conditions by providing treatment, including
appropriate nutrition, hydration, and medication which, in the treating physician's or advanced
practice registered nurse's reasonable medical judgment, will be most likely to be effective
in ameliorating or correcting all conditions, except that the term does not include the failure
to provide treatment other than appropriate nutrition, hydration, or medication to an infant
when, in the treating physician's or advanced practice registered nurse's reasonable medical
judgment:
(i) the infant is chronically and irreversibly comatose;
(ii) the provision of the treatment would merely prolong dying, not be effective in
ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
futile in terms of the survival of the infant; or
(iii) the provision of the treatment would be virtually futile in terms of the survival of
the infant and the treatment itself under the circumstances would be inhumane;
(6) is one whose parent, guardian, or other custodian for good cause desires to be relieved
of the child's care and custody, including a child who entered foster care under a voluntary
placement agreement between the parent and the responsible social services agency under
section 260C.227;
(7) has been placed for adoption or care in violation of law;
(8) is without proper parental care because of the emotional, mental, or physical disability,
or state of immaturity of the child's parent, guardian, or other custodian;
(9) is one whose behavior, condition, or environment is such as to be injurious or
dangerous to the child or others. An injurious or dangerous environment may include, but
is not limited to, the exposure of a child to criminal activity in the child's home;
(10) is experiencing growth delays, which may be referred to as failure to thrive, that
have been diagnosed by a physician and are due to parental neglect;
(11) is a sexually exploited youth;
(12) has committed a delinquent act or a juvenile petty offense before becoming deleted text begin tendeleted text end new text begin 13new text end
years old;
(13) is a runaway;
(14) is a habitual truant;
(15) has been found incompetent to proceed or has been found not guilty by reason of
mental illness or mental deficiency in connection with a delinquency proceeding, a
certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
proceeding involving a juvenile petty offense; or
(16) has a parent whose parental rights to one or more other children were involuntarily
terminated or whose custodial rights to another child have been involuntarily transferred to
a relative and there is a case plan prepared by the responsible social services agency
documenting a compelling reason why filing the termination of parental rights petition under
section 260C.503, subdivision 2, is not in the best interests of the child.
Sec. 14.
Minnesota Statutes 2020, section 260C.007, subdivision 26c, is amended to read:
Subd. 26c.
Qualified individual.
new text begin (a) new text end "Qualified individual" means a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is deleted text begin notdeleted text end new text begin qualified to conduct the assessment approved
by the commissioner. The qualified individual must not benew text end an employee of the responsible
social services agency and who is not connected to or affiliated with any placement setting
in which a responsible social services agency has placed children.
new text begin
(b) When the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, applies to a child, the county must contact the child's tribe without delay to
give the tribe the option to designate a qualified individual who is a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is not employed by the responsible social services
agency and who is not connected to or affiliated with any placement setting in which a
responsible social services agency has placed children. Only a federal waiver that
demonstrates maintained objectivity may allow a responsible social services agency employee
or tribal employee affiliated with any placement setting in which the responsible social
services agency has placed children to be designated the qualified individual.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260C.007, subdivision 31, is amended to read:
Subd. 31.
Sexually exploited youth.
"Sexually exploited youth" means an individual
who:
(1) is alleged to have engaged in conduct which would, if committed by an adult, violate
any federal, state, or local law relating to being hired, offering to be hired, or agreeing to
be hired by another individual to engage in sexual penetration or sexual conduct;
(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
609.3451, 609.3453, 609.352, 617.246, or 617.247;
(3) is a victim of a crime described in United States Code, title 18, section 2260; 2421;
2422; 2423; 2425; 2425A; or 2256; deleted text begin or
deleted text end
(4) is a sex trafficking victim as defined in section 609.321, subdivision 7bdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is a victim of commercial sexual exploitation as defined in United States Code, title
22, section 7102(11)(A) and (12).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 16.
Minnesota Statutes 2020, section 260C.157, subdivision 3, is amended to read:
Subd. 3.
Juvenile treatment screening team.
(a) The responsible social services agency
shall establish a juvenile treatment screening team to conduct screenings under this chapter
deleted text begin and section , subdivision 3,deleted text end new text begin and chapter 260Dnew text end for a child to receive treatment for
an emotional disturbance, a developmental disability, or related condition in a residential
treatment facility licensed by the commissioner of human services under chapter 245A, or
licensed or approved by a tribe. A screening team is not required for a child to be in: (1) a
residential facility specializing in prenatal, postpartum, or parenting support; (2) a facility
specializing in high-quality residential care and supportive services to children and youth
who deleted text begin aredeleted text end new text begin have been or are at risk of becoming victims ofnew text end sex-trafficking deleted text begin victims or are at
risk of becoming sex-trafficking victimsdeleted text end new text begin or commercial sexual exploitationnew text end ; (3) supervised
settings for youthnew text begin who arenew text end 18 years deleted text begin olddeleted text end new text begin of agenew text end or oldernew text begin andnew text end living independently; or (4) a
licensed residential family-based treatment facility for substance abuse consistent with
section 260C.190. Screenings are also not required when a child must be placed in a facility
due to an emotional crisis or other mental health emergency.
(b) The responsible social services agency shall conduct screenings within 15 days of a
request for a screening, unless the screening is for the purpose of residential treatment and
the child is enrolled in a prepaid health program under section 256B.69, in which case the
agency shall conduct the screening within ten working days of a request. The responsible
social services agency shall convene the new text begin juvenile treatment screening new text end team, which may be
constituted under section 245.4885 or 256B.092 or Minnesota Rules, parts 9530.6600 to
9530.6655. The team shall consist of social workers; persons with expertise in the treatment
of juveniles who are emotionally deleted text begin disableddeleted text end new text begin disturbednew text end , chemically dependent, or have a
developmental disability; and the child's parent, guardian, or permanent legal custodian.
The team may include the child's relatives as defined in section 260C.007, subdivisions 26b
and 27, the child's foster care provider, and professionals who are a resource to the child's
family such as teachers, medical or mental health providers, and clergy, as appropriate,
consistent with the family and permanency team as defined in section 260C.007, subdivision
16a. Prior to forming the team, the responsible social services agency must consult with new text begin the
child's parents,new text end the child if the child is age 14 or older, deleted text begin the child's parents,deleted text end and, if applicable,
the child's tribe new text begin to obtain recommendations regarding which individuals to include on the
team andnew text end to ensure that the team is family-centered and will act in the child's best deleted text begin interestdeleted text end
new text begin interestsnew text end . If the child, child's parents, or legal guardians raise concerns about specific relatives
or professionals, the team should not include those individuals. This provision does not
apply to paragraph (c).
(c) If the agency provides notice to tribes under section 260.761, and the child screened
is an Indian child, the responsible social services agency must make a rigorous and concerted
effort to include a designated representative of the Indian child's tribe on the juvenile
treatment screening team, unless the child's tribal authority declines to appoint a
representative. The Indian child's tribe may delegate its authority to represent the child to
any other federally recognized Indian tribe, as defined in section 260.755, subdivision 12.
The provisions of the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, and the Minnesota Indian Family Preservation Act, sections 260.751 to
260.835, apply to this section.
(d) If the court, prior to, or as part of, a final disposition or other court order, proposes
to place a child with an emotional disturbance or developmental disability or related condition
in residential treatment, the responsible social services agency must conduct a screening.
If the team recommends treating the child in a qualified residential treatment program, the
agency must follow the requirements of sections 260C.70 to 260C.714.
The court shall ascertain whether the child is an Indian child and shall notify the
responsible social services agency and, if the child is an Indian child, shall notify the Indian
child's tribe as paragraph (c) requires.
(e) When the responsible social services agency is responsible for placing and caring
for the child and the screening team recommends placing a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the agency must: (1)
begin the assessment and processes required in section 260C.704 without delay; and (2)
conduct a relative search according to section 260C.221 to assemble the child's family and
permanency team under section 260C.706. Prior to notifying relatives regarding the family
and permanency team, the responsible social services agency must consult with new text begin the child's
parent or legal guardian,new text end the child if the child is age 14 or older, deleted text begin the child's parentsdeleted text end and, if
applicable, the child's tribe to ensure that the agency is providing notice to individuals who
will act in the child's best deleted text begin interestdeleted text end new text begin interestsnew text end . The child and the child's parents may identify
a culturally competent qualified individual to complete the child's assessment. The agency
shall make efforts to refer the assessment to the identified qualified individual. The
assessment may not be delayed for the purpose of having the assessment completed by a
specific qualified individual.
(f) When a screening team determines that a child does not need treatment in a qualified
residential treatment program, the screening team must:
(1) document the services and supports that will prevent the child's foster care placement
and will support the child remaining at home;
(2) document the services and supports that the agency will arrange to place the child
in a family foster home; or
(3) document the services and supports that the agency has provided in any other setting.
(g) When the Indian child's tribe or tribal health care services provider or Indian Health
Services provider proposes to place a child for the primary purpose of treatment for an
emotional disturbance, a developmental disability, or co-occurring emotional disturbance
and chemical dependency, the Indian child's tribe or the tribe delegated by the child's tribe
shall submit necessary documentation to the county juvenile treatment screening team,
which must invite the Indian child's tribe to designate a representative to the screening team.
(h) The responsible social services agency must conduct and document the screening in
a format approved by the commissioner of human services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 260C.212, subdivision 1a, is amended to read:
Subd. 1a.
Out-of-home placement plan update.
(a) Within 30 days of placing the child
in foster care, the agency must file thenew text begin child'snew text end initial out-of-home placement plan with the
court. After filing thenew text begin child'snew text end initial out-of-home placement plan, the agency shall update
and file thenew text begin child'snew text end out-of-home placement plan with the court as follows:
(1) when the agency moves a child to a different foster care setting, the agency shall
inform the court within 30 days of the new text begin child's new text end placement change or court-ordered trial home
visit. The agency must file the new text begin child's new text end updated out-of-home placement plan with the court
at the next required review hearing;
(2) when the agency places a child in a qualified residential treatment program as defined
in section 260C.007, subdivision 26d, or moves a child from one qualified residential
treatment program to a different qualified residential treatment program, the agency must
update thenew text begin child'snew text end out-of-home placement plan within 60 days. To meet the requirements
of section 260C.708, the agency must file thenew text begin child'snew text end out-of-home placement plan deleted text begin with the
court as part of the 60-day hearing anddeleted text end new text begin along with the agency's report seeking the court's
approval of the child's placement at a qualified residential treatment program under section
260C.71. After the court issues an order, the agencynew text end must update thenew text begin child's out-of-home
placementnew text end plan deleted text begin after the court hearingdeleted text end to document the court's approval or disapproval of
the child's placement in a qualified residential treatment program;
(3) when the agency places a child with the child's parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190, the agency
must identify the treatment programnew text begin where the child will be placednew text end in the child's out-of-home
placement plan prior to the child's placement. The agency must file thenew text begin child'snew text end out-of-home
placement plan with the court at the next required review hearing; and
(4) under sections 260C.227 and 260C.521, the agency must update thenew text begin child'snew text end
out-of-home placement plan and file thenew text begin child's out-of-home placementnew text end plan with the court.
(b) When none of the items in paragraph (a) apply, the agency must update thenew text begin child'snew text end
out-of-home placement plan no later than 180 days after the child's initial placement and
every six months thereafter, consistent with section 260C.203, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 18.
Minnesota Statutes 2020, section 260C.212, subdivision 13, is amended to read:
Subd. 13.
Protecting missing and runaway children and youth at risk of sex
traffickingnew text begin or commercial sexual exploitationnew text end .
(a) The local social services agency shall
expeditiously locate any child missing from foster care.
(b) The local social services agency shall report immediately, but no later than 24 hours,
after receiving information on a missing or abducted child to the local law enforcement
agency for entry into the National Crime Information Center (NCIC) database of the Federal
Bureau of Investigation, and to the National Center for Missing and Exploited Children.
(c) The local social services agency shall not discharge a child from foster care or close
the social services case until diligent efforts have been exhausted to locate the child and the
court terminates the agency's jurisdiction.
(d) The local social services agency shall determine the primary factors that contributed
to the child's running away or otherwise being absent from care and, to the extent possible
and appropriate, respond to those factors in current and subsequent placements.
(e) The local social services agency shall determine what the child experienced while
absent from care, including screening the child to determine if the child is a possible sex
traffickingnew text begin or commercial sexual exploitationnew text end victim as defined in section deleted text begin 609.321,
subdivision 7bdeleted text end new text begin 260C.007, subdivision 31new text end .
(f) The local social services agency shall report immediately, but no later than 24 hours,
to the local law enforcement agency any reasonable cause to believe a child is, or is at risk
of being, a sex traffickingnew text begin or commercial sexual exploitationnew text end victim.
(g) The local social services agency shall determine appropriate services as described
in section 145.4717 with respect to any child for whom the local social services agency has
responsibility for placement, care, or supervision when the local social services agency has
reasonable cause to believenew text begin thatnew text end the child is, or is at risk of being, a sex traffickingnew text begin or
commercial sexual exploitationnew text end victim.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 19.
Minnesota Statutes 2020, section 260C.4412, is amended to read:
260C.4412 PAYMENT FOR RESIDENTIAL PLACEMENTS.
(a) When a child is placed in a foster care group residential setting under Minnesota
Rules, parts 2960.0020 to 2960.0710, a foster residence licensed under chapter 245A that
meets the standards of Minnesota Rules, parts 2960.3200 to 2960.3230, or a children's
residential facility licensed or approved by a tribe, foster care maintenance payments must
be made on behalf of the child to cover the cost of providing food, clothing, shelter, daily
supervision, school supplies, child's personal incidentals and supports, reasonable travel for
visitation, or other transportation needs associated with the items listed. Daily supervision
in the group residential setting includes routine day-to-day direction and arrangements to
ensure the well-being and safety of the child. It may also include reasonable costs of
administration and operation of the facility.
(b) The commissioner of human services shall specify the title IV-E administrative
procedures under section 256.82 for each of the following residential program settings:
(1) residential programs licensed under chapter 245A or licensed by a tribe, including:
(i) qualified residential treatment programs as defined in section 260C.007, subdivision
26d;
(ii) program settings specializing in providing prenatal, postpartum, or parenting supports
for youth; and
(iii) program settings providing high-quality residential care and supportive services to
children and youth who are, or are at risk of becoming, sex trafficking victims;
(2) licensed residential family-based substance use disorder treatment programs as
defined in section 260C.007, subdivision 22a; and
(3) supervised settings in which a foster child age 18 or older may live independently,
consistent with section 260C.451.
new text begin
(c) A lead county contract under section 256.0112, subdivision 6, is not required to
establish the foster care maintenance payment in paragraph (a) for foster residence settings
licensed under chapter 245A that meet the standards of Minnesota Rules, parts 2960.3200
to 2960.3230. The foster care maintenance payment for these settings must be consistent
with section 256N.26, subdivision 3, and subject to the annual revision as specified in section
256N.26, subdivision 9.
new text end
Sec. 20.
Minnesota Statutes 2020, section 260C.452, is amended to read:
260C.452 SUCCESSFUL TRANSITION TO ADULTHOOD.
Subdivision 1.
Scopenew text begin and purposenew text end .
new text begin
(a) For purposes of this section, "youth" means a
person who is at least 14 years of age and under 23 years of age.
new text end
new text begin (b) new text end This section pertains to a deleted text begin childdeleted text end new text begin youthnew text end whonew text begin :
new text end
new text begin (1)new text end isnew text begin in foster care and is 14 years of age or older, including a youth who isnew text end under the
guardianship of the commissioner of human servicesdeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (2)new text end has a permanency disposition of permanent custody to the agencydeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (3)new text end will leave foster care deleted text begin at 18 to 21 years of age.deleted text end new text begin when the youth is 18 years of age or
older and under 21 years of age;
new text end
new text begin
(4) has left foster care due to adoption when the youth was 16 years of age or older;
new text end
new text begin
(5) has left foster care due to a transfer of permanent legal and physical custody to a
relative, or Tribal equivalent, when the youth was 16 years of age or older; or
new text end
new text begin
(6) was reunified with the youth's primary caretaker when the youth was 14 years of age
or older and under 18 years of age.
new text end
new text begin
(c) The purpose of this section is to provide support to each youth who is transitioning
to adulthood by providing services to the youth in the areas of:
new text end
new text begin
(1) education;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) daily living skills such as financial literacy training and driving instruction; preventive
health activities including promoting abstinence from substance use and smoking; and
nutrition education and pregnancy prevention;
new text end
new text begin
(4) forming meaningful, permanent connections with caring adults;
new text end
new text begin
(5) engaging in age and developmentally appropriate activities under section 260C.212,
subdivision 14, and positive youth development;
new text end
new text begin
(6) financial, housing, counseling, and other services to assist a youth over 18 years of
age in achieving self-sufficiency and accepting personal responsibility for the transition
from adolescence to adulthood; and
new text end
new text begin
(7) making vouchers available for education and training.
new text end
new text begin
(d) The responsible social services agency may provide support and case management
services to a youth as defined in paragraph (a) until the youth reaches the age of 23 years.
According to section 260C.451, a youth's placement in a foster care setting will end when
the youth reaches the age of 21 years.
new text end
new text begin Subd. 1a. new text end
new text begin Case management services. new text end
new text begin
Case management services include the
responsibility for planning, coordinating, authorizing, monitoring, and evaluating services
for a youth and shall be provided to a youth by the responsible social services agency or
the contracted agency. Case management services include the out-of-home placement plan
under section 260C.212, subdivision 1, when the youth is in out-of-home placement.
new text end
Subd. 2.
Independent living plan.
When the deleted text begin childdeleted text end new text begin youthnew text end is 14 years of age or oldernew text begin and
is receiving support from the responsible social services agency under this sectionnew text end , the
responsible social services agency, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall complete thenew text begin
youth'snew text end independent living plan according to section 260C.212, subdivision 1, paragraph
(c), clause (12)new text begin , regardless of the youth's current placement statusnew text end .
deleted text begin Subd. 3. deleted text end
deleted text begin Notification. deleted text end
deleted text begin
Six months before the child is expected to be discharged from
foster care, the responsible social services agency shall provide written notice to the child
regarding the right to continued access to services for certain children in foster care past 18
years of age and of the right to appeal a denial of social services under section 256.045.
deleted text end
Subd. 4.
Administrative or court review of placements.
(a) When the deleted text begin childdeleted text end new text begin youthnew text end is
14 years of age or older, the court, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall review thenew text begin
youth'snew text end independent living plan according to section 260C.203, paragraph (d).
(b) The responsible social services agency shall file a copy of the notification deleted text begin required
in subdivision 3deleted text end new text begin of foster care benefits for a youth who is 18 years of age or older according
to section 260C.451, subdivision 1,new text end with the court. If the responsible social services agency
does not file the notice by the time the deleted text begin childdeleted text end new text begin youthnew text end is 17-1/2 years of age, the court shall
require the responsible social services agency to file the notice.
(c) new text begin When a youth is 18 years of age or older, new text end the court shall ensure that the responsible
social services agency assists the deleted text begin childdeleted text end new text begin youthnew text end in obtaining the following documents before
the deleted text begin childdeleted text end new text begin youthnew text end leaves foster care: a Social Security card; an official or certified copy of the
deleted text begin child'sdeleted text end new text begin youth'snew text end birth certificate; a state identification card or driver's license, tribal enrollment
identification card, green card, or school visa; health insurance information; the deleted text begin child'sdeleted text end new text begin
youth'snew text end school, medical, and dental records; a contact list of the deleted text begin child'sdeleted text end new text begin youth'snew text end medical,
dental, and mental health providers; and contact information for the deleted text begin child'sdeleted text end new text begin youth'snew text end siblings,
if the siblings are in foster care.
(d) For a deleted text begin childdeleted text end new text begin youthnew text end who will be discharged from foster care at 18 years of age or older
new text begin because the youth is not eligible for extended foster care benefits or chooses to leave foster
carenew text end , the responsible social services agency must develop a personalized transition plan as
directed by the deleted text begin childdeleted text end new text begin youthnew text end during the 90-day period immediately prior to the expected date
of discharge. The transition plan must be as detailed as the deleted text begin childdeleted text end new text begin youthnew text end elects and include
specific options, including but not limited to:
(1) affordable housing with necessary supports that does not include a homeless shelter;
(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;
(3) education, including application to the Education and Training Voucher Program;
(4) local opportunities for mentors and continuing support servicesdeleted text begin , including the Healthy
Transitions and Homeless Prevention program, if availabledeleted text end ;
(5) workforce supports and employment services;
(6) a copy of the deleted text begin child'sdeleted text end new text begin youth'snew text end consumer credit report as defined in section 13C.001
and assistance in interpreting and resolving any inaccuracies in the report, at no cost to the
deleted text begin childdeleted text end new text begin youthnew text end ;
(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
deleted text begin childdeleted text end new text begin youthnew text end if the deleted text begin childdeleted text end new text begin youthnew text end becomes unable to participate in decisions;
(8) appropriate contact information through 21 years of age if the deleted text begin childdeleted text end new text begin youthnew text end needs
information or help dealing with a crisis situation; and
(9) official documentation that the youth was previously in foster care.
Subd. 5.
Notice of termination of deleted text begin foster caredeleted text end new text begin social servicesnew text end .
(a) deleted text begin Whendeleted text end new text begin Beforenew text end a deleted text begin childdeleted text end new text begin
youth who is 18 years of age or oldernew text end leaves foster care deleted text begin at 18 years of age or olderdeleted text end , the
responsible social services agency shall give the deleted text begin childdeleted text end new text begin youthnew text end written notice that foster care
shall terminate 30 days from the datenew text begin thatnew text end the notice is sentnew text begin by the agency according to
section 260C.451, subdivision 8new text end .
deleted text begin
(b) The child or the child's guardian ad litem may file a motion asking the court to review
the responsible social services agency's determination within 15 days of receiving the notice.
The child shall not be discharged from foster care until the motion is heard. The responsible
social services agency shall work with the child to transition out of foster care.
deleted text end
deleted text begin
(c) The written notice of termination of benefits shall be on a form prescribed by the
commissioner and shall give notice of the right to have the responsible social services
agency's determination reviewed by the court under this section or sections 260C.203,
260C.317, and 260C.515, subdivision 5 or 6. A copy of the termination notice shall be sent
to the child and the child's attorney, if any, the foster care provider, the child's guardian ad
litem, and the court. The responsible social services agency is not responsible for paying
foster care benefits for any period of time after the child leaves foster care.
deleted text end
new text begin
(b) Before case management services will end for a youth who is at least 18 years of
age and under 23 years of age, the responsible social services agency shall give the youth:
(1) written notice that case management services for the youth shall terminate; and (2)
written notice that the youth has the right to appeal the termination of case management
services under section 256.045, subdivision 3, by responding in writing within ten days of
the date that the agency mailed the notice. The termination notice must include information
about services for which the youth is eligible and how to access the services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 260C.704, is amended to read:
260C.704 REQUIREMENTS FOR THE QUALIFIED INDIVIDUAL'S
ASSESSMENT OF THE CHILD FOR PLACEMENT IN A QUALIFIED
RESIDENTIAL TREATMENT PROGRAM.
(a) A qualified individual must complete an assessment of the child prior to deleted text begin or withindeleted text end
deleted text begin 30 days ofdeleted text end the child's placement in a qualified residential treatment program in a format
approved by the commissioner of human servicesdeleted text begin , anddeleted text end new text begin unless, due to a crisis, the child must
immediately be placed in a qualified residential treatment program. When a child must
immediately be placed in a qualified residential treatment program without an assessment,
the qualified individual must complete the child's assessment within 30 days of the child's
placement. The qualified individualnew text end must:
(1) assess the child's needs and strengths, using an age-appropriate, evidence-based,
validated, functional assessment approved by the commissioner of human services;
(2) determine whether the child's needs can be met by the child's family members or
through placement in a family foster home; or, if not, determine which residential setting
would provide the child with the most effective and appropriate level of care to the child
in the least restrictive environment;
(3) develop a list of short- and long-term mental and behavioral health goals for the
child; and
(4) work with the child's family and permanency team using culturally competent
practices.
new text begin
If a level of care determination was conducted under section 245.4885, that information
must be shared with the qualified individual and the juvenile treatment screening team.
new text end
(b) The child and the child's parents, when appropriate, may request that a specific
culturally competent qualified individual complete the child's assessment. The agency shall
make efforts to refer the child to the identified qualified individual to complete the
assessment. The assessment must not be delayed for a specific qualified individual to
complete the assessment.
(c) The qualified individual must provide the assessment, when complete, to the
responsible social services agencydeleted text begin , the child's parents or legal guardians, the guardian ad
litem, and the courtdeleted text end new text begin . If the assessment recommends placement of the child in a qualified
residential treatment facility, the agency must distribute the assessment to the child's parent
or legal guardian and file the assessment with the court reportnew text end as required in section 260C.71new text begin ,
subdivision 2. If the assessment does not recommend placement in a qualified residential
treatment facility, the agency must provide a copy of the assessment to the parents or legal
guardians and the guardian ad litem and file the assessment determination with the court at
the next required hearing as required in section 260C.71, subdivision 5new text end . If court rules and
chapter 13 permit disclosure of the results of the child's assessment, the agency may share
the results of the child's assessment with the child's foster care provider, other members of
the child's family, and the family and permanency team. The agency must not share the
child's private medical data with the family and permanency team unless: (1) chapter 13
permits the agency to disclose the child's private medical data to the family and permanency
team; or (2) the child's parent has authorized the agency to disclose the child's private medical
data to the family and permanency team.
(d) For an Indian child, the assessment of the child must follow the order of placement
preferences in the Indian Child Welfare Act of 1978, United States Code, title 25, section
1915.
(e) In the assessment determination, the qualified individual must specify in writing:
(1) the reasons why the child's needs cannot be met by the child's family or in a family
foster home. A shortage of family foster homes is not an acceptable reason for determining
that a family foster home cannot meet a child's needs;
(2) why the recommended placement in a qualified residential treatment program will
provide the child with the most effective and appropriate level of care to meet the child's
needs in the least restrictive environment possible and how placing the child at the treatment
program is consistent with the short-term and long-term goals of the child's permanency
plan; and
(3) if the qualified individual's placement recommendation is not the placement setting
that the parent, family and permanency team, child, or tribe prefer, the qualified individual
must identify the reasons why the qualified individual does not recommend the parent's,
family and permanency team's, child's, or tribe's placement preferences. The out-of-home
placement plan under section 260C.708 must also include reasons why the qualified
individual did not recommend the preferences of the parents, family and permanency team,
child, or tribe.
(f) If the qualified individual determines that the child's family or a family foster home
or other less restrictive placement may meet the child's needs, the agency must move the
child out of the qualified residential treatment program and transition the child to a less
restrictive setting within 30 days of the determination.new text begin If the responsible social services
agency has placement authority of the child, the agency must make a plan for the child's
placement according to section 260C.212, subdivision 2. The agency must file the child's
assessment determination with the court at the next required hearing.
new text end
new text begin
(g) If the qualified individual recommends placing the child in a qualified residential
treatment program and if the responsible social services agency has placement authority of
the child, the agency shall make referrals to appropriate qualified residential treatment
programs and upon acceptance by an appropriate program, place the child in an approved
or certified qualified residential treatment program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 260C.706, is amended to read:
260C.706 FAMILY AND PERMANENCY TEAM REQUIREMENTS.
(a) When the responsible social services agency's juvenile treatment screening team, as
defined in section 260C.157, recommends placing the child in a qualified residential treatment
program, the agency must assemble a family and permanency team within ten days.
(1) The team must include all appropriate biological family members, the child's parents,
legal guardians or custodians, foster care providers, and relatives as defined in section
260C.007, subdivisions deleted text begin 26cdeleted text end new text begin 26bnew text end and 27, and professionals, as appropriate, who are a resource
to the child's family, such as teachers, medical or mental health providers, or clergy.
(2) When a child is placed in foster care prior to the qualified residential treatment
program, the agency shall include relatives responding to the relative search notice as
required under section 260C.221 on this team, unless the juvenile court finds that contacting
a specific relative would deleted text begin endangerdeleted text end new text begin present a safety or health risk tonew text end the parent, guardian,
child, sibling, or any other family member.
(3) When a qualified residential treatment program is the child's initial placement setting,
the responsible social services agency must engage with the child and the child's parents to
determine the appropriate family and permanency team members.
(4) When the permanency goal is to reunify the child with the child's parent or legal
guardian, the purpose of the relative search and focus of the family and permanency team
is to preserve family relationships and identify and develop supports for the child and parents.
(5) The responsible agency must make a good faith effort to identify and assemble all
appropriate individuals to be part of the child's family and permanency team and request
input from the parents regarding relative search efforts consistent with section 260C.221.
The out-of-home placement plan in section 260C.708 must include all contact information
for the team members, as well as contact information for family members or relatives who
are not a part of the family and permanency team.
(6) If the child is age 14 or older, the team must include members of the family and
permanency team that the child selects in accordance with section 260C.212, subdivision
1, paragraph (b).
(7) Consistent with section 260C.221, a responsible social services agency may disclose
relevant and appropriate private data about the child to relatives in order for the relatives
to participate in caring and planning for the child's placement.
(8) If the child is an Indian child under section 260.751, the responsible social services
agency must make active efforts to include the child's tribal representative on the family
and permanency team.
(b) The family and permanency team shall meet regarding the assessment required under
section 260C.704 to determine whether it is necessary and appropriate to place the child in
a qualified residential treatment program and to participate in case planning under section
260C.708.
(c) When reunification of the child with the child's parent or legal guardian is the
permanency plan, the family and permanency team shall support the parent-child relationship
by recognizing the parent's legal authority, consulting with the parent regarding ongoing
planning for the child, and assisting the parent with visiting and contacting the child.
(d) When the agency's permanency plan is to transfer the child's permanent legal and
physical custody to a relative or for the child's adoption, the team shall:
(1) coordinate with the proposed guardian to provide the child with educational services,
medical care, and dental care;
(2) coordinate with the proposed guardian, the agency, and the foster care facility to
meet the child's treatment needs after the child is placed in a permanent placement with the
proposed guardian;
(3) plan to meet the child's need for safety, stability, and connection with the child's
family and community after the child is placed in a permanent placement with the proposed
guardian; and
(4) in the case of an Indian child, communicate with the child's tribe to identify necessary
and appropriate services for the child, transition planning for the child, the child's treatment
needs, and how to maintain the child's connections to the child's community, family, and
tribe.
(e) The agency shall invite the family and permanency team to participate in case planning
and the agency shall give the team notice of court reviews under sections 260C.152 and
260C.221 until: (1) the child is reunited with the child's parents; or (2) the child's foster care
placement ends and the child is in a permanent placement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 260C.708, is amended to read:
260C.708 OUT-OF-HOME PLACEMENT PLAN FOR QUALIFIED
RESIDENTIAL TREATMENT PROGRAM PLACEMENTS.
(a) When the responsible social services agency places a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the out-of-home
placement plan must include:
(1) the case plan requirements in section deleted text begin 260.212, subdivision 1deleted text end new text begin 260C.212new text end ;
(2) the reasonable and good faith efforts of the responsible social services agency to
identify and include all of the individuals required to be on the child's family and permanency
team under section 260C.007;
(3) all contact information for members of the child's family and permanency team and
for other relatives who are not part of the family and permanency team;
(4) evidence that the agency scheduled meetings of the family and permanency team,
including meetings relating to the assessment required under section 260C.704, at a time
and place convenient for the family;
new text begin
(5) evidence that the family and permanency team is involved in the assessment required
under section 260C.704 to determine the appropriateness of the child's placement in a
qualified residential treatment program;
new text end
new text begin
(6) the family and permanency team's placement preferences for the child in the
assessment required under section 260C.704. When making a decision about the child's
placement preferences, the family and permanency team must recognize:
new text end
new text begin
(i) that the agency should place a child with the child's siblings unless a court finds that
placing a child with the child's siblings is not possible due to a child's specialized placement
needs or is otherwise contrary to the child's best interests; and
new text end
new text begin
(ii) that the agency should place an Indian child according to the requirements of the
Indian Child Welfare Act, the Minnesota Family Preservation Act under sections 260.751
to 260.835, and section 260C.193, subdivision 3, paragraph (g);
new text end
deleted text begin (5)deleted text end new text begin (7)new text end when reunification of the child with the child's parent or legal guardian is the
agency's goal, evidence demonstrating that the parent or legal guardian provided input about
the members of the family and permanency team under section 260C.706;
deleted text begin (6)deleted text end new text begin (8)new text end when the agency's permanency goal is to reunify the child with the child's parent
or legal guardian, the out-of-home placement plan must identify services and supports that
maintain the parent-child relationship and the parent's legal authority, decision-making, and
responsibility for ongoing planning for the child. In addition, the agency must assist the
parent with visiting and contacting the child;
deleted text begin (7)deleted text end new text begin (9)new text end when the agency's permanency goal is to transfer permanent legal and physical
custody of the child to a proposed guardian or to finalize the child's adoption, the case plan
must document the agency's steps to transfer permanent legal and physical custody of the
child or finalize adoption, as required in section 260C.212, subdivision 1, paragraph (c),
clauses (6) and (7); and
deleted text begin (8)deleted text end new text begin (10)new text end the qualified individual's recommendation regarding the child's placement in a
qualified residential treatment program and the court approval or disapproval of the placement
as required in section 260C.71.
(b) If the placement preferences of the family and permanency team, child, and tribe, if
applicable, are not consistent with the placement setting that the qualified individual
recommends, the case plan must include the reasons why the qualified individual did not
recommend following the preferences of the family and permanency team, child, and the
tribe.
(c) The agency must file the out-of-home placement plan with the court as part of the
60-day deleted text begin hearingdeleted text end new text begin court ordernew text end under section 260C.71.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 24.
Minnesota Statutes 2020, section 260C.71, is amended to read:
260C.71 COURT APPROVAL REQUIREMENTS.
new text begin Subdivision 1. new text end
new text begin Judicial review. new text end
new text begin
When the responsible social services agency has legal
authority to place a child at a qualified residential treatment facility under section 260C.007,
subdivision 21a, and the child's assessment under section 260C.704 recommends placing
the child in a qualified residential treatment facility, the agency shall place the child at a
qualified residential facility. Within 60 days of placing the child at a qualified residential
treatment facility, the agency must obtain a court order finding that the child's placement
is appropriate and meets the child's individualized needs.
new text end
new text begin Subd. 2. new text end
new text begin Qualified residential treatment program; agency report to court. new text end
new text begin
(a) The
responsible social services agency shall file a written report with the court after receiving
the qualified individual's assessment as specified in section 260C.704 prior to the child's
placement or within 35 days of the date of the child's placement in a qualified residential
treatment facility. The written report shall contain or have attached:
new text end
new text begin
(1) the child's name, date of birth, race, gender, and current address;
new text end
new text begin
(2) the names, races, dates of birth, residence, and post office address of the child's
parents or legal custodian, or guardian;
new text end
new text begin
(3) the name and address of the qualified residential treatment program, including a
chief administrator of the facility;
new text end
new text begin
(4) a statement of the facts that necessitated the child's foster care placement;
new text end
new text begin
(5) the child's out-of-home placement plan under section 260C.212, subdivision 1,
including the requirements in section 260C.708;
new text end
new text begin
(6) if the child is placed in an out-of-state qualified residential treatment program, the
compelling reasons why the child's needs cannot be met by an in-state placement;
new text end
new text begin
(7) the qualified individual's assessment of the child under section 260C.704, paragraph
(c), in a format approved by the commissioner;
new text end
new text begin
(8) if, at the time required for the report under this subdivision, the child's parent or legal
guardian, a child who is ten years of age or older, the family and permanency team, or a
tribe disagrees with the recommended qualified residential treatment program placement,
the agency shall include information regarding the disagreement, and to the extent possible,
the basis for the disagreement in the report;
new text end
new text begin
(9) any other information that the responsible social services agency, child's parent, legal
custodian or guardian, child, or in the case of an Indian child, tribe would like the court to
consider; and
new text end
new text begin
(10) the agency shall file the written report with the court and serve on the parties a
request for a hearing or a court order without a hearing.
new text end
new text begin
(b) The agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the court review requirements of this section and the child's and
child's parent's or legal guardian's right to submit information to the court:
new text end
new text begin
(1) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the reporting date and the date by which the agency must receive
information from the child and child's parent so that the agency is able to submit the report
required by this subdivision to the court;
new text end
new text begin
(2) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older that the court will hold a hearing upon the request of the child or the
child's parent; and
new text end
new text begin
(3) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older that they have the right to request a hearing and the right to present
information to the court for the court's review under this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Court hearing. new text end
new text begin
(a) The court shall hold a hearing when a party or a child who
is ten years of age or older requests a hearing.
new text end
new text begin
(b) In all other circumstances, the court has the discretion to hold a hearing or issue an
order without a hearing.
new text end
new text begin Subd. 4. new text end
new text begin Court findings and order. new text end
(a) Within 60 days from the beginning of each
placement in a qualified residential treatment programnew text begin when the qualified individual's
assessment of the child recommends placing the child in a qualified residential treatment
programnew text end , the court mustnew text begin consider the qualified individual's assessment of the child under
section 260C.704 and issue an order tonew text end :
deleted text begin
(1) consider the qualified individual's assessment of whether it is necessary and
appropriate to place the child in a qualified residential treatment program under section
260C.704;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a family foster home can meet the child's needs, whether it is
necessary and appropriate to place a child in a qualified residential treatment program that
is the least restrictive environment possible, and whether the child's placement is consistent
with the child's short and long term goals as specified in the permanency plan; and
deleted text begin (3)deleted text end new text begin (2)new text end approve or disapprove of the child's placement.
(b) deleted text begin In the out-of-home placement plan, the agency must document the court's approval
or disapproval of the placement, as specified in section 260C.708.deleted text end new text begin If the court disapproves
of the child's placement in a qualified residential treatment program, the responsible social
services agency shall: (1) remove the child from the qualified residential treatment program
within 30 days of the court's order; and (2) make a plan for the child's placement that is
consistent with the child's best interests under section 260C.212, subdivision 2.
new text end
new text begin Subd. 5. new text end
new text begin Court review and approval not required. new text end
new text begin
When the responsible social services
agency has legal authority to place a child under section 260C.007, subdivision 21a, and
the qualified individual's assessment of the child does not recommend placing the child in
a qualified residential treatment program, the court is not required to hold a hearing and the
court is not required to issue an order. Pursuant to section 260C.704, paragraph (f), the
responsible social services agency shall make a plan for the child's placement consistent
with the child's best interests under section 260C.212, subdivision 2. The agency must file
the agency's assessment determination for the child with the court at the next required
hearing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 25.
Minnesota Statutes 2020, section 260C.712, is amended to read:
260C.712 ONGOING REVIEWS AND PERMANENCY HEARING
REQUIREMENTS.
As long as a child remains placed in a qualified residential treatment program, the
responsible social services agency shall submit evidence at each administrative review under
section 260C.203; each court review under sections 260C.202, 260C.203, deleted text begin anddeleted text end 260C.204new text begin ,
260D.06, 260D.07, and 260D.08new text end ; and each permanency hearing under section 260C.515,
260C.519, deleted text begin ordeleted text end 260C.521,new text begin or 260D.07new text end that:
(1) demonstrates that an ongoing assessment of the strengths and needs of the child
continues to support the determination that the child's needs cannot be met through placement
in a family foster home;
(2) demonstrates that the placement of the child in a qualified residential treatment
program provides the most effective and appropriate level of care for the child in the least
restrictive environment;
(3) demonstrates how the placement is consistent with the short-term and long-term
goals for the child, as specified in the child's permanency plan;
(4) documents how the child's specific treatment or service needs will be met in the
placement;
(5) documents the length of time that the agency expects the child to need treatment or
services; deleted text begin and
deleted text end
(6) documents the responsible social services agency's efforts to prepare the child to
return home or to be placed with a fit and willing relative, legal guardian, adoptive parent,
or foster familydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) if the child is placed in a qualified residential treatment program out-of-state, the
compelling reasons for placing the child out-of-state and the reasons that the child's needs
cannot be met by an in-state placement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 260C.714, is amended to read:
260C.714 REVIEW OF EXTENDED QUALIFIED RESIDENTIAL TREATMENT
PROGRAM PLACEMENTS.
(a) When a responsible social services agency places a child in a qualified residential
treatment program for more than 12 consecutive months or 18 nonconsecutive months or,
in the case of a child who is under 13 years of age, for more than six consecutive or
nonconsecutive months, the agency must submit: (1) the signed approval by the county
social services director of the responsible social services agency; and (2) the evidence
supporting the child's placement at the most recent court review or permanency hearing
under section 260C.712deleted text begin , paragraph (b)deleted text end .
(b) The commissioner shall specify the procedures and requirements for the agency's
review and approval of a child's extended qualified residential treatment program placement.
The commissioner may consult with counties, tribes, child-placing agencies, mental health
providers, licensed facilities, the child, the child's parents, and the family and permanency
team members to develop case plan requirements and engage in periodic reviews of the
case plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 260D.01, is amended to read:
260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.
(a) Sections 260D.01 to 260D.10, may be cited as the "child in voluntary foster care for
treatment" provisions of the Juvenile Court Act.
(b) The juvenile court has original and exclusive jurisdiction over a child in voluntary
foster care for treatment upon the filing of a report or petition required under this chapter.
All obligations of thenew text begin responsible social servicesnew text end agency to a child and family in foster care
contained in chapter 260C not inconsistent with this chapter are also obligations of the
agency with regard to a child in foster care for treatment under this chapter.
(c) This chapter shall be construed consistently with the mission of the children's mental
health service system as set out in section 245.487, subdivision 3, and the duties of an agency
under sections 256B.092 and 260C.157 and Minnesota Rules, parts 9525.0004 to 9525.0016,
to meet the needs of a child with a developmental disability or related condition. This
chapter:
(1) establishes voluntary foster care through a voluntary foster care agreement as the
means for an agency and a parent to provide needed treatment when the child must be in
foster care to receive necessary treatment for an emotional disturbance or developmental
disability or related condition;
(2) establishes court review requirements for a child in voluntary foster care for treatment
due to emotional disturbance or developmental disability or a related condition;
(3) establishes the ongoing responsibility of the parent as legal custodian to visit the
child, to plan together with the agency for the child's treatment needs, to be available and
accessible to the agency to make treatment decisions, and to obtain necessary medical,
dental, and other care for the child; deleted text begin and
deleted text end
(4) applies to voluntary foster care when the child's parent and the agency agree that the
child's treatment needs require foster care either:
(i) due to a level of care determination by the agency's screening team informed by thenew text begin
child'snew text end diagnostic and functional assessment under section 245.4885; or
(ii) due to a determination regarding the level of services needed bynew text begin the child bynew text end the
responsible social deleted text begin services'deleted text end new text begin services agency'snew text end screening team under section 256B.092, and
Minnesota Rules, parts 9525.0004 to 9525.0016deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) includes the requirements for a child's placement in sections 260C.70 to 260C.714,
when the juvenile treatment screening team recommends placing a child in a qualified
residential treatment program, except as modified by this chapter.
new text end
(d) This chapter does not apply when there is a current determination under chapter
260E that the child requires child protective services or when the child is in foster care for
any reason other than treatment for the child's emotional disturbance or developmental
disability or related condition. When there is a determination under chapter 260E that the
child requires child protective services based on an assessment that there are safety and risk
issues for the child that have not been mitigated through the parent's engagement in services
or otherwise, or when the child is in foster care for any reason other than the child's emotional
disturbance or developmental disability or related condition, the provisions of chapter 260C
apply.
(e) The paramount consideration in all proceedings concerning a child in voluntary foster
care for treatment is the safety, health, and the best interests of the child. The purpose of
this chapter is:
(1) to ensurenew text begin thatnew text end a child with a disability is provided the services necessary to treat or
ameliorate the symptoms of the child's disability;
(2) to preserve and strengthen the child's family ties whenever possible and in the child's
best interests, approving the child's placement away from the child's parents only when the
child's need for care or treatment requires deleted text begin itdeleted text end new text begin out-of-home placementnew text end and the child cannot
be maintained in the home of the parent; and
(3) to ensurenew text begin thatnew text end the child's parent retains legal custody of the child and associated
decision-making authority unless the child's parent willfully fails or is unable to make
decisions that meet the child's safety, health, and best interests. The court may not find that
the parent willfully fails or is unable to make decisions that meet the child's needs solely
because the parent disagrees with the agency's choice of foster care facility, unless the
agency files a petition under chapter 260C, and establishes by clear and convincing evidence
that the child is in need of protection or services.
(f) The legal parent-child relationship shall be supported under this chapter by maintaining
the parent's legal authority and responsibility for ongoing planning for the child and by the
agency's assisting the parent, deleted text begin wheredeleted text end new text begin whennew text end necessary, to exercise the parent's ongoing right
and obligation to visit or to have reasonable contact with the child. Ongoing planning means:
(1) actively participating in the planning and provision of educational services, medical,
and dental care for the child;
(2) actively planning and participating with the agency and the foster care facility for
the child's treatment needs; deleted text begin and
deleted text end
(3) planning to meet the child's need for safety, stability, and permanency, and the child's
need to stay connected to the child's family and communitydeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) engaging with the responsible social services agency to ensure that the family and
permanency team under section 260C.706 consists of appropriate family members. For
purposes of voluntary placement of a child in foster care for treatment under chapter 260D,
prior to forming the child's family and permanency team, the responsible social services
agency must consult with the child's parent or legal guardian, the child if the child is 14
years of age or older, and, if applicable, the child's tribe to obtain recommendations regarding
which individuals to include on the team and to ensure that the team is family-centered and
will act in the child's best interests. If the child, child's parents, or legal guardians raise
concerns about specific relatives or professionals, the team should not include those
individuals unless the individual is a treating professional or an important connection to the
youth as outlined in the case or crisis plan; and
new text end
new text begin
(5) For a voluntary placement under this chapter in a qualified residential treatment
program, as defined in section 260C.007, subdivision 26d, for purposes of engaging in a
relative search as provided in section 260C.221, the county agency must consult with the
child's parent or legal guardian, the child if the child is 14 years of age or older, and, if
applicable, the child's tribe to obtain recommendations regarding which adult relatives the
county agency should notify. If the child, child's parents, or legal guardians raise concerns
about specific relatives, the county agency should not notify those relatives.
new text end
(g) The provisions of section 260.012 to ensure placement prevention, family
reunification, and all active and reasonable effort requirements of that section apply. This
chapter shall be construed consistently with the requirements of the Indian Child Welfare
Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the
Minnesota Indian Family Preservation Act, sections 260.751 to 260.835.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 260D.05, is amended to read:
260D.05 ADMINISTRATIVE REVIEW OF CHILD IN VOLUNTARY FOSTER
CARE FOR TREATMENT.
The administrative reviews required under section 260C.203 must be conducted for a
child in voluntary foster care for treatment, except that the initial administrative review
must take place prior to the submission of the report to the court required under section
260D.06, subdivision 2.new text begin When a child is placed in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d, the responsible social services agency
must submit evidence to the court as specified in section 260C.712.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 260D.06, subdivision 2, is amended to read:
Subd. 2.
Agency report to court; court review.
The agency shall obtain judicial review
by reporting to the court according to the following procedures:
(a) A written report shall be forwarded to the court within 165 days of the date of the
voluntary placement agreement. The written report shall contain or have attached:
(1) a statement of facts that necessitate the child's foster care placement;
(2) the child's name, date of birth, race, gender, and current address;
(3) the names, race, date of birth, residence, and post office addresses of the child's
parents or legal custodian;
(4) a statement regarding the child's eligibility for membership or enrollment in an Indian
tribe and the agency's compliance with applicable provisions of sections 260.751 to 260.835;
(5) the names and addresses of the foster parents or chief administrator of the facility in
which the child is placed, if the child is not in a family foster home or group home;
(6) a copy of the out-of-home placement plan required under section 260C.212,
subdivision 1;
(7) a written summary of the proceedings of any administrative review required under
section 260C.203; deleted text begin and
deleted text end
(8) new text begin evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d; and
new text end
new text begin (9) new text end any other information the agency, parent or legal custodian, the child or the foster
parent, or other residential facility wants the court to consider.
(b) In the case of a child in placement due to emotional disturbance, the written report
shall include as an attachment, the child's individual treatment plan developed by the child's
treatment professional, as provided in section 245.4871, subdivision 21, or the child's
standard written plan, as provided in section 125A.023, subdivision 3, paragraph (e).
(c) In the case of a child in placement due to developmental disability or a related
condition, the written report shall include as an attachment, the child's individual service
plan, as provided in section 256B.092, subdivision 1b; the child's individual program plan,
as provided in Minnesota Rules, part 9525.0004, subpart 11; the child's waiver care plan;
or the child's standard written plan, as provided in section 125A.023, subdivision 3, paragraph
(e).
(d) The agency must inform the child, age 12 or older, the child's parent, and the foster
parent or foster care facility of the reporting and court review requirements of this section
and of their right to submit information to the court:
(1) if the child or the child's parent or the foster care provider wants to send information
to the court, the agency shall advise those persons of the reporting date and the date by
which the agency must receive the information they want forwarded to the court so the
agency is timely able submit it with the agency's report required under this subdivision;
(2) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care facility that they have the right to be heard in person by the court and how to
exercise that right;
(3) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care provider that an in-court hearing will be held if requested by the child, the parent,
or the foster care provider; and
(4) if, at the time required for the report under this section, a child, age 12 or older,
disagrees about the foster care facility or services provided under the out-of-home placement
plan required under section 260C.212, subdivision 1, the agency shall include information
regarding the child's disagreement, and to the extent possible, the basis for the child's
disagreement in the report required under this section.
(e) After receiving the required report, the court has jurisdiction to make the following
determinations and must do so within ten days of receiving the forwarded report, whether
a hearing is requested:
(1) whether the voluntary foster care arrangement is in the child's best interests;
(2) whether the parent and agency are appropriately planning for the child; and
(3) in the case of a child age 12 or older, who disagrees with the foster care facility or
services provided under the out-of-home placement plan, whether it is appropriate to appoint
counsel and a guardian ad litem for the child using standards and procedures under section
260C.163.
(f) Unless requested by a parent, representative of the foster care facility, or the child,
no in-court hearing is required in order for the court to make findings and issue an order as
required in paragraph (e).
(g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit, individualized findings to support its determination. The
individualized findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported under paragraph (d).
(h) The court shall send a copy of the order to the county attorney, the agency, parent,
child, age 12 or older, and the foster parent or foster care facility.
(i) The court shall also send the parent, the child, age 12 or older, the foster parent, or
representative of the foster care facility notice of the permanency review hearing required
under section 260D.07, paragraph (e).
(j) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent are not appropriately planning for the child,
the court shall notify the agency, the parent, the foster parent or foster care facility, the child,
age 12 or older, and the county attorney of the court's determinations and the basis for the
court's determinations. In this case, the court shall set the matter for hearing and appoint a
guardian ad litem for the child under section 260C.163, subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 30.
Minnesota Statutes 2020, section 260D.07, is amended to read:
260D.07 REQUIRED PERMANENCY REVIEW HEARING.
(a) When the court has found that the voluntary arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child pursuant to the report
submitted under section 260D.06, and the child continues in voluntary foster care as defined
in section 260D.02, subdivision 10, for 13 months from the date of the voluntary foster care
agreement, or has been in placement for 15 of the last 22 months, the agency must:
(1) terminate the voluntary foster care agreement and return the child home; or
(2) determine whether there are compelling reasons to continue the voluntary foster care
arrangement and, if the agency determines there are compelling reasons, seek judicial
approval of its determination; or
(3) file a petition for the termination of parental rights.
(b) When the agency is asking for the court's approval of its determination that there are
compelling reasons to continue the child in the voluntary foster care arrangement, the agency
shall file a "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" and ask the court to proceed under this section.
(c) The "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" shall be drafted or approved by the county attorney and be under oath. The
petition shall include:
(1) the date of the voluntary placement agreement;
(2) whether the petition is due to the child's developmental disability or emotional
disturbance;
(3) the plan for the ongoing care of the child and the parent's participation in the plan;
(4) a description of the parent's visitation and contact with the child;
(5) the date of the court finding that the foster care placement was in the best interests
of the child, if required under section 260D.06, or the date the agency filed the motion under
section 260D.09, paragraph (b);
(6) the agency's reasonable efforts to finalize the permanent plan for the child, including
returning the child to the care of the child's family; deleted text begin and
deleted text end
(7) a citation to this chapter as the basis for the petitiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d.
new text end
(d) An updated copy of the out-of-home placement plan required under section 260C.212,
subdivision 1, shall be filed with the petition.
(e) The court shall set the date for the permanency review hearing no later than 14 months
after the child has been in placement or within 30 days of the petition filing date when the
child has been in placement 15 of the last 22 months. The court shall serve the petition
together with a notice of hearing by United States mail on the parent, the child age 12 or
older, the child's guardian ad litem, if one has been appointed, the agency, the county
attorney, and counsel for any party.
(f) The court shall conduct the permanency review hearing on the petition no later than
14 months after the date of the voluntary placement agreement, within 30 days of the filing
of the petition when the child has been in placement 15 of the last 22 months, or within 15
days of a motion to terminate jurisdiction and to dismiss an order for foster care under
chapter 260C, as provided in section 260D.09, paragraph (b).
(g) At the permanency review hearing, the court shall:
(1) inquire of the parent if the parent has reviewed the "Petition for Permanency Review
Regarding a Child in Voluntary Foster Care for Treatment," whether the petition is accurate,
and whether the parent agrees to the continued voluntary foster care arrangement as being
in the child's best interests;
(2) inquire of the parent if the parent is satisfied with the agency's reasonable efforts to
finalize the permanent plan for the child, including whether there are services available and
accessible to the parent that might allow the child to safely be with the child's family;
(3) inquire of the parent if the parent consents to the court entering an order that:
(i) approves the responsible agency's reasonable efforts to finalize the permanent plan
for the child, which includes ongoing future planning for the safety, health, and best interests
of the child; and
(ii) approves the responsible agency's determination that there are compelling reasons
why the continued voluntary foster care arrangement is in the child's best interests; and
(4) inquire of the child's guardian ad litem and any other party whether the guardian or
the party agrees that:
(i) the court should approve the responsible agency's reasonable efforts to finalize the
permanent plan for the child, which includes ongoing and future planning for the safety,
health, and best interests of the child; and
(ii) the court should approve of the responsible agency's determination that there are
compelling reasons why the continued voluntary foster care arrangement is in the child's
best interests.
(h) At a permanency review hearing under this section, the court may take the following
actions based on the contents of the sworn petition and the consent of the parent:
(1) approve the agency's compelling reasons that the voluntary foster care arrangement
is in the best interests of the child; and
(2) find that the agency has made reasonable efforts to finalize the permanent plan for
the child.
(i) A child, age 12 or older, may object to the agency's request that the court approve its
compelling reasons for the continued voluntary arrangement and may be heard on the reasons
for the objection. Notwithstanding the child's objection, the court may approve the agency's
compelling reasons and the voluntary arrangement.
(j) If the court does not approve the voluntary arrangement after hearing from the child
or the child's guardian ad litem, the court shall dismiss the petition. In this case, either:
(1) the child must be returned to the care of the parent; or
(2) the agency must file a petition under section 260C.141, asking for appropriate relief
under sections 260C.301 or 260C.503 to 260C.521.
(k) When the court approves the agency's compelling reasons for the child to continue
in voluntary foster care for treatment, and finds that the agency has made reasonable efforts
to finalize a permanent plan for the child, the court shall approve the continued voluntary
foster care arrangement, and continue the matter under the court's jurisdiction for the purposes
of reviewing the child's placement every 12 months while the child is in foster care.
(l) A finding that the court approves the continued voluntary placement means the agency
has continued legal authority to place the child while a voluntary placement agreement
remains in effect. The parent or the agency may terminate a voluntary agreement as provided
in section 260D.10. Termination of a voluntary foster care placement of an Indian child is
governed by section 260.765, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 260D.08, is amended to read:
260D.08 ANNUAL REVIEW.
(a) After the court conducts a permanency review hearing under section 260D.07, the
matter must be returned to the court for further review of the responsible social services
reasonable efforts to finalize the permanent plan for the child and the child's foster care
placement at least every 12 months while the child is in foster care. The court shall give
notice to the parent and child, age 12 or older, and the foster parents of the continued review
requirements under this section at the permanency review hearing.
(b) Every 12 months, the court shall determine whether the agency made reasonable
efforts to finalize the permanency plan for the child, which means the exercise of due
diligence by the agency to:
(1) ensure that the agreement for voluntary foster care is the most appropriate legal
arrangement to meet the child's safety, health, and best interests and to conduct a genuine
examination of whether there is another permanency disposition order under chapter 260C,
including returning the child home, that would better serve the child's need for a stable and
permanent home;
(2) engage and support the parent in continued involvement in planning and decision
making for the needs of the child;
(3) strengthen the child's ties to the parent, relatives, and community;
(4) implement the out-of-home placement plan required under section 260C.212,
subdivision 1, and ensure that the plan requires the provision of appropriate services to
address the physical health, mental health, and educational needs of the child; deleted text begin and
deleted text end
new text begin
(5) submit evidence to the court as specified in section 260C.712 when a child is placed
in a qualified residential treatment program setting as defined in section 260C.007,
subdivision 26d; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end ensure appropriate planning for the child's safe, permanent, and independent
living arrangement after the child's 18th birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 260D.14, is amended to read:
260D.14 SUCCESSFUL TRANSITION TO ADULTHOOD FOR deleted text begin CHILDRENdeleted text end new text begin
YOUTHnew text end IN VOLUNTARY PLACEMENT.
Subdivision 1.
Case planning.
When deleted text begin the childdeleted text end new text begin a youthnew text end is 14 years of age or older, the
responsible social services agency shall ensurenew text begin thatnew text end a deleted text begin childdeleted text end new text begin youthnew text end in foster care under this
chapter is provided with the case plan requirements in section 260C.212, subdivisions 1
and 14.
Subd. 2.
Notification.
The responsible social services agency shall providenew text begin a youth withnew text end
written notice of deleted text begin the right to continued access to services for certain children in foster care
past 18 years of age under section 260C.452, subdivision 3deleted text end new text begin foster care benefits that a youth
who is 18 years of age or older may continue to receive according to section 260C.451,
subdivision 1new text end , and of the right to appeal a denial of social services under section 256.045.
The notice must be provided to the deleted text begin childdeleted text end new text begin youthnew text end six months before the deleted text begin child'sdeleted text end new text begin youth'snew text end 18th
birthday.
Subd. 3.
Administrative or court reviews.
When deleted text begin the childdeleted text end new text begin a youthnew text end is deleted text begin 17deleted text end new text begin 14new text end years of
age or older, the administrative review or court hearing must include a review of the
responsible social services agency's support for the deleted text begin child'sdeleted text end new text begin youth'snew text end successful transition to
adulthood as required in section 260C.452, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 260E.06, subdivision 1, is amended to read:
Subdivision 1.
Mandatory reporters.
(a) A person who knows or has reason to believe
a child is being maltreated, as defined in section 260E.03, or has been maltreated within
the preceding three years shall immediately report the information to the local welfare
agency, agency responsible for assessing or investigating the report, police department,
county sheriff, tribal social services agency, or tribal police department if the person is:
(1) a professional or professional's delegate who is engaged in the practice of the healing
arts, social services, hospital administration, psychological or psychiatric treatment, child
care, education, correctional supervision, probation and correctional services, or law
enforcement; deleted text begin or
deleted text end
(2) employed as a member of the clergy and received the information while engaged in
ministerial duties, provided that a member of the clergy is not required by this subdivision
to report information that is otherwise privileged under section 595.02, subdivision 1,
paragraph (c)deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) an owner, administrator, or employee who is 18 years of age or older of a public or
private youth recreation program or other organization that provides services or activities
requiring face-to-face contact with and supervision of children.
new text end
(b) "Practice of social services" for the purposes of this subdivision includes but is not
limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.
Sec. 34.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall conduct a face-to-face contact with the child reported to be maltreated and
with the child's primary caregiver sufficient to complete a safety assessment and ensure the
immediate safety of the child.
(b) deleted text begin Thedeleted text end Face-to-face contact with the child and primary caregiver shall occur immediately
if sexual abuse or substantial child endangerment is alleged and within five calendar days
for all other reports. If the alleged offender was not already interviewed as the primary
caregiver, the local welfare agency shall also conduct a face-to-face interview with the
alleged offender in the early stages of the assessment or investigation.new text begin Face-to-face contact
with the child and primary caregiver in response to a report alleging sexual abuse or
substantial child endangerment may be postponed for no more than five calendar days if
the child is residing in a location that is confirmed to restrict contact with the alleged offender
as established in guidelines issued by the commissioner, or if the local welfare agency is
pursuing a court order for the child's caregiver to produce the child for questioning under
section 260E.22, subdivision 5.
new text end
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statement. The
alleged offender may submit supporting documentation relevant to the assessment or
investigation.
Sec. 35.
Minnesota Statutes 2020, section 260E.31, subdivision 1, is amended to read:
Subdivision 1.
Reports required.
(a) Except as provided in paragraph (b), a person
mandated to report under this chapter shall immediately report to the local welfare agency
if the person knows or has reason to believe that a woman is pregnant and has used a
controlled substance for a nonmedical purpose during the pregnancy, including but not
limited to tetrahydrocannabinol, or has consumed alcoholic beverages during the pregnancy
in any way that is habitual or excessive.
(b) A health care professional or a social service professional who is mandated to report
under this chapter is exempt from reporting under paragraph (a) deleted text begin a woman's use or
consumption of tetrahydrocannabinol or alcoholic beverages during pregnancydeleted text end if the
professional is providing new text begin or collaborating with other professionals to provide new text end the woman
with prenatal carenew text begin , postpartum care,new text end or other health care servicesnew text begin , including care of the
woman's infantnew text end . new text begin If the woman does not continue to receive regular prenatal or postpartum
care, after the woman's health care professional has made attempts to contact the woman,
then the professional is required to report under paragraph (a).
new text end
(c) Any person may make a voluntary report if the person knows or has reason to believe
that a woman is pregnant and has used a controlled substance for a nonmedical purpose
during the pregnancy, including but not limited to tetrahydrocannabinol, or has consumed
alcoholic beverages during the pregnancy in any way that is habitual or excessive.
(d) An oral report shall be made immediately by telephone or otherwise. An oral report
made by a person required to report shall be followed within 72 hours, exclusive of weekends
and holidays, by a report in writing to the local welfare agency. Any report shall be of
sufficient content to identify the pregnant woman, the nature and extent of the use, if known,
and the name and address of the reporter. The local welfare agency shall accept a report
made under paragraph (c) notwithstanding refusal by a voluntary reporter to provide the
reporter's name or address as long as the report is otherwise sufficient.
(e) For purposes of this section, "prenatal care" means the comprehensive package of
medical and psychological support provided throughout the pregnancy.
Sec. 36.
Minnesota Statutes 2020, section 260E.33, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Notification of contested case hearing. new text end
new text begin
When an appeal of a lead investigative
agency determination results in a contested case hearing under chapter 245A or 245C, the
administrative law judge shall notify the parent, legal custodian, or guardian of the child
who is the subject of the maltreatment determination. The notice must be sent by certified
mail and inform the parent, legal custodian, or guardian of the child of the right to file a
signed written statement in the proceedings and the right to attend and participate in the
hearing. The parent, legal custodian, or guardian of the child may file a written statement
with the administrative law judge hearing the case no later than five business days before
commencement of the hearing. The administrative law judge shall include the written
statement in the hearing record and consider the statement in deciding the appeal. The lead
investigative agency shall provide to the administrative law judge the address of the parent,
legal custodian, or guardian of the child. If the lead investigative agency is not reasonably
able to determine the address of the parent, legal custodian, or guardian of the child, the
administrative law judge is not required to send a hearing notice under this subdivision.
new text end
Sec. 37.
Minnesota Statutes 2020, section 260E.36, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Sex trafficking and sexual exploitation training requirement. new text end
new text begin
As required
by the Child Abuse Prevention and Treatment Act amendments through Public Law 114-22
and to implement Public Law 115-123, all child protection social workers and social services
staff who have responsibility for child protective duties under this chapter or chapter 260C
shall complete training implemented by the commissioner of human services regarding sex
trafficking and sexual exploitation of children and youth.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 38. new text begin DIRECTION TO THE COMMISSIONER; QUALIFIED RESIDENTIAL
TREATMENT TRANSITION SUPPORTS.
new text end
new text begin
The commissioner of human services shall consult with stakeholders to develop policies
regarding aftercare supports for the transition of a child from a qualified residential treatment
program, as defined in Minnesota Statutes, section 260C.007, subdivision 26d, to
reunification with the child's parent or legal guardian, including potential placement in a
less restrictive setting prior to reunification that aligns with the child's permanency plan and
person-centered support plan, when applicable. The policies must be consistent with
Minnesota Rules, part 2960.0190, and Minnesota Statutes, section 245A.25, subdivision 4,
paragraph (i), and address the coordination of the qualified residential treatment program
discharge planning and aftercare supports where needed, the county social services case
plan, and services from community-based providers, to maintain the child's progress with
behavioral health goals in the child's treatment plan. The commissioner must complete
development of the policy guidance by December 31, 2022.
new text end
Sec. 39. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall place the following first grade headnote in Minnesota
Statutes, chapter 260C, preceding Minnesota Statutes, sections 260C.70 to 260C.714:
PLACEMENT OF CHILDREN IN QUALIFIED RESIDENTIAL TREATMENT.
new text end
ARTICLE 4
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2020, section 62A.15, is amended by adding a subdivision
to read:
new text begin Subd. 3c. new text end
new text begin Mental health services. new text end
new text begin
All benefits provided by a policy or contract referred
to in subdivision 1 relating to expenses incurred for mental health treatment or services
provided by a mental health professional must also include treatment and services provided
by a clinical trainee to the extent that the services and treatment are within the scope of
practice of the clinical trainee according to Minnesota Rules, part 9505.0371, subpart 5,
item C. This subdivision is intended to provide equal payment of benefits for mental health
treatment and services provided by a mental health professional, as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A, or a clinical trainee and is not intended to change
or add to the benefits provided for in those policies or contracts.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to policies
and contracts offered, issued, or renewed on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62A.15, subdivision 4, is amended to read:
Subd. 4.
Denial of benefits.
(a) No carrier referred to in subdivision 1 may, in the
payment of claims to employees in this state, deny benefits payable for services covered by
the policy or contract if the services are lawfully performed by a licensed chiropractor,
licensed optometrist, a registered nurse meeting the requirements of subdivision 3a, deleted text begin ordeleted text end a
licensed acupuncture practitionernew text begin , or a mental health clinical traineenew text end .
(b) When carriers referred to in subdivision 1 make claim determinations concerning
the appropriateness, quality, or utilization of chiropractic health care for Minnesotans, any
of these determinations that are made by health care professionals must be made by, or
under the direction of, or subject to the review of licensed doctors of chiropractic.
(c) When a carrier referred to in subdivision 1 makes a denial of payment claim
determination concerning the appropriateness, quality, or utilization of acupuncture services
for individuals in this state performed by a licensed acupuncture practitioner, a denial of
payment claim determination that is made by a health professional must be made by, under
the direction of, or subject to the review of a licensed acupuncture practitioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 3.
Minnesota Statutes 2020, section 144.1501, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
(b) "Advanced dental therapist" means an individual who is licensed as a dental therapist
under section 150A.06, and who is certified as an advanced dental therapist under section
150A.106.
new text begin
(c) "Alcohol and drug counselor" means an individual who is licensed as an alcohol and
drug counselor under chapter 148F.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.
deleted text begin (d)deleted text end new text begin (e)new text end "Dentist" means an individual who is licensed to practice dentistry.
deleted text begin (e)deleted text end new text begin (f)new text end "Designated rural area" means a statutory and home rule charter city or township
that is outside the seven-county metropolitan area as defined in section 473.121, subdivision
2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.
deleted text begin (f)deleted text end new text begin (g)new text end "Emergency circumstances" means those conditions that make it impossible for
the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.
deleted text begin (g)deleted text end new text begin (h)new text end "Mental health professional" means an individual providing clinical services in
the treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.
deleted text begin (h)deleted text end new text begin (i)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (i)deleted text end new text begin (j)new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse anesthetist,
advanced clinical nurse specialist, or physician assistant.
deleted text begin (j)deleted text end new text begin (k)new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.
deleted text begin (k)deleted text end new text begin (l)new text end "Nurse-midwife" means a registered nurse who has graduated from a program of
study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (l)deleted text end new text begin (m)new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.
deleted text begin (m)deleted text end new text begin (n)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (n)deleted text end new text begin (o)new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (o)deleted text end new text begin (p)new text end "Physician assistant" means a person licensed under chapter 147A.
deleted text begin (p)deleted text end new text begin (q)new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.
deleted text begin (q)deleted text end new text begin (r)new text end "Qualified educational loan" means a government, commercial, or foundation
loan for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
deleted text begin (r)deleted text end new text begin (s)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 4.
Minnesota Statutes 2020, section 144.1501, subdivision 2, is amended to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents deleted text begin anddeleted text end new text begin ,new text end mental health professionalsnew text begin , and alcohol and drug
counselorsnew text end agreeing to practice in designated rural areas or underserved urban communities
or specializing in the area of pediatric psychiatry;
(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;
(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; a hospital if the hospital owns and operates
a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse
is in the nursing home; a housing with services establishment as defined in section 144D.01,
subdivision 4; or for a home care provider as defined in section 144A.43, subdivision 4; or
agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a
postsecondary program at the undergraduate level or the equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;
(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas; and
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303.
(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.
Sec. 5.
Minnesota Statutes 2020, section 144.1501, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program, an
individual must:
(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, new text begin alcohol and drug counselor, new text end pharmacist, public health nurse, midlevel
practitioner, registered nurse, or a licensed practical nurse. The commissioner may also
consider applications submitted by graduates in eligible professions who are licensed and
in practice; and
(2) submit an application to the commissioner of health.
(b) An applicant selected to participate must sign a contract to agree to serve a minimum
three-year full-time service obligation according to subdivision 2, which shall begin no later
than March 31 following completion of required training, with the exception of a nurse,
who must agree to serve a minimum two-year full-time service obligation according to
subdivision 2, which shall begin no later than March 31 following completion of required
training.
Sec. 6.
Minnesota Statutes 2020, section 148.90, subdivision 2, is amended to read:
Subd. 2.
Members.
(a) The members of the board shall:
(1) be appointed by the governor;
(2) be residents of the state;
(3) serve for not more than two consecutive terms;
(4) designate the officers of the board; and
(5) administer oaths pertaining to the business of the board.
(b) A public member of the board shall represent the public interest and shall not:
(1) be a psychologist or have engaged in the practice of psychology;
(2) be an applicant or former applicant for licensure;
(3) be a member of another health profession and be licensed by a health-related licensing
board as defined under section 214.01, subdivision 2; the commissioner of health; or licensed,
certified, or registered by another jurisdiction;
(4) be a member of a household that includes a psychologist; or
(5) have conflicts of interest or the appearance of conflicts with duties as a board member.
new text begin
(c) At the time of their appointments, at least two members of the board must reside
outside of the seven-county metropolitan area.
new text end
new text begin
(d) At the time of their appointments, at least two members of the board must be members
of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 7.
Minnesota Statutes 2020, section 148.911, is amended to read:
148.911 CONTINUING EDUCATION.
new text begin (a) new text end Upon application for license renewal, a licensee shall provide the board with
satisfactory evidence that the licensee has completed continuing education requirements
established by the board. Continuing education programs shall be approved under section
148.905, subdivision 1, clause (10). The board shall establish by rule the number of
continuing education training hours required each year and may specify subject or skills
areas that the licensee shall address.
new text begin
(b) At least four of the required continuing education hours must be on increasing the
knowledge, understanding, self-awareness, and practice skills to competently address the
psychological needs of individuals from culturally diverse socioeconomic and cultural
backgrounds. Topics include but are not limited to:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression;
new text end
new text begin
(4) understanding cultural humility; and
new text end
new text begin
(5) understanding human diversity, meaning individual client differences that are
associated with the client's cultural group, including race, ethnicity, national origin, religious
affiliation, language, age, gender, gender identity, physical and mental capabilities, sexual
orientation, and socioeconomic status.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 148B.30, subdivision 1, is amended to read:
Subdivision 1.
Creation.
new text begin (a) new text end There is created a Board of Marriage and Family Therapy
that consists of seven members appointed by the governor. Four members shall be licensed,
practicing marriage and family therapists, each of whom shall for at least five years
immediately preceding appointment, have been actively engaged as a marriage and family
therapist, rendering professional services in marriage and family therapy. One member shall
be engaged in the professional teaching and research of marriage and family therapy. Two
members shall be representatives of the general public who have no direct affiliation with
the practice of marriage and family therapy. All members shall have been a resident of the
state two years preceding their appointment. Of the first board members appointed, three
shall continue in office for two years, two members for three years, and two members,
including the chair, for terms of four years respectively. Their successors shall be appointed
for terms of four years each, except that a person chosen to fill a vacancy shall be appointed
only for the unexpired term of the board member whom the newly appointed member
succeeds. Upon the expiration of a board member's term of office, the board member shall
continue to serve until a successor is appointed and qualified.
new text begin
(b) At the time of their appointments, at least two members must reside outside of the
seven-county metropolitan area.
new text end
new text begin
(c) At the time of their appointments, at least two members must be members of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 9.
Minnesota Statutes 2020, section 148B.31, is amended to read:
148B.31 DUTIES OF THE BOARD.
new text begin (a) new text end The board shall:
(1) adopt and enforce rules for marriage and family therapy licensing, which shall be
designed to protect the public;
(2) develop by rule appropriate techniques, including examinations and other methods,
for determining whether applicants and licensees are qualified under sections 148B.29 to
148B.392;
(3) issue licenses to individuals who are qualified under sections 148B.29 to 148B.392;
(4) establish and implement procedures designed to assure that licensed marriage and
family therapists will comply with the board's rules;
(5) study and investigate the practice of marriage and family therapy within the state in
order to improve the standards imposed for the licensing of marriage and family therapists
and to improve the procedures and methods used for enforcement of the board's standards;
(6) formulate and implement a code of ethics for all licensed marriage and family
therapists; and
(7) establish continuing education requirements for marriage and family therapists.
new text begin
(b) At least four of the 40 continuing education training hours required under Minnesota
Rules, part 5300.0320, subpart 2, must be on increasing the knowledge, understanding,
self-awareness, and practice skills that enable a marriage and family therapist to serve clients
from diverse socioeconomic and cultural backgrounds. Topics include but are not limited
to:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 10.
Minnesota Statutes 2020, section 148B.51, is amended to read:
148B.51 BOARD OF BEHAVIORAL HEALTH AND THERAPY.
new text begin (a) new text end The Board of Behavioral Health and Therapy consists of 13 members appointed by
the governor. Five of the members shall be professional counselors licensed or eligible for
licensure under sections 148B.50 to 148B.593. Five of the members shall be alcohol and
drug counselors licensed under chapter 148F. Three of the members shall be public members
as defined in section 214.02. The board shall annually elect from its membership a chair
and vice-chair. The board shall appoint and employ an executive director who is not a
member of the board. The employment of the executive director shall be subject to the terms
described in section 214.04, subdivision 2a. Chapter 214 applies to the Board of Behavioral
Health and Therapy unless superseded by sections 148B.50 to 148B.593.
new text begin
(b) At the time of their appointments, at least three members must reside outside of the
seven-county metropolitan area.
new text end
new text begin
(c) At the time of their appointments, at least three members must be members of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 11.
Minnesota Statutes 2020, section 148B.54, subdivision 2, is amended to read:
Subd. 2.
Continuing education.
new text begin (a) new text end At the completion of the first four years of licensure,
a licensee must provide evidence satisfactory to the board of completion of 12 additional
postgraduate semester credit hours or its equivalent in counseling as determined by the
board, except that no licensee shall be required to show evidence of greater than 60 semester
hours or its equivalent. In addition to completing the requisite graduate coursework, each
licensee shall also complete in the first four years of licensure a minimum of 40 hours of
continuing education activities approved by the board under Minnesota Rules, part 2150.2540.
Graduate credit hours successfully completed in the first four years of licensure may be
applied to both the graduate credit requirement and to the requirement for 40 hours of
continuing education activities. A licensee may receive 15 continuing education hours per
semester credit hour or ten continuing education hours per quarter credit hour. Thereafter,
at the time of renewal, each licensee shall provide evidence satisfactory to the board that
the licensee has completed during each two-year period at least the equivalent of 40 clock
hours of professional postdegree continuing education in programs approved by the board
and continues to be qualified to practice under sections 148B.50 to 148B.593.
new text begin
(b) At least four of the required 40 continuing education clock hours must be on increasing
the knowledge, understanding, self-awareness, and practice skills that enable a licensed
professional counselor and licensed professional clinical counselor to serve clients from
diverse socioeconomic and cultural backgrounds. Topics include but are not limited to:
new text end
new text begin
(1) understanding culture, culture's functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2020, section 148E.010, is amended by adding a subdivision
to read:
new text begin Subd. 7f. new text end
new text begin Cultural responsiveness. new text end
new text begin
"Cultural responsiveness" means increasing the
knowledge, understanding, self-awareness, and practice skills that enable a social worker
to serve clients from diverse socioeconomic and cultural backgrounds including:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
Sec. 13.
Minnesota Statutes 2020, section 148E.130, subdivision 1, is amended to read:
Subdivision 1.
Total clock hours required.
(a) A licensee must complete 40 hours of
continuing education for each two-year renewal term. At the time of license renewal, a
licensee must provide evidence satisfactory to the board that the licensee has completed the
required continuing education hours during the previous renewal term. Of the total clock
hours required:
(1) all licensees must completenew text begin : (i)new text end two hours in social work ethics as defined in section
148E.010; new text begin and (ii) four hours in cultural responsiveness as defined in section 148E.010;
new text end
(2) licensed independent clinical social workers must complete 12 clock hours in one
or more of the clinical content areas specified in section 148E.055, subdivision 5, paragraph
(a), clause (2);
(3) licensees providing licensing supervision according to sections 148E.100 to 148E.125,
must complete six clock hours in supervision as defined in section 148E.010; and
(4) no more than half of the required clock hours may be completed via continuing
education independent learning as defined in section 148E.010.
(b) If the licensee's renewal term is prorated to be less or more than 24 months, the total
number of required clock hours is prorated proportionately.
Sec. 14.
Minnesota Statutes 2020, section 148E.130, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin New content clock hours required effective July 1, 2021. new text end
new text begin
(a) The content
clock hours specified in subdivision 1, paragraph (a), clause (1), item (ii), apply to all new
licenses issued effective July 1, 2021, under section 148E.055.
new text end
new text begin
(b) Any licensee issued a license prior to July 1, 2021, under section 148E.055 must
comply with clock hours in subdivision 1, including the content clock hours in subdivision
1, paragraph (a), clause (1), item (ii), at the first two-year renewal term after July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
(a) "Mental health practitioner" means a person
providing services to adults with mental illness or children with emotional disturbance who
is qualified in at least one of the ways described in paragraphs (b) to (g). A mental health
practitioner for a child client must have training working with children. A mental health
practitioner for an adult client must have training working with adults.
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, substance use disorder, or emotional disturbance; or
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
(3) is working in a day treatment program under section 245.4712, subdivision 2; deleted text begin or
deleted text end
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fieldsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is in the process of completing a practicum or internship as part of a formal
undergraduate or graduate training program in social work, psychology, or counseling.
new text end
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, substance use disorder, or emotional disturbance; or
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
Sec. 16.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intakedeleted text begin , except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9deleted text end .
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
Sec. 17.
Minnesota Statutes 2020, section 245.4882, subdivision 1, is amended to read:
Subdivision 1.
Availability of residential treatment services.
County boards must
provide or contract for enough residential treatment services to meet the needs of each child
with severe emotional disturbance residing in the county and needing this level of care.
Length of stay is based on the child's residential treatment need and shall be deleted text begin subject to the
six-month review process established in section , and for children in voluntary
placement for treatment, the court review process in section 260D.06deleted text end new text begin reviewed every 90
daysnew text end . Services must be appropriate to the child's age and treatment needs and must be made
available as close to the county as possible. Residential treatment must be designed to:
(1) help the child improve family living and social interaction skills;
(2) help the child gain the necessary skills to return to the community;
(3) stabilize crisis admissions; and
(4) work with families throughout the placement to improve the ability of the families
to care for children with severe emotional disturbance in the home.
Sec. 18.
Minnesota Statutes 2020, section 245.4882, subdivision 3, is amended to read:
Subd. 3.
Transition to community.
Residential treatment facilities and regional treatment
centers serving children must plan for and assist those children and their families in making
a transition to less restrictive community-based services. new text begin Discharge planning for the child
to return to the community must include identification of and referrals to appropriate home
and community supports that meet the needs of the child and family. Discharge planning
must begin within 30 days after the child enters residential treatment and be updated every
60 days. new text end Residential treatment facilities must also arrange for appropriate follow-up care
in the community. Before a child is discharged, the residential treatment facility or regional
treatment center shall provide notification to the child's case manager, if any, so that the
case manager can monitor and coordinate the transition and make timely arrangements for
the child's appropriate follow-up care in the community.
Sec. 19.
Minnesota Statutes 2020, 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 deleted text begin publicdeleted text end new text begin countynew text end funds are used to pay for thenew text begin child'snew text end services.
(b) The deleted text begin responsible social services agencydeleted text end new text begin county boardnew text end shall determine the appropriate
level of care for a child when county-controlled funds are used to pay for the child's deleted text begin services
or placement in a qualified residential treatment facility under chapter deleted text end deleted text begin 260Cdeleted text end deleted text begin and licensed
by the commissioner under chapter deleted text end deleted text begin 245Adeleted text end deleted text begin . In accordance with section 260C.157, a juvenile
treatment screening team shall conduct a screening before the team may recommend whether
to place a childdeleted text end new text begin residential treatment under this chapter, including residential treatment
providednew text end in a qualified residential treatment program as defined in section 260C.007,
subdivision 26d. When a deleted text begin social services agencydeleted text end new text begin county boardnew text end 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 carenew text begin for the childnew text end . 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 deleted text begin to bedeleted text end usednew text begin for the childnew text end , the Indian Health Services or 638 tribal health facility
must determine the appropriate level of carenew text begin for the childnew text end . When more than one entity bears
responsibility fornew text begin a child'snew text end coverage, the entities shall coordinate level of care determination
activities new text begin for the child new text end to the extent possible.
(c) The deleted text begin responsible social services agency must make the level of care determination
available to the juvenile treatment screening team, as permitted under chapter deleted text end deleted text begin 13deleted text end deleted text begin . The level
of care determination shall inform the juvenile treatment screening team process and the
assessment in section 260C.704 when considering whether to place the child in a qualified
residential treatment program. When the responsible social services agency is not involved
in determining a child's placement, thedeleted text end 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
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the deleted text begin responsible social services
agencydeleted text end new text begin county boardnew text end or other entity may not determine that a screening deleted text begin under section
260C.157 ordeleted text end new text begin ,new text end referralnew text begin ,new text end or admission to a deleted text begin treatment foster care setting ordeleted text end 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
assessmentnew text begin of a childnew text end that deleted text begin includes a functional assessment whichdeleted text end evaluates 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 carenew text begin to the childnew text end . The validated tool must be approved by the
commissioner of human services. If a diagnostic assessment deleted text begin including a functional assessmentdeleted text end
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
or not these services are available and accessible to the child andnew text begin the child'snew text end family.new text begin 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.
new text end
(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.
deleted text begin
(f) When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 unless a court
terminates the parent's rights or court orders restrict the parent from participating in case
planning, visitation, or parental responsibilities.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end The level of care determination, and placement decision, and recommendations
for mental health services must be documented in the child's recorddeleted text begin , as required in chapter
deleted text end deleted text begin 260Cdeleted text end new text begin and made available to the child's family, as appropriatenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 20.
Minnesota Statutes 2020, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of out-of-home placement. A child is not required to have case
management services to receive respite care services;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minoritiesnew text begin , including
supervision of clinical trainees who are Black, indigenous, or people of color, providing
services in clinics that serve clients enrolled in medical assistancenew text end ;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services under section 245.4901;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(18) mental health services based on traditional, spiritual, and holistic healing practices,
provided by cultural healers from African American, American Indian, Asian American,
Latinx, Pacific Islander, and Pan-African communities.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
Sec. 21.
new text begin
[245.4902] CULTURALLY INFORMED AND CULTURALLY
RESPONSIVE MENTAL HEALTH TASK FORCE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; duties. new text end
new text begin
The Culturally Informed and Culturally
Responsive Mental Health Task Force is established to evaluate and make recommendations
on improving the provision of culturally informed and culturally responsive mental health
services throughout Minnesota. The task force must make recommendations on:
new text end
new text begin
(1) recruiting mental health providers from diverse racial and ethnic communities;
new text end
new text begin
(2) training all mental health providers on cultural competency and cultural humility;
new text end
new text begin
(3) assessing the extent to which mental health provider organizations embrace diversity
and demonstrate proficiency in culturally competent mental health treatment and services;
and
new text end
new text begin
(4) increasing the number of mental health organizations owned, managed, or led by
individuals who are Black, indigenous, or people of color.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The task force must consist of the following 16 members:
new text end
new text begin
(1) the commissioner of human services or the commissioner's designee;
new text end
new text begin
(2) one representative from the Board of Psychology;
new text end
new text begin
(3) one representative from the Board of Marriage and Family Therapy;
new text end
new text begin
(4) one representative from the Board of Behavioral Health and Therapy;
new text end
new text begin
(5) one representative from the Board of Social Work;
new text end
new text begin
(6) three members representing undergraduate and graduate-level mental health
professional education programs, appointed by the governor;
new text end
new text begin
(7) three mental health providers who are members of communities of color or
underrepresented communities, as defined in section 148E.010, subdivision 20, appointed
by the governor;
new text end
new text begin
(8) two members representing mental health advocacy organizations, appointed by the
governor;
new text end
new text begin
(9) two mental health providers, appointed by the governor; and
new text end
new text begin
(10) one expert in providing training and education in cultural competency and cultural
responsiveness, appointed by the governor.
new text end
new text begin
(b) Appointments to the task force must be made no later than June 1, 2022.
new text end
new text begin
(c) Member compensation and reimbursement for expenses are governed by section
15.059, subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Chairs; meetings. new text end
new text begin
The members of the task force must elect two cochairs of
the task force no earlier than July 1, 2022, and the cochairs must convene the first meeting
of the task force no later than August 15, 2022. The task force must meet upon the call of
the cochairs, sufficiently often to accomplish the duties identified in this section. The task
force is subject to the open meeting law under chapter 13D.
new text end
new text begin Subd. 4. new text end
new text begin Administrative support. new text end
new text begin
The Department of Human Services must provide
administrative support and meeting space for the task force.
new text end
new text begin Subd. 5. new text end
new text begin Reports. new text end
new text begin
No later than January 1, 2023, and by January 1 of each year thereafter,
the task force must submit a written report to the members of the legislative committees
with jurisdiction over health and human services on the recommendations developed under
subdivision 1.
new text end
new text begin Subd. 6. new text end
new text begin Expiration. new text end
new text begin
The task force expires on January 1, 2025.
new text end
Sec. 22.
Minnesota Statutes 2020, 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)new text begin that satisfy all federal requirements necessary for CCBHCs certified under this
section to be eligible for reimbursement under medical assistance, without service area
limits based on geographic area or regionnew text end . new text begin The commissioner shall consult with CCBHC
stakeholders before establishing and implementing changes in the certification process and
requirements.new text end Entities that choose to be CCBHCs must:
deleted text begin
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
deleted text end
new text begin
(1) comply with state licensing requirements and other requirements issued by the
commissioner;
new text end
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's 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 and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization servicesnew text begin through existing
mobile crisis servicesnew text end ; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered 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 veteransdeleted text begin ;deleted text end new text begin . CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
new text end
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served 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;
(9) comply with standards new text begin established by the commissioner new text end relating to deleted text begin mental health
services in Minnesota Rules, parts 9505.0370 to 9505.0372deleted text end new text begin CCBHC screenings, assessments,
and evaluationsnew text end ;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under sections
256B.0624 and 256B.0944;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If deleted text begin an entitydeleted text end new text begin a certified CCBHCnew text end is unable to provide one or more of the services listed
in paragraph (a), clauses (6) to (17), the deleted text begin commissioner may certify the entity as adeleted text end CCBHCdeleted text begin ,
if the entity has a currentdeleted text end new text begin maynew text end contract with another entity that has the required authority
to provide that service and that meets deleted text begin federal CCBHCdeleted text end new text begin the followingnew text end criteria as a designated
collaborating organizationdeleted text begin , 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.deleted text end new text begin :
new text end
new text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
new text end
new text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end
new text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end
new text begin
(4) the entity meets any additional requirements issued by the commissioner.
new text end
(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 section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. 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 requirementsnew text begin
for services reimbursed under medical assistancenew text end . 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. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
(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.
(f) 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.
Sec. 23.
Minnesota Statutes 2020, section 245.735, subdivision 5, is amended to read:
Subd. 5.
Information systems support.
The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with new text begin state and new text end federal requirements.
Sec. 24.
Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Demonstration entities. new text end
new text begin
The commissioner may operate the demonstration
program established by section 223 of the Protecting Access to Medicare Act if federal
funding for the demonstration program remains available from the United States Department
of Health and Human Services. To the extent practicable, the commissioner shall align the
requirements of the demonstration program with the requirements under this section for
CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to
participate as a billing provider in both the CCBHC federal demonstration and the benefit
for CCBHCs under the medical assistance program.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245A.043, subdivision 3, is amended to read:
Subd. 3.
Change of ownership process.
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. deleted text begin A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
deleted text end
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
Sec. 26.
Minnesota Statutes 2020, section 245F.04, subdivision 2, is amended to read:
Subd. 2.
Contents of application.
Prior to the issuance of a license, an applicant must
submit, on forms provided by the commissioner, documentation demonstrating the following:
(1) compliance with this section;
(2) compliance with applicable building, fire, and safety codes; health rules; zoning
ordinances; and other applicable rules and regulations or documentation that a waiver has
been granted. The granting of a waiver does not constitute modification of any requirement
of this section;new text begin and
new text end
(3) deleted text begin completion of an assessment of need for a new or expanded program as required by
Minnesota Rules, part 9530.6800; and
deleted text end
deleted text begin (4)deleted text end insurance coverage, including bonding, sufficient to cover all patient funds, property,
and interests.
Sec. 27.
Minnesota Statutes 2020, section 245G.03, subdivision 2, is amended to read:
Subd. 2.
Application.
new text begin (a) new text end Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires.
new text begin
(b) At least 60 days prior to submitting an application for licensure under this chapter,
the applicant must notify the county human services director in writing of the applicant's
intent to open a new treatment program. The written notification must include, at a minimum:
new text end
new text begin
(1) a description of the proposed treatment program;
new text end
new text begin
(2) a description of the target population to be served by the treatment program; and
new text end
new text begin
(3) a copy of the program's abuse prevention plan, as required under section 245A.65,
subdivision 2.
new text end
new text begin
(c) The county human services director may submit a written statement to the
commissioner regarding the county's support of or opposition to the opening of the new
treatment program. The written statement must include documentation of the rationale for
the county's determination. The commissioner shall consider the county's written statement
when determining whether to issue a license for the treatment program. If the county does
not submit a written statement, the commissioner shall confirm with the county that the
county received the notification required by paragraph (b).
new text end
Sec. 28.
Minnesota Statutes 2020, section 254B.01, subdivision 4a, is amended to read:
Subd. 4a.
Culturally specific new text begin or culturally responsive new text end program.
(a) "Culturally specific
new text begin or culturally responsive new text end program" means a substance use disorder treatment service program
or subprogram that is deleted text begin recovery-focused anddeleted text end new text begin culturally responsive or new text end culturally specific when
the programnew text begin attests that itnew text end :
(1) improves service quality to and outcomes of a specific deleted text begin populationdeleted text end new text begin community that
shares a common language, racial, ethnic, or social backgroundnew text end by advancing health equity
to help eliminate health disparities; deleted text begin and
deleted text end
(2) ensures effective, equitable, comprehensive, and respectful quality care services that
are responsive to an individual within a specific deleted text begin population'sdeleted text end new text begin community'snew text end values, beliefs
and practices, health literacy, preferred language, and other communication needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) is compliant with the national standards for culturally and linguistically appropriate
services or other equivalent standards, as determined by the commissioner.
new text end
(b) A tribally licensed substance use disorder program that is designated as serving a
culturally specific population by the applicable tribal government is deemed to satisfy this
subdivision.
new text begin
(c) A program satisfies the requirements of this subdivision if it attests that the program:
new text end
new text begin
(1) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
new text end
new text begin
(2) is governed with significant input from individuals of that specific background; and
new text end
new text begin
(3) employs individuals to provide treatment services, at least 50 percent of whom are
members of the specific community being served.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 29.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 4b. new text end
new text begin Disability responsive program. new text end
new text begin
"Disability responsive program" means a
program that:
new text end
new text begin
(1) is designed to serve individuals with disabilities, including individuals with traumatic
brain injuries, developmental disabilities, cognitive disabilities, and physical disabilities;
and
new text end
new text begin
(2) employs individuals to provide treatment services who have the necessary professional
training, as approved by the commissioner, to serve individuals with the specific disabilities
that the program is designed to serve.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 30.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502deleted text begin ;
deleted text end
(2) culturally specificnew text begin or culturally responsivenew text end programs as defined in section 254B.01,
subdivision 4adeleted text begin ,deleted text end new text begin ;new text end or
new text begin
(3) disability responsive programs as defined in section 254B.01, subdivision 4b.
new text end
deleted text begin
programs or subprograms serving special populations, if the program or subprogram
meets the following requirements:
deleted text end
deleted text begin
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
deleted text end
deleted text begin
(ii) is governed with significant input from individuals of that specific background; and
deleted text end
deleted text begin
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
deleted text end
deleted text begin
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
deleted text end
deleted text begin
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
deleted text end
deleted text begin
(i) the program meets the co-occurring requirements in section 245G.20;
deleted text end
deleted text begin
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
deleted text end
deleted text begin
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
deleted text end
deleted text begin
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
deleted text end
deleted text begin
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
deleted text end
deleted text begin
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
deleted text end
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
deleted text begin
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
deleted text end
deleted text begin (f)deleted text end new text begin (e) new text end Subject to federal approval, deleted text begin chemical dependencydeleted text end new text begin substance use disorder new text end services
that are otherwise covered as direct face-to-face services may be provided via two-way
interactive videonew text begin according to section 256B.0625, subdivision 3bnew text end . deleted text begin The use of two-way
interactive video must be medically appropriate to the condition and needs of the person
being served. Reimbursement shall be at the same rates and under the same conditions that
would otherwise apply to direct face-to-face services. The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end For the purpose of reimbursement under this section, substance use disorder
treatment services provided in a group setting without a group participant maximum or
maximum client to staff ratio under chapter 245G shall not exceed a client to staff ratio of
48 to one. At least one of the attending staff must meet the qualifications as established
under this chapter for the type of treatment service provided. A recovery peer may not be
included as part of the staff ratio.
new text begin
(g) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, except paragraph (e) is effective July 1, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 254B.12, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin
Culturally specific or culturally responsive program and disability
responsive program provider rate increase.
new text end
new text begin
For the chemical dependency services listed
in section 254B.05, subdivision 5, provided by programs that meet the requirements of
section 254B.05, subdivision 5, paragraph (c), clauses (1), (2), and (3), on or after January
1, 2022, payment rates shall increase by five percent over the rates in effect on January 1,
2021. The commissioner shall increase prepaid medical assistance capitation rates as
appropriate to reflect this increase.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later.
new text end
Sec. 32.
new text begin
[254B.151] SUBSTANCE USE DISORDER COMMUNITY OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of human services, in
consultation with substance use disorder subject matter experts, shall establish a substance
use disorder community of practice. The purposes of the community of practice are to
improve treatment outcomes for individuals with substance use disorders and reduce
disparities by using evidence-based and best practices through peer-to-peer and
person-to-provider sharing.
new text end
new text begin Subd. 2. new text end
new text begin Participants; meetings. new text end
new text begin
(a) The community of practice must include the
following participants:
new text end
new text begin
(1) researchers or members of the academic community who are substance use disorder
subject matter experts, who do not have financial relationships with treatment providers;
new text end
new text begin
(2) substance use disorder treatment providers;
new text end
new text begin
(3) representatives from recovery community organizations;
new text end
new text begin
(4) a representative from the Department of Human Services;
new text end
new text begin
(5) a representative from the Department of Health;
new text end
new text begin
(6) a representative from the Department of Corrections;
new text end
new text begin
(7) representatives from county social services agencies;
new text end
new text begin
(8) representatives from tribal nations or tribal social services providers; and
new text end
new text begin
(9) representatives from managed care organizations.
new text end
new text begin
(b) The community of practice must include individuals who have used substance use
disorder treatment services and must highlight the voices and experiences of individuals
who are Black, indigenous, people of color, and people from other communities that are
disproportionately impacted by substance use disorders.
new text end
new text begin
(c) The community of practice must meet regularly and must hold its first meeting before
January 1, 2022.
new text end
new text begin
(d) Compensation and reimbursement for expenses for participants in paragraph (b) are
governed by section 15.059, subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
(a) The community of practice must:
new text end
new text begin
(1) identify gaps in substance use disorder treatment services;
new text end
new text begin
(2) enhance collective knowledge of issues related to substance use disorder;
new text end
new text begin
(3) understand evidence-based practices, best practices, and promising approaches to
address substance use disorder;
new text end
new text begin
(4) use knowledge gathered through the community of practice to develop strategic plans
to improve outcomes for individuals who participate in substance use disorder treatment
and related services in Minnesota;
new text end
new text begin
(5) increase knowledge about the challenges and opportunities learned by implementing
strategies; and
new text end
new text begin
(6) develop capacity for community advocacy.
new text end
new text begin
(b) The commissioner, in collaboration with subject matter experts and other participants,
may issue reports and recommendations to the legislative chairs and ranking minority
members of committees with jurisdiction over health and human services policy and finance
and local and regional governments.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256.042, subdivision 2, is amended to read:
Subd. 2.
Membership.
(a) The council shall consist of the following deleted text begin 19deleted text end new text begin 28new text end voting
members, appointed by the commissioner of human services except as otherwise specified,
and three nonvoting members:
(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;
(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;
(3) one member appointed by the Board of Pharmacy;
(4) one member who is a physician appointed by the Minnesota Medical Association;
(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;
(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;
(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;
(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;
(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;
(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;
(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;
(12) deleted text begin twodeleted text end new text begin 11new text end members representing Indian tribes, one representing deleted text begin the Ojibwe tribes and
one representing the Dakota tribesdeleted text end new text begin each of Minnesota's tribal nationsnew text end ;
(13) one public member who is a Minnesota resident and who is suffering from chronic
pain, intractable pain, or a rare disease or condition;
(14) one mental health advocate representing persons with mental illness;
(15) one member appointed by the Minnesota Hospital Association;
(16) one member representing a local health department; and
(17) the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.
(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half of council members appointed by the commissioner reside outside of the
seven-county metropolitan area. Of the members appointed by the commissioner, to the
extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.
(c) The council is governed by section 15.059, except that members of the council shall
serve three-year terms and shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.
(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.
(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.
(f) The council is subject to chapter 13D.
Sec. 34.
Minnesota Statutes 2020, section 256.042, subdivision 4, is amended to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming deleted text begin fiscaldeleted text end new text begin calendarnew text end
year to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance, by deleted text begin Marchdeleted text end new text begin Decembernew text end 1 of
each year, beginning March 1, 2020.
(b) The commissioner of human services shall award grants from the opiate epidemic
response fund under section 256.043. The grants shall be awarded to proposals selected by
the advisory council that address the priorities in subdivision 1, paragraph (a), clauses (1)
to (4), unless otherwise appropriated by the legislature. No more than deleted text begin threedeleted text end new text begin tennew text end percent of
the grant amount may be used by a grantee for administration.
Sec. 35.
Minnesota Statutes 2020, section 256.043, subdivision 3, is amended to read:
Subd. 3.
Appropriations from fund.
(a) After the appropriations in Laws 2019, chapter
63, article 3, section 1, paragraphs (e), (f), (g), and (h) are made, $249,000 is appropriated
to the commissioner of human services for the provision of administrative services to the
Opiate Epidemic Response Advisory Council and for the administration of the grants awarded
under paragraph (e).
(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.
(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
(d) After the appropriations in paragraphs (a) to (c) are made, 50 percent of the remaining
amount is appropriated to the commissioner of human services for distribution to county
social service and tribal social service agencies to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to counties and tribal social service agencies based on out-of-home
placement episodes where parental drug abuse is the primary reason for the out-of-home
placement using data from the previous calendar year. County and tribal social service
agencies receiving funds from the opiate epidemic response fund must annually report to
the commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and tribal social service agencies must not use funds received under this paragraph to supplant
current state or local funding received for child protection services for children and families
who are affected by addiction.
(e) After making the appropriations in paragraphs (a) to (d), the remaining amount in
the fund is appropriated to the commissioner to award grants as specified by the Opiate
Epidemic Response Advisory Council in accordance with section 256.042, unless otherwise
appropriated by the legislature.
new text begin
(f) Beginning in fiscal year 2022 and each year thereafter, funds for county social service
and tribal social service agencies under paragraph (d) and grant funds specified by the Opiate
Epidemic Response Advisory Council under paragraph (e) shall be distributed on a calendar
year basis.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.0625, subdivision 5m, is amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
(b) The commissioner shall deleted text begin establish standards and methodologies for adeleted text end new text begin reimburse
CCBHCs on a per-visit basis under the new text end prospective payment system for medical assistance
payments deleted text begin for services delivered by a CCBHC, in accordance with guidance issued by the
Centers for Medicare and Medicaid Servicesdeleted text end new text begin as described in paragraph (c)new text end . The commissioner
shall include a quality deleted text begin bonusdeleted text end new text begin incentivenew text end payment in the prospective payment system deleted text begin based
on federal criteriadeleted text end new text begin , as described in paragraph (e)new text end . There is no county share for medical
assistance services when reimbursed through the CCBHC prospective payment system.
(c) deleted text begin Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:deleted text end new text begin The commissioner shall ensure that the prospective
payment system for CCBHC payments under medical assistance meets the following
requirements:
new text end
new text begin
(1) the prospective payment rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
costs for CCBHCs divided by the total annual number of CCBHC visits. For calculating
the payment rate, total annual visits include visits covered by medical assistance and visits
not covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
new text end
new text begin
(2) payment shall be limited to one payment per day per medical assistance enrollee for
each CCBHC visit eligible for reimbursement. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
new text end
new text begin
(3) new payment rates set by the commissioner for newly certified CCBHCs under
section 245.735, subdivision 3, shall be based on rates for established CCBHCs with a
similar scope of services. If no comparable CCBHC exists, the commissioner shall establish
a clinic-specific rate using audited historical cost report data adjusted for the estimated cost
of delivering CCBHC services, including the estimated cost of providing the full scope of
services and the projected change in visits resulting from the change in scope;
new text end
deleted text begin (1)deleted text end new text begin (4)new text end the commissioner shall rebase CCBHC rates deleted text begin at leastdeleted text end new text begin oncenew text end every three years new text begin and
12 months following an initial rate or a rate change due to a change in the scope of services,
whichever is earliernew text end ;
deleted text begin (2)deleted text end new text begin (5)new text end the commissioner shall provide for a 60-day appeals process new text begin after notice of the
results new text end of the rebasing;
deleted text begin
(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
deleted text end
deleted text begin (4)deleted text end new text begin (6)new text end the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
deleted text begin (5)deleted text end new text begin (7)new text end payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap paymentsnew text begin . The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the prospective payment system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafternew text end ;
deleted text begin
(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services;
deleted text end
deleted text begin (7)deleted text end new text begin (8)new text end the prospective payment rate for each CCBHC shall be deleted text begin adjusted annuallydeleted text end new text begin updatednew text end
bynew text begin trending each provider-specific rate bynew text end the Medicare Economic Index deleted text begin as defined for the
federal section 223 CCBHC demonstrationdeleted text end new text begin for primary care services. This update shall
occur each year in between rebasing periods determined by the commissioner in accordance
with clause (4). CCBHCs must provide data on costs and visits to the state annually using
the CCBHC cost report established by the commissionernew text end ; and
new text begin
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Rate adjustments for changes in scope shall occur no more than
once per year in between rebasing periods per CCBHC and are effective on the date of the
annual CCBHC rate update.
new text end
deleted text begin
(8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
for changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner in consultation with CCBHCs.
deleted text end
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
new text begin
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
new text end
new text begin
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the prospective payment system described in
paragraph (c);
new text end
new text begin
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
new text end
new text begin
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
new text end
new text begin
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
new text end
new text begin
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
new text end
new text begin
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
new text end
new text begin
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
new text end
new text begin
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the adult's legal representative or a
contact by interactive video that meets the requirements of subdivision 20b; or
(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by interactive video that meets the requirements
of subdivision 20b with the adult or the adult's legal representative within the preceding
two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county deleted text begin or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribedeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment for
mental health case management provided by vendors who contract with a tribe must be
based on a monthly rate negotiated by the tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the
rate charged by the vendor for the same service to other payers. If the service is provided
by a team of contracted vendors, the deleted text begin county or tribe may negotiate a team rate with a vendor
who is a member of the team. Thedeleted text end team shall determine how to distribute the rate among
its members. No reimbursement received by contracted vendors shall be returned to the
county or tribe, except to reimburse the county or tribe for advance funding provided by
the county or tribe to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
Sec. 38.
Minnesota Statutes 2020, section 256B.0759, subdivision 2, is amended to read:
Subd. 2.
Provider participation.
new text begin (a) Outpatient new text end substance use disorder treatment
providers may elect to participate in the demonstration project and meet the requirements
of subdivision 3. To participate, a provider must notify the commissioner of the provider's
intent to participate in a format required by the commissioner and enroll as a demonstration
project provider.
new text begin
(b) A program licensed by the Department of Human Services as a residential treatment
program according to section 245G.21 and that receives payment under this chapter must
enroll as a demonstration project provider and meet the requirements of subdivision 3 by
January 1, 2022. The commissioner may grant an extension, for a period not to exceed six
months, to a program that is unable to meet the requirements of subdivision 3 due to
demonstrated extraordinary circumstances. A program seeking an extension must apply in
a format approved by the commissioner by November 1, 2021. A program that does not
meet the requirements under this paragraph by July 1, 2023, is ineligible for payment for
services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(c) A program licensed by the Department of Human Services as a withdrawal
management program according to chapter 245F and that receives payment under this
chapter must enroll as a demonstration project provider and meet the requirements of
subdivision 3 by January 1, 2022. The commissioner may grant an extension, for a period
not to exceed six months, to a program that is unable to meet the requirements of subdivision
3 due to demonstrated extraordinary circumstances. A program seeking an extension must
apply in a format approved by the commissioner by November 1, 2021. A program that
does not meet the requirements under this paragraph by July 1, 2023, is ineligible for payment
for services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(d) An out-of-state residential substance use disorder treatment program that receives
payment under this chapter must enroll as a demonstration project provider and meet the
requirements of subdivision 3 by January 1, 2022. The commissioner may grant an extension,
for a period not to exceed six months, to a program that is unable to meet the requirements
of subdivision 3 due to demonstrated extraordinary circumstances. A program seeking an
extension must apply in a format approved by the commissioner by November 1, 2021.
Programs that do not meet the requirements under this paragraph by July 1, 2023, are
ineligible for payment for services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(e) Tribally licensed programs may elect to participate in the demonstration project and
meet the requirements of subdivision 3. The Department of Human Services must consult
with tribal nations to discuss participation in the substance use disorder demonstration
project.
new text end
new text begin
(f) All rate enhancements for services rendered by demonstration project providers that
voluntarily enrolled before July 1, 2021, are applicable only to dates of service on or after
the effective date of the provider's enrollment in the demonstration project, except as
authorized under paragraph (g). The commissioner shall recoup any rate enhancements paid
under paragraph (g) to a provider that does not meet the requirements of subdivision 3 by
July 1, 2021.
new text end
new text begin
(g) The commissioner may allow providers enrolled in the demonstration project before
July 1, 2021, to receive applicable rate enhancements authorized under subdivision 4 for
services provided to fee-for-service enrollees on dates of service no earlier than July 22,
2020, and to managed care enrollees on dates of service no earlier than January 1, 2021, if:
new text end
new text begin
(1) the provider attests that during the time period for which it is seeking the rate
enhancement, it was taking meaningful steps and had a reasonable plan approved by the
commissioner to meet the demonstration project requirements in subdivision 3;
new text end
new text begin
(2) the provider submits the attestation and evidence of meeting the requirements of
subdivision 3, including all information requested by the commissioner, in a format specified
by the commissioner; and
new text end
new text begin
(3) the commissioner received the provider's application for enrollment on or before
June 1, 2021.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later, except paragraphs (f) and (g) are effective the day following final
enactment.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.0759, subdivision 4, is amended to read:
Subd. 4.
Provider payment rates.
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirementsnew text begin , provider standards
under subdivision 3,new text end and provide evidence of formal referral arrangements with providers
delivering step-up or step-down levels of care.
new text begin
(b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the requirements in paragraph (a) are not
met. Payments withheld from the provider must be made once the commissioner determines
that the requirements in paragraph (a) are met.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clause (8), provided on or after July 1, 2020, payment rates must be increased
by deleted text begin 15deleted text end new text begin 30new text end percent over the rates in effect on December 31, 2019.
deleted text begin (c)deleted text end new text begin (d)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clauses (1), (6), and (7), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by deleted text begin tendeleted text end new text begin 25new text end percent over the rates
in effect on December 31, 2020.
deleted text begin (d)deleted text end new text begin (e)new text end Effective January 1, 2021, and contingent on annual federal approval, managed
care plans and county-based purchasing plans must reimburse providers of the substance
use disorder services meeting the criteria described in paragraph (a) who are employed by
or under contract with the plan an amount that is at least equal to the fee-for-service base
rate payment for the substance use disorder services described in paragraphs deleted text begin (b)deleted text end new text begin (c)new text end and deleted text begin (c)deleted text end new text begin
(d)new text end . The commissioner must monitor the effect of this requirement on the rate of access to
substance use disorder services and residential substance use disorder rates. Capitation rates
paid to managed care organizations and county-based purchasing plans must reflect the
impact of this requirement. This paragraph expires if federal approval is not received at any
time as required under this paragraph.
deleted text begin (e)deleted text end new text begin (f)new text end Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph deleted text begin (d)deleted text end new text begin (e)new text end applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph deleted text begin (d)deleted text end new text begin (e)new text end is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except the amendments to
the payment rate percentage increases in paragraphs (c) and (d) are effective January 1,
2022.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Data and outcome measures; public posting. new text end
new text begin
Beginning July 1, 2021, and at
least annually thereafter, all data and outcome measures from the previous year of the
demonstration project shall be posted publicly on the Department of Human Services website
in an accessible and user-friendly format.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Federal approval; demonstration project extension. new text end
new text begin
The commissioner shall
seek a five-year extension of the demonstration project under this section and to receive
enhanced federal financial participation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Demonstration project evaluation work group. new text end
new text begin
Beginning October 1, 2021,
the commissioner shall assemble a work group of relevant stakeholders, including but not
limited to demonstration project participants and the Minnesota Association of Resources
for Recovery and Chemical Health, that shall meet quarterly for the duration of the
demonstration to evaluate the long-term sustainability of any improvements to quality or
access to substance use disorder treatment services caused by participation in the
demonstration project. The work group shall also determine how to implement successful
outcomes of the demonstration project once the project expires.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 43.
new text begin
[256B.076] CASE MANAGEMENT SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) It is the policy of this state to ensure that individuals on
medical assistance receive cost-effective and coordinated care, including efforts to address
the profound effects of housing instability, food insecurity, and other social determinants
of health. Therefore, subject to federal approval, medical assistance covers targeted case
management services as described in this section.
new text end
new text begin
(b) The commissioner, in collaboration with tribes, counties, providers, and individuals
served, must propose further modifications to targeted case management services to ensure
a program that complies with all federal requirements, delivers services in a cost-effective
and efficient manner, creates uniform expectations for targeted case management services,
addresses health disparities, and promotes person- and family-centered services.
new text end
new text begin Subd. 2. new text end
new text begin Rate setting. new text end
new text begin
(a) The commissioner must develop and implement a statewide
rate methodology for any county that subcontracts targeted case management services to a
vendor. On January 1, 2022, or upon federal approval, whichever is later, a county must
use this methodology for any targeted case management services paid by medical assistance
and delivered through a subcontractor.
new text end
new text begin
(b) In setting this rate, the commissioner must include the following:
new text end
new text begin
(1) prevailing wages;
new text end
new text begin
(2) employee-related expense factor;
new text end
new text begin
(3) paid time off and training factors;
new text end
new text begin
(4) supervision and span of control;
new text end
new text begin
(5) distribution of time factor;
new text end
new text begin
(6) administrative factor;
new text end
new text begin
(7) absence factor;
new text end
new text begin
(8) program support factor; and
new text end
new text begin
(9) caseload sizes as described in subdivision 3.
new text end
new text begin
(c) A county may request that the commissioner authorize a rate based on a lower caseload
size when a subcontractor is assigned to serve individuals with needs, such as homelessness
or specific linguistic or cultural needs, that significantly exceed other eligible populations.
A county must include the following in the request:
new text end
new text begin
(1) the number of clients to be served by a full-time equivalent staffer;
new text end
new text begin
(2) the specific factors that require a case manager to provide significantly more hours
of reimbursable services to a client; and
new text end
new text begin
(3) how the county intends to monitor case size and outcomes.
new text end
new text begin
(d) The commissioner must adjust only the factor for caseload in paragraph (b), clause
(9), in response to a request under paragraph (c).
new text end
new text begin Subd. 3. new text end
new text begin Caseload sizes. new text end
new text begin
A county-subcontracted provider of targeted case management
services to the following populations must not exceed the following limits:
new text end
new text begin
(1) for children with severe emotional disturbance, 15 clients to one full-time equivalent
case manager;
new text end
new text begin
(2) for adults with severe and persistent mental illness, 30 clients to one full-time
equivalent case manager;
new text end
new text begin
(3) for child welfare targeted case management, 25 clients to one full-time equivalent
case manager; and
new text end
new text begin
(4) for vulnerable adults and adults who have developmental disabilities, 45 clients to
one full-time equivalent case manager.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:
Subd. 6.
Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
with the adult or the adult's legal representative, family, primary caregiver, or other relevant
persons identified as necessary to the development or implementation of the goals of the
personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate deleted text begin negotiated by the host countydeleted text end new text begin calculated in accordance with
section 256B.076, subdivision 2new text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged by
the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county may negotiate a team rate with a vendor who is a member
of the team. Thedeleted text end team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county, except to
reimburse the county for advance funding provided by the county to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.
(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.
(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
Sec. 45.
Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:
Subd. 6.
Medical assistance reimbursement of case management services.
(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the minimum standards in clauses (1) and (2):
(1) there must be a face-to-face contact at least once a month except as provided in clause
(2); and
(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face contact.
(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).
(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.
(d) Payment for case management provided by county deleted text begin or tribal social servicesdeleted text end contracted
vendors deleted text begin shall be based on a monthly rate negotiated by the host county or tribal social
servicesdeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment
for case management provided by vendors who contract with a tribe must be based on a
monthly rate negotiated by the tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged
by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county or tribal social services may negotiate a team rate with a
vendor who is a member of the team. Thedeleted text end team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county or tribal social services, except to reimburse the county or tribal social services
for advance funding provided by the county or tribal social services to the vendor.
(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.
Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.
Sec. 46. new text begin DIRECTION TO THE COMMISSIONER; ADULT MENTAL HEALTH
INITIATIVES REFORM.
new text end
new text begin
In establishing a legislative proposal for reforming the funding formula to distribute
adult mental health initiative funds, the commissioner of human services shall ensure that
funding currently received as a result of the closure of the Moose Lake Regional Treatment
Center is not reallocated from any region that does not have a community behavioral health
hospital. Upon finalization of the adult mental health initiatives reform, the commissioner
shall notify the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services finance and policy.
new text end
Sec. 47. new text begin DIRECTION TO THE COMMISSIONER; ALTERNATIVE MENTAL
HEALTH PROFESSIONAL LICENSING PATHWAYS WORK GROUP.
new text end
new text begin
(a) The commissioners of human services and health must convene a work group
consisting of representatives from the Board of Psychology; the Board of Marriage and
Family Therapy; the Board of Social Work; the Board of Behavioral Health and Therapy;
five mental health providers from diverse cultural communities; a representative from the
Minnesota Council of Health Plans; a representative from a state health care program; two
representatives from mental health associations or community mental health clinics led by
individuals who are Black, indigenous, or people of color; and representatives from mental
health professional graduate programs to evaluate and make recommendations on possible
alternative pathways to mental health professional licensure in Minnesota. The work group
must:
new text end
new text begin
(1) identify barriers to licensure in mental health professions;
new text end
new text begin
(2) collect data on the number of individuals graduating from educational programs but
not passing licensing exams;
new text end
new text begin
(3) evaluate the feasibility of alternative pathways for licensure in mental health
professions, ensuring provider competency and professionalism; and
new text end
new text begin
(4) consult with national behavioral health testing entities.
new text end
new text begin
(b) Mental health providers participating in the work group may be reimbursed for
expenses in the same manner as authorized by the commissioner's plan adopted under
Minnesota Statutes, section 43A.18, subdivision 2, upon approval by the commissioner.
Members who, as a result of time spent attending work group meetings, incur child care
expenses that would not otherwise have been incurred, may be reimbursed for those expenses
upon approval by the commissioner. Reimbursements may be approved for no more than
five individual providers.
new text end
new text begin
(c) No later than February 1, 2023, the commissioners must submit a written report to
the members of the legislative committees with jurisdiction over health and human services
on the work group's findings and recommendations developed on alternative licensing
pathways.
new text end
Sec. 48. new text begin DIRECTION TO THE COMMISSIONER; CHILDREN'S MENTAL
HEALTH RESIDENTIAL TREATMENT WORK GROUP.
new text end
new text begin
The commissioner of human services, in consultation with counties, children's mental
health residential providers, and children's mental health advocates, must organize a work
group and develop recommendations on how to efficiently and effectively fund room and
board costs for children's mental health residential treatment under the children's mental
health act. The work group may also provide recommendations on how to address systemic
barriers in transitioning children into the community and community-based treatment options.
The commissioner shall submit the recommendations to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by February 15, 2022.
new text end
Sec. 49. new text begin DIRECTION TO THE COMMISSIONER; CULTURALLY AND
LINGUISTICALLY APPROPRIATE SERVICES.
new text end
new text begin
The commissioner of human services, in consultation with substance use disorder
treatment providers, lead agencies, and individuals who receive substance use disorder
treatment services, shall develop a statewide implementation and transition plan for culturally
and linguistically appropriate services (CLAS) national standards, including technical
assistance for providers to transition to the CLAS standards and to improve disparate
treatment outcomes. The commissioner must consult with individuals who are Black,
indigenous, people of color, and linguistically diverse in the development of the
implementation and transition plans under this section.
new text end
Sec. 50. new text begin DIRECTION TO THE COMMISSIONER; RATE RECOMMENDATIONS
FOR OPIOID TREATMENT PROGRAMS.
new text end
new text begin
The commissioner of human services shall evaluate the rate structure for opioid treatment
programs licensed under Minnesota Statutes, section 245G.22, and report recommendations,
including a revised rate structure and proposed draft legislation, to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance by October 1, 2021.
new text end
Sec. 51. new text begin DIRECTION TO THE COMMISSIONER; SOBER HOUSING PROGRAM
RECOMMENDATIONS.
new text end
new text begin
(a) The commissioner of human services, in consultation with stakeholders, must develop
recommendations on:
new text end
new text begin
(1) increasing access to sober housing programs;
new text end
new text begin
(2) promoting person-centered practices and cultural responsiveness in sober housing
programs;
new text end
new text begin
(3) potential oversight of sober housing programs; and
new text end
new text begin
(4) providing consumer protections for individuals in sober housing programs with
substance use disorders and individuals with co-occurring mental illnesses.
new text end
new text begin
(b) Stakeholders include but are not limited to the Minnesota Association of Sober
Homes, the Minnesota Association of Resources for Recovery and Chemical Health,
Minnesota Recovery Connection, NAMI Minnesota, the National Alliance of Recovery
Residencies (NARR), Oxford Houses, Inc., sober housing programs based in Minnesota
that are not members of the Minnesota Association of Sober Homes, a member of Alcoholics
Anonymous, and residents and former residents of sober housing programs based in
Minnesota. Stakeholders must equitably represent various geographic areas of the state and
must include individuals in recovery and providers representing Black, indigenous, people
of color, or immigrant communities.
new text end
new text begin
(c) The commissioner must complete and submit a report on these recommendations to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services policy and finance on or before March 1, 2022.
new text end
Sec. 52. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PAPERWORK REDUCTION.
new text end
new text begin
(a) The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment professional associations, and other
relevant stakeholders, shall develop, assess, and recommend systems improvements to
minimize regulatory paperwork and improve systems for substance use disorder programs
licensed under Minnesota Statutes, chapter 245A, and regulated under Minnesota Statutes,
chapters 245F and 245G, and Minnesota Rules, chapters 2960 and 9530. The commissioner
of human services shall make available any resources needed from other divisions within
the department to implement systems improvements.
new text end
new text begin
(b) The commissioner of health shall make available needed information and resources
from the Division of Health Policy.
new text end
new text begin
(c) The Office of MN.IT Services shall provide advance consultation and implementation
of the changes needed in data systems.
new text end
new text begin
(d) The commissioner of human services shall contract with a vendor that has experience
with developing statewide system changes for multiple states at the payer and provider
levels. If the commissioner, after exercising reasonable diligence, is unable to secure a
vendor with the requisite qualifications, then the commissioner may select the best qualified
vendor available. When developing recommendations, the commissioner shall consider
input from all stakeholders. The commissioner's recommendations shall maximize benefits
for clients and utility for providers, regulatory agencies, and payers.
new text end
new text begin
(e) The commissioner of human services and contracted vendor shall follow the
recommendations from the report issued in response to Laws 2019, First Special Session
chapter 9, article 6, section 76.
new text end
new text begin
(f) By December 15, 2022, the commissioner of human services shall take steps to
implement paperwork reductions and systems improvements within the commissioner's
authority and submit to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services a report that includes recommendations
for changes in statutes that would further enhance systems improvements to reduce
paperwork. The report shall include a summary of the approaches developed and assessed
by the commissioner of human services and stakeholders and the results of any assessments
conducted.
new text end
Sec. 53. new text begin MENTAL HEALTH CULTURAL COMMUNITY CONTINUING
EDUCATION GRANT PROGRAM.
new text end
new text begin
The commissioner of health shall develop a grant program, in consultation with the
relevant mental health licensing boards, to provide for the continuing education necessary
for social workers, marriage and family therapists, psychologists, and professional clinical
counselors who are members of communities of color or underrepresented communities,
as defined in Minnesota Statutes, section 148E.010, subdivision 20, and who work for
community mental health providers, to become supervisors for individuals pursuing licensure
in mental health professions.
new text end
Sec. 54. new text begin MENTAL HEALTH PROFESSIONAL LICENSING SUPERVISION.
new text end
new text begin
(a) The Board of Psychology, the Board of Marriage and Family Therapy, the Board of
Social Work, and the Board of Behavioral Health and Therapy must convene to develop
recommendations for:
new text end
new text begin
(1) providing certification of individuals across multiple mental health professions who
may serve as supervisors;
new text end
new text begin
(2) adopting a single, common supervision certificate for all mental health professional
education programs;
new text end
new text begin
(3) determining ways for internship hours to be counted toward licensure in mental
health professions; and
new text end
new text begin
(4) determining ways for practicum hours to count toward supervisory experience.
new text end
new text begin
(b) No later than February 1, 2023, the commissioners must submit a written report to
the members of the legislative committees with jurisdiction over health and human services
on the recommendations developed under paragraph (a).
new text end
Sec. 55. new text begin SUBSTANCE USE DISORDER TREATMENT RATE RESTRUCTURE
ANALYSIS.
new text end
new text begin
(a) By January 1, 2022, the commissioner shall issue a request for proposals for
frameworks and modeling of substance use disorder rates. Rates must be predicated on a
uniform methodology that is transparent, culturally responsive, supports staffing needed to
treat a patient's assessed need, and promotes quality service delivery and patient choice.
The commissioner must consult with substance use disorder treatment programs across the
spectrum of services, substance use disorder treatment programs from across each region
of the state, and culturally responsive providers in the development of the request for proposal
process and for the duration of the contract.
new text end
new text begin
(b) By January 15, 2023, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance on the results of the vendor's work. The report must
include legislative language necessary to implement a new substance use disorder treatment
rate methodology and a detailed fiscal analysis.
new text end
Sec. 56. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall replace "EXCELLENCE IN MENTAL HEALTH
DEMONSTRATION PROJECT" with "CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINIC SERVICES" in the section headnote for Minnesota Statutes, section
245.735.
new text end
Sec. 57. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.0596,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, and 4,
new text end
new text begin
are repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2020, section 245.4871, subdivision 32a,
new text end
new text begin
is repealed.
new text end
new text begin
(d)
new text end
new text begin
Minnesota Rules, parts 9530.6800; and 9530.6810,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (c) is effective September 30, 2021. Paragraph (d) is
effective the day following final enactment.
new text end
ARTICLE 5
DIRECT CARE AND TREATMENT
Section 1.
Minnesota Statutes 2020, section 246.54, subdivision 1b, is amended to read:
Subd. 1b.
Community behavioral health hospitals.
A county's payment of the cost of
care provided at state-operated community-based behavioral health hospitalsnew text begin for adults and
childrennew text end shall be according to the following schedule:
(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and
(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.
ARTICLE 6
DISABILITY SERVICES AND CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the deleted text begin commissioner of healthdeleted text end new text begin federal databasenew text end MDS assessments that conform with
the assessment schedule defined by deleted text begin Code of Federal Regulations, title 42, section 483.20,
and published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, indeleted text end the Long Term Carenew text begin Facility Residentnew text end Assessment
Instrument User's Manual, version 3.0,deleted text begin and subsequent updates whendeleted text end new text begin or its successornew text end issued
by the Centers for Medicare and Medicaid Services. The commissioner of health may
substitute successor manuals or question and answer documents published by the United
States Department of Health and Human Services, Centers for Medicare and Medicaid
Services, to replace or supplement the current version of the manual or document.
(b) The assessments new text begin required under the Omnibus Budget Reconciliation Act of 1987
(OBRA) new text end used to determine a case mix classification for reimbursement include the following:
(1) a new admissionnew text begin comprehensivenew text end assessmentnew text begin , which must have an assessment reference
date (ARD) within 14 calendar days after admission, excluding readmissionsnew text end ;
(2) an annual new text begin comprehensive new text end assessmentnew text begin ,new text end which must have an deleted text begin assessment reference date
(ARD)deleted text end new text begin ARDnew text end within 92 days of deleted text begin thedeleted text end new text begin anew text end previousnew text begin quarterly reviewnew text end assessment deleted text begin and thedeleted text end new text begin or a new text end
previous comprehensive assessmentnew text begin , which must occur at least once every 366 daysnew text end ;
(3) a significant change in statusnew text begin comprehensivenew text end assessmentnew text begin , whichnew text end must deleted text begin be completeddeleted text end new text begin
have an ARDnew text end within 14 days deleted text begin of the identification ofdeleted text end new text begin after the facility determines, or should
have determined, that there has beennew text end a significant changenew text begin in the resident's physical or mental
conditionnew text end , whethernew text begin annew text end improvement or new text begin a new text end decline, and regardless of the amount of time since
the last deleted text begin significant change in statusdeleted text end new text begin comprehensivenew text end assessmentnew text begin or quarterly review
assessmentnew text end ;
(4) deleted text begin alldeleted text end new text begin anew text end quarterly deleted text begin assessmentsdeleted text end new text begin review assessmentnew text end must have an deleted text begin assessment reference
date (ARD)deleted text end new text begin ARDnew text end within 92 days of the ARD of the previousnew text begin quarterly review assessment
or a previous comprehensivenew text end assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; deleted text begin and
deleted text end
(6) any significant correction to a prior quarterlynew text begin reviewnew text end assessment, if the assessment
being corrected is the current one being used for RUG classificationdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) a required significant change in status assessment when:
new text end
new text begin
(i) all speech, occupational, and physical therapies have ended. The ARD of this
assessment must be set on day eight after all therapy services have ended; and
new text end
new text begin
(ii) isolation for an infectious disease has ended. The ARD of this assessment must be
set on day 15 after isolation has ended; and
new text end
new text begin
(8) any modifications to the most recent assessments under clauses (1) to (7).
new text end
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
Sec. 2.
Minnesota Statutes 2020, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end
(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agencydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 and residing in the
customized living setting before July 1, 2022, for which a license is required. A customized
living service provider subject to this exception may rebut the presumption that a license
is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
new text end
new text begin
(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
new text end
new text begin
(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
new text end
new text begin
(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
new text end
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.
(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.
(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. Face-to-face
assessments must be conducted according to paragraphs (b) to (i).
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) The assessment must be conducted by a certified assessor in a face-to-face
conversational interview with the person being assessed. The person's legal representative
must provide input during the assessment process and may do so remotely if requested. At
the request of the person, other individuals may participate in the assessment to provide
information on the needs, strengths, and preferences of the person necessary to develop a
community support plan that ensures the person's health and safety. Except for legal
representatives or family members invited by the person, persons participating in the
assessment may not be a provider of service or have any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living or adult
day services under chapter 256S, with the permission of the person being assessed or the
person's designated or legal representative, the client's current or proposed provider of
services may submit a copy of the provider's nursing assessment or written report outlining
its recommendations regarding the client's care needs. The person conducting the assessment
must notify the provider of the date by which this information is to be submitted. This
information shall be provided to the person conducting the assessment prior to the assessment.
For a person who is to be assessed for waiver services under section 256B.092 or 256B.49,
with the permission of the person being assessed or the person's designated legal
representative, the person's current provider of services may submit a written report outlining
recommendations regarding the person's care needs the person completed in consultation
with someone who is known to the person and has interaction with the person on a regular
basis. The provider must submit the report at least 60 days before the end of the person's
current service agreement. The certified assessor must consider the content of the submitted
report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) Face-to-face assessment completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.
new text begin
(n) If a person who receives home and community-based waiver services under section
256B.0913, 256B.092, or 256B.49 or chapter 256S temporarily enters for 121 days or less
a hospital, institution of mental disease, nursing facility, intensive residential treatment
services program, transitional care unit, or inpatient substance use disorder treatment setting,
the person may return to the community with home and community-based waiver services
under the same waiver, without requiring an assessment or reassessment under this section,
unless the person's annual reassessment is otherwise due. Nothing in this section shall change
annual long-term care consultation reassessment requirements, payment for institutional or
treatment services, medical assistance financial eligibility, or any other law.
new text end
deleted text begin (n)deleted text end new text begin (o)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver residential supports and services currently residing in a community
residential setting, licensed adult foster care home that is either not the primary residence
of the license holder or in which the license holder is not the primary caregiver, family adult
foster care residence, customized living setting, or supervised living facility to determine
if that person would prefer to be served in a community-living setting as defined in section
256B.49, subdivision 23, in a setting not controlled by a provider, or to receive integrated
community supports as described in section 245D.03, subdivision 1, paragraph (c), clause
(8). The certified assessor shall offer the person, through a person-centered planning process,
the option to receive alternative housing and service options.
deleted text begin (o)deleted text end new text begin (p)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver day services to determine if that person would prefer to receive employment
services as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7).
The certified assessor shall describe to the person through a person-centered planning process
the option to receive employment services.
deleted text begin (p)deleted text end new text begin (q)new text end At the time of reassessment, the certified assessor shall assess each person
receiving non-self-directed waiver services to determine if that person would prefer an
available service and setting option that would permit self-directed services and supports.
The certified assessor shall describe to the person through a person-centered planning process
the option to receive self-directed services and supports.
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 is obtained.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.092, subdivision 4, is amended to read:
Subd. 4.
Home and community-based services for developmental disabilities.
(a)
The commissioner shall make payments to approved vendors participating in the medical
assistance program to pay costs of providing home and community-based services, including
case management service activities provided as an approved home and community-based
service, to medical assistance eligible persons with developmental disabilities who have
been screened under subdivision 7 and according to federal requirements. Federal
requirements include those services and limitations included in the federally approved
application for home and community-based services for persons with developmental
disabilities and subsequent amendments.
deleted text begin
(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental disabilities
authorized but not receiving those services as of June 30, 1995, based upon the average
resource need of persons with similar functional characteristics. To ensure service continuity
for service recipients receiving home and community-based waivered services for persons
with developmental disabilities prior to July 1, 1995, the commissioner shall make available
to the county of financial responsibility home and community-based waivered services
resources based upon fiscal year 1995 authorized levels.
deleted text end
deleted text begin
(c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers for the elderly authorized
under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, 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. 5.
Minnesota Statutes 2020, section 256B.092, subdivision 5, is amended to read:
Subd. 5.
Federal waivers.
(a) The commissioner shall apply for any federal waivers
necessary to secure, to the extent allowed by law, federal financial participation under United
States Code, title 42, sections 1396 et seq., as amended, for the provision of services to
persons who, in the absence of the services, would need the level of care provided in a
regional treatment center or a community intermediate care facility for persons with
developmental disabilities. The commissioner may seek amendments to the waivers or apply
for additional waivers under United States Code, title 42, sections 1396 et seq., as amended,
to contain costs. The commissioner shall ensure that payment for the cost of providing home
and community-based alternative services under the federal waiver plan shall not exceed
the cost of intermediate care services including day training and habilitation services that
would have been provided without the waivered services.
The commissioner shall seek an amendment to the 1915c home and community-based
waiver to allow properly licensed adult foster care homes to provide residential services to
up to five individuals with developmental disabilities. If the amendment to the waiver is
approved, adult foster care providers that can accommodate five individuals shall increase
their capacity to five beds, provided the providers continue to meet all applicable licensing
requirements.
(b) The commissioner, in administering home and community-based waivers for persons
with developmental disabilities, shall ensure that day services for eligible persons are not
provided by the person's residential service provider, unless the person or the person's legal
representative is offered a choice of providers and agrees in writing to provision of day
services by the residential service provider. The coordinated service and support plan for
individuals who choose to have their residential service provider provide their day services
must describe how health, safety, protection, and habilitation needs will be met, including
how frequent and regular contact with persons other than the residential service provider
will occur. The coordinated service and support plan must address the provision of services
during the day outside the residence on weekdays.
(c) When a lead agency is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.0916 for an individual, the lead agency shall
offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the coordinated service and support plan. The reduction
in the authorized services for an individual due to changes in funding for waivered services
may not exceed the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.
new text begin
(d) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
new text end
new text begin
(e) The transition to two disability home and community-based services waiver programs
must align with the independent living first policy under section 256B.4905. Unless
superseded by any other state or federal law, waiver eligibility criteria shall be the same for
each waiver. The waiver program that a person uses shall be determined by the support
planning process and whether the person chooses to live in a provider-controlled setting or
in the person's own home.
new text end
new text begin
(f) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 90 days after 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. 6.
Minnesota Statutes 2020, section 256B.092, subdivision 12, is amended to read:
Subd. 12.
deleted text begin Waivereddeleted text end new text begin Waivernew text end services statewide priorities.
(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for developmental disabilities
(DD) waiver services, as of January 1, 2010. The statewide priorities must include, but are
not limited to, individuals who continue to have a need for waiver services after they have
maximized the use of state plan services and other funding resources, including natural
supports, prior to accessing waiver services, and who meet at least one of the following
criteria:
(1) no longer require the intensity of services provided where they are currently living;
or
(2) make a request to move from an institutional setting.
(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:
(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;
(2) are moving from an institution due to bed closures;
(3) experience a sudden closure of their current living arrangement;
(4) require protection from confirmed abuse, neglect, or exploitation;
(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or
(6) meet other priorities established by the department.
(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end
Sec. 7.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Regional quality councils and systems improvement. new text end
new text begin
The commissioner of
human services shall maintain the regional quality councils initially established under
Minnesota Statutes 2020, section 256B.097, subdivision 4. The regional quality councils
shall:
new text end
new text begin
(1) support efforts and initiatives that drive overall systems and social change to promote
inclusion of people who have disabilities in the state of Minnesota;
new text end
new text begin
(2) improve person-centered outcomes in disability services; and
new text end
new text begin
(3) identify or enhance quality of life indicators for people who have disabilities.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Membership and staff. new text end
new text begin
(a) Regional quality councils shall be comprised of
key stakeholders including, but not limited to:
new text end
new text begin
(1) individuals who have disabilities;
new text end
new text begin
(2) family members of people who have disabilities;
new text end
new text begin
(3) disability service providers;
new text end
new text begin
(4) disability advocacy groups;
new text end
new text begin
(5) lead agency staff; and
new text end
new text begin
(6) staff of state agencies with jurisdiction over special education and disability services.
new text end
new text begin
(b) Membership in a regional quality council must be representative of the communities
in which the council operates, with an emphasis on individuals with lived experience from
diverse racial and cultural backgrounds.
new text end
new text begin
(c) Each regional quality council may hire staff to perform the duties assigned in
subdivision 9.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Duties. new text end
new text begin
(a) Each regional quality council shall:
new text end
new text begin
(1) identify issues and barriers that impede Minnesotans who have disabilities from
optimizing choice of home and community-based services;
new text end
new text begin
(2) promote informed decision making, autonomy, and self-direction;
new text end
new text begin
(3) analyze and review quality outcomes and critical incident data, and immediately
report incidents of life safety concerns to the Department of Human Services Licensing
Division;
new text end
new text begin
(4) inform a comprehensive system for effective incident reporting, investigation, analysis,
and follow-up;
new text end
new text begin
(5) collaborate on projects and initiatives to advance priorities shared with state agencies,
lead agencies, educational institutions, advocacy organizations, community partners, and
other entities engaged in disability service improvements;
new text end
new text begin
(6) establish partnerships and working relationships with individuals and groups in the
regions;
new text end
new text begin
(7) identify and implement regional and statewide quality improvement projects;
new text end
new text begin
(8) transform systems and drive social change in alignment with the disability rights and
disability justice movements identified by leaders who have disabilities;
new text end
new text begin
(9) provide information and training programs for persons who have disabilities and
their families and legal representatives on formal and informal support options and quality
expectations;
new text end
new text begin
(10) make recommendations to state agencies and other key decision-makers regarding
disability services and supports;
new text end
new text begin
(11) submit every two years a report to committees with jurisdiction over disability
services on the status, outcomes, improvement priorities, and activities in the region;
new text end
new text begin
(12) support people by advocating to resolve complaints between the counties, providers,
persons receiving services, and their families and legal representatives; and
new text end
new text begin
(13) recruit, train, and assign duties to regional quality council teams, including council
members, interns, and volunteers, taking into account the skills necessary for the team
members to be successful in this work.
new text end
new text begin
(b) Each regional quality council may engage in quality improvement initiatives related
to but not limited to:
new text end
new text begin
(1) the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
including brain injuries and services for those persons who qualify for nursing facility level
of care or hospital facility level of care and any other services licensed under chapter 245D;
new text end
new text begin
(2) home care services under section 256B.0651;
new text end
new text begin
(3) family support grants under section 252.32;
new text end
new text begin
(4) consumer support grants under section 256.476;
new text end
new text begin
(5) semi-independent living services under section 252.275; and
new text end
new text begin
(6) services provided through an intermediate care facility for persons with developmental
disabilities.
new text end
new text begin
(c) Each regional quality council's work must be informed and directed by the needs
and desires of persons who have disabilities in the region in which the council operates.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Compensation. new text end
new text begin
(a) A member of a regional quality council who does not
receive a salary or wages from an employer may be paid a per diem and reimbursed for
expenses related to the member's participation in efforts and initiatives described in
subdivision 9 in the same manner and in an amount not to exceed the amount authorized
by the commissioner's plan adopted under section 43A.18, subdivision 2.
new text end
new text begin
(b) Regional quality councils may charge fees for their services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision
to read:
new text begin Subd. 3c. new text end
new text begin
Contact information for consumer surveys for nursing facilities and home
and community-based services.
new text end
new text begin
For purposes of conducting the consumer surveys under
subdivisions 3 and 3a, the commissioner may request contact information of clients and
associated key representatives. Providers must furnish the contact information available to
the provider.
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. 12.
Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision
to read:
new text begin Subd. 3d. new text end
new text begin
Resident experience survey and family survey for assisted living
facilities.
new text end
new text begin
The commissioner shall develop and administer a resident experience survey for
assisted living facility residents and a family survey for families of assisted living facility
residents. Money appropriated to the commissioner to administer the resident experience
survey and family survey is available in either fiscal year of the biennium in which it is
appropriated.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.49, subdivision 11, is amended to read:
Subd. 11.
Authority.
(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the new text begin federal new text end Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:
(1) promote the support of persons with disabilities in the most integrated settings;
(2) expand the availability of services for persons who are eligible for medical assistance;
(3) promote cost-effective options to institutional care; and
(4) obtain federal financial participation.
(b) The provision of deleted text begin waivereddeleted text end new text begin waivernew text end services to medical assistance recipients with
disabilities shall comply with the requirements outlined in the federally approved applications
for home and community-based services and subsequent amendments, including provision
of services according to a service plan designed to meet the needs of the individual. For
purposes of this section, the approved home and community-based application is considered
the necessary federal requirement.
(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.
(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
new text begin federal new text end Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.
(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.
(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.
new text begin
(g) The commissioner shall seek approval to allow for the reconfiguration of the 1915(c)
home and community-based waivers in this section, as authorized under section 1915(c) of
the federal Social Security Act, to implement a two-waiver program structure.
new text end
new text begin
(h) The commissioner shall seek approval for the 1915(c) home and community-based
waivers in this section, as authorized under section 1915(c) of the federal Social Security
Act, to implement an individual resource allocation methodology.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 90 days after 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. 14.
Minnesota Statutes 2020, section 256B.49, subdivision 11a, is amended to read:
Subd. 11a.
deleted text begin Waivereddeleted text end new text begin Waivernew text end services statewide priorities.
(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for community alternative
care, community access for disability inclusion, and brain injury waiver services, as of
January 1, 2010. The statewide priorities must include, but are not limited to, individuals
who continue to have a need for waiver services after they have maximized the use of state
plan services and other funding resources, including natural supports, prior to accessing
waiver services, and who meet at least one of the following criteria:
(1) no longer require the intensity of services provided where they are currently living;
or
(2) make a request to move from an institutional setting.
(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:
(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;
(2) are moving from an institution due to bed closures;
(3) experience a sudden closure of their current living arrangement;
(4) require protection from confirmed abuse, neglect, or exploitation;
(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or
(6) meet other priorities established by the department.
(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, 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. 15.
Minnesota Statutes 2020, section 256B.49, subdivision 17, is amended to read:
Subd. 17.
Cost of services and supports.
(a) The commissioner shall ensure that the
average per capita expenditures estimated in any fiscal year for home and community-based
waiver recipients does not exceed the average per capita expenditures that would have been
made to provide institutional services for recipients in the absence of the waiver.
deleted text begin
(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based waivered
service resources available to support recipients with disabilities in need of the level of care
provided in a nursing facility or a hospital. The commissioner shall allocate resources to
single counties and county partnerships in a manner that reflects consideration of:
deleted text end
deleted text begin
(1) an incentive-based payment process for achieving outcomes;
deleted text end
deleted text begin
(2) the need for a state-level risk pool;
deleted text end
deleted text begin
(3) the need for retention of management responsibility at the state agency level; and
deleted text end
deleted text begin
(4) a phase-in strategy as appropriate.
deleted text end
deleted text begin
(c) Until the allocation methods described in paragraph (b) are implemented, the annual
allowable reimbursement level of home and community-based waiver services shall be the
greater of:
deleted text end
deleted text begin
(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of any
provider rate increase appropriated for home and community-based services; or
deleted text end
deleted text begin
(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The increased
reimbursement level must be necessary to allow the recipient to be discharged from an
institution or to prevent imminent placement in an institution. The additional reimbursement
may be used to secure environmental modifications; assistive technology and equipment;
and increased costs for supervision, training, and support services necessary to address the
recipient's extraordinary needs. The commissioner may approve an increased reimbursement
level for up to one year of the recipient's relocation from an institution or up to six months
of a determination that a current waiver recipient is at imminent risk of being placed in an
institution.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end Beginning July 1, 2001, medically necessary home care nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
to 256B.0654 and 256B.0659. The rate established by the commissioner for registered nurse
or licensed practical nurse services under any home and community-based waiver as of
January 1, 2001, shall not be reduced.
deleted text begin (e)deleted text end new text begin (c)new text end Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care services,
the county must negotiate a revised per diem rate for room and board and waiver services
that reflects the legislated rate reduction and results in an overall average per diem reduction
for all foster care recipients in that home. The revised per diem must allow the provider to
maintain, as much as possible, the level of services or enhanced services provided in the
residence, while mitigating the losses of the legislated rate reduction.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, 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. 16.
Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin
Customized living moratorium for brain injury and community access
for disability inclusion waivers.
new text end
new text begin
(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), the commissioner shall not enroll new customized living settings
serving four or fewer people in a single-family home to deliver customized living services
as defined under the brain injury or community access for disability inclusion waiver plans
under section 256B.49 to prevent new developments of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14.
new text end
new text begin
(b) The commissioner may approve an exception to paragraph (a) when:
new text end
new text begin
(1) a customized living setting with a change in ownership at the same address is in
existence and operational on or before June 30, 2021; and
new text end
new text begin
(2) a customized living setting is serving four or fewer people in a multiple-family
dwelling if each person has a personal self-contained living unit that contains living, sleeping,
eating, cooking, and bathroom areas.
new text end
new text begin
(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.
new text end
new text begin
(d) For any new customized living settings operational on or after July 1, 2021, serving
four or fewer people in a single-family home to deliver customized living services as defined
in paragraph (a), the authorizing lead agency is financially responsible for all home and
community-based service payments in the setting.
new text end
new text begin
(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person on or before June 30, 2021, in the customized living
setting.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021. This section applies only
to customized living services as defined under the brain injury or community access for
disability inclusion waiver plans under Minnesota Statutes, section 256B.49.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);
(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);
(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employersdeleted text begin , except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employersdeleted text end ;
(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);
(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).
(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin
(c) Component values for family foster care are:
deleted text end
deleted text begin
(1) competitive workforce factor: 4.7 percent;
deleted text end
deleted text begin
(2) supervisory span of control ratio: 11 percent;
deleted text end
deleted text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end
deleted text begin
(4) employee-related cost ratio: 23.6 percent;
deleted text end
deleted text begin
(5) general administrative support ratio: 3.3 percent;
deleted text end
deleted text begin
(6) program-related expense ratio: 1.3 percent; and
deleted text end
deleted text begin
(7) absence factor: 1.7 percent.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end Component values for day training and habilitation, day support services, and
prevocational services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: ten percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
new text begin
(d) Component values for day support services and prevocational services delivered
remotely are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 5.6 percent;
new text end
new text begin
(6) client programming and support ratio: 7.67 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 1.8 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 9.4 percent.
new text end
(e) Component values for adult day services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: 7.4 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
(f) Component values for unit-based services with programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan supports ratio: 15.5 percent;
(6) client programming and supports ratio: 4.7 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 6.1 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(g) Component values for unit-based services with programming delivered remotely
are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan supports ratio: 5.6 percent;
new text end
new text begin
(6) client programming and supports ratio: 1.53 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 6.1 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (g)deleted text end new text begin (h)new text end Component values for unit-based services without programming except respite
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 7.0 percent;
(6) client programming and support ratio: 2.3 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 2.9 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(i) Component values for unit-based services without programming delivered remotely,
except respite, are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 1.3 percent;
new text end
new text begin
(6) client programming and support ratio: 1.14 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 2.9 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (h)deleted text end new text begin (j)new text end Component values for unit-based services without programming for respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 2.9 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin (i)deleted text end new text begin (k)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.
deleted text begin (j)deleted text end new text begin (l)new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:
(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
(3) workforce data as required under subdivision 10a, paragraph (g).
The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
deleted text begin (k)deleted text end new text begin (m)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (6); paragraph deleted text begin (e)deleted text end new text begin (d)new text end , clause (6);
paragraph deleted text begin (f)deleted text end new text begin (e)new text end , clause (6); deleted text begin anddeleted text end paragraph deleted text begin (g)deleted text end new text begin (f)new text end , clause (6); new text begin paragraph (g), clause (6);
paragraph (h), clause 6; and paragraph (i), clause (6); new text end subdivision 6, paragraphs (b), clauses
(9) and (10), and (e), clause (10); and subdivision 7, clauses (11), (17), and (18)new text begin ; and
subdivision 18new text end , for changes in the Consumer Price Index. The commissioner shall adjust
these values higher or lower by the percentage change in the CPI-U from the date of the
previous update to the data available 30 months and one day prior to the scheduled update.
The commissioner shall publish these updated values and load them into the rate management
system.
deleted text begin (l)deleted text end new text begin (n)new text end Upon the implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin (k)new text end and deleted text begin (k)deleted text end new text begin (m)new text end , rate
adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108,
article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be removed
from service rates calculated under this section.
deleted text begin (m)deleted text end new text begin (o)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin
(k)new text end and deleted text begin (k)deleted text end new text begin (m)new text end .
deleted text begin (n)deleted text end new text begin (p)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 18.
Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, deleted text begin family residential services, foster care
services,deleted text end new text begin and new text end integrated community supportsdeleted text begin , and supportive living services dailydeleted text end .
(b) Payments for community residential servicesdeleted text begin , corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care servicesdeleted text end
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;
(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;
(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);
(9) for client programming and supports, the commissioner shall add $2,179; and
(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(c) The total rate must be calculated using the following steps:
(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(d) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.new text begin Customized living and 24-hour customized living rates determined under
this section shall not include more than 24 hours of support in a daily unit. The commissioner
shall establish acuity-based input limits, based on case mix, for customized living and
24-hour customized living rates determined under this section.
new text end
(e) Payments for integrated community support services must be calculated as follows:
(1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;
(2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;
(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;
(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);
(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;
(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);
(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;
(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
(f) The total rate must be calculated as follows:
(1) add the results of paragraph (e), clauses (9) and (10);
(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.
(h) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 19.
Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:
Subd. 7.
Payments for day programs.
Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day servicesnew text begin , provided in person or remotely,new text end must
be calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;
(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (2)new text begin , for in-person services or
subdivision 5, paragraph (d), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (d), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (d), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (d), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (d), clause (6), for remote servicesnew text end ;
(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needsnew text begin for in-person service onlynew text end ;
(12) for adult day bath services, add $7.01 per 15 minute unit;
(13) this is the subtotal rate;
(14) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;
(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;
(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 20.
Minnesota Statutes 2020, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including employment exploration services, employment
development services, housing access coordination, individualized home supports with
family training, individualized home supports with training, in-home family support,
independent living skills training, and hourly supported living services provided to an
individual outside of any day or residential service plannew text begin , provided in person or remotely,new text end
must be calculated as follows, unless the services are authorized separately under subdivision
6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (f), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (2),new text begin for in-person services or subdivision
5, paragraph (g), clause (2), for remote services,new text end and the appropriate supervision wage in
subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(3)new text begin , for in-person services or subdivision 5, paragraph (g), clause (3), for remote servicesnew text end .
This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan supports ratio in subdivision 5, paragraph (f), clause (5)new text begin , for in-person services or
subdivision 5, paragraph (g), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (4)new text begin , for in-person services
or subdivision 5, paragraph (g), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and supports ratio in subdivision 5, paragraph (f), clause (6)new text begin , for
in-person services or subdivision 5, paragraph (g), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills training, individualized home supports with training, and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed two; and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 21.
Minnesota Statutes 2020, section 256B.4914, subdivision 9, is amended to read:
Subd. 9.
Payments for unit-based services without programming.
Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plannew text begin , provided in person or remotely,new text end must be calculated
as follows unless the services are authorized separately under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (2)new text begin , for in-person services or
subdivision 5, paragraph (i), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (i), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (i), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (i), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (i), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for respite services, determine the number of day units of service to meet an
individual's needs;
(15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (1);
(17) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (16);
(18) multiply the number of direct staff hours by the appropriate staff wage;
(19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin
(j)new text end , clause (3). This is defined as the direct staffing rate;
(21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (4);
(22) this is the subtotal rate;
(23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;
(25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
(26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
(27) adjust the result of clauses (13), (25), and (26) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 22.
Minnesota Statutes 2020, section 256B.4914, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Payments for family residential services. new text end
new text begin
The commissioner shall establish
rates for family residential services based on a person's assessed needs as described in the
federally approved waiver plans.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, 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. 23.
Minnesota Statutes 2020, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plansnew text begin :
new text end
new text begin (1)new text end use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659deleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider agency with which the plan has a contract.
new text end
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.85, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this sectionnew text begin and section 256B.851new text end , the terms
defined in this subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, and is specified in a community support plan, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section 256B.0651;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physician and requiring specialized assistance
from another on a daily basis; and
(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in section 256S.10.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
may not be found to be dependent in an activity of daily living if, because of the child's age,
an adult would either perform the activity for the child or assist the child with the activity
and the assistance needed is the assistance appropriate for a typical child of the same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression deleted text begin towardsdeleted text end new text begin towardnew text end self or others or
destruction of property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker may not determine medication
dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected. If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:
(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into an agreement to receive
services at the same time and in the same setting by the same employer.
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
new text begin
[256B.851] COMMUNITY FIRST SERVICES AND SUPPORTS; PAYMENT
RATES.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
(a) The payment methodologies in this section apply to:
new text end
new text begin
(1) community first services and supports (CFSS), extended CFSS, and enhanced rate
CFSS under section 256B.85; and
new text end
new text begin
(2) personal care assistance services under section 256B.0625, subdivisions 19a and
19c; extended personal care assistance service as defined in section 256B.0659, subdivision
1; and enhanced rate personal care assistance services under section 256B.0659, subdivision
17a.
new text end
new text begin
(b) This section does not change existing personal care assistance program or community
first services and supports policies and procedures.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given in section 256B.85, subdivision 2, and as follows.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Component value" means an underlying factor that is built into the rate methodology
to calculate service rates and is part of the cost of providing services.
new text end
new text begin
(d) "Payment rate" or "rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
new text end
new text begin Subd. 3. new text end
new text begin Payment rates; base wage index. new text end
new text begin
(a) When initially establishing the base wage
component values, the commissioner must use the Minnesota-specific median wage for the
standard occupational classification (SOC) codes published by the Bureau of Labor Statistics
in the edition of the Occupational Handbook available January 1, 2021. The commissioner
must calculate the base wage component values as follows for:
new text end
new text begin
(1) personal care assistance services, CFSS, extended personal care assistance services,
and extended CFSS. The base wage component value equals the median wage for personal
care aide (SOC code 31-1120);
new text end
new text begin
(2) enhanced rate personal care assistance services and enhanced rate CFSS. The base
wage component value equals the product of median wage for personal care aide (SOC
code 31-1120) and the value of the enhanced rate under section 256B.0659, subdivision
17a; and
new text end
new text begin
(3) qualified professional services and CFSS worker training and development. The base
wage component value equals the sum of 70 percent of the median wage for registered nurse
(SOC code 29-1141), 15 percent of the median wage for health care social worker (SOC
code 21-1099), and 15 percent of the median wage for social and human service assistant
(SOC code 21-1093).
new text end
new text begin
(b) On January 1, 2025, and every two years thereafter, the commissioner must update
the base wage component values based on the wage data by SOC codes from the Bureau
of Labor Statistics available 30 months and a day prior to the scheduled update.
new text end
new text begin
(c) On August 1, 2024, and every two years thereafter, the commissioner shall report to
the chairs and ranking minority members of the legislative committees and divisions with
jurisdiction over health and human services policy and finance an update of the framework
components as calculated in paragraph (b).
new text end
new text begin Subd. 4. new text end
new text begin Payment rates; total wage index. new text end
new text begin
(a) The commissioner must multiply the
base wage component values in subdivision 3 by one plus the appropriate competitive
workforce factor. The product is the total wage component value.
new text end
new text begin
(b) For personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, and enhanced
rate CFSS, the initial competitive workforce factor is 4.7 percent.
new text end
new text begin
(c) For qualified professional services and CFSS worker training and development, the
competitive workforce factor is zero percent.
new text end
new text begin
(d) On August 1, 2024, and every two years thereafter, the commissioner shall report to
the chairs and ranking minority members of the legislative committees and divisions with
jurisdiction over health and human services policy and finance an update of the competitive
workforce factors in this subdivision using the most recently available data. The
commissioner shall calculate the biennial adjustments to the competitive workforce factor
after determining the base wage index updates required in subdivision 3, paragraph (b). The
commissioner shall adjust the competitive workforce factor toward the percent difference
between: (1) the median wage for personal care aide (SOC code 31-1120); and (2) the
weighted average wage for all other SOC codes with the same Bureau of Labor Statistics
classifications for education, experience, and training required for job competency.
new text end
new text begin
(e) The commissioner shall recommend an increase or decrease of the competitive
workforce factor from its previous value by no more than three percentage points. If, after
a biennial adjustment, the competitive workforce factor is less than or equal to zero, the
competitive workforce factor shall be zero.
new text end
new text begin Subd. 5. new text end
new text begin Payment rates; component values. new text end
new text begin
(a) The commissioner must use the
following component values:
new text end
new text begin
(1) employee vacation, sick, and training factor, 8.71 percent;
new text end
new text begin
(2) employer taxes and workers' compensation factor, 11.56 percent;
new text end
new text begin
(3) employee benefits factor, 12.04 percent;
new text end
new text begin
(4) client programming and supports factor, 2.30 percent;
new text end
new text begin
(5) program plan support factor, 7.00 percent;
new text end
new text begin
(6) general business and administrative expenses factor, 13.25 percent;
new text end
new text begin
(7) program administration expenses factor, 2.90 percent; and
new text end
new text begin
(8) absence and utilization factor, 3.90 percent.
new text end
new text begin
(b) For purposes of implementation, the commissioner shall use the following
implementation components:
new text end
new text begin
(1) personal care assistance services and CFSS: 75.45 percent;
new text end
new text begin
(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45
percent; and
new text end
new text begin
(3) qualified professional services and CFSS worker training and development: 75.45
percent.
new text end
new text begin
(c) On January 1, 2026, and each January 1 thereafter, the commissioner shall increase
the implementation components by two percentage points until the value of each
implementation component equals 100 percent.
new text end
new text begin
(d) On January 1, 2025, and every two years thereafter, the commissioner shall update
the component value in paragraph (a), clause (4), for changes in the Consumer Price Index
by the percentage change from the date of any previous update to the data available six
months and one day prior to the scheduled update.
new text end
new text begin
(e) On August 1, 2024, and every two years thereafter, the commissioner shall report to
the chairs and ranking minority members of the legislative committees and divisions with
jurisdiction over health and human services policy and finance an update on the component
values as calculated in paragraph (d).
new text end
new text begin Subd. 6. new text end
new text begin Payment rates; rate determination. new text end
new text begin
(a) The commissioner must determine
the rate for personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, enhanced rate
CFSS, qualified professional services, and CFSS worker training and development as
follows:
new text end
new text begin
(1) multiply the appropriate total wage component value calculated in subdivision 4 by
one plus the employee vacation, sick, and training factor in subdivision 5;
new text end
new text begin
(2) for program plan support, multiply the result of clause (1) by one plus the program
plan support factor in subdivision 5;
new text end
new text begin
(3) for employee-related expenses, add the employer taxes and workers' compensation
factor in subdivision 5 and the employee benefits factor in subdivision 5. The sum is
employee-related expenses. Multiply the product of clause (2) by one plus the value for
employee-related expenses;
new text end
new text begin
(4) for client programming and supports, multiply the product of clause (3) by one plus
the client programming and supports factor in subdivision 5;
new text end
new text begin
(5) for administrative expenses, add the general business and administrative expenses
factor in subdivision 5, the program administration expenses factor in subdivision 5, and
the absence and utilization factor in subdivision 5;
new text end
new text begin
(6) divide the result of clause (4) by one minus the result of clause (5). The quotient is
the hourly rate;
new text end
new text begin
(7) multiply the hourly rate by the appropriate implementation component under
subdivision 5. This is the adjusted hourly rate; and
new text end
new text begin
(8) divide the adjusted hourly rate by four. The quotient is the total adjusted payment
rate.
new text end
new text begin
(b) The commissioner must publish the total adjusted payment rates.
new text end
new text begin Subd. 7. new text end
new text begin
Personal care provider agency; required reporting and analysis of cost
data.
new text end
new text begin
(a) The commissioner shall evaluate on an ongoing basis whether the base wage
component values and component values in this section appropriately address the cost to
provide the service. The commissioner shall make recommendations to adjust the rate
methodology as indicated by the evaluation. As determined by the commissioner and in
consultation with stakeholders, agencies enrolled to provide services with rates determined
under this section must submit requested cost data to the commissioner. The commissioner
may request cost data, including but not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) staff vacancy rates; and
new text end
new text begin
(11) other data relating to costs required to provide services requested by the
commissioner.
new text end
new text begin
(b) At least once in any three-year period, a provider must submit the required cost data
for a fiscal year that ended not more than 18 months prior to the submission date. The
commissioner must provide each provider a 90-day notice prior to its submission due date.
If a provider fails to submit required cost data, the commissioner must provide notice to a
provider that has not provided required cost data 30 days after the required submission date
and a second notice to a provider that has not provided required cost data 60 days after the
required submission date. The commissioner must temporarily suspend payments to a
provider if the commissioner has not received required cost data 90 days after the required
submission date. The commissioner must make withheld payments when the required cost
data is received by the commissioner.
new text end
new text begin
(c) The commissioner must conduct a random validation of data submitted under this
subdivision to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.
new text end
new text begin
(d) The commissioner shall analyze cost documentation in paragraph (a) and may submit
recommendations on component values, updated base wage component values, and
competitive workforce factors to the chair and ranking minority members of the legislative
committees and divisions with jurisdiction over human services policy and finance every
two years beginning August 1, 2026. The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.
new text end
new text begin
(e) The commissioner, in consultation with stakeholders, must develop and implement
a process for providing training and technical assistance necessary to support provider
submission of cost data required under this subdivision.
new text end
new text begin Subd. 8. new text end
new text begin Payment rates; reports required. new text end
new text begin
(a) The commissioner must assess the
standard component values and publish evaluation findings and recommended changes to
the rate methodology in a report to the legislature by August 1, 2026.
new text end
new text begin
(b) The commissioner must assess the long-term impacts of the rate methodology
implementation on staff providing services with rates determined under this section, including
but not limited to measuring changes in wages, benefits provided, hours worked, and
retention. The commissioner must publish evaluation findings in a report to the legislature
by August 1, 2028, and once every two years thereafter.
new text end
new text begin Subd. 9. new text end
new text begin Payment rates; collective bargaining. new text end
new text begin
The commissioner's authority to set
payment rates, including wages and benefits, for the services of individual providers defined
in section 256B.0711, subdivision 1, paragraph (d), is subject to the state's obligations to
meet and negotiate under chapter 179A, as modified and made applicable to individual
providers under section 179A.54, and to agreements with any exclusive representative of
individual providers, as authorized by chapter 179A, as modified and made applicable to
individual providers under section 179A.54.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to deleted text begin 226deleted text end new text begin 500new text end supportive
housing units in Anoka, new text begin Carver, new text end Dakota, Hennepin, deleted text begin ordeleted text end Ramseynew text begin , Scott, or Washingtonnew text end County
for homeless adults with a mental illness, a history of substance abuse, or human
immunodeficiency virus or acquired immunodeficiency syndrome. For purposes of this
section, "homeless adult" means a person who is living on the street or in a shelter deleted text begin or
discharged from a regional treatment center, community hospital, or residential treatment
program anddeleted text end new text begin ,new text end has no appropriate housing availablenew text begin ,new text end and lacks the resources and support
necessary to access appropriate housing. deleted text begin At least 70 percent of the supportive housing units
must serve homeless adults with mental illness, substance abuse problems, or human
immunodeficiency virus or acquired immunodeficiency syndrome who are about to be or,
within the previous six months, have been discharged from a regional treatment center, or
a state-contracted psychiatric bed in a community hospital, or a residential mental health
or chemical dependency treatment program.deleted text end If a person meets the requirements of subdivision
1, paragraph (a)new text begin or (b)new text end , and receives a federal or state housing subsidy, the housing support
rate for that person is limited to the supplementary rate under section 256I.05, subdivision
1adeleted text begin , and is determined by subtracting the amount of the person's countable income that
exceeds the MSA equivalent rate from the housing support supplementary service ratedeleted text end . A
resident in a demonstration project site who no longer participates in the demonstration
program shall retain eligibility for a housing support payment in an amount determined
under section 256I.06, subdivision 8, using the MSA equivalent ratedeleted text begin . Service funding under
section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
available and the services can be provided through a managed care entity. If federal matching
funds are not available, then service funding will continue under section 256I.05, subdivision
1adeleted text end ;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a housing support contract with the county and has been licensed as a board and lodge
facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a housing support provider that currently operates a 304-bed facility
in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; and
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed chemical dependency treatment program.
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
new text begin
(c) The appropriation for this subdivision must include administrative funding equal to
the cost of two full-time equivalent employees to process eligibility. The commissioner
must disburse administrative funding to the fiscal agent for the counties under this
subdivision.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the deleted text begin countydeleted text end agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient under a home and community-based waiver
under title XIX of the new text begin federal new text end Social Security Act; or funding from the medical assistance
program under section 256B.0659, for personal care services for residents in the setting; or
residing in a setting which receives funding under section 245.73. If funding is available
for other necessary services through a home and community-based waiver, or personal care
services under section 256B.0659, then the housing support rate is limited to the rate set in
subdivision 1. Unless otherwise provided in law, in no case may the supplementary service
rate exceed $426.37. The registration and licensure requirement does not apply to
establishments which are exempt from state licensure because they are located on Indian
reservations and for which the tribe has prescribed health and safety requirements. Service
payments under this section may be prohibited under rules to prevent the supplanting of
federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
the approval of the Secretary of Health and Human Services to provide home and
community-based waiver services under title XIX of the new text begin federal new text end Social Security Act for
residents who are not eligible for an existing home and community-based waiver due to a
primary diagnosis of mental illness or chemical dependency and shall apply for a waiver if
it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the deleted text begin county or countiesdeleted text end new text begin agencynew text end in which the affected beds
are located. The commissioner may also make cost-neutral transfers from the housing support
fund to deleted text begin county human servicedeleted text end agencies for beds permanently removed from the housing
support census under a plan submitted by the deleted text begin countydeleted text end agency and approved by the
commissioner. The commissioner shall report the amount of any transfers under this provision
annually to the legislature.
(c) deleted text begin Countiesdeleted text end new text begin Agenciesnew text end must not negotiate supplementary service rates with providers of
housing support that are licensed as board and lodging with special services and that do not
encourage a policy of sobriety on their premises and make referrals to available community
services for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).
(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.
(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.
(d) When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences are reported in advance
to the county agency's social service staff. Advance reporting is not required for emergency
absences due to crisis, illness, or injury.new text begin For purposes of maintaining housing while
temporarily absent due to residential behavioral health treatment or health care treatment
that requires admission to an inpatient hospital, nursing facility, or other health care facility,
the room and board rate for an individual is payable beyond an 18-calendar-day absence
period, not to exceed 150 days in a calendar year.
new text end
(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the establishment experiences a 25 percent increase or decrease in
the total number of its beds, if the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or if the residence physically
moves, or changes its licensure, and incurs a resulting increase in operation and property
costs.
(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.
Sec. 29.
Minnesota Statutes 2020, section 256I.05, subdivision 11, is amended to read:
Subd. 11.
Transfer of emergency shelter funds.
(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to deleted text begin county human service
agenciesdeleted text end new text begin the agencynew text end for emergency shelter beds removed from the housing support census
under a biennial plan submitted by the deleted text begin countydeleted text end new text begin agencynew text end and approved by the commissioner.
The plan must describe: (1) anticipated and actual outcomes for persons experiencing
homelessness in emergency shelters; (2) improved efficiencies in administration; (3)
requirements for individual eligibility; and (4) plans for quality assurance monitoring and
quality assurance outcomes. The commissioner shall review the deleted text begin countydeleted text end new text begin agencynew text end plan to
monitor implementation and outcomes at least biennially, and more frequently if the
commissioner deems necessary.
(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
deleted text begin countydeleted text end new text begin agencynew text end may return beds to the housing support fund with 180 days' notice, including
financial reconciliation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256S.18, subdivision 7, is amended to read:
Subd. 7.
Monthly case mix budget cap exception.
The commissioner shall approve an
exception to the monthly case mix budget cap in deleted text begin paragraph (a)deleted text end new text begin subdivision 3new text end to account for
the additional cost of providing enhanced rate personal care assistance services under section
256B.0659 or new text begin enhanced rate community first services and supports under section new text end 256B.85.
deleted text begin The exception shall not exceed 107.5 percent of the budget otherwise available to the
individual.deleted text end new text begin The commissioner must calculate the difference between the rate for personal
care assistance services and enhanced rate personal care assistance services. The additional
budget amount approved under an exception must not exceed this difference. new text end The exception
must be reapproved on an annual basis at the time of a participant's annual reassessment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256S.20, subdivision 1, is amended to read:
Subdivision 1.
Customized living services provider requirements.
deleted text begin Only a provider
licensed by the Department of Health as a comprehensive home care provider may providedeleted text end new text begin
To delivernew text end customized living services or 24-hour customized living servicesdeleted text begin .deleted text end new text begin , a provider
must:
new text end
new text begin
(1) be licensed as an assisted living facility under chapter 144G; or
new text end
new text begin (2) be licensed as a comprehensive home care provider under chapter 144A and be
delivering services in a setting defined under section 144G.08, subdivision 7, clauses (10)
to (13).new text end A licensed home care provider is subject to section 256B.0651, subdivision 14.
Sec. 32.
Laws 2020, Fifth Special Session chapter 3, article 10, section 3, is amended to
read:
Sec. 3. TEMPORARY PERSONAL CARE ASSISTANCE COMPENSATION FOR
SERVICES PROVIDED BY A PARENT OR SPOUSE.
(a) Notwithstanding Minnesota Statutes, section 256B.0659, subdivisions 3, paragraph
(a), clause (1); 11, paragraph (c); and 19, paragraph (b), clause (3), during a peacetime
emergency declared by the governor under Minnesota Statutes, section 12.31, subdivision
2, for an outbreak of COVID-19, a parent, stepparent, or legal guardian of a minor who is
a personal care assistance recipient or a spouse of a personal care assistance recipient may
provide and be paid for providing personal care assistance services.
(b) This section expires deleted text begin February 7, 2021deleted text end new text begin upon the expiration of the COVID-19 public
health emergency declared by the United States Secretary of Health and Human Servicesnew text end .
new text begin EFFECTIVE DATE; REVIVAL AND REENACTMENT. new text end
new text begin
This section is effective
the day following final enactment, or upon federal approval, whichever is later, and Laws
2020, Fifth Special Session chapter 3, article 10, section 3, is revived and reenacted as of
that date.
new text end
Sec. 33. new text begin SELF-DIRECTED WORKER CONTRACT RATIFICATION.
new text end
new text begin
The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota, submitted to the Legislative Coordinating
Commission on March 1, 2021, is ratified.
new text end
Sec. 34. new text begin DIRECTION TO THE COMMISSIONER; CUSTOMIZED LIVING
REPORT.
new text end
new text begin
(a) By January 15, 2022, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance. The report must include the commissioner's:
new text end
new text begin
(1) assessment of the prevalence of customized living services provided under Minnesota
Statutes, section 256B.49, supplanting the provision of residential services and supports
licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under
Minnesota Statutes, chapter 245A;
new text end
new text begin
(2) recommendations regarding the continuation of the moratorium on home and
community-based services customized living settings under Minnesota Statutes, section
256B.49, subdivision 28;
new text end
new text begin
(3) other policy recommendations to ensure that customized living services are being
provided in a manner consistent with the policy objectives of the foster care licensing
moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and
new text end
new text begin
(4) recommendations for needed statutory changes to implement the transition from
existing four-person or fewer customized living settings to corporate adult foster care or
community residential settings.
new text end
new text begin
(b) The commissioner of health shall provide the commissioner of human services with
the required data to complete the report in paragraph (a) and implement the moratorium on
home and community-based services customized living settings under Minnesota Statutes,
section 256B.49, subdivision 28. The data must include, at a minimum, each registered
housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as
a customized living setting to deliver customized living services as defined under the brain
injury or community access for disability inclusion waiver plans under Minnesota Statutes,
section 256B.49.
new text end
Sec. 35. new text begin GOVERNOR'S COUNCIL ON AN AGE-FRIENDLY MINNESOTA.
new text end
new text begin
The Governor's Council on an Age-Friendly Minnesota, established in Executive Order
19-38, shall: (1) work to advance age-friendly policies; and (2) coordinate state, local, and
private partners' collaborative work on emergency preparedness, with a focus on older
adults, communities, and persons in zip codes most impacted by the COVID-19 pandemic.
The Governor's Council on an Age-Friendly Minnesota is extended and expires October 1,
2022.
new text end
Sec. 36. new text begin RATE INCREASE FOR DIRECT SUPPORT SERVICES WORKFORCE.
new text end
new text begin
(a) Effective October 1, 2021, or upon federal approval, whichever is later, if the labor
agreement between the state of Minnesota and the Service Employees International Union
Healthcare Minnesota under Minnesota Statutes, section 179A.54, is approved pursuant to
Minnesota Statutes, section 3.855, the commissioner of human services shall increase:
new text end
new text begin
(1) reimbursement rates, individual budgets, grants, or allocations by 4.14 percent for
services under paragraph (b) provided on or after October 1, 2021, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
new text end
new text begin
(2) reimbursement rates, individual budgets, grants, or allocations by 2.95 percent for
services under paragraph (b) provided on or after July 1, 2022, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
new text end
new text begin
(3) individual budgets, grants, or allocations by 1.58 percent for services under paragraph
(c) provided on or after October 1, 2021, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement; and
new text end
new text begin
(4) individual budgets, grants, or allocations by .81 percent for services under paragraph
(c) provided on or after July 1, 2022, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement.
new text end
new text begin
(b) The rate changes described in paragraph (a), clauses (1) and (2), apply to direct
support services provided through a covered program, as defined in Minnesota Statutes,
section 256B.0711, subdivision 1, with the exception of consumer-directed community
supports available under programs established pursuant to home and community-based
service waivers authorized under section 1915(c) of the federal Social Security Act and
Minnesota Statutes, including but not limited to chapter 256S and sections 256B.092 and
256B.49, and under the alternative care program under Minnesota Statutes, section
256B.0913.
new text end
new text begin
(c) The funding changes described in paragraph (a), clauses (3) and (4), apply to
consumer-directed community supports available under programs established pursuant to
home and community-based service waivers authorized under section 1915(c) of the federal
Social Security Act, and Minnesota Statutes, including but not limited to chapter 256S and
sections 256B.092 and 256B.49, and under the alternative care program under Minnesota
Statutes, section 256B.0913.
new text end
Sec. 37. new text begin WAIVER REIMAGINE PHASE II.
new text end
new text begin
(a) The commissioner of human services must implement a two-home and
community-based services waiver program structure, as authorized under section 1915(c)
of the federal Social Security Act, that serves persons who are determined by a certified
assessor to require the levels of care provided in a nursing home, a hospital, a neurobehavioral
hospital, or an intermediate care facility for persons with developmental disabilities.
new text end
new text begin
(b) The commissioner of human services must implement an individualized budget
methodology, as authorized under section 1915(c) of the federal Social Security Act, that
serves persons who are determined by a certified assessor to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities.
new text end
new text begin
(c) The commissioner of human services may seek all federal authority necessary to
implement this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2024, or 90 days after
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. 38. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.097, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed effective July 1, 2021.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256B.0916, subdivisions 2, 3, 4, 5, 8, 11, and 12;
and 256B.49, subdivisions 26 and 27,
new text end
new text begin
are repealed effective January 1, 2023, 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
ARTICLE 7
COMMUNITY SUPPORTS POLICY
Section 1.
Minnesota Statutes 2020, 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 must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e) new text begin The treatment team must completenew text end an individual treatment plan new text begin for each client and
the individual treatment plannew text end must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(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;
(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;
(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;
(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;
(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;
(7) 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. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) 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;
(9) 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
(10) 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.
(f) 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.
(g) 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.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 2.
Minnesota Statutes 2020, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans use the assessment and
authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all personal
care assistance services under section 256B.0659new text begin and community first services and supports
under section 256B.85new text end .
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
Sec. 3.
Minnesota Statutes 2020, section 256B.85, subdivision 1, is amended to read:
Subdivision 1.
Basis and scope.
(a) Upon federal approval, the commissioner shall
establish a state plan option for the provision of home and community-based personal
assistance service and supports called "community first services and supports (CFSS)."
(b) CFSS is a participant-controlled method of selecting and providing services and
supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports to
perform that function.
(c) CFSS is available statewide to eligible people to assist with accomplishing activities
of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related
procedures and tasks through hands-on assistance to accomplish the task or constant
supervision and cueing to accomplish the task; and to assist with acquiring, maintaining,
and enhancing the skills necessary to accomplish ADLs, IADLs, and health-related
procedures and tasks. CFSS allows payment for new text begin the participant for new text end certain supports and
goods such as environmental modifications and technology that are intended to replace or
decrease the need for human assistance.
(d) Upon federal approval, CFSS will replace the personal care assistance program under
sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
new text begin
(e) For the purposes of this section, notwithstanding the provisions of section 144A.43,
subdivision 3, supports purchased under CFSS are not considered home care services.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.85, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means deleted text begin eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.deleted text end new text begin :
new text end
new text begin
(1) dressing, including assistance with choosing, applying, and changing clothing and
applying special appliances, wraps, or clothing;
new text end
new text begin
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Grooming includes nail
care, except for recipients who are diabetic or have poor circulation;
new text end
new text begin
(3) bathing, including assistance with basic personal hygiene and skin care;
new text end
new text begin
(4) eating, including assistance with hand washing and applying orthotics required for
eating, transfers, or feeding;
new text end
new text begin
(5) transfers, including assistance with transferring the participant from one seating or
reclining area to another;
new text end
new text begin
(6) mobility, including assistance with ambulation and use of a wheelchair. Mobility
does not include providing transportation for a participant;
new text end
new text begin
(7) positioning, including assistance with positioning or turning a participant for necessary
care and comfort; and
new text end
new text begin
(8) toileting, including assistance with bowel or bladder elimination and care, transfers,
mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing
the perineal area, inspection of the skin, and adjusting clothing.
new text end
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, new text begin advanced practice registered nurse, or physician's assistant
new text end and is specified in a community support plan, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section 256B.0651;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physiciannew text begin , advanced practice registered nurse,
or physician's assistantnew text end and requiring specialized assistance from another on a daily basis;
and
(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
deleted text begin maydeleted text end new text begin mustnew text end not be found to be dependent in an activity of daily living if, because of the child's
age, an adult would either perform the activity for the child or assist the child with the
activity and the assistance needed is the assistance appropriate for a typical child of the
same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.new text begin Extended CFSS excludes the purchase of goods.
new text end
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression towards self or others or destruction
of property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker deleted text begin maydeleted text end new text begin mustnew text end not determine
medication dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. deleted text begin This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected.deleted text end If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. deleted text begin Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:
deleted text end
deleted text begin
(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
deleted text end
deleted text begin
(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and
deleted text end
deleted text begin
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
deleted text end
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into deleted text begin andeleted text end new text begin a writtennew text end agreement to
receive services at the same time deleted text begin anddeleted text end new text begin ,new text end in the same setting deleted text begin bydeleted text end new text begin , and throughnew text end the same deleted text begin employerdeleted text end new text begin
agency-provider or FMS providernew text end .
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
Sec. 5.
Minnesota Statutes 2020, section 256B.85, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) CFSS is available to a person who deleted text begin meets one of the followingdeleted text end :
deleted text begin
(1) is an enrollee of medical assistance as determined under section 256B.055, 256B.056,
or 256B.057, subdivisions 5 and 9;
deleted text end
new text begin
(1) is determined eligible for medical assistance under this chapter, excluding those
under section 256B.057, subdivisions 3, 3a, 3b, and 4;
new text end
(2) is a participant in the alternative care program under section 256B.0913;
(3) is a waiver participant as defined under chapter 256S or section 256B.092, 256B.093,
or 256B.49; or
(4) has medical services identified in a person's individualized education program and
is eligible for services as determined in section 256B.0625, subdivision 26.
(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and
(2) is not a participant under a family support grant under section 252.32.
(c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
Sec. 6.
Minnesota Statutes 2020, section 256B.85, subdivision 4, is amended to read:
Subd. 4.
Eligibility for other services.
Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state plan
benefit or other services available through new text begin the new text end alternative carenew text begin programnew text end .
Sec. 7.
Minnesota Statutes 2020, section 256B.85, subdivision 5, is amended to read:
Subd. 5.
Assessment requirements.
(a) The assessment of functional need must:
(1) be conducted by a certified assessor according to the criteria established in section
256B.0911, subdivision 3a;
(2) be conducted face-to-face, initially and at least annually thereafter, or when there is
a significant change in the participant's condition or a change in the need for services and
supports, or at the request of the participant when the participant experiences a change in
condition or needs a change in the services or supports; and
(3) be completed using the format established by the commissioner.
(b) The results of the assessment and any recommendations and authorizations for CFSS
must be determined and communicated in writing by the lead agency's deleted text begin certifieddeleted text end assessor as
defined in section 256B.0911 to the participant deleted text begin and the agency-provider or FMS provider
chosen by the participantdeleted text end new text begin or the participant's representative and chosen CFSS providersnew text end
within deleted text begin 40 calendardeleted text end new text begin ten business new text end days and must include the participant's right to appeal new text begin the
assessment new text end under section 256.045, subdivision 3.
(c) The lead agency assessor may authorize a temporary authorization for CFSS services
to be provided under the agency-provider model. new text begin The lead agency assessor may authorize
a temporary authorization for CFSS services to be provided under the agency-provider
model without using the assessment process described in this subdivision. new text end Authorization
for a temporary level of CFSS services under the agency-provider model is limited to the
time specified by the commissioner, but shall not exceed 45 days. The level of services
authorized under this paragraph shall have no bearing on a future authorization. deleted text begin Participants
approved for a temporary authorization shall access the consultation servicedeleted text end new text begin For CFSS
services needed beyond the 45-day temporary authorization, the lead agency must conduct
an assessment as described in this subdivision and participants must use consultation servicesnew text end
to complete their orientation and selection of a service model.
Sec. 8.
Minnesota Statutes 2020, section 256B.85, subdivision 6, is amended to read:
Subd. 6.
Community first services and supports service delivery plan.
(a) The CFSS
service delivery plan must be developed and evaluated through a person-centered planning
process by the participant, or the participant's representative or legal representative who
may be assisted by a consultation services provider. The CFSS service delivery plan must
reflect the services and supports that are important to the participant and for the participant
to meet the needs assessed by the certified assessor and identified in the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10. The
CFSS service delivery plan must be reviewed by the participant, the consultation services
provider, and the agency-provider or FMS provider prior to starting services and at least
annually upon reassessment, or when there is a significant change in the participant's
condition, or a change in the need for services and supports.
(b) The commissioner shall establish the format and criteria for the CFSS service delivery
plan.
(c) The CFSS service delivery plan must be person-centered and:
(1) specify the consultation services provider, agency-provider, or FMS provider selected
by the participant;
(2) reflect the setting in which the participant resides that is chosen by the participant;
(3) reflect the participant's strengths and preferences;
(4) include the methods and supports used to address the needs as identified through an
assessment of functional needs;
(5) include the participant's identified goals and desired outcomes;
(6) reflect the services and supports, paid and unpaid, that will assist the participant to
achieve identified goals, including the costs of the services and supports, and the providers
of those services and supports, including natural supports;
(7) identify the amount and frequency of face-to-face supports and amount and frequency
of remote supports and technology that will be used;
(8) identify risk factors and measures in place to minimize them, including individualized
backup plans;
(9) be understandable to the participant and the individuals providing support;
(10) identify the individual or entity responsible for monitoring the plan;
(11) be finalized and agreed to in writing by the participant and signed by deleted text begin alldeleted text end individuals
and providers responsible for its implementation;
(12) be distributed to the participant and other people involved in the plan;
(13) prevent the provision of unnecessary or inappropriate care;
(14) include a detailed budget for expenditures for budget model participants or
participants under the agency-provider model if purchasing goods; and
(15) include a plan for worker training and development provided according to
subdivision 18a detailing what service components will be used, when the service components
will be used, how they will be provided, and how these service components relate to the
participant's individual needs and CFSS support worker services.
(d) new text begin The CFSS service delivery plan must describe the units or dollar amount available
to the participant. new text end The total units of agency-provider services or the service budget amount
for the budget model include both annual totals and a monthly average amount that cover
the number of months of the service agreement. The amount used each month may vary,
but additional funds must not be provided above the annual service authorization amount,
determined according to subdivision 8, unless a change in condition is assessed and
authorized by the certified assessor and documented in the coordinated service and support
plan and CFSS service delivery plan.
(e) In assisting with the development or modification of the CFSS service delivery plan
during the authorization time period, the consultation services provider shall:
(1) consult with the FMS provider on the spending budget when applicable; and
(2) consult with the participant or participant's representative, agency-provider, and case
managerdeleted text begin /deleted text end new text begin or new text end care coordinator.
(f) The CFSS service delivery plan must be approved by the consultation services provider
for participants without a case manager or care coordinator who is responsible for authorizing
services. A case manager or care coordinator must approve the plan for a waiver or alternative
care program participant.
Sec. 9.
Minnesota Statutes 2020, section 256B.85, subdivision 7, is amended to read:
Subd. 7.
Community first services and supports; covered services.
Services and
supports covered under CFSS include:
(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;
(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;
(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:
(i) relate to a need identified in a participant's CFSS service delivery plan; and
(ii) increase independence or substitute for human assistancenew text begin ,new text end to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;
(4) observation and redirection for behavior or symptoms where there is a need for
assistance;
(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;
(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;
(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;
(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. These support
workers shall notnew text begin :
new text end
new text begin (i)new text end provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and
new text begin
(ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and
new text end
(9) worker training and development services as described in subdivision 18a.
Sec. 10.
Minnesota Statutes 2020, section 256B.85, subdivision 8, is amended to read:
Subd. 8.
Determination of CFSS service authorization amount.
(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.
(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).
(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:
(1) the total number of dependencies of activities of daily living;
(2) the presence of complex health-related needs; and
(3) the presence of Level I behavior.
(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.
(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:
(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;
(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;
(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;
(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;
(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;
(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;
(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;
(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;
(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and
(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.
(f) Additional service units are provided through the assessment and identification of
the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;
(2) 30 additional minutes per day for each complex health-related need; and
(3) 30 additional minutes per day deleted text begin when thedeleted text end new text begin for eachnew text end behavior new text begin under this clause that
new text end requires assistance at least four times per week deleted text begin for one or more of the following behaviorsdeleted text end :
(i) level I behaviornew text begin that requires the immediate response of another personnew text end ;
(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
or
(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.
(g) The service budget for budget model participants shall be based on:
(1) assessed units as determined by the home care rating; and
(2) an adjustment needed for administrative expenses.
Sec. 11.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Authorization; exceptions. new text end
new text begin
All CFSS services must be authorized by the
commissioner or the commissioner's designee as described in subdivision 8 except when:
new text end
new text begin
(1) the lead agency temporarily authorizes services in the agency-provider model as
described in subdivision 5, paragraph (c);
new text end
new text begin
(2) CFSS services in the agency-provider model were required to treat an emergency
medical condition that if not immediately treated could cause a participant serious physical
or mental disability, continuation of severe pain, or death. The CFSS agency provider must
request retroactive authorization from the lead agency no later than five working days after
providing the initial emergency service. The CFSS agency provider must be able to
substantiate the emergency through documentation such as reports, notes, and admission
or discharge histories. A lead agency must follow the authorization process in subdivision
5 after the lead agency receives the request for authorization from the agency provider;
new text end
new text begin
(3) the lead agency authorizes a temporary increase to the amount of services authorized
in the agency or budget model to accommodate the participant's temporary higher need for
services. Authorization for a temporary level of CFSS services is limited to the time specified
by the commissioner, but shall not exceed 45 days. The level of services authorized under
this clause shall have no bearing on a future authorization;
new text end
new text begin
(4) a participant's medical assistance eligibility has lapsed, is then retroactively reinstated,
and an authorization for CFSS services is completed based on the date of a current
assessment, eligibility, and request for authorization;
new text end
new text begin
(5) a third-party payer for CFSS services has denied or adjusted a payment. Authorization
requests must be submitted by the provider within 20 working days of the notice of denial
or adjustment. A copy of the notice must be included with the request;
new text end
new text begin
(6) the commissioner has determined that a lead agency or state human services agency
has made an error; or
new text end
new text begin
(7) a participant enrolled in managed care experiences a temporary disenrollment from
a health plan, in which case the commissioner shall accept the current health plan
authorization for CFSS services for up to 60 days. The request must be received within the
first 30 days of the disenrollment. If the recipient's reenrollment in managed care is after
the 60 days and before 90 days, the provider shall request an additional 30-day extension
of the current health plan authorization, for a total limit of 90 days from the time of
disenrollment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.85, subdivision 9, is amended to read:
Subd. 9.
Noncovered services.
(a) Services or supports that are not eligible for payment
under this section include those that:
(1) are not authorized by the certified assessor or included in the CFSS service delivery
plan;
(2) are provided prior to the authorization of services and the approval of the CFSS
service delivery plan;
(3) are duplicative of other paid services in the CFSS service delivery plan;
(4) supplant natural unpaid supports that appropriately meet a need in the CFSS service
delivery plan, are provided voluntarily to the participant, and are selected by the participant
in lieu of other services and supports;
(5) are not effective means to meet the participant's needs; and
(6) are available through other funding sources, includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end funding
through title IV-E of the Social Security Act.
(b) Additional services, goods, or supports that are not covered include:
(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;
(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;
(3) insurance, except for insurance costs related to employee coverage;
(4) room and board costs for the participant;
(5) services, supports, or goods that are not related to the assessed needs;
(6) special education and related services provided under the Individuals with Disabilities
Education Act and vocational rehabilitation services provided under the Rehabilitation Act
of 1973;
(7) assistive technology devices and assistive technology services other than those for
back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
(8) medical supplies and equipment covered under medical assistance;
(9) environmental modifications, except as specified in subdivision 7;
(10) expenses for travel, lodging, or meals related to training the participant or the
participant's representative or legal representative;
(11) experimental treatments;
(12) any service or good covered by other state plan services, including prescription and
over-the-counter medications, compounds, and solutions and related fees, including premiums
and co-payments;
(13) membership dues or costs, except when the service is necessary and appropriate to
treat a health condition or to improve or maintain the new text begin adult new text end participant's health condition.
The condition must be identified in the participant's CFSS service delivery plan and
monitored by a Minnesota health care program enrolled physiciannew text begin , advanced practice
registered nurse, or physician's assistantnew text end ;
(14) vacation expenses other than the cost of direct services;
(15) vehicle maintenance or modifications not related to the disability, health condition,
or physical need;
(16) tickets and related costs to attend sporting or other recreational or entertainment
events;
(17) services provided and billed by a provider who is not an enrolled CFSS provider;
(18) CFSS provided by a participant's representative or paid legal guardian;
(19) services that are used solely as a child care or babysitting service;
(20) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;
(21) sterile procedures;
(22) giving of injections into veins, muscles, or skin;
(23) homemaker services that are not an integral part of the assessed CFSS service;
(24) home maintenance or chore services;
(25) home care services, including hospice services if elected by the participant, covered
by Medicare or any other insurance held by the participant;
(26) services to other members of the participant's household;
(27) services not specified as covered under medical assistance as CFSS;
(28) application of restraints or implementation of deprivation procedures;
(29) assessments by CFSS provider organizations or by independently enrolled registered
nurses;
(30) services provided in lieu of legally required staffing in a residential or child care
setting; deleted text begin and
deleted text end
(31) services provided by deleted text begin the residential or programdeleted text end new text begin a foster carenew text end license holder deleted text begin in a
residence for more than four participants.deleted text end new text begin except when the home of the person receiving
services is the licensed foster care provider's primary residence;
new text end
new text begin
(32) services that are the responsibility of the foster care provider under the terms of the
foster care placement agreement, assessment under sections 256N.24 and 260C.4411, and
administrative rules under sections 256N.24 and 260C.4411;
new text end
new text begin
(33) services in a setting that has a licensed capacity greater than six, unless all conditions
for a variance under section 245A.04, subdivision 9a, are satisfied for a sibling, as defined
in section 260C.007, subdivision 32;
new text end
new text begin
(34) services from a provider who owns or otherwise controls the living arrangement,
except when the provider of services is related by blood, marriage, or adoption or when the
provider is a licensed foster care provider who is not prohibited from providing services
under clauses (31) to (33);
new text end
new text begin
(35) instrumental activities of daily living for children younger than 18 years of age,
except when immediate attention is needed for health or hygiene reasons integral to an
assessed need for assistance with activities of daily living, health-related procedures, and
tasks or behaviors; or
new text end
new text begin
(36) services provided to a resident of a nursing facility, hospital, intermediate care
facility, or health care facility licensed by the commissioner of health.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.85, subdivision 10, is amended to read:
Subd. 10.
Agency-provider and FMS provider qualifications and duties.
(a)
Agency-providers identified in subdivision 11 and FMS providers identified in subdivision
13a shall:
(1) enroll as a medical assistance Minnesota health care programs provider and meet all
applicable provider standards and requirementsnew text begin including completion of required provider
training as determined by the commissionernew text end ;
(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;
(4) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers;
(5) not engage in any agency-initiated direct contact or marketing in person, by telephone,
or other electronic means to potential participants, guardians, family members, or participants'
representatives;
(6) directly provide services and not use a subcontractor or reporting agent;
(7) meet the financial requirements established by the commissioner for financial
solvency;
(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health care
programs provider; and
(9) have an office located in Minnesota.
(b) In conducting general duties, agency-providers and FMS providers shall:
(1) pay support workers based upon actual hours of services provided;
(2) pay for worker training and development services based upon actual hours of services
provided or the unit cost of the training session purchased;
(3) withhold and pay all applicable federal and state payroll taxes;
(4) make arrangements and pay unemployment insurance, taxes, workers' compensation,
liability insurance, and other benefits, if any;
(5) enter into a written agreement with the participant, participant's representative, or
legal representative that assigns roles and responsibilities to be performed before services,
supports, or goods are providednew text begin and that meets the requirements of subdivisions 20a, 20b,
and 20c for agency-providersnew text end ;
(6) report maltreatment as required under section 626.557 and chapter 260E;
(7) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a;
(8) comply with any data requests from the department consistent with the Minnesota
Government Data Practices Act under chapter 13; deleted text begin and
deleted text end
(9) maintain documentation for the requirements under subdivision 16, paragraph (e),
clause (2), to qualify for an enhanced rate under this sectiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) request reassessments 60 days before the end of the current authorization for CFSS
on forms provided by the commissioner.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.85, subdivision 11, is amended to read:
Subd. 11.
Agency-provider model.
(a) The agency-provider model includes services
provided by support workers and staff providing worker training and development services
who are employed by an agency-provider that meets the criteria established by the
commissioner, including required training.
(b) The agency-provider shall allow the participant to have a significant role in the
selection and dismissal of the support workers for the delivery of the services and supports
specified in the participant's CFSS service delivery plan.new text begin The agency must make a reasonable
effort to fulfill the participant's request for the participant's preferred worker.
new text end
(c) A participant may use authorized units of CFSS services as needed within a service
agreement that is not greater than 12 months. Using authorized units in a flexible manner
in either the agency-provider model or the budget model does not increase the total amount
of services and supports authorized for a participant or included in the participant's CFSS
service delivery plan.
(d) A participant may share CFSS services. Two or three CFSS participants may share
services at the same time provided by the same support worker.
(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated
by the medical assistance payment for CFSS for support worker wages and benefits, except
all of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the worker training and development services and the reasonable costs
associated with the worker training and development services must not be used in making
this calculation.
(f) The agency-provider model must be used by deleted text begin individualsdeleted text end new text begin participantsnew text end who are restricted
by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to
9505.2245.
(g) Participants purchasing goods under this model, along with support worker services,
must:
(1) specify the goods in the CFSS service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider, case manager, or
care coordinator; and
(2) use the FMS provider for the billing and payment of such goods.
Sec. 15.
Minnesota Statutes 2020, section 256B.85, subdivision 11b, is amended to read:
Subd. 11b.
Agency-provider model; support worker competency.
(a) The
agency-provider must ensure that support workers are competent to meet the participant's
assessed needs, goals, and additional requirements as written in the CFSS service delivery
plan. deleted text begin Within 30 days of any support worker beginning to provide services for a participant,deleted text end
The agency-provider must evaluate the competency of the worker through direct observation
of the support worker's performance of the job functions in a setting where the participant
is using CFSSdeleted text begin .deleted text end new text begin within 30 days of:
new text end
new text begin
(1) any support worker beginning to provide services for a participant; or
new text end
new text begin
(2) any support worker beginning to provide shared services.
new text end
(b) The agency-provider must verify and maintain evidence of support worker
competency, including documentation of the support worker's:
(1) education and experience relevant to the job responsibilities assigned to the support
worker and the needs of the participant;
(2) relevant training received from sources other than the agency-provider;
(3) orientation and instruction to implement services and supports to participant needs
and preferences as identified in the CFSS service delivery plan; deleted text begin and
deleted text end
new text begin
(4) orientation and instruction delivered by an individual competent to perform, teach,
or assign the health-related tasks for tracheostomy suctioning and services to participants
on ventilator support, including equipment operation and maintenance; and
new text end
deleted text begin (4)deleted text end new text begin (5)new text end periodic performance reviews completed by the agency-provider at least annually,
including any evaluations required under subdivision 11a, paragraph (a). If a support worker
is a minor, all evaluations of worker competency must be completed in person and in a
setting where the participant is using CFSS.
(c) The agency-provider must develop a worker training and development plan with the
participant to ensure support worker competency. The worker training and development
plan must be updated when:
(1) the support worker begins providing services;
new text begin
(2) the support worker begins providing shared services;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end there is any change in condition or a modification to the CFSS service delivery
plan; or
deleted text begin (3)deleted text end new text begin (4)new text end a performance review indicates that additional training is needed.
Sec. 16.
Minnesota Statutes 2020, section 256B.85, subdivision 12, is amended to read:
Subd. 12.
Requirements for enrollment of CFSS agency-providers.
(a) All CFSS
agency-providers must provide, at the time of enrollment, reenrollment, and revalidation
as a CFSS agency-provider in a format determined by the commissioner, information and
documentation that includesdeleted text begin ,deleted text end but is not limited todeleted text begin ,deleted text end the following:
(1) the CFSS agency-provider's current contact information including address, telephone
number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid
revenue in the previous calendar year is greater than $300,000, the agency-provider must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000new text begin per provider locationnew text end ;
(4) proof of workers' compensation insurance coverage;
(5) proof of liability insurance;
(6) a deleted text begin descriptiondeleted text end new text begin copynew text end of the CFSS agency-provider's deleted text begin organizationdeleted text end new text begin organizational chartnew text end
identifying the names new text begin and roles new text end of all owners, managing employees, staff, board of directors,
and deleted text begin thedeleted text end new text begin additional documentation reporting anynew text end affiliations of the directors and owners to
other service providers;
(7) deleted text begin a copy ofdeleted text end new text begin proof thatnew text end the CFSS deleted text begin agency-provider'sdeleted text end new text begin agency-provider hasnew text end written policies
and procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety, including the process for notification and resolution of
participant grievances, incident response, identification and prevention of communicable
diseases, and employee misconduct;
(8) deleted text begin copies of all other formsdeleted text end new text begin proof thatnew text end the CFSS agency-provider deleted text begin uses in the course of
daily business including, but not limited todeleted text end new text begin has all of the following forms and documentsnew text end :
(i) a copy of the CFSS agency-provider's time sheet; and
(ii) a copy of the participant's individual CFSS service delivery plan;
(9) a list of all training and classes that the CFSS agency-provider requires of its staff
providing CFSS services;
(10) documentation that the CFSS agency-provider and staff have successfully completed
all the training required by this section;
(11) documentation of the agency-provider's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties that
are used or could be used for providing home care services;
(13) documentation that the agency-provider will use at least the following percentages
of revenue generated from the medical assistance rate paid for CFSS services for CFSS
support worker wages and benefits: 72.5 percent of revenue from CFSS providers, except
100 percent of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The revenue generated by the worker training and development services and the
reasonable costs associated with the worker training and development services shall not be
used in making this calculation; and
(14) documentation that the agency-provider does not burden participants' free exercise
of their right to choose service providers by requiring CFSS support workers to sign an
agreement not to work with any particular CFSS participant or for another CFSS
agency-provider after leaving the agency and that the agency is not taking action on any
such agreements or requirements regardless of the date signed.
(b) CFSS agency-providers shall provide to the commissioner the information specified
in paragraph (a).
(c) All CFSS agency-providers shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day management
and operations of the agency to complete mandatory training as determined by the
commissioner. Employees in management and supervisory positions and owners who are
active in the day-to-day operations of an agency who have completed the required training
as an employee with a CFSS agency-provider do not need to repeat the required training if
they are hired by another agencydeleted text begin , ifdeleted text end new text begin andnew text end they have completed the training within the past
three years. CFSS agency-provider billing staff shall complete training about CFSS program
financial management. Any new owners or employees in management and supervisory
positions involved in the day-to-day operations are required to complete mandatory training
as a requisite of working for the agency.
deleted text begin
(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
deleted text end
deleted text begin
(1) list the materials and information the agency-provider is required to submit;
deleted text end
deleted text begin
(2) provide instructions on submitting information to the commissioner; and
deleted text end
deleted text begin
(3) provide a due date by which the commissioner must receive the requested information.
deleted text end
deleted text begin
Agency-providers shall submit all required documentation for annual review within 30 days
of notification from the commissioner. If an agency-provider fails to submit all the required
documentation, the commissioner may take action under subdivision 23a.
deleted text end
new text begin
(d) Agency-providers shall submit all required documentation in this section within 30
days of notification from the commissioner. If an agency-provider fails to submit all the
required documentation, the commissioner may take action under subdivision 23a.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.85, subdivision 12b, is amended to read:
Subd. 12b.
CFSS agency-provider requirements; notice regarding termination of
services.
(a) An agency-provider must provide written notice when it intends to terminate
services with a participant at least deleted text begin tendeleted text end new text begin 30new text end calendar days before the proposed service
termination is to become effective, except in cases where:
(1) the participant engages in conduct that significantly alters the terms of the CFSS
service delivery plan with the agency-provider;
(2) the participant or other persons at the setting where services are being provided
engage in conduct that creates an imminent risk of harm to the support worker or other
agency-provider staff; or
(3) an emergency or a significant change in the participant's condition occurs within a
24-hour period that results in the participant's service needs exceeding the participant's
identified needs in the current CFSS service delivery plan so that the agency-provider cannot
safely meet the participant's needs.
(b) When a participant initiates a request to terminate CFSS services with the
agency-provider, the agency-provider must give the participant a written deleted text begin acknowledgementdeleted text end new text begin
acknowledgmentnew text end of the participant's service termination request that includes the date the
request was received by the agency-provider and the requested date of termination.
(c) The agency-provider must participate in a coordinated transfer of the participant to
a new agency-provider to ensure continuity of care.
Sec. 18.
Minnesota Statutes 2020, section 256B.85, subdivision 13, is amended to read:
Subd. 13.
Budget model.
(a) Under the budget model participants exercise responsibility
and control over the services and supports described and budgeted within the CFSS service
delivery plan. Participants must use services specified in subdivision 13a provided by an
FMS provider. Under this model, participants may use their approved service budget
allocation to:
(1) directly employ support workers, and pay wages, federal and state payroll taxes, and
premiums for workers' compensation, liability, and health insurance coverage; and
(2) obtain supports and goods as defined in subdivision 7.
(b) Participants who are unable to fulfill any of the functions listed in paragraph (a) may
authorize a legal representative or participant's representative to do so on their behalf.
new text begin
(c) If two or more participants using the budget model live in the same household and
have the same worker, the participants must use the same FMS provider.
new text end
new text begin
(d) If the FMS provider advises that there is a joint employer in the budget model, all
participants associated with that joint employer must use the same FMS provider.
new text end
deleted text begin (c)deleted text end new text begin (e)new text end The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under, but not limited to, the following
circumstances:
(1) when a participant has been restricted by the Minnesota restricted recipient program,
in which case the participant may be excluded for a specified time period under Minnesota
Rules, parts 9505.2160 to 9505.2245;
(2) when a participant exits the budget model during the participant's service plan year.
Upon transfer, the participant shall not access the budget model for the remainder of that
service plan year; or
(3) when the department determines that the participant or participant's representative
or legal representative is unable to fulfill the responsibilities under the budget model, as
specified in subdivision 14.
deleted text begin (d)deleted text end new text begin (f)new text end A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph deleted text begin (c)deleted text end new text begin (e)new text end , clause (3), to
disenroll or exclude the participant from the budget model.
Sec. 19.
Minnesota Statutes 2020, section 256B.85, subdivision 13a, is amended to read:
Subd. 13a.
Financial management services.
(a) Services provided by an FMS provider
include but are not limited to: filing and payment of federal and state payroll taxes on behalf
of the participant; initiating and complying with background study requirements under
chapter 245C and maintaining documentation of background study requests and results;
billing for approved CFSS services with authorized funds; monitoring expenditures;
accounting for and disbursing CFSS funds; providing assistance in obtaining and filing for
liability, workers' compensation, and unemployment coverage; and providing participant
instruction and technical assistance to the participant in fulfilling employer-related
requirements in accordance with section 3504 of the Internal Revenue Code and related
regulations and interpretations, including Code of Federal Regulations, title 26, section
31.3504-1.
(b) Agency-provider services shall not be provided by the FMS provider.
(c) The FMS provider shall provide service functions as determined by the commissioner
for budget model participants that include but are not limited to:
(1) assistance with the development of the detailed budget for expenditures portion of
the CFSS service delivery plan as requested by the consultation services provider or
participant;
(2) data recording and reporting of participant spending;
(3) other duties established by the department, including with respect to providing
assistance to the participant, participant's representative, or legal representative in performing
employer responsibilities regarding support workers. The support worker shall not be
considered the employee of the FMS provider; and
(4) billing, payment, and accounting of approved expenditures for goods.
(d) The FMS provider shall obtain an assurance statement from the participant employer
agreeing to follow state and federal regulations and CFSS policies regarding employment
of support workers.
(e) The FMS provider shall:
(1) not limit or restrict the participant's choice of service or support providers or service
delivery models consistent with any applicable state and federal requirements;
(2) provide the participant, consultation services provider, and case manager or care
coordinator, if applicable, with a monthly written summary of the spending for services and
supports that were billed against the spending budget;
(3) be knowledgeable of state and federal employment regulations, including those under
the Fair Labor Standards Act of 1938, and comply with the requirements under section 3504
of the Internal Revenue Code and related regulations and interpretations, including Code
of Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability
for vendor fiscal/employer agent, and any requirements necessary to process employer and
employee deductions, provide appropriate and timely submission of employer tax liabilities,
and maintain documentation to support medical assistance claims;
(4) have current and adequate liability insurance and bonding and sufficient cash flow
as determined by the commissioner and have on staff or under contract a certified public
accountant or an individual with a baccalaureate degree in accounting;
(5) assume fiscal accountability for state funds designated for the program and be held
liable for any overpayments or violations of applicable statutes or rules, including but not
limited to the Minnesota False Claims Act, chapter 15C; deleted text begin and
deleted text end
(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support workers.
The documentation and time records must be maintained for a minimum of five years from
the claim date and be available for audit or review upon request by the commissioner. Claims
submitted by the FMS provider to the commissioner for payment must correspond with
services, amounts, and time periods as authorized in the participant's service budget and
service plan and must contain specific identifying information as determined by the
commissionerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) provide written notice to the participant or the participant's representative at least 30
calendar days before a proposed service termination becomes effective.
new text end
(f) The commissioner deleted text begin of human servicesdeleted text end shall:
(1) establish rates and payment methodology for the FMS provider;
(2) identify a process to ensure quality and performance standards for the FMS provider
and ensure statewide access to FMS providers; and
(3) establish a uniform protocol for delivering and administering CFSS services to be
used by eligible FMS providers.
Sec. 20.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 14a. new text end
new text begin Participant's representative responsibilities. new text end
new text begin
(a) If a participant is unable
to direct the participant's own care, the participant must use a participant's representative
to receive CFSS services. A participant's representative is required if:
new text end
new text begin
(1) the person is under 18 years of age;
new text end
new text begin
(2) the person has a court-appointed guardian; or
new text end
new text begin
(3) an assessment according to section 256B.0659, subdivision 3a, determines that the
participant is in need of a participant's representative.
new text end
new text begin
(b) A participant's representative must:
new text end
new text begin
(1) be at least 18 years of age;
new text end
new text begin
(2) actively participate in planning and directing CFSS services;
new text end
new text begin
(3) have sufficient knowledge of the participant's circumstances to use CFSS services
consistent with the participant's health and safety needs identified in the participant's service
delivery plan;
new text end
new text begin
(4) not have a financial interest in the provision of any services included in the
participant's CFSS service delivery plan; and
new text end
new text begin
(5) be capable of providing the support necessary to assist the participant in the use of
CFSS services.
new text end
new text begin
(c) A participant's representative must not be the:
new text end
new text begin
(1) support worker;
new text end
new text begin
(2) worker training and development service provider;
new text end
new text begin
(3) agency-provider staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(4) consultation service provider, unless related to the participant by blood, marriage,
or adoption;
new text end
new text begin
(5) FMS staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(6) FMS owner or manager; or
new text end
new text begin
(7) lead agency staff acting as part of employment.
new text end
new text begin
(d) A licensed family foster parent who lives with the participant may be the participant's
representative if the family foster parent meets the other participant's representative
requirements.
new text end
new text begin
(e) There may be two persons designated as the participant's representative, including
instances of divided households and court-ordered custodies. Each person named as the
participant's representative must meet the program criteria and responsibilities.
new text end
new text begin
(f) The participant or the participant's legal representative shall appoint a participant's
representative. The participant's representative must be identified at the time of assessment
and listed on the participant's service agreement and CFSS service delivery plan.
new text end
new text begin
(g) A participant's representative must enter into a written agreement with an
agency-provider or FMS on a form determined by the commissioner and maintained in the
participant's file, to:
new text end
new text begin
(1) be available while care is provided using a method agreed upon by the participant
or the participant's legal representative and documented in the participant's service delivery
plan;
new text end
new text begin
(2) monitor CFSS services to ensure the participant's service delivery plan is followed;
new text end
new text begin
(3) review and sign support worker time sheets after services are provided to verify the
provision of services;
new text end
new text begin
(4) review and sign vendor paperwork to verify receipt of goods; and
new text end
new text begin
(5) in the budget model, review and sign documentation to verify worker training and
development expenditures.
new text end
new text begin
(h) A participant's representative may delegate responsibility to another adult who is not
the support worker during a temporary absence of at least 24 hours but not more than six
months. To delegate responsibility, the participant's representative must:
new text end
new text begin
(1) ensure that the delegate serving as the participant's representative satisfies the
requirements of the participant's representative;
new text end
new text begin
(2) ensure that the delegate performs the functions of the participant's representative;
new text end
new text begin
(3) communicate to the CFSS agency-provider or FMS provider about the need for a
delegate by updating the written agreement to include the name of the delegate and the
delegate's contact information; and
new text end
new text begin
(4) ensure that the delegate protects the participant's privacy according to federal and
state data privacy laws.
new text end
new text begin
(i) The designation of a participant's representative remains in place until:
new text end
new text begin
(1) the participant revokes the designation;
new text end
new text begin
(2) the participant's representative withdraws the designation or becomes unable to fulfill
the duties;
new text end
new text begin
(3) the legal authority to act as a participant's representative changes; or
new text end
new text begin
(4) the participant's representative is disqualified.
new text end
new text begin
(j) A lead agency may disqualify a participant's representative who engages in conduct
that creates an imminent risk of harm to the participant, the support workers, or other staff.
A participant's representative who fails to provide support required by the participant must
be referred to the common entry point.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.85, subdivision 15, is amended to read:
Subd. 15.
Documentation of support services provided; time sheets.
(a) CFSS services
provided to a participant by a support worker employed by either an agency-provider or the
participant employer must be documented daily by each support worker, on a time sheet.
Time sheets may be created, submitted, and maintained electronically. Time sheets must
be submitted by the support worker new text begin at least once per month new text end to the:
(1) agency-provider when the participant is using the agency-provider model. The
agency-provider must maintain a record of the time sheet and provide a copy of the time
sheet to the participant; or
(2) participant and the participant's FMS provider when the participant is using the
budget model. The participant and the FMS provider must maintain a record of the time
sheet.
(b) The documentation on the time sheet must correspond to the participant's assessed
needs within the scope of CFSS covered services. The accuracy of the time sheets must be
verified by the:
(1) agency-provider when the participant is using the agency-provider model; or
(2) participant employer and the participant's FMS provider when the participant is using
the budget model.
(c) The time sheet must document the time the support worker provides services to the
participant. The following elements must be included in the time sheet:
(1) the support worker's full name and individual provider number;
(2) the agency-provider's name and telephone numbers, when responsible for the CFSS
service delivery plan;
(3) the participant's full name;
(4) the dates within the pay period established by the agency-provider or FMS provider,
including month, day, and year, and arrival and departure times with a.m. or p.m. notations
for days worked within the established pay period;
(5) the covered services provided to the participant on each date of service;
(6) deleted text begin adeleted text end new text begin thenew text end signature deleted text begin line fordeleted text end new text begin ofnew text end the participant or the participant's representative and a
statement that the participant's or participant's representative's signature is verification of
the time sheet's accuracy;
(7) the deleted text begin personaldeleted text end signature of the support worker;
(8) any shared care provided, if applicable;
(9) a statement that it is a federal crime to provide false information on CFSS billings
for medical assistance payments; and
(10) dates and location of participant stays in a hospital, care facility, or incarceration
occurring within the established pay period.
Sec. 22.
Minnesota Statutes 2020, section 256B.85, subdivision 17a, is amended to read:
Subd. 17a.
Consultation services provider qualifications and
requirements.
Consultation services providers must meet the following qualifications and
requirements:
(1) meet the requirements under subdivision 10, paragraph (a), excluding clauses (4)
and (5);
(2) are under contract with the department;
(3) are not the FMS provider, the lead agency, or the CFSS or home and community-based
services waiver vendor or agency-provider to the participant;
(4) meet the service standards as established by the commissioner;
new text begin
(5) have proof of surety bond coverage. Upon new enrollment, or if the consultation
service provider's Medicaid revenue in the previous calendar year is less than or equal to
$300,000, the consultation service provider must purchase a surety bond of $50,000. If the
agency-provider's Medicaid revenue in the previous calendar year is greater than $300,000,
the consultation service provider must purchase a surety bond of $100,000. The surety bond
must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end employ lead professional staff with a minimum of deleted text begin threedeleted text end new text begin two new text end years of experience
in providing services such as support planning, support broker, case management or care
coordination, or consultation services and consumer education to participants using a
self-directed program using FMS under medical assistance;
new text begin
(7) report maltreatment as required under chapter 260E and section 626.557;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end comply with medical assistance provider requirements;
deleted text begin (7)deleted text end new text begin (9)new text end understand the CFSS program and its policies;
deleted text begin (8)deleted text end new text begin (10)new text end are knowledgeable about self-directed principles and the application of the
person-centered planning process;
deleted text begin (9)deleted text end new text begin (11)new text end have general knowledge of the FMS provider duties and the vendor
fiscal/employer agent model, including all applicable federal, state, and local laws and
regulations regarding tax, labor, employment, and liability and workers' compensation
coverage for household workers; and
deleted text begin (10)deleted text end new text begin (12)new text end have all employees, including lead professional staff, staff in management and
supervisory positions, and owners of the agency who are active in the day-to-day management
and operations of the agency, complete training as specified in the contract with the
department.
Sec. 23.
Minnesota Statutes 2020, section 256B.85, subdivision 18a, is amended to read:
Subd. 18a.
Worker training and development services.
(a) The commissioner shall
develop the scope of tasks and functions, service standards, and service limits for worker
training and development services.
(b) Worker training and development costs are in addition to the participant's assessed
service units or service budget. Services provided according to this subdivision must:
(1) help support workers obtain and expand the skills and knowledge necessary to ensure
competency in providing quality services as needed and defined in the participant's CFSS
service delivery plan and as required under subdivisions 11b and 14;
(2) be provided or arranged for by the agency-provider under subdivision 11, or purchased
by the participant employer under the budget model as identified in subdivision 13; deleted text begin and
deleted text end
new text begin
(3) be delivered by an individual competent to perform, teach, or assign the tasks,
including health-related tasks, identified in the plan through education, training, and work
experience relevant to the person's assessed needs; and
new text end
deleted text begin (3)deleted text end new text begin (4)new text end be described in the participant's CFSS service delivery plan and documented in
the participant's file.
(c) Services covered under worker training and development shall include:
(1) support worker training on the participant's individual assessed needs and condition,
provided individually or in a group setting by a skilled and knowledgeable trainer beyond
any training the participant or participant's representative provides;
(2) tuition for professional classes and workshops for the participant's support workers
that relate to the participant's assessed needs and condition;
(3) direct observation, monitoring, coaching, and documentation of support worker job
skills and tasks, beyond any training the participant or participant's representative provides,
including supervision of health-related tasks or behavioral supports that is conducted by an
appropriate professional based on the participant's assessed needs. These services must be
provided at the start of services or the start of a new support worker except as provided in
paragraph (d) and must be specified in the participant's CFSS service delivery plan; and
(4) the activities to evaluate CFSS services and ensure support worker competency
described in subdivisions 11a and 11b.
(d) The services in paragraph (c), clause (3), are not required to be provided for a new
support worker providing services for a participant due to staffing failures, unless the support
worker is expected to provide ongoing backup staffing coverage.
(e) Worker training and development services shall not include:
(1) general agency training, worker orientation, or training on CFSS self-directed models;
(2) payment for preparation or development time for the trainer or presenter;
(3) payment of the support worker's salary or compensation during the training;
(4) training or supervision provided by the participant, the participant's support worker,
or the participant's informal supports, including the participant's representative; or
(5) services in excess of deleted text begin 96 unitsdeleted text end new text begin the rate set by the commissionernew text end per annual service
agreement, unless approved by the department.
Sec. 24.
Minnesota Statutes 2020, section 256B.85, subdivision 20b, is amended to read:
Subd. 20b.
Service-related rights under an agency-provider.
A participant receiving
CFSS from an agency-provider has service-related rights to:
(1) participate in and approve the initial development and ongoing modification and
evaluation of CFSS services provided to the participant;
(2) refuse or terminate services and be informed of the consequences of refusing or
terminating services;
(3) before services are initiated, be told the limits to the services available from the
agency-provider, including the agency-provider's knowledge, skill, and ability to meet the
participant's needs identified in the CFSS service delivery plan;
(4) a coordinated transfer of services when there will be a change in the agency-provider;
(5) before services are initiated, be told what the agency-provider charges for the services;
(6) before services are initiated, be told to what extent payment may be expected from
health insurance, public programs, or other sources, if known; and what charges the
participant may be responsible for paying;
(7) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the participant's CFSS service delivery plan;
(8) have the participant's preferences for support workers identified and documented,
and have those preferences met when possible; and
(9) before services are initiated, be told the choices that are available from the
agency-provider for meeting the participant's assessed needs identified in the CFSS service
delivery plan, including but not limited to which support worker staff will be providing
services deleted text begin anddeleted text end new text begin ,new text end the proposed frequency and schedule of visitsnew text begin , and any agreements for shared
servicesnew text end .
Sec. 25.
Minnesota Statutes 2020, section 256B.85, subdivision 23, is amended to read:
Subd. 23.
Commissioner's access.
(a) When the commissioner is investigating a possible
overpayment of Medicaid funds, the commissioner must be given immediate access without
prior notice to the agency-provider, consultation services provider, or FMS provider's office
during regular business hours and to documentation and records related to services provided
and submission of claims for services provided. deleted text begin Denying the commissioner access to records
is cause for immediate suspension of payment and terminatingdeleted text end new text begin Ifnew text end the deleted text begin agency-provider's
enrollment ordeleted text end new text begin agency-provider,new text end FMS deleted text begin provider's enrollmentdeleted text end new text begin provider, or consultation services
provider denies the commissioner access to records, the provider's payment may be
immediately suspended or the provider's enrollment may be terminatednew text end according to section
256B.064 deleted text begin or terminating the consultation services provider contractdeleted text end .
(b) The commissioner has the authority to request proof of compliance with laws, rules,
and policies from agency-providers, consultation services providers, FMS providers, and
participants.
(c) When relevant to an investigation conducted by the commissioner, the commissioner
must be given access to the business office, documents, and records of the agency-provider,
consultation services provider, or FMS provider, including records maintained in electronic
format; participants served by the program; and staff during regular business hours. The
commissioner must be given access without prior notice and as often as the commissioner
considers necessary if the commissioner is investigating an alleged violation of applicable
laws or rules. The commissioner may request and shall receive assistance from lead agencies
and other state, county, and municipal agencies and departments. The commissioner's access
includes being allowed to photocopy, photograph, and make audio and video recordings at
the commissioner's expense.
Sec. 26.
Minnesota Statutes 2020, section 256B.85, subdivision 23a, is amended to read:
Subd. 23a.
Sanctions; information for participants upon termination of services.
(a)
The commissioner may withhold payment from the provider or suspend or terminate the
provider enrollment number if the provider fails to comply fully with applicable laws or
rules. The provider has the right to appeal the decision of the commissioner under section
256B.064.
(b) Notwithstanding subdivision 13, paragraph (c), if a participant employer fails to
comply fully with applicable laws or rules, the commissioner may disenroll the participant
from the budget model. A participant may appeal in writing to the department under section
256.045, subdivision 3, to contest the department's decision to disenroll the participant from
the budget model.
(c) Agency-providers of CFSS services or FMS providers must provide each participant
with a copy of participant protections in subdivision 20c at least 30 days prior to terminating
services to a participant, if the termination results from sanctions under this subdivision or
section 256B.064, such as a payment withhold or a suspension or termination of the provider
enrollment number. If a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end determines it is unable to continue providing services to a participant because of
an action under this subdivision or section 256B.064, the agency-provider deleted text begin ordeleted text end new text begin , new text end FMS providernew text begin ,
or consultation services providernew text end must notify the participant, the participant's representative,
and the commissioner 30 days prior to terminating services to the participant, and must
assist the commissioner and lead agency in supporting the participant in transitioning to
another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services providernew text end of the
participant's choice.
(d) In the event the commissioner withholds payment from a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end
FMS providernew text begin , or consultation services providernew text end , or suspends or terminates a provider
enrollment number of a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end under this subdivision or section 256B.064, the commissioner may inform the
Office of Ombudsman for Long-Term Care and the lead agencies for all participants with
active service agreements with the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . At the commissioner's request, the lead agencies must contact participants
to ensure that the participants are continuing to receive needed care, and that the participants
have been given free choice of agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end if they transfer to another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . In addition, the commissioner or the commissioner's delegate may directly
notify participants who receive care from the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or
consultation services providernew text end that payments have been new text begin or will be new text end withheld or that the
provider's participation in medical assistance has been new text begin or will be new text end suspended or terminated,
if the commissioner determines that the notification is necessary to protect the welfare of
the participants.
ARTICLE 8
MISCELLANEOUS
Section 1.
Minnesota Statutes 2020, section 256.041, is amended to read:
256.041 CULTURAL AND ETHNIC COMMUNITIES LEADERSHIP COUNCIL.
Subdivision 1.
Establishment; purpose.
new text begin (a) new text end There is hereby established the Cultural
and Ethnic Communities Leadership Council for the Department of Human Services. The
purpose of the council is to advise the commissioner of human services on deleted text begin reducingdeleted text end new text begin
implementing strategies to reduce inequities andnew text end disparities that new text begin particularly new text end affect racial
and ethnic groupsnew text begin in Minnesotanew text end .
new text begin
(b) This council is comprised of racially and ethnically diverse community leaders
including American Indians who are residents of Minnesota facing the compounded
challenges of systemic inequities. Members include people who are refugees, immigrants,
and LGBTQ+; people who have disabilities; and people who live in rural Minnesota.
new text end
Subd. 2.
Members.
(a) The council must consist of:
(1) the chairs and ranking minority members of the committees in the house of
representatives and the senate with jurisdiction over human services; and
(2) no fewer than 15 and no more than 25 members appointed by and serving at the
pleasure of the commissioner of human services, in consultation with county, tribal, cultural,
and ethnic communities; diverse program participants; deleted text begin anddeleted text end parent representatives from these
communitiesnew text begin ; and cultural and ethnic communities leadership council membersnew text end .
(b) In making appointments under this section, the commissioner shall give priority
consideration to public members of the legislative councils of color established under deleted text begin chapter
3deleted text end new text begin section 15.0145new text end .
(c) Members must be appointed to allow for representation of the following groups:
(1) racial and ethnic minority groups;
(2) the American Indian community, which must be represented by two members;
(3) culturally and linguistically specific advocacy groups and service providers;
(4) human services program participants;
(5) public and private institutions;
(6) parents of human services program participants;
(7) members of the faith community;
(8) Department of Human Services employees; and
(9) any other group the commissioner deems appropriate to facilitate the goals and duties
of the council.
Subd. 3.
Guidelines.
The commissioner shall direct the development of guidelines
defining the membership of the council; setting out definitions; and developing duties of
the commissioner, the council, and council members regarding racial and ethnic disparities
reduction. The guidelines must be developed in consultation with:
(1) the chairs of relevant committees; and
(2) county, tribal, and cultural communities and program participants from these
communities.
Subd. 4.
Chair.
The commissioner shall new text begin accept recommendations from the council to
new text end appoint a chairnew text begin or chairsnew text end .
deleted text begin Subd. 5. deleted text end
deleted text begin Terms for first appointees. deleted text end
deleted text begin
The initial members appointed shall serve until
January 15, 2016.
deleted text end
Subd. 6.
Terms.
A term shall be for two years and appointees may be reappointed to
serve two additional terms. The commissioner shall make appointments to replace members
vacating their positions deleted text begin by January 15 of each yeardeleted text end new text begin in a timely manner, no more than three
months after the council reviews panel recommendationsnew text end .
Subd. 7.
Duties of commissioner.
(a) The commissioner of human services or the
commissioner's designee shall:
(1) maintain new text begin and actively engage with new text end the council established in this section;
(2) supervise and coordinate policies for persons from racial, ethnic, cultural, linguistic,
and tribal communities who experience disparities in access and outcomes;
(3) identify human services rules or statutes affecting persons from racial, ethnic, cultural,
linguistic, and tribal communities that may need to be revised;
(4) investigate and implement deleted text begin cost-effectivedeleted text end new text begin equitable and culturally responsivenew text end models
of service delivery deleted text begin such asdeleted text end new text begin includingnew text end careful deleted text begin adaptationdeleted text end new text begin adoptionnew text end of deleted text begin clinicallydeleted text end proven services
deleted text begin that constitute one strategy for increasingdeleted text end new text begin to increasenew text end the number of culturally relevant
services available to currently underserved populations; deleted text begin and
deleted text end
(5) based on recommendations of the council, review identified department policies that
maintain racial, ethnic, cultural, linguistic, and tribal disparitiesdeleted text begin , anddeleted text end new text begin ;new text end make adjustments to
ensure those disparities are not perpetuateddeleted text begin .deleted text end new text begin ; and advise the department on progress and
accountability measures for addressing inequities;
new text end
new text begin
(6) in partnership with the council, renew and implement equity policy with action plans
and resources necessary to implement the action plans;
new text end
new text begin
(7) support interagency collaboration to advance equity;
new text end
new text begin
(8) address the council at least twice annually on the state of equity within the department;
and
new text end
new text begin
(9) support member participation in the council, including participation in educational
and community engagement events across Minnesota that address equity in human services.
new text end
(b) The commissioner of human services or the commissioner's designee shall consult
with the council and receive recommendations from the council when meeting the
requirements in this subdivision.
Subd. 8.
Duties of council.
The council shall:
(1) recommend to the commissioner for review deleted text begin identified policies in thedeleted text end Department of
Human Services new text begin policy, budgetary, and operational decisions and practices new text end that deleted text begin maintaindeleted text end new text begin
impactnew text end racial, ethnic, cultural, linguistic, and tribal disparities;
(2) new text begin with community input, advance legislative proposals to improve racial and health
equity outcomes;
new text end
new text begin (3) new text end identify issues regarding new text begin inequities and new text end disparities by engaging diverse populations
in human services programs;
deleted text begin (3)deleted text end new text begin (4)new text end engage in mutual learning essential for achieving human services parity and
optimal wellness for service recipients;
deleted text begin (4)deleted text end new text begin (5)new text end raise awareness about human services disparities to the legislature and media;
deleted text begin (5)deleted text end new text begin (6)new text end provide technical assistance and consultation support to counties, private nonprofit
agencies, and other service providers to build their capacity to provide equitable human
services for persons from racial, ethnic, cultural, linguistic, and tribal communities who
experience disparities in access and outcomes;
deleted text begin (6)deleted text end new text begin (7)new text end provide technical assistance to promote statewide development of culturally and
linguistically appropriate, accessible, and cost-effective human services and related policies;
deleted text begin (7) providedeleted text end new text begin (8) recommend and monitornew text end training and outreach to facilitate access to
culturally and linguistically appropriate, accessible, and cost-effective human services to
prevent disparities;
deleted text begin
(8) facilitate culturally appropriate and culturally sensitive admissions, continued services,
discharges, and utilization review for human services agencies and institutions;
deleted text end
(9) form work groups to help carry out the duties of the council that include, but are not
limited to, persons who provide and receive services and representatives of advocacy groups,
and provide the work groups with clear guidelines, standardized parameters, and tasks for
the work groups to accomplish;
(10) promote information sharing in the human services community and statewide; and
(11) by February 15 deleted text begin each yeardeleted text end new text begin in the second year of the bienniumnew text end , prepare and submit
to the chairs and ranking minority members of the committees in the house of representatives
and the senate with jurisdiction over human services a report that summarizes the activities
of the council, identifies the major problems and issues confronting racial and ethnic groups
in accessing human services, makes recommendations to address issues, and lists the specific
objectives that the council seeks to attain during the next bienniumnew text begin , and recommendations
to strengthen equity, diversity, and inclusion within the departmentnew text end . The report must deleted text begin also
include a list of programs, groups, and grants used to reduce disparities, and statistically
valid reports of outcomes on the reduction of the disparities.deleted text end new text begin identify racial and ethnic groups'
difficulty in accessing human services and make recommendations to address the issues.
The report must include any updated Department of Human Services equity policy,
implementation plans, equity initiatives, and the council's progress.
new text end
Subd. 9.
Duties of council members.
The members of the council shall:
(1) new text begin with no more than three absences per year, new text end attend and participate in scheduled
meetings and be prepared by reviewing meeting notes;
(2) maintain open communication channels with respective constituencies;
(3) identify and communicate issues and risks that could impact the timely completion
of tasks;
(4) collaborate on new text begin inequity and new text end disparity reduction efforts;
(5) communicate updates of the council's work progress and status on the Department
of Human Services website; deleted text begin and
deleted text end
(6) participate in any activities the council or chair deems appropriate and necessary to
facilitate the goals and duties of the councildeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) participate in work groups to carry out council duties.
new text end
Subd. 10.
Expiration.
The council deleted text begin expires on June 30, 2022deleted text end new text begin shall expire when racial
and ethnic-based disparities no longer exist in the state of Minnesotanew text end .
new text begin Subd. 11. new text end
new text begin Compensation. new text end
new text begin
Compensation for members of the council is governed by
section 15.059, subdivision 3.
new text end
ARTICLE 9
MENTAL HEALTH UNIFORM SERVICE STANDARDS
Section 1.
new text begin
[245I.01] PURPOSE AND CITATION.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
new text end
new text begin Subd. 2. new text end
new text begin Purpose. new text end
new text begin
In accordance with sections 245.461 and 245.487, the purpose of this
chapter is to create a system of mental health care that is unified, accountable, and
comprehensive, and to promote the recovery and resiliency of Minnesotans who have mental
illnesses. The state's public policy is to support Minnesotans' access to quality outpatient
and residential mental health services. Further, the state's public policy is to protect the
health and safety, rights, and well-being of Minnesotans receiving mental health services.
new text end
Sec. 2.
new text begin
[245I.011] APPLICABILITY.
new text end
new text begin Subdivision 1. new text end
new text begin License requirements. new text end
new text begin
A license holder under this chapter must comply
with the requirements in chapters 245A, 245C, and 260E; section 626.557; and Minnesota
Rules, chapter 9544.
new text end
new text begin Subd. 2. new text end
new text begin Variances. new text end
new text begin
(a) The commissioner may grant a variance to an applicant, license
holder, or certification holder as long as the variance does not affect the staff qualifications
or the health or safety of any person in a licensed or certified program and the applicant,
license holder, or certification holder meets the following conditions:
new text end
new text begin
(1) an applicant, license holder, or certification holder must request the variance on a
form approved by the commissioner and in a manner prescribed by the commissioner;
new text end
new text begin
(2) the request for a variance must include the:
new text end
new text begin
(i) reasons that the applicant, license holder, or certification holder cannot comply with
a requirement as stated in the law; and
new text end
new text begin
(ii) alternative equivalent measures that the applicant, license holder, or certification
holder will follow to comply with the intent of the law; and
new text end
new text begin
(3) the request for a variance must state the period of time when the variance is requested.
new text end
new text begin
(b) The commissioner may grant a permanent variance when the conditions under which
the applicant, license holder, or certification holder requested the variance do not affect the
health or safety of any person whom the licensed or certified program serves, and when the
conditions of the variance do not compromise the qualifications of staff who provide services
to clients. A permanent variance expires when the conditions that warranted the variance
change in any way. Any applicant, license holder, or certification holder must inform the
commissioner of any changes to the conditions that warranted the permanent variance. If
an applicant, license holder, or certification holder fails to advise the commissioner of
changes to the conditions that warranted the variance, the commissioner must revoke the
permanent variance and may impose other sanctions under sections 245A.06 and 245A.07.
new text end
new text begin
(c) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal under the provisions of chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Certification required. new text end
new text begin
(a) An individual, organization, or government entity
that is exempt from licensure under section 245A.03, subdivision 2, paragraph (a), clause
(19), and chooses to be identified as a certified mental health clinic must:
new text end
new text begin
(1) be a mental health clinic that is certified under section 245I.20;
new text end
new text begin
(2) comply with all of the responsibilities assigned to a license holder by this chapter
except subdivision 1; and
new text end
new text begin
(3) comply with all of the responsibilities assigned to a certification holder by chapter
245A.
new text end
new text begin
(b) An individual, organization, or government entity described by this subdivision must
obtain a criminal background study for each staff person or volunteer who provides direct
contact services to clients.
new text end
new text begin Subd. 4. new text end
new text begin License required. new text end
new text begin
An individual, organization, or government entity providing
intensive residential treatment services or residential crisis stabilization to adults must be
licensed under section 245I.23. An entity with an adult foster care license providing
residential crisis stabilization is exempt from licensure under section 245I.23.
new text end
new text begin Subd. 5. new text end
new text begin Programs certified under chapter 256B. new text end
new text begin
(a) An individual, organization, or
government entity certified under the following sections must comply with all of the
responsibilities assigned to a license holder under this chapter except subdivision 1:
new text end
new text begin
(1) an assertive community treatment provider under section 256B.0622, subdivision
3a;
new text end
new text begin
(2) an adult rehabilitative mental health services provider under section 256B.0623;
new text end
new text begin
(3) a mobile crisis team under section 256B.0624;
new text end
new text begin
(4) a children's therapeutic services and supports provider under section 256B.0943;
new text end
new text begin
(5) an intensive treatment in foster care provider under section 256B.0946; and
new text end
new text begin
(6) an intensive nonresidential rehabilitative mental health services provider under section
256B.0947.
new text end
new text begin
(b) An individual, organization, or government entity certified under the sections listed
in paragraph (a), clauses (1) to (6), must obtain a criminal background study for each staff
person and volunteer providing direct contact services to a client.
new text end
Sec. 3.
new text begin
[245I.02] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of this chapter, the terms in this section have the
meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Approval. new text end
new text begin
"Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document. An individual may demonstrate
approval with a written signature, secure electronic signature, or documented oral approval.
new text end
new text begin Subd. 3. new text end
new text begin Behavioral sciences or related fields. new text end
new text begin
"Behavioral sciences or related fields"
means an education from an accredited college or university in social work, psychology,
sociology, community counseling, family social science, child development, child
psychology, community mental health, addiction counseling, counseling and guidance,
special education, nursing, and other similar fields approved by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Business day. new text end
new text begin
"Business day" means a weekday on which government offices
are open for business. Business day does not include state or federal holidays, Saturdays,
or Sundays.
new text end
new text begin Subd. 5. new text end
new text begin Case manager. new text end
new text begin
"Case manager" means a client's case manager according to
section 256B.0596; 256B.0621; 256B.0625, subdivision 20; 256B.092, subdivision 1a;
256B.0924; 256B.093, subdivision 3a; 256B.094; or 256B.49.
new text end
new text begin Subd. 6. new text end
new text begin Certified rehabilitation specialist. new text end
new text begin
"Certified rehabilitation specialist" means
a staff person who meets the qualifications of section 245I.04, subdivision 8.
new text end
new text begin Subd. 7. new text end
new text begin Child. new text end
new text begin
"Child" means a client under the age of 18.
new text end
new text begin Subd. 8. new text end
new text begin Client. new text end
new text begin
"Client" means a person who is seeking or receiving services regulated
by this chapter. For the purpose of a client's consent to services, client includes a parent,
guardian, or other individual legally authorized to consent on behalf of a client to services.
new text end
new text begin Subd. 9. new text end
new text begin Clinical trainee. new text end
new text begin
"Clinical trainee" means a staff person who is qualified
according to section 245I.04, subdivision 6.
new text end
new text begin Subd. 10. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of human services
or the commissioner's designee.
new text end
new text begin Subd. 11. new text end
new text begin Co-occurring substance use disorder treatment. new text end
new text begin
"Co-occurring substance
use disorder treatment" means the treatment of a person who has a co-occurring mental
illness and substance use disorder. Co-occurring substance use disorder treatment is
characterized by stage-wise comprehensive treatment, treatment goal setting, and flexibility
for clients at each stage of treatment. Co-occurring substance use disorder treatment includes
assessing and tracking each client's stage of change readiness and treatment using a treatment
approach based on a client's stage of change, such as motivational interviewing when working
with a client at an earlier stage of change readiness and a cognitive behavioral approach
and relapse prevention to work with a client at a later stage of change; and facilitating a
client's access to community supports.
new text end
new text begin Subd. 12. new text end
new text begin Crisis plan. new text end
new text begin
"Crisis plan" means a plan to prevent and de-escalate a client's
future crisis situation, with the goal of preventing future crises for the client and the client's
family and other natural supports. Crisis plan includes a crisis plan developed according to
section 245.4871, subdivision 9a.
new text end
new text begin Subd. 13. new text end
new text begin Critical incident. new text end
new text begin
"Critical incident" means an occurrence involving a client
that requires a license holder to respond in a manner that is not part of the license holder's
ordinary daily routine. Critical incident includes a client's suicide, attempted suicide, or
homicide; a client's death; an injury to a client or other person that is life-threatening or
requires medical treatment; a fire that requires a fire department's response; alleged
maltreatment of a client; an assault of a client; an assault by a client; or other situation that
requires a response by law enforcement, the fire department, an ambulance, or another
emergency response provider.
new text end
new text begin Subd. 14. new text end
new text begin Diagnostic assessment. new text end
new text begin
"Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses that a mental health professional or clinical trainee
completes under section 245I.10, subdivisions 4 to 6.
new text end
new text begin Subd. 15. new text end
new text begin Direct contact. new text end
new text begin
"Direct contact" has the meaning given in section 245C.02,
subdivision 11.
new text end
new text begin Subd. 16. new text end
new text begin Family and other natural supports. new text end
new text begin
"Family and other natural supports"
means the people whom a client identifies as having a high degree of importance to the
client. Family and other natural supports also means people that the client identifies as being
important to the client's mental health treatment, regardless of whether the person is related
to the client or lives in the same household as the client.
new text end
new text begin Subd. 17. new text end
new text begin Functional assessment. new text end
new text begin
"Functional assessment" means the assessment of a
client's current level of functioning relative to functioning that is appropriate for someone
the client's age. For a client five years of age or younger, a functional assessment is the
Early Childhood Service Intensity Instrument (ESCII). For a client six to 17 years of age,
a functional assessment is the Child and Adolescent Service Intensity Instrument (CASII).
For a client 18 years of age or older, a functional assessment is the functional assessment
described in section 245I.10, subdivision 9.
new text end
new text begin Subd. 18. new text end
new text begin Individual abuse prevention plan. new text end
new text begin
"Individual abuse prevention plan" means
a plan according to section 245A.65, subdivision 2, paragraph (b), and section 626.557,
subdivision 14.
new text end
new text begin Subd. 19. new text end
new text begin Level of care assessment. new text end
new text begin
"Level of care assessment" means the level of care
decision support tool appropriate to the client's age. For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).
new text end
new text begin Subd. 20. new text end
new text begin License. new text end
new text begin
"License" has the meaning given in section 245A.02, subdivision 8.
new text end
new text begin Subd. 21. new text end
new text begin License holder. new text end
new text begin
"License holder" has the meaning given in section 245A.02,
subdivision 9.
new text end
new text begin Subd. 22. new text end
new text begin Licensed prescriber. new text end
new text begin
"Licensed prescriber" means an individual who is
authorized to prescribe legend drugs under section 151.37.
new text end
new text begin Subd. 23. new text end
new text begin Mental health behavioral aide. new text end
new text begin
"Mental health behavioral aide" means a
staff person who is qualified under section 245I.04, subdivision 16.
new text end
new text begin Subd. 24. new text end
new text begin Mental health certified family peer specialist. new text end
new text begin
"Mental health certified
family peer specialist" means a staff person who is qualified under section 245I.04,
subdivision 12.
new text end
new text begin Subd. 25. new text end
new text begin Mental health certified peer specialist. new text end
new text begin
"Mental health certified peer
specialist" means a staff person who is qualified under section 245I.04, subdivision 10.
new text end
new text begin Subd. 26. new text end
new text begin Mental health practitioner. new text end
new text begin
"Mental health practitioner" means a staff person
who is qualified under section 245I.04, subdivision 4.
new text end
new text begin Subd. 27. new text end
new text begin Mental health professional. new text end
new text begin
"Mental health professional" means a staff person
who is qualified under section 245I.04, subdivision 2.
new text end
new text begin Subd. 28. new text end
new text begin Mental health rehabilitation worker. new text end
new text begin
"Mental health rehabilitation worker"
means a staff person who is qualified under section 245I.04, subdivision 14.
new text end
new text begin Subd. 29. new text end
new text begin Mental illness. new text end
new text begin
"Mental illness" means any of the conditions included in the
most recent editions of the DC: 0-5 Diagnostic Classification of Mental Health and
Development Disorders of Infancy and Early Childhood published by Zero to Three or the
Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric
Association.
new text end
new text begin Subd. 30. new text end
new text begin Organization. new text end
new text begin
"Organization" has the meaning given in section 245A.02,
subdivision 10c.
new text end
new text begin Subd. 31. new text end
new text begin Personnel file. new text end
new text begin
"Personnel file" means a set of records under section 245I.07,
paragraph (a). Personnel files excludes information related to a person's employment that
is not included in section 245I.07.
new text end
new text begin Subd. 32. new text end
new text begin Registered nurse. new text end
new text begin
"Registered nurse" means a staff person who is qualified
under section 148.171, subdivision 20.
new text end
new text begin Subd. 33. new text end
new text begin Rehabilitative mental health services. new text end
new text begin
"Rehabilitative mental health services"
means mental health services provided to an adult client that enable the client to develop
and achieve psychiatric stability, social competencies, personal and emotional adjustment,
independent living skills, family roles, and community skills when symptoms of mental
illness has impaired any of the client's abilities in these areas.
new text end
new text begin Subd. 34. new text end
new text begin Residential program. new text end
new text begin
"Residential program" has the meaning given in section
245A.02, subdivision 14.
new text end
new text begin Subd. 35. new text end
new text begin Signature. new text end
new text begin
"Signature" means a written signature or an electronic signature
defined in section 325L.02, paragraph (h).
new text end
new text begin Subd. 36. new text end
new text begin Staff person. new text end
new text begin
"Staff person" means an individual who works under a license
holder's direction or under a contract with a license holder. Staff person includes an intern,
consultant, contractor, individual who works part-time, and an individual who does not
provide direct contact services to clients. Staff person includes a volunteer who provides
treatment services to a client or a volunteer whom the license holder regards as a staff person
for the purpose of meeting staffing or service delivery requirements. A staff person must
be 18 years of age or older.
new text end
new text begin Subd. 37. new text end
new text begin Strengths. new text end
new text begin
"Strengths" means a person's inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to a client's resilience
and core competencies. A person can build on strengths to support recovery.
new text end
new text begin Subd. 38. new text end
new text begin Trauma. new text end
new text begin
"Trauma" means an event, series of events, or set of circumstances
that is experienced by an individual as physically or emotionally harmful or life-threatening
that has lasting adverse effects on the individual's functioning and mental, physical, social,
emotional, or spiritual well-being. Trauma includes group traumatic experiences. Group
traumatic experiences are emotional or psychological harm that a group experiences. Group
traumatic experiences can be transmitted across generations within a community and are
often associated with racial and ethnic population groups who suffer major intergenerational
losses.
new text end
new text begin Subd. 39. new text end
new text begin Treatment plan. new text end
new text begin
"Treatment plan" means services that a license holder
formulates to respond to a client's needs and goals. A treatment plan includes individual
treatment plans under section 245I.10, subdivisions 7 and 8; initial treatment plans under
section 245I.23, subdivision 7; and crisis treatment plans under sections 245I.23, subdivision
8, and 256B.0624, subdivision 11.
new text end
new text begin Subd. 40. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means a mental health
professional's or certified rehabilitation specialist's oversight, direction, and evaluation of
a staff person providing services to a client according to section 245I.06.
new text end
new text begin Subd. 41. new text end
new text begin Volunteer. new text end
new text begin
"Volunteer" means an individual who, under the direction of the
license holder, provides services to or facilitates an activity for a client without compensation.
new text end
Sec. 4.
new text begin
[245I.03] REQUIRED POLICIES AND PROCEDURES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must establish, enforce, and maintain policies
and procedures to comply with the requirements of this chapter and chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; and Minnesota Rules, chapter 9544. The license
holder must make all policies and procedures available in writing to each staff person. The
license holder must complete and document a review of policies and procedures every two
years and update policies and procedures as necessary. Each policy and procedure must
identify the date that it was initiated and the dates of all revisions. The license holder must
clearly communicate any policy and procedural change to each staff person and provide
necessary training to each staff person to implement any policy and procedural change.
new text end
new text begin Subd. 2. new text end
new text begin Health and safety. new text end
new text begin
A license holder must have policies and procedures to
ensure the health and safety of each staff person and client during the provision of services,
including policies and procedures for services based in community settings.
new text end
new text begin Subd. 3. new text end
new text begin Client rights. new text end
new text begin
A license holder must have policies and procedures to ensure
that each staff person complies with the client rights and protections requirements in section
245I.12.
new text end
new text begin Subd. 4. new text end
new text begin Behavioral emergencies. new text end
new text begin
(a) A license holder must have procedures that each
staff person follows when responding to a client who exhibits behavior that threatens the
immediate safety of the client or others. A license holder's behavioral emergency procedures
must incorporate person-centered planning and trauma-informed care.
new text end
new text begin
(b) A license holder's behavioral emergency procedures must include:
new text end
new text begin
(1) a plan designed to prevent the client from inflicting self-harm and harming others;
new text end
new text begin
(2) contact information for emergency resources that a staff person must use when the
license holder's behavioral emergency procedures are unsuccessful in controlling a client's
behavior;
new text end
new text begin
(3) the types of behavioral emergency procedures that a staff person may use;
new text end
new text begin
(4) the specific circumstances under which the program may use behavioral emergency
procedures; and
new text end
new text begin
(5) the staff persons whom the license holder authorizes to implement behavioral
emergency procedures.
new text end
new text begin
(c) The license holder's behavioral emergency procedures must not include secluding
or restraining a client except as allowed under section 245.8261.
new text end
new text begin
(d) Staff persons must not use behavioral emergency procedures to enforce program
rules or for the convenience of staff persons. Behavioral emergency procedures must not
be part of any client's treatment plan. A staff person may not use behavioral emergency
procedures except in response to a client's current behavior that threatens the immediate
safety of the client or others.
new text end
new text begin Subd. 5. new text end
new text begin Health services and medications. new text end
new text begin
If a license holder is licensed as a residential
program, stores or administers client medications, or observes clients self-administer
medications, the license holder must ensure that a staff person who is a registered nurse or
licensed prescriber reviews and approves of the license holder's policies and procedures to
comply with the health services and medications requirements in section 245I.11, the training
requirements in section 245I.05, subdivision 6, and the documentation requirements in
section 245I.08, subdivision 5.
new text end
new text begin Subd. 6. new text end
new text begin Reporting maltreatment. new text end
new text begin
A license holder must have policies and procedures
for reporting a staff person's suspected maltreatment, abuse, or neglect of a client according
to chapter 260E and section 626.557.
new text end
new text begin Subd. 7. new text end
new text begin Critical incidents. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must have policies and procedures for reporting and maintaining records of
critical incidents according to section 245I.13.
new text end
new text begin Subd. 8. new text end
new text begin Personnel. new text end
new text begin
A license holder must have personnel policies and procedures that:
new text end
new text begin
(1) include a chart or description of the organizational structure of the program that
indicates positions and lines of authority;
new text end
new text begin
(2) ensure that it will not adversely affect a staff person's retention, promotion, job
assignment, or pay when a staff person communicates in good faith with the Department
of Human Services, the Office of Ombudsman for Mental Health and Developmental
Disabilities, the Department of Health, a health-related licensing board, a law enforcement
agency, or a local agency investigating a complaint regarding a client's rights, health, or
safety;
new text end
new text begin
(3) prohibit a staff person from having sexual contact with a client in violation of chapter
604, sections 609.344 or 609.345;
new text end
new text begin
(4) prohibit a staff person from neglecting, abusing, or maltreating a client as described
in chapter 260E and sections 626.557 and 626.5572;
new text end
new text begin
(5) include the drug and alcohol policy described in section 245A.04, subdivision 1,
paragraph (c);
new text end
new text begin
(6) describe the process for disciplinary action, suspension, or dismissal of a staff person
for violating a policy provision described in clauses (3) to (5);
new text end
new text begin
(7) describe the license holder's response to a staff person who violates other program
policies or who has a behavioral problem that interferes with providing treatment services
to clients; and
new text end
new text begin
(8) describe each staff person's position that includes the staff person's responsibilities,
authority to execute the responsibilities, and qualifications for the position.
new text end
new text begin Subd. 9. new text end
new text begin Volunteers. new text end
new text begin
A license holder must have policies and procedures for using
volunteers, including when a license holder must submit a background study for a volunteer,
and the specific tasks that a volunteer may perform.
new text end
new text begin Subd. 10. new text end
new text begin Data privacy. new text end
new text begin
(a) A license holder must have policies and procedures that
comply with all applicable state and federal law. A license holder's use of electronic record
keeping or electronic signatures does not alter a license holder's obligations to comply with
applicable state and federal law.
new text end
new text begin
(b) A license holder must have policies and procedures for a staff person to promptly
document a client's revocation of consent to disclose the client's health record. The license
holder must verify that the license holder has permission to disclose a client's health record
before releasing any client data.
new text end
Sec. 5.
new text begin
[245I.04] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Tribal providers. new text end
new text begin
For purposes of this section, a tribal entity may
credential an individual according to section 256B.02, subdivision 7, paragraphs (b) and
(c).
new text end
new text begin Subd. 2. new text end
new text begin Mental health professional qualifications. new text end
new text begin
The following individuals may
provide services to a client as a mental health professional:
new text end
new text begin
(1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a: (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and
mental health nursing by a national certification organization; or (ii) nurse practitioner in
adult or family psychiatric and mental health nursing by a national nurse certification
organization;
new text end
new text begin
(2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
new text end
new text begin
(3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
new text end
new text begin
(4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
new text end
new text begin
(5) a marriage and family therapist licensed under sections 148B.29 to 148B.392; or
new text end
new text begin
(6) a licensed professional clinical counselor licensed under section 148B.5301.
new text end
new text begin Subd. 3. new text end
new text begin Mental health professional scope of practice. new text end
new text begin
A mental health professional
must maintain a valid license with the mental health professional's governing health-related
licensing board and must only provide services to a client within the scope of practice
determined by the applicable health-related licensing board.
new text end
new text begin Subd. 4. new text end
new text begin Mental health practitioner qualifications. new text end
new text begin
(a) An individual who is qualified
in at least one of the ways described in paragraph (b) to (d) may serve as a mental health
practitioner.
new text end
new text begin
(b) An individual is qualified as a mental health practitioner through relevant coursework
if the individual completes at least 30 semester hours or 45 quarter hours in behavioral
sciences or related fields and:
new text end
new text begin
(1) has at least 2,000 hours of experience providing services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to a client;
new text end
new text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, and completes the additional training described in section
245I.05, subdivision 3, paragraph (c), before providing direct contact services to a client;
new text end
new text begin
(3) is working in a day treatment program under section 256B.0671, subdivision 3, or
256B.0943; or
new text end
new text begin
(4) has completed a practicum or internship that (i) required direct interaction with adult
clients or child clients, and (ii) was focused on behavioral sciences or related fields.
new text end
new text begin
(c) An individual is qualified as a mental health practitioner through work experience
if the individual:
new text end
new text begin
(1) has at least 4,000 hours of experience in the delivery of services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients; or
new text end
new text begin
(2) receives treatment supervision at least once per week until meeting the requirement
in clause (1) of 4,000 hours of experience and has at least 2,000 hours of experience providing
services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients.
new text end
new text begin
(d) An individual is qualified as a mental health practitioner if the individual has a
master's or other graduate degree in behavioral sciences or related fields.
new text end
new text begin Subd. 5. new text end
new text begin Mental health practitioner scope of practice. new text end
new text begin
(a) A mental health practitioner
under the treatment supervision of a mental health professional or certified rehabilitation
specialist may provide an adult client with client education, rehabilitative mental health
services, functional assessments, level of care assessments, and treatment plans. A mental
health practitioner under the treatment supervision of a mental health professional may
provide skill-building services to a child client and complete treatment plans for a child
client.
new text end
new text begin
(b) A mental health practitioner must not provide treatment supervision to other staff
persons. A mental health practitioner may provide direction to mental health rehabilitation
workers and mental health behavioral aides.
new text end
new text begin
(c) A mental health practitioner who provides services to clients according to section
256B.0624 or 256B.0944 may perform crisis assessments and interventions for a client.
new text end
new text begin Subd. 6. new text end
new text begin Clinical trainee qualifications. new text end
new text begin
(a) A clinical trainee is a staff person who: (1)
is enrolled in an accredited graduate program of study to prepare the staff person for
independent licensure as a mental health professional and who is participating in a practicum
or internship with the license holder through the individual's graduate program; or (2) has
completed an accredited graduate program of study to prepare the staff person for independent
licensure as a mental health professional and who is in compliance with the requirements
of the applicable health-related licensing board, including requirements for supervised
practice.
new text end
new text begin
(b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure that the trainee meets the requirements of the health-related licensing board.
As permitted by a health-related licensing board, treatment supervision under this chapter
may be integrated into a plan to meet the supervisory requirements of the health-related
licensing board but does not supersede those requirements.
new text end
new text begin Subd. 7. new text end
new text begin Clinical trainee scope of practice. new text end
new text begin
(a) A clinical trainee under the treatment
supervision of a mental health professional may provide a client with psychotherapy, client
education, rehabilitative mental health services, diagnostic assessments, functional
assessments, level of care assessments, and treatment plans.
new text end
new text begin
(b) A clinical trainee must not provide treatment supervision to other staff persons. A
clinical trainee may provide direction to mental health behavioral aides and mental health
rehabilitation workers.
new text end
new text begin
(c) A psychological clinical trainee under the treatment supervision of a psychologist
may perform psychological testing of clients.
new text end
new text begin
(d) A clinical trainee must not provide services to clients that violate any practice act of
a health-related licensing board, including failure to obtain licensure if licensure is required.
new text end
new text begin Subd. 8. new text end
new text begin Certified rehabilitation specialist qualifications. new text end
new text begin
A certified rehabilitation
specialist must have:
new text end
new text begin
(1) a master's degree from an accredited college or university in behavioral sciences or
related fields;
new text end
new text begin
(2) at least 4,000 hours of post-master's supervised experience providing mental health
services to clients; and
new text end
new text begin
(3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
new text end
new text begin Subd. 9. new text end
new text begin Certified rehabilitation specialist scope of practice. new text end
new text begin
(a) A certified
rehabilitation specialist may provide an adult client with client education, rehabilitative
mental health services, functional assessments, level of care assessments, and treatment
plans.
new text end
new text begin
(b) A certified rehabilitation specialist may provide treatment supervision to a mental
health certified peer specialist, mental health practitioner, and mental health rehabilitation
worker.
new text end
new text begin Subd. 10. new text end
new text begin Mental health certified peer specialist qualifications. new text end
new text begin
A mental health
certified peer specialist must:
new text end
new text begin
(1) have been diagnosed with a mental illness;
new text end
new text begin
(2) be a current or former mental health services client; and
new text end
new text begin
(3) have a valid certification as a mental health certified peer specialist under section
256B.0615.
new text end
new text begin Subd. 11. new text end
new text begin Mental health certified peer specialist scope of practice. new text end
new text begin
A mental health
certified peer specialist under the treatment supervision of a mental health professional or
certified rehabilitation specialist must:
new text end
new text begin
(1) provide individualized peer support to each client;
new text end
new text begin
(2) promote a client's recovery goals, self-sufficiency, self-advocacy, and development
of natural supports; and
new text end
new text begin
(3) support a client's maintenance of skills that the client has learned from other services.
new text end
new text begin Subd. 12. new text end
new text begin Mental health certified family peer specialist qualifications. new text end
new text begin
A mental
health certified family peer specialist must:
new text end
new text begin
(1) have raised or be currently raising a child with a mental illness;
new text end
new text begin
(2) have experience navigating the children's mental health system; and
new text end
new text begin
(3) have a valid certification as a mental health certified family peer specialist under
section 256B.0616.
new text end
new text begin Subd. 13. new text end
new text begin Mental health certified family peer specialist scope of practice. new text end
new text begin
A mental
health certified family peer specialist under the treatment supervision of a mental health
professional must provide services to increase the child's ability to function in the child's
home, school, and community. The mental health certified family peer specialist must:
new text end
new text begin
(1) provide family peer support to build on a client's family's strengths and help the
family achieve desired outcomes;
new text end
new text begin
(2) provide nonadversarial advocacy to a child client and the child's family that
encourages partnership and promotes the child's positive change and growth;
new text end
new text begin
(3) support families in advocating for culturally appropriate services for a child in each
treatment setting;
new text end
new text begin
(4) promote resiliency, self-advocacy, and development of natural supports;
new text end
new text begin
(5) support maintenance of skills learned from other services;
new text end
new text begin
(6) establish and lead parent support groups;
new text end
new text begin
(7) assist parents in developing coping and problem-solving skills; and
new text end
new text begin
(8) educate parents about mental illnesses and community resources, including resources
that connect parents with similar experiences to one another.
new text end
new text begin Subd. 14. new text end
new text begin Mental health rehabilitation worker qualifications. new text end
new text begin
(a) A mental health
rehabilitation worker must:
new text end
new text begin
(1) have a high school diploma or equivalent; and
new text end
new text begin
(2) meet one of the following qualification requirements:
new text end
new text begin
(i) be fluent in the non-English language or competent in the culture of the ethnic group
to which at least 20 percent of the mental health rehabilitation worker's clients belong;
new text end
new text begin
(ii) have an associate of arts degree;
new text end
new text begin
(iii) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
new text end
new text begin
(iv) be a registered nurse;
new text end
new text begin
(v) have, within the previous ten years, three years of personal life experience with
mental illness;
new text end
new text begin
(vi) have, within the previous ten years, three years of life experience as a primary
caregiver to an adult with a mental illness, traumatic brain injury, substance use disorder,
or developmental disability; or
new text end
new text begin
(vii) have, within the previous ten years, 2,000 hours of work experience providing
health and human services to individuals.
new text end
new text begin
(b) A mental health rehabilitation worker who is scheduled as an overnight staff person
and works alone is exempt from the additional qualification requirements in paragraph (a),
clause (2).
new text end
new text begin Subd. 15. new text end
new text begin Mental health rehabilitation worker scope of practice. new text end
new text begin
A mental health
rehabilitation worker under the treatment supervision of a mental health professional or
certified rehabilitation specialist may provide rehabilitative mental health services to an
adult client according to the client's treatment plan.
new text end
new text begin Subd. 16. new text end
new text begin Mental health behavioral aide qualifications. new text end
new text begin
(a) A level 1 mental health
behavioral aide must have: (1) a high school diploma or equivalent; or (2) two years of
experience as a primary caregiver to a child with mental illness within the previous ten
years.
new text end
new text begin
(b) A level 2 mental health behavioral aide must: (1) have an associate or bachelor's
degree; or (2) be certified by a program under section 256B.0943, subdivision 8a.
new text end
new text begin Subd. 17. new text end
new text begin Mental health behavioral aide scope of practice. new text end
new text begin
While under the treatment
supervision of a mental health professional, a mental health behavioral aide may practice
psychosocial skills with a child client according to the child's treatment plan and individual
behavior plan that a mental health professional, clinical trainee, or mental health practitioner
has previously taught to the child.
new text end
Sec. 6.
new text begin
[245I.05] TRAINING REQUIRED.
new text end
new text begin Subdivision 1. new text end
new text begin Training plan. new text end
new text begin
A license holder must develop a training plan to ensure
that staff persons receive ongoing training according to this section. The training plan must
include:
new text end
new text begin
(1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation of a staff person satisfies this requirement;
new text end
new text begin
(2) a description of how the license holder conducts ongoing training of each staff person,
including whether ongoing training is based on a staff person's hire date or a specified annual
cycle determined by the program;
new text end
new text begin
(3) a description of how the license holder verifies and documents each staff person's
previous training experience. A license holder may consider a staff person to have met a
training requirement in subdivision 3, paragraph (d) or (e), if the staff person has received
equivalent postsecondary education in the previous four years or training experience in the
previous two years; and
new text end
new text begin
(4) a description of how the license holder determines when a staff person needs
additional training, including when the license holder will provide additional training.
new text end
new text begin Subd. 2. new text end
new text begin Documentation of training. new text end
new text begin
(a) The license holder must provide training to
each staff person according to the training plan and must document that the license holder
provided the training to each staff person. The license holder must document the following
information for each staff person's training:
new text end
new text begin
(1) the topics of the training;
new text end
new text begin
(2) the name of the trainee;
new text end
new text begin
(3) the name and credentials of the trainer;
new text end
new text begin
(4) the license holder's method of evaluating the trainee's competency upon completion
of training;
new text end
new text begin
(5) the date of the training; and
new text end
new text begin
(6) the length of training in hours and minutes.
new text end
new text begin
(b) Documentation of a staff person's continuing education credit accepted by the
governing health-related licensing board is sufficient to document training for purposes of
this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Initial training. new text end
new text begin
(a) A staff person must receive training about:
new text end
new text begin
(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
new text end
new text begin
(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
new text end
new text begin
(b) Before providing direct contact services to a client, a staff person must receive training
about:
new text end
new text begin
(1) client rights and protections under section 245I.12;
new text end
new text begin
(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
new text end
new text begin
(3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
new text end
new text begin
(4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
new text end
new text begin
(5) professional boundaries that the staff person must maintain; and
new text end
new text begin
(6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, physical and
mental abilities.
new text end
new text begin
(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner qualified under section
245I.04, subdivision 4, must receive 30 hours of training about:
new text end
new text begin
(1) mental illnesses;
new text end
new text begin
(2) client recovery and resiliency;
new text end
new text begin
(3) mental health de-escalation techniques;
new text end
new text begin
(4) co-occurring mental illness and substance use disorders; and
new text end
new text begin
(5) psychotropic medications and medication side effects.
new text end
new text begin
(d) Within 90 days of first providing direct contact services to an adult client, a clinical
trainee, mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
new text end
new text begin
(1) trauma-informed care and secondary trauma;
new text end
new text begin
(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
new text end
new text begin
(3) co-occurring substance use disorders; and
new text end
new text begin
(4) culturally responsive treatment practices.
new text end
new text begin
(e) Within 90 days of first providing direct contact services to a child client, a clinical
trainee, mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
new text end
new text begin
(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
new text end
new text begin
(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
new text end
new text begin
(3) mental illness and co-occurring substance use disorders in family systems;
new text end
new text begin
(4) culturally responsive treatment practices; and
new text end
new text begin
(5) child development, including cognitive functioning, and physical and mental abilities.
new text end
new text begin
(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Ongoing training. new text end
new text begin
(a) A license holder must ensure that staff persons who
provide direct contact services to clients receive annual training about the topics in
subdivision 3, paragraphs (a) and (b), clauses (1) to (3).
new text end
new text begin
(b) A license holder must ensure that each staff person who is qualified under section
245I.04 who is not a mental health professional receives 30 hours of training every two
years. The training topics must be based on the program's needs and the staff person's areas
of competency.
new text end
new text begin Subd. 5. new text end
new text begin Additional training for medication administration. new text end
new text begin
(a) Prior to administering
medications to a client under delegated authority or observing a client self-administer
medications, a staff person who is not a licensed prescriber, registered nurse, or licensed
practical nurse qualified under section 148.171, subdivision 8, must receive training about
psychotropic medications, side effects, and medication management.
new text end
new text begin
(b) Prior to administering medications to a client under delegated authority, a staff person
must successfully complete a:
new text end
new text begin
(1) medication administration training program for unlicensed personnel through an
accredited Minnesota postsecondary educational institution with completion of the course
documented in writing and placed in the staff person's personnel file; or
new text end
new text begin
(2) formalized training program taught by a registered nurse or licensed prescriber that
is offered by the license holder. A staff person's successful completion of the formalized
training program must include direct observation of the staff person to determine the staff
person's areas of competency.
new text end
Sec. 7.
new text begin
[245I.06] TREATMENT SUPERVISION.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must ensure that a mental health
professional or certified rehabilitation specialist provides treatment supervision to each staff
person who provides services to a client and who is not a mental health professional or
certified rehabilitation specialist. When providing treatment supervision, a treatment
supervisor must follow a staff person's written treatment supervision plan.
new text end
new text begin
(b) Treatment supervision must focus on each client's treatment needs and the ability of
the staff person under treatment supervision to provide services to each client, including
the following topics related to the staff person's current caseload:
new text end
new text begin
(1) a review and evaluation of the interventions that the staff person delivers to each
client;
new text end
new text begin
(2) instruction on alternative strategies if a client is not achieving treatment goals;
new text end
new text begin
(3) a review and evaluation of each client's assessments, treatment plans, and progress
notes for accuracy and appropriateness;
new text end
new text begin
(4) instruction on the cultural norms or values of the clients and communities that the
license holder serves and the impact that a client's culture has on providing treatment;
new text end
new text begin
(5) evaluation of and feedback regarding a direct service staff person's areas of
competency; and
new text end
new text begin
(6) coaching, teaching, and practicing skills with a staff person.
new text end
new text begin
(c) A treatment supervisor must provide treatment supervision to a staff person using
methods that allow for immediate feedback, including in-person, telephone, and interactive
video supervision.
new text end
new text begin
(d) A treatment supervisor's responsibility for a staff person receiving treatment
supervision is limited to the services provided by the associated license holder. If a staff
person receiving treatment supervision is employed by multiple license holders, each license
holder is responsible for providing treatment supervision related to the treatment of the
license holder's clients.
new text end
new text begin Subd. 2. new text end
new text begin Treatment supervision planning. new text end
new text begin
(a) A treatment supervisor and the staff
person supervised by the treatment supervisor must develop a written treatment supervision
plan. The license holder must ensure that a new staff person's treatment supervision plan is
completed and implemented by a treatment supervisor and the new staff person within 30
days of the new staff person's first day of employment. The license holder must review and
update each staff person's treatment supervision plan annually.
new text end
new text begin
(b) Each staff person's treatment supervision plan must include:
new text end
new text begin
(1) the name and qualifications of the staff person receiving treatment supervision;
new text end
new text begin
(2) the names and licensures of the treatment supervisors who are supervising the staff
person;
new text end
new text begin
(3) how frequently the treatment supervisors must provide treatment supervision to the
staff person; and
new text end
new text begin
(4) the staff person's authorized scope of practice, including a description of the client
population that the staff person serves, and a description of the treatment methods and
modalities that the staff person may use to provide services to clients.
new text end
new text begin Subd. 3. new text end
new text begin
Treatment supervision and direct observation of mental health
rehabilitation workers and mental health behavioral aides.
new text end
new text begin
(a) A mental health behavioral
aide or a mental health rehabilitation worker must receive direct observation from a mental
health professional, clinical trainee, certified rehabilitation specialist, or mental health
practitioner while the mental health behavioral aide or mental health rehabilitation worker
provides treatment services to clients, no less than twice per month for the first six months
of employment and once per month thereafter. The staff person performing the direct
observation must approve of the progress note for the observed treatment service.
new text end
new text begin
(b) For a mental health rehabilitation worker qualified under section 245I.04, subdivision
14, paragraph (a), clause (2), item (i), treatment supervision in the first 2,000 hours of work
must at a minimum consist of:
new text end
new text begin
(1) monthly individual supervision; and
new text end
new text begin
(2) direct observation twice per month.
new text end
Sec. 8.
new text begin
[245I.07] PERSONNEL FILES.
new text end
new text begin
(a) For each staff person, a license holder must maintain a personnel file that includes:
new text end
new text begin
(1) verification of the staff person's qualifications required for the position including
training, education, practicum or internship agreement, licensure, and any other required
qualifications;
new text end
new text begin
(2) documentation related to the staff person's background study;
new text end
new text begin
(3) the hiring date of the staff person;
new text end
new text begin
(4) a description of the staff person's job responsibilities with the license holder;
new text end
new text begin
(5) the date that the staff person's specific duties and responsibilities became effective,
including the date that the staff person began having direct contact with clients;
new text end
new text begin
(6) documentation of the staff person's training as required by section 245I.05, subdivision
2;
new text end
new text begin
(7) a verification copy of license renewals that the staff person completed during the
staff person's employment;
new text end
new text begin
(8) annual job performance evaluations; and
new text end
new text begin
(9) if applicable, the staff person's alleged and substantiated violations of the license
holder's policies under section 245I.03, subdivision 8, clauses (3) to (7), and the license
holder's response.
new text end
new text begin
(b) The license holder must ensure that all personnel files are readily accessible for the
commissioner's review. The license holder is not required to keep personnel files in a single
location.
new text end
Sec. 9.
new text begin
[245I.08] DOCUMENTATION STANDARDS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must ensure that all documentation required
by this chapter complies with this section.
new text end
new text begin Subd. 2. new text end
new text begin Documentation standards. new text end
new text begin
A license holder must ensure that all documentation
required by this chapter:
new text end
new text begin
(1) is legible;
new text end
new text begin
(2) identifies the applicable client and staff person on each page; and
new text end
new text begin
(3) is signed and dated by the staff persons who provided services to the client or
completed the documentation, including the staff persons' credentials.
new text end
new text begin Subd. 3. new text end
new text begin Documenting approval. new text end
new text begin
A license holder must ensure that all diagnostic
assessments, functional assessments, level of care assessments, and treatment plans completed
by a clinical trainee or mental health practitioner contain documentation of approval by a
treatment supervisor within five business days of initial completion by the staff person under
treatment supervision.
new text end
new text begin Subd. 4. new text end
new text begin Progress notes. new text end
new text begin
A license holder must use a progress note to document each
occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
new text end
new text begin
(1) the type of service;
new text end
new text begin
(2) the date of service;
new text end
new text begin
(3) the start and stop time of the service unless the license holder is licensed as a
residential program;
new text end
new text begin
(4) the location of the service;
new text end
new text begin
(5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention; (iv) the staff person's plan to take future
actions, including changes in treatment that the staff person will implement if the intervention
was ineffective; and (v) the service modality;
new text end
new text begin
(6) the signature, printed name, and credentials of the staff person who provided the
service to the client;
new text end
new text begin
(7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
new text end
new text begin
(8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration record. new text end
new text begin
If a license holder administers or observes
a client self-administer medications, the license holder must maintain a medication
administration record for each client that contains the following, as applicable:
new text end
new text begin
(1) the client's date of birth;
new text end
new text begin
(2) the client's allergies;
new text end
new text begin
(3) all medication orders for the client, including client-specific orders for
over-the-counter medications and approved condition-specific protocols;
new text end
new text begin
(4) the name of each ordered medication, date of each medication's expiration, each
medication's dosage frequency, method of administration, and time;
new text end
new text begin
(5) the licensed prescriber's name and telephone number;
new text end
new text begin
(6) the date of initiation;
new text end
new text begin
(7) the signature, printed name, and credentials of the staff person who administered the
medication or observed the client self-administer the medication; and
new text end
new text begin
(8) the reason that the license holder did not administer the client's prescribed medication
or observe the client self-administer the client's prescribed medication.
new text end
Sec. 10.
new text begin
[245I.09] CLIENT FILES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must maintain a file for each client that
contains the client's current and accurate records. The license holder must store each client
file on the premises where the license holder provides or coordinates services for the client.
The license holder must ensure that all client files are readily accessible for the
commissioner's review. The license holder is not required to keep client files in a single
location.
new text end
new text begin
(b) The license holder must protect client records against loss, tampering, or unauthorized
disclosure of confidential client data according to the Minnesota Government Data Practices
Act, chapter 13; the privacy provisions of the Minnesota health care programs provider
agreement; the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
Public Law 104-191; and the Minnesota Health Records Act, sections 144.291 to 144.298.
new text end
new text begin Subd. 2. new text end
new text begin Record retention. new text end
new text begin
A license holder must retain client records of a discharged
client for a minimum of five years from the date of the client's discharge. A license holder
who ceases to provide treatment services to a client must retain the client's records for a
minimum of five years from the date that the license holder stopped providing services to
the client and must notify the commissioner of the location of the client records and the
name of the individual responsible for storing and maintaining the client records.
new text end
new text begin Subd. 3. new text end
new text begin Contents. new text end
new text begin
A license holder must retain a clear and complete record of the
information that the license holder receives regarding a client, and of the services that the
license holder provides to the client. If applicable, each client's file must include the following
information:
new text end
new text begin
(1) the client's screenings, assessments, and testing;
new text end
new text begin
(2) the client's treatment plans and reviews of the client's treatment plan;
new text end
new text begin
(3) the client's individual abuse prevention plans;
new text end
new text begin
(4) the client's health care directive under section 145C.01, subdivision 5a, and the
client's emergency contacts;
new text end
new text begin
(5) the client's crisis plans;
new text end
new text begin
(6) the client's consents for releases of information and documentation of the client's
releases of information;
new text end
new text begin
(7) the client's significant medical and health-related information;
new text end
new text begin
(8) a record of each communication that a staff person has with the client's other mental
health providers and persons interested in the client, including the client's case manager,
family members, primary caregiver, legal representatives, court representatives,
representatives from the correctional system, or school administration;
new text end
new text begin
(9) written information by the client that the client requests to include in the client's file;
and
new text end
new text begin
(10) the date of the client's discharge from the license holder's program, the reason that
the license holder discontinued services for the client, and the client's discharge summaries.
new text end
Sec. 11.
new text begin
[245I.10] ASSESSMENT AND TREATMENT PLANNING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Diagnostic formulation" means a written analysis and
explanation of a client's clinical assessment to develop a hypothesis about the cause and
nature of a client's presenting problems and to identify the most suitable approach for treating
the client.
new text end
new text begin
(b) "Responsivity factors" means the factors other than the diagnostic formulation that
may modify a client's treatment needs. This includes a client's learning style, abilities,
cognitive functioning, cultural background, and personal circumstances. When documenting
a client's responsivity factors a mental health professional or clinical trainee must include
an analysis of how a client's strengths are reflected in the license holder's plan to deliver
services to the client.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
new text end
new text begin
(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
new text end
new text begin
(1) an explanation of findings;
new text end
new text begin
(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
new text end
new text begin
(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
new text end
new text begin
(4) crisis assessment services according to section 256B.0624; and
new text end
new text begin
(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245.23, subdivision 7.
new text end
new text begin
(c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
new text end
new text begin
(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
new text end
new text begin
(2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
new text end
new text begin
(d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
new text end
new text begin
(e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
new text end
new text begin
(1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
new text end
new text begin
(2) up to five days of day treatment services or partial hospitalization.
new text end
new text begin
(f) A license holder must complete a new standard diagnostic assessment of a client:
new text end
new text begin
(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
new text end
new text begin
(2) at least annually following the client's initial diagnostic assessment if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
new text end
new text begin
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
new text end
new text begin
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
new text end
new text begin
(g) For an existing client, the license holder must ensure that a new standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client, and an update regarding what information has not significantly changed,
including a discussion with the client about changes in the client's life situation, functioning,
presenting problems, and progress with achieving treatment goals since the client's last
diagnostic assessment was completed.
new text end
new text begin Subd. 3. new text end
new text begin Continuity of services. new text end
new text begin
(a) For any client with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date
of this section, the diagnostic assessment is valid for authorizing the client's treatment and
billing for one calendar year after the date that the assessment was completed.
new text end
new text begin
(b) For any client with an individual treatment plan completed under section 256B.0622,
256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts 9505.0370 to
9505.0372, the client's treatment plan is valid for authorizing treatment and billing until the
treatment plan's expiration date.
new text end
new text begin
(c) This subdivision expires July 1, 2023.
new text end
new text begin Subd. 4. new text end
new text begin Diagnostic assessment. new text end
new text begin
A client's diagnostic assessment must: (1) identify at
least one mental health diagnosis for which the client meets the diagnostic criteria and
recommend mental health services to develop the client's mental health services and treatment
plan; or (2) include a finding that the client does not meet the criteria for a mental health
disorder.
new text end
new text begin Subd. 5. new text end
new text begin Brief diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or clinical trainee may complete a brief diagnostic assessment of a client. A
license holder may only use a brief diagnostic assessment for a client who is six years of
age or older.
new text end
new text begin
(b) When conducting a brief diagnostic assessment of a client, the assessor must complete
a face-to-face interview with the client and a written evaluation of the client. The assessor
must gather and document initial components of the client's standard diagnostic assessment,
including the client's:
new text end
new text begin
(1) age;
new text end
new text begin
(2) description of symptoms, including the reason for the client's referral;
new text end
new text begin
(3) history of mental health treatment;
new text end
new text begin
(4) cultural influences on the client; and
new text end
new text begin
(5) mental status examination.
new text end
new text begin
(c) Based on the initial components of the assessment, the assessor must develop a
provisional diagnostic formulation about the client. The assessor may use the client's
provisional diagnostic formulation to address the client's immediate needs and presenting
problems.
new text end
new text begin
(d) A mental health professional or clinical trainee may use treatment sessions with the
client authorized by a brief diagnostic assessment to gather additional information about
the client to complete the client's standard diagnostic assessment if the number of sessions
will exceed the coverage limits in subdivision 2.
new text end
new text begin Subd. 6. new text end
new text begin Standard diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
new text end
new text begin
(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
new text end
new text begin
(1) the client's age;
new text end
new text begin
(2) the client's current living situation, including the client's housing status and household
members;
new text end
new text begin
(3) the status of the client's basic needs;
new text end
new text begin
(4) the client's education level and employment status;
new text end
new text begin
(5) the client's current medications;
new text end
new text begin
(6) any immediate risks to the client's health and safety;
new text end
new text begin
(7) the client's perceptions of the client's condition;
new text end
new text begin
(8) the client's description of the client's symptoms, including the reason for the client's
referral;
new text end
new text begin
(9) the client's history of mental health treatment; and
new text end
new text begin
(10) cultural influences on the client.
new text end
new text begin
(c) If the assessor cannot obtain the information that this subdivision requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:
new text end
new text begin
(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
new text end
new text begin
(2) the client's strengths and resources, including the extent and quality of the client's
social networks;
new text end
new text begin
(3) important developmental incidents in the client's life;
new text end
new text begin
(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
new text end
new text begin
(5) the client's history of or exposure to alcohol and drug usage and treatment; and
new text end
new text begin
(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
new text end
new text begin
(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
new text end
new text begin
(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
new text end
new text begin
(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
new text end
new text begin
(3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.
new text end
new text begin
(4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.
new text end
new text begin
(5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.
new text end
new text begin
(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
new text end
new text begin
(1) the client's mental status examination;
new text end
new text begin
(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
new text end
new text begin
(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
new text end
new text begin
(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
new text end
new text begin Subd. 7. new text end
new text begin Individual treatment plan. new text end
new text begin
A license holder must follow each client's written
individual treatment plan when providing services to the client with the following exceptions:
new text end
new text begin
(1) services that do not require that a license holder completes a standard diagnostic
assessment of a client before providing services to the client;
new text end
new text begin
(2) when developing a service plan; and
new text end
new text begin
(3) when a client re-engages in services under subdivision 8, paragraph (b).
new text end
new text begin Subd. 8. new text end
new text begin Individual treatment plan; required elements. new text end
new text begin
(a) After completing a client's
diagnostic assessment and before providing services to the client, the license holder must
complete the client's individual treatment plan. The license holder must:
new text end
new text begin
(1) base the client's individual treatment plan on the client's diagnostic assessment and
baseline measurements;
new text end
new text begin
(2) for a child client, use a child-centered, family-driven, and culturally appropriate
planning process that allows the child's parents and guardians to observe and participate in
the child's individual and family treatment services, assessments, and treatment planning;
new text end
new text begin
(3) for an adult client, use a person-centered, culturally appropriate planning process
that allows the client's family and other natural supports to observe and participate in the
client's treatment services, assessments, and treatment planning;
new text end
new text begin
(4) identify the client's treatment goals, measureable treatment objectives, a schedule
for accomplishing the client's treatment goals and objectives, a treatment strategy, and the
individuals responsible for providing treatment services and supports to the client. The
license holder must have a treatment strategy to engage the client in treatment if the client:
new text end
new text begin
(i) has a history of not engaging in treatment; and
new text end
new text begin
(ii) is ordered by a court to participate in treatment services or to take neuroleptic
medications;
new text end
new text begin
(5) identify the participants involved in the client's treatment planning. The client must
be a participant in the client's treatment planning. If applicable, the license holder must
document the reasons that the license holder did not involve the client's family or other
natural supports in the client's treatment planning;
new text end
new text begin
(6) review the client's individual treatment plan every 180 days and update the client's
individual treatment plan with the client's treatment progress, new treatment objectives and
goals or, if the client has not made treatment progress, changes in the license holder's
approach to treatment; and
new text end
new text begin
(7) ensure that the client approves of the client's individual treatment plan unless a court
orders the client's treatment plan under chapter 253B.
new text end
new text begin
(b) If the client disagrees with the client's treatment plan, the license holder must
document in the client file the reasons why the client does not agree with the treatment plan.
If the license holder cannot obtain the client's approval of the treatment plan, a mental health
professional must make efforts to obtain approval from a person who is authorized to consent
on the client's behalf within 30 days after the client's previous individual treatment plan
expired. A license holder may not deny a client service during this time period solely because
the license holder could not obtain the client's approval of the client's individual treatment
plan. A license holder may continue to bill for the client's otherwise eligible services when
the client re-engages in services.
new text end
new text begin Subd. 9. new text end
new text begin Functional assessment; required elements. new text end
new text begin
When a license holder is
completing a functional assessment for an adult client, the license holder must:
new text end
new text begin
(1) complete a functional assessment of the client after completing the client's diagnostic
assessment;
new text end
new text begin
(2) use a collaborative process that allows the client and the client's family and other
natural supports, the client's referral sources, and the client's providers to provide information
about how the client's symptoms of mental illness impact the client's functioning;
new text end
new text begin
(3) if applicable, document the reasons that the license holder did not contact the client's
family and other natural supports;
new text end
new text begin
(4) assess and document how the client's symptoms of mental illness impact the client's
functioning in the following areas:
new text end
new text begin
(i) the client's mental health symptoms;
new text end
new text begin
(ii) the client's mental health service needs;
new text end
new text begin
(iii) the client's substance use;
new text end
new text begin
(iv) the client's vocational and educational functioning;
new text end
new text begin
(v) the client's social functioning, including the use of leisure time;
new text end
new text begin
(vi) the client's interpersonal functioning, including relationships with the client's family
and other natural supports;
new text end
new text begin
(vii) the client's ability to provide self-care and live independently;
new text end
new text begin
(viii) the client's medical and dental health;
new text end
new text begin
(ix) the client's financial assistance needs; and
new text end
new text begin
(x) the client's housing and transportation needs;
new text end
new text begin
(5) include a narrative summarizing the client's strengths, resources, and all areas of
functional impairment;
new text end
new text begin
(6) complete the client's functional assessment before the client's initial individual
treatment plan unless a service specifies otherwise; and
new text end
new text begin
(7) update the client's functional assessment with the client's current functioning whenever
there is a significant change in the client's functioning or at least every 180 days, unless a
service specifies otherwise.
new text end
Sec. 12.
new text begin
[245I.11] HEALTH SERVICES AND MEDICATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
If a license holder is licensed as a residential program, stores
or administers client medications, or observes clients self-administer medications, the license
holder must ensure that a staff person who is a registered nurse or licensed prescriber is
responsible for overseeing storage and administration of client medications and observing
as a client self-administers medications, including training according to section 245I.05,
subdivision 6, and documenting the occurrence according to section 245I.08, subdivision
5.
new text end
new text begin Subd. 2. new text end
new text begin Health services. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must:
new text end
new text begin
(1) ensure that a client is screened for health issues within 72 hours of the client's
admission;
new text end
new text begin
(2) monitor the physical health needs of each client on an ongoing basis;
new text end
new text begin
(3) offer referrals to clients and coordinate each client's care with psychiatric and medical
services;
new text end
new text begin
(4) identify circumstances in which a staff person must notify a registered nurse or
licensed prescriber of any of a client's health concerns and the process for providing
notification of client health concerns; and
new text end
new text begin
(5) identify the circumstances in which the license holder must obtain medical care for
a client and the process for obtaining medical care for a client.
new text end
new text begin Subd. 3. new text end
new text begin Storing and accounting for medications. new text end
new text begin
(a) If a license holder stores client
medications, the license holder must:
new text end
new text begin
(1) store client medications in original containers in a locked location;
new text end
new text begin
(2) store refrigerated client medications in special trays or containers that are separate
from food;
new text end
new text begin
(3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;
new text end
new text begin
(4) store Schedule II to IV drugs listed in section 152.02, subdivisions 3 to 5, in a
compartment that is locked separately from other medications;
new text end
new text begin
(5) ensure that only authorized staff persons have access to stored client medications;
new text end
new text begin
(6) follow a documentation procedure on each shift to account for all scheduled drugs;
and
new text end
new text begin
(7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.
new text end
new text begin
(b) If a license holder is licensed as a residential program, the license holder must allow
clients who self-administer medications to keep a private medication supply. The license
holder must ensure that the client stores all private medication in a locked container in the
client's private living area, unless the private medication supply poses a health and safety
risk to any clients. A client must not maintain a private medication supply of a prescription
medication without a written medication order from a licensed prescriber and a prescription
label that includes the client's name.
new text end
new text begin Subd. 4. new text end
new text begin Medication orders. new text end
new text begin
(a) If a license holder stores, prescribes, or administers
medications or observes a client self-administer medications, the license holder must:
new text end
new text begin
(1) ensure that a licensed prescriber writes all orders to accept, administer, or discontinue
client medications;
new text end
new text begin
(2) accept nonwritten orders to administer client medications in emergency circumstances
only;
new text end
new text begin
(3) establish a timeline and process for obtaining a written order with the licensed
prescriber's signature when the license holder accepts a nonwritten order to administer client
medications;
new text end
new text begin
(4) obtain prescription medication renewals from a licensed prescriber for each client
every 90 days for psychotropic medications and annually for all other medications; and
new text end
new text begin
(5) maintain the client's right to privacy and dignity.
new text end
new text begin
(b) If a license holder employs a licensed prescriber, the license holder must inform the
client about potential medication effects and side effects and obtain and document the client's
informed consent before the licensed prescriber prescribes a medication.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration. new text end
new text begin
If a license holder is licensed as a residential
program, the license holder must:
new text end
new text begin
(1) assess and document each client's ability to self-administer medication. In the
assessment, the license holder must evaluate the client's ability to: (i) comply with prescribed
medication regimens; and (ii) store the client's medications safely and in a manner that
protects other individuals in the facility. Through the assessment process, the license holder
must assist the client in developing the skills necessary to safely self-administer medication;
new text end
new text begin
(2) monitor the effectiveness of medications, side effects of medications, and adverse
reactions to medications for each client. The license holder must address and document any
concerns about a client's medications;
new text end
new text begin
(3) ensure that no staff person or client gives a legend drug supply for one client to
another client;
new text end
new text begin
(4) have policies and procedures for: (i) keeping a record of each client's medication
orders; (ii) keeping a record of any incident of deferring a client's medications; (iii)
documenting any incident when a client's medication is omitted; and (iv) documenting when
a client refuses to take medications as prescribed; and
new text end
new text begin
(5) document and track medication errors, document whether the license holder notified
anyone about the medication error, determine if the license holder must take any follow-up
actions, and identify the staff persons who are responsible for taking follow-up actions.
new text end
Sec. 13.
new text begin
[245I.12] CLIENT RIGHTS AND PROTECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Client rights. new text end
new text begin
A license holder must ensure that all clients have the
following rights:
new text end
new text begin
(1) the rights listed in the health care bill of rights in section 144.651;
new text end
new text begin
(2) the right to be free from discrimination based on age, race, color, creed, religion,
national origin, gender, marital status, disability, sexual orientation, and status with regard
to public assistance. The license holder must follow all applicable state and federal laws
including the Minnesota Human Rights Act, chapter 363A; and
new text end
new text begin
(3) the right to be informed prior to a photograph or audio or video recording being made
of the client. The client has the right to refuse to allow any recording or photograph of the
client that is not for the purposes of identification or supervision by the license holder.
new text end
new text begin Subd. 2. new text end
new text begin Restrictions to client rights. new text end
new text begin
If the license holder restricts a client's right, the
license holder must document in the client file a mental health professional's approval of
the restriction and the reasons for the restriction.
new text end
new text begin Subd. 3. new text end
new text begin Notice of rights. new text end
new text begin
The license holder must give a copy of the client's rights
according to this section to each client on the day of the client's admission. The license
holder must document that the license holder gave a copy of the client's rights to each client
on the day of the client's admission according to this section. The license holder must post
a copy of the client rights in an area visible or accessible to all clients. The license holder
must include the client rights in Minnesota Rules, chapter 9544, for applicable clients.
new text end
new text begin Subd. 4. new text end
new text begin Client property. new text end
new text begin
(a) The license holder must meet the requirements of section
245A.04, subdivision 13.
new text end
new text begin
(b) If the license holder is unable to obtain a client's signature acknowledging the receipt
or disbursement of the client's funds or property required by section 245A.04, subdivision
13, paragraph (c), clause (1), two staff persons must sign documentation acknowledging
that the staff persons witnessed the client's receipt or disbursement of the client's funds or
property.
new text end
new text begin
(c) The license holder must return all of the client's funds and other property to the client
except for the following items:
new text end
new text begin
(1) illicit drugs, drug paraphernalia, and drug containers that are subject to forfeiture
under section 609.5316. The license holder must give illicit drugs, drug paraphernalia, and
drug containers to a local law enforcement agency or destroy the items; and
new text end
new text begin
(2) weapons, explosives, and other property that may cause serious harm to the client
or others. The license holder may give a client's weapons and explosives to a local law
enforcement agency. The license holder must notify the client that a local law enforcement
agency has the client's property and that the client has the right to reclaim the property if
the client has a legal right to possess the item.
new text end
new text begin
(d) If a client leaves the license holder's program but abandons the client's funds or
property, the license holder must retain and store the client's funds or property, including
medications, for a minimum of 30 days after the client's discharge from the program.
new text end
new text begin Subd. 5. new text end
new text begin Client grievances. new text end
new text begin
(a) The license holder must have a grievance procedure
that:
new text end
new text begin
(1) describes to clients how the license holder will meet the requirements in this
subdivision; and
new text end
new text begin
(2) contains the current public contact information of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health, Office of Health Facilities Complaints; and all
applicable health-related licensing boards.
new text end
new text begin
(b) On the day of each client's admission, the license holder must explain the grievance
procedure to the client.
new text end
new text begin
(c) The license holder must:
new text end
new text begin
(1) post the grievance procedure in a place visible to clients and provide a copy of the
grievance procedure upon request;
new text end
new text begin
(2) allow clients, former clients, and their authorized representatives to submit a grievance
to the license holder;
new text end
new text begin
(3) within three business days of receiving a client's grievance, acknowledge in writing
that the license holder received the client's grievance. If applicable, the license holder must
include a notice of the client's separate appeal rights for a managed care organization's
reduction, termination, or denial of a covered service;
new text end
new text begin
(4) within 15 business days of receiving a client's grievance, provide a written final
response to the client's grievance containing the license holder's official response to the
grievance; and
new text end
new text begin
(5) allow the client to bring a grievance to the person with the highest level of authority
in the program.
new text end
Sec. 14.
new text begin
[245I.13] CRITICAL INCIDENTS.
new text end
new text begin
If a license holder is licensed as a residential program, the license holder must report all
critical incidents to the commissioner within ten days of learning of the incident on a form
approved by the commissioner. The license holder must keep a record of critical incidents
in a central location that is readily accessible to the commissioner for review upon the
commissioner's request for a minimum of two licensing periods.
new text end
Sec. 15.
new text begin
[245I.20] MENTAL HEALTH CLINIC.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
Certified mental health clinics provide clinical services for the
treatment of mental illnesses with a treatment team that reflects multiple disciplines and
areas of expertise.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical services" means services provided to a client to
diagnose, describe, predict, and explain the client's status relative to a condition or problem
as described in the: (1) current edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association; or (2) current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood published by Zero to Three. Where necessary, clinical services includes
services to treat a client to reduce the client's impairment due to the client's condition.
Clinical services also includes individual treatment planning, case review, record-keeping
required for a client's treatment, and treatment supervision. For the purposes of this section,
clinical services excludes services delivered to a client under a separate license and services
listed under section 245I.011, subdivision 5.
new text end
new text begin
(b) "Competent" means having professional education, training, continuing education,
consultation, supervision, experience, or a combination thereof necessary to demonstrate
sufficient knowledge of and proficiency in a specific clinical service.
new text end
new text begin
(c) "Discipline" means a branch of professional knowledge or skill acquired through a
specific course of study, training, and supervised practice. Discipline is usually documented
by a specific educational degree, licensure, or certification of proficiency. Examples of the
mental health disciplines include but are not limited to psychiatry, psychology, clinical
social work, marriage and family therapy, clinical counseling, and psychiatric nursing.
new text end
new text begin
(d) "Treatment team" means the mental health professionals, mental health practitioners,
and clinical trainees who provide clinical services to clients.
new text end
new text begin Subd. 3. new text end
new text begin Organizational structure. new text end
new text begin
(a) A mental health clinic location must be an entire
facility or a clearly identified unit within a facility that is administratively and clinically
separate from the rest of the facility. The mental health clinic location may provide services
other than clinical services to clients, including medical services, substance use disorder
services, social services, training, and education.
new text end
new text begin
(b) The certification holder must notify the commissioner of all mental health clinic
locations. If there is more than one mental health clinic location, the certification holder
must designate one location as the main location and all of the other locations as satellite
locations. The main location as a unit and the clinic as a whole must comply with the
minimum staffing standards in subdivision 4.
new text end
new text begin
(c) The certification holder must ensure that each satellite location:
new text end
new text begin
(1) adheres to the same policies and procedures as the main location;
new text end
new text begin
(2) provides treatment team members with face-to-face or telephone access to a mental
health professional for the purposes of supervision whenever the satellite location is open.
The certification holder must maintain a schedule of the mental health professionals who
will be available and the contact information for each available mental health professional.
The schedule must be current and readily available to treatment team members; and
new text end
new text begin
(3) enables clients to access all of the mental health clinic's clinical services and treatment
team members, as needed.
new text end
new text begin Subd. 4. new text end
new text begin Minimum staffing standards. new text end
new text begin
(a) A certification holder's treatment team must
consist of at least four mental health professionals. At least two of the mental health
professionals must be employed by or under contract with the mental health clinic for a
minimum of 35 hours per week each. Each of the two mental health professionals must
specialize in a different mental health discipline.
new text end
new text begin
(b) The treatment team must include:
new text end
new text begin
(1) a physician qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (4), or a nurse qualified as a mental health professional according to
section 245I.04, subdivision 2, clause (1); and
new text end
new text begin
(2) a psychologist qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (3).
new text end
new text begin
(c) The staff persons fulfilling the requirement in paragraph (b) must provide clinical
services at least:
new text end
new text begin
(1) eight hours every two weeks if the mental health clinic has over 25.0 full-time
equivalent treatment team members;
new text end
new text begin
(2) eight hours each month if the mental health clinic has 15.1 to 25.0 full-time equivalent
treatment team members;
new text end
new text begin
(3) four hours each month if the mental health clinic has 5.1 to 15.0 full-time equivalent
treatment team members; or
new text end
new text begin
(4) two hours each month if the mental health clinic has 2.0 to 5.0 full-time equivalent
treatment team members or only provides in-home services to clients.
new text end
new text begin
(d) The certification holder must maintain a record that demonstrates compliance with
this subdivision.
new text end
new text begin Subd. 5. new text end
new text begin Treatment supervision specified. new text end
new text begin
(a) A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
new text end
new text begin
(b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must complete a case review of each client assigned
to the mental health professional when the client is receiving clinical services from a mental
health practitioner or clinical trainee. The case review must include a consultation process
that thoroughly examines the client's condition and treatment, including: (1) a review of the
client's reason for seeking treatment, diagnoses and assessments, and the individual treatment
plan; (2) a review of the appropriateness, duration, and outcome of treatment provided to
the client; and (3) treatment recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures required by section 245I.03, the certification holder must establish, enforce,
and maintain the policies and procedures required by this subdivision.
new text end
new text begin
(b) The certification holder must have a clinical evaluation procedure to identify and
document each treatment team member's areas of competence.
new text end
new text begin
(c) The certification holder must have policies and procedures for client intake and case
assignment that:
new text end
new text begin
(1) outline the client intake process;
new text end
new text begin
(2) describe how the mental health clinic determines the appropriateness of accepting a
client into treatment by reviewing the client's condition and need for treatment, the clinical
services that the mental health clinic offers to clients, and other available resources; and
new text end
new text begin
(3) contain a process for assigning a client's case to a mental health professional who is
responsible for the client's case and other treatment team members.
new text end
new text begin Subd. 7. new text end
new text begin Referrals. new text end
new text begin
If necessary treatment for a client or treatment desired by a client
is not available at the mental health clinic, the certification holder must facilitate appropriate
referrals for the client. When making a referral for a client, the treatment team member must
document a discussion with the client that includes: (1) the reason for the client's referral;
(2) potential treatment resources for the client; and (3) the client's response to receiving a
referral.
new text end
new text begin Subd. 8. new text end
new text begin Emergency service. new text end
new text begin
For the certification holder's telephone numbers that clients
regularly access, the certification holder must include the contact information for the area's
mental health crisis services as part of the certification holder's message when a live operator
is not available to answer clients' calls.
new text end
new text begin Subd. 9. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) At a minimum, a certification
holder must develop a written quality assurance and improvement plan that includes a plan
for:
new text end
new text begin
(1) encouraging ongoing consultation among members of the treatment team;
new text end
new text begin
(2) obtaining and evaluating feedback about services from clients, family and other
natural supports, referral sources, and staff persons;
new text end
new text begin
(3) measuring and evaluating client outcomes;
new text end
new text begin
(4) reviewing client suicide deaths and suicide attempts;
new text end
new text begin
(5) examining the quality of clinical service delivery to clients; and
new text end
new text begin
(6) self-monitoring of compliance with this chapter.
new text end
new text begin
(b) At least annually, the certification holder must review, evaluate, and update the
quality assurance and improvement plan. The review must: (1) include documentation of
the actions that the certification holder will take as a result of information obtained from
monitoring activities in the plan; and (2) establish goals for improved service delivery to
clients for the next year.
new text end
new text begin Subd. 10. new text end
new text begin Application procedures. new text end
new text begin
(a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.
new text end
new text begin
(b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
new text end
new text begin
(c) The commissioner must act on an application within 90 working days of receiving
a completed application.
new text end
new text begin
(d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
new text end
new text begin
(e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail or personal service.
In the notice of denial, the commissioner must state the reasons that the commissioner denied
the application and must inform the applicant of the applicant's right to request a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
applicant may appeal the denial by notifying the commissioner in writing by certified mail
or personal service. If mailed, the appeal must be postmarked and sent to the commissioner
within 20 calendar days after the applicant received the notice of denial. If an applicant
delivers an appeal by personal service, the commissioner must receive the appeal within 20
calendar days after the applicant received the notice of denial.
new text end
new text begin Subd. 11. new text end
new text begin Commissioner's right of access. new text end
new text begin
(a) When the commissioner is exercising
the powers conferred to the commissioner by this chapter, if the mental health clinic is in
operation and the information is relevant to the commissioner's inspection or investigation,
the certification holder must provide the commissioner access to:
new text end
new text begin
(1) the physical facility and grounds where the program is located;
new text end
new text begin
(2) documentation and records, including electronically maintained records;
new text end
new text begin
(3) clients served by the mental health clinic;
new text end
new text begin
(4) staff persons of the mental health clinic; and
new text end
new text begin
(5) personnel records of current and former staff of the mental health clinic.
new text end
new text begin
(b) The certification holder must provide the commissioner with access to the facility
and grounds, documentation and records, clients, and staff without prior notice and as often
as the commissioner considers necessary if the commissioner is investigating alleged
maltreatment or a violation of a law or rule, or conducting an inspection. When conducting
an inspection, the commissioner may request and must receive assistance from other state,
county, and municipal governmental agencies and departments. The applicant or certification
holder must allow the commissioner, at the commissioner's expense, to photocopy,
photograph, and make audio and video recordings during an inspection.
new text end
new text begin Subd. 12. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) The commissioner may conduct a certification
review of the certified mental health clinic every two years to determine the certification
holder's compliance with applicable rules and statutes.
new text end
new text begin
(b) The commissioner must offer the certification holder a choice of dates for an
announced certification review. A certification review must occur during the clinic's normal
working hours.
new text end
new text begin
(c) The commissioner must make the results of certification reviews and investigations
publicly available on the department's website.
new text end
new text begin Subd. 13. new text end
new text begin Correction orders. new text end
new text begin
(a) If the applicant or certification holder fails to comply
with a law or rule, the commissioner may issue a correction order. The correction order
must state:
new text end
new text begin
(1) the condition that constitutes a violation of the law or rule;
new text end
new text begin
(2) the specific law or rule that the applicant or certification holder has violated; and
new text end
new text begin
(3) the time that the applicant or certification holder is allowed to correct each violation.
new text end
new text begin
(b) If the applicant or certification holder believes that the commissioner's correction
order is erroneous, the applicant or certification holder may ask the commissioner to
reconsider the part of the correction order that is allegedly erroneous. An applicant or
certification holder must make a request for reconsideration in writing. The request must
be postmarked and sent to the commissioner within 20 calendar days after the applicant or
certification holder received the correction order; and the request must:
new text end
new text begin
(1) specify the part of the correction order that is allegedly erroneous;
new text end
new text begin
(2) explain why the specified part is erroneous; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
(c) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
new text end
new text begin
(d) If the commissioner finds that the applicant or certification holder failed to correct
the violation specified in the correction order, the commissioner may decertify the certified
mental health clinic according to subdivision 14.
new text end
new text begin
(e) Nothing in this subdivision prohibits the commissioner from decertifying a mental
health clinic according to subdivision 14.
new text end
new text begin Subd. 14. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner may decertify a mental health clinic
if a certification holder:
new text end
new text begin
(1) failed to comply with an applicable law or rule; or
new text end
new text begin
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, during an
investigation, or regarding compliance with applicable laws or rules.
new text end
new text begin
(b) When considering decertification of a mental health clinic, the commissioner must
consider the nature, chronicity, or severity of the violation of law or rule and the effect of
the violation on the health, safety, or rights of clients.
new text end
new text begin
(c) If the commissioner decertifies a mental health clinic, the order of decertification
must inform the certification holder of the right to have a contested case hearing under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The certification holder
may appeal the decertification. The certification holder must appeal a decertification in
writing and send or deliver the appeal to the commissioner by certified mail or personal
service. If the certification holder mails the appeal, the appeal must be postmarked and sent
to the commissioner within ten calendar days after the certification holder receives the order
of decertification. If the certification holder delivers an appeal by personal service, the
commissioner must receive the appeal within ten calendar days after the certification holder
received the order. If a certification holder submits a timely appeal of an order of
decertification, the certification holder may continue to operate the program until the
commissioner issues a final order on the decertification.
new text end
new text begin
(d) If the commissioner decertifies a mental health clinic pursuant to paragraph (a),
clause (1), based on a determination that the mental health clinic was responsible for
maltreatment, and if the certification holder appeals the decertification according to paragraph
(c), and appeals the maltreatment determination under section 260E.33, the final
decertification determination is stayed until the commissioner issues a final decision regarding
the maltreatment appeal.
new text end
new text begin Subd. 15. new text end
new text begin Transfer prohibited. new text end
new text begin
A certification issued under this section is only valid
for the premises and the individual, organization, or government entity identified by the
commissioner on the certification. A certification is not transferable or assignable.
new text end
new text begin Subd. 16. new text end
new text begin Notifications required and noncompliance. new text end
new text begin
(a) A certification holder must
notify the commissioner, in a manner prescribed by the commissioner, and obtain the
commissioner's approval before making any change to the name of the certification holder
or the location of the mental health clinic.
new text end
new text begin
(b) Changes in mental health clinic organization, staffing, treatment, or quality assurance
procedures that affect the ability of the certification holder to comply with the minimum
standards of this section must be reported in writing by the certification holder to the
commissioner within 15 days of the occurrence. Review of the change must be conducted
by the commissioner. A certification holder with changes resulting in noncompliance in
minimum standards must receive written notice and may have up to 180 days to correct the
areas of noncompliance before being decertified. Interim procedures to resolve the
noncompliance on a temporary basis must be developed and submitted in writing to the
commissioner for approval within 30 days of the commissioner's determination of the
noncompliance. Not reporting an occurrence of a change that results in noncompliance
within 15 days, failure to develop an approved interim procedure within 30 days of the
determination of the noncompliance, or nonresolution of the noncompliance within 180
days will result in immediate decertification.
new text end
new text begin
(c) The mental health clinic may be required to submit written information to the
department to document that the mental health clinic has maintained compliance with this
section and mental health clinic procedures.
new text end
Sec. 16.
new text begin
[245I.23] INTENSIVE RESIDENTIAL TREATMENT SERVICES AND
RESIDENTIAL CRISIS STABILIZATION.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) Intensive residential treatment services is a community-based
medically monitored level of care for an adult client that uses established rehabilitative
principles to promote a client's recovery and to develop and achieve psychiatric stability,
personal and emotional adjustment, self-sufficiency, and other skills that help a client
transition to a more independent setting.
new text end
new text begin
(b) Residential crisis stabilization provides structure and support to an adult client in a
community living environment when a client has experienced a mental health crisis and
needs short-term services to ensure that the client can safely return to the client's home or
precrisis living environment with additional services and supports identified in the client's
crisis assessment.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Program location" means a set of rooms that are each physically
self-contained and have defining walls extending from floor to ceiling. Program location
includes bedrooms, living rooms or lounge areas, bathrooms, and connecting areas.
new text end
new text begin
(b) "Treatment team" means a group of staff persons who provide intensive residential
treatment services or residential crisis stabilization to clients. The treatment team includes
mental health professionals, mental health practitioners, clinical trainees, certified
rehabilitation specialists, mental health rehabilitation workers, and mental health certified
peer specialists.
new text end
new text begin Subd. 3. new text end
new text begin Treatment services description. new text end
new text begin
The license holder must describe in writing
all treatment services that the license holder provides. The license holder must have the
description readily available for the commissioner upon the commissioner's request.
new text end
new text begin Subd. 4. new text end
new text begin Required intensive residential treatment services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's treatment plan to provide intensive residential treatment
services to the client to improve the client'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 each client:
new text end
new text begin
(1) rehabilitative mental health services;
new text end
new text begin
(2) crisis prevention planning to assist a client with:
new text end
new text begin
(i) identifying and addressing patterns in the client's history and experience of the client's
mental illness; and
new text end
new text begin
(ii) developing crisis prevention strategies that include de-escalation strategies that have
been effective for the client in the past;
new text end
new text begin
(3) health services and administering medication;
new text end
new text begin
(4) co-occurring substance use disorder treatment;
new text end
new text begin
(5) engaging the client's family and other natural supports in the client's treatment and
educating the client's family and other natural supports to strengthen the client's social and
family relationships; and
new text end
new text begin
(6) making referrals for the client to other service providers in the community and
supporting the client's transition from intensive residential treatment services to another
setting.
new text end
new text begin
(c) The license holder must include Illness Management and Recovery (IMR), Enhanced
Illness Management and Recovery (E-IMR), or other similar interventions in the license
holder's programming as approved by the commissioner.
new text end
new text begin Subd. 5. new text end
new text begin Required residential crisis stabilization services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's individual crisis treatment plan to provide services to
the client in residential crisis stabilization to improve the client'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 the client:
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) rehabilitative mental health services;
new text end
new text begin
(3) health services and administering the client's medications; and
new text end
new text begin
(4) making referrals for the client to other service providers in the community and
supporting the client's transition from residential crisis stabilization to another setting.
new text end
new text begin Subd. 6. new text end
new text begin Optional treatment services. new text end
new text begin
(a) If the license holder offers additional treatment
services to a client, the treatment service must be:
new text end
new text begin
(1) approved by the commissioner; and
new text end
new text begin
(2)(i) a mental health evidence-based practice that the federal Department of Health and
Human Services Substance Abuse and Mental Health Service Administration has adopted;
new text end
new text begin
(ii) a nationally recognized mental health service that substantial research has validated
as effective in helping individuals with serious mental illness achieve treatment goals; or
new text end
new text begin
(iii) developed under state-sponsored research of publicly funded mental health programs
and validated to be effective for individuals, families, and communities.
new text end
new text begin
(b) Before providing an optional treatment service to a client, the license holder must
provide adequate training to a staff person about providing the optional treatment service
to a client.
new text end
new text begin Subd. 7. new text end
new text begin
Intensive residential treatment services assessment and treatment
planning.
new text end
new text begin
(a) Within 12 hours of a client's admission, the license holder must evaluate and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of the client's admission, the license holder must complete an initial
treatment plan for the client. The license holder must:
new text end
new text begin
(1) base the client's initial treatment plan on the client's referral information and an
assessment of the client's immediate needs;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the client in the past;
new text end
new text begin
(3) identify the client's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the client engage in treatment;
new text end
new text begin
(4) identify the participants involved in the client's treatment planning. The client must
be a participant; and
new text end
new text begin
(5) ensure that a treatment supervisor approves of the client's initial treatment plan if a
mental health practitioner or clinical trainee completes the client's treatment plan,
notwithstanding section 245I.08, subdivision 3.
new text end
new text begin
(c) According to section 245A.65, subdivision 2, paragraph (b), the license holder must
complete an individual abuse prevention plan as part of a client's initial treatment plan.
new text end
new text begin
(d) Within five days of the client's admission and again within 60 days after the client's
admission, the license holder must complete a level of care assessment of the client. If the
license holder determines that a client does not need a medically monitored level of service,
a treatment supervisor must document how the client's admission to and continued services
in intensive residential treatment services are medically necessary for the client.
new text end
new text begin
(e) Within ten days of a client's admission, the license holder must complete or review
and update the client's standard diagnostic assessment.
new text end
new text begin
(f) Within ten days of a client's admission, the license holder must complete the client's
individual treatment plan, notwithstanding section 245I.10, subdivision 8. Within 40 days
after the client's admission and again within 70 days after the client's admission, the license
holder must update the client's individual treatment plan. The license holder must focus the
client's treatment planning on preparing the client for a successful transition from intensive
residential treatment services to another setting. In addition to the required elements of an
individual treatment plan under section 245I.10, subdivision 8, the license holder must
identify the following information in the client's individual treatment plan: (1) the client's
referrals and resources for the client's health and safety; and (2) the staff persons who are
responsible for following up with the client's referrals and resources. If the client does not
receive a referral or resource that the client needs, the license holder must document the
reason that the license holder did not make the referral or did not connect the client to a
particular resource. The license holder is responsible for determining whether additional
follow-up is required on behalf of the client.
new text end
new text begin
(g) Within 30 days of the client's admission, the license holder must complete a functional
assessment of the client. Within 60 days after the client's admission, the license holder must
update the client's functional assessment to include any changes in the client's functioning
and symptoms.
new text end
new text begin
(h) For a client with a current substance use disorder diagnosis and for a client whose
substance use disorder screening in the client's standard diagnostic assessment indicates the
possibility that the client has a substance use disorder, the license holder must complete a
written assessment of the client's substance use within 30 days of the client's admission. In
the substance use assessment, the license holder must: (1) evaluate the client's history of
substance use, relapses, and hospitalizations related to substance use; (2) assess the effects
of the client's substance use on the client's relationships including with family member and
others; (3) identify financial problems, health issues, housing instability, and unemployment;
(4) assess the client's legal problems, past and pending incarceration, violence, and
victimization; and (5) evaluate the client's suicide attempts, noncompliance with taking
prescribed medications, and noncompliance with psychosocial treatment.
new text end
new text begin
(i) On a weekly basis, a mental health professional or certified rehabilitation specialist
must review each client's treatment plan and individual abuse prevention plan. The license
holder must document in the client's file each weekly review of the client's treatment plan
and individual abuse prevention plan.
new text end
new text begin Subd. 8. new text end
new text begin Residential crisis stabilization assessment and treatment planning. new text end
new text begin
(a)
Within 12 hours of a client's admission, the license holder must evaluate the client and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of a client's admission, the license holder must complete a crisis
treatment plan for the client under section 256B.0624, subdivision 11. The license holder
must base the client's crisis treatment plan on the client's referral information and an
assessment of the client's immediate needs.
new text end
new text begin
(c) Section 245A.65, subdivision 2, paragraph (b), requires the license holder to complete
an individual abuse prevention plan for a client as part of the client's crisis treatment plan.
new text end
new text begin Subd. 9. new text end
new text begin Key staff positions. new text end
new text begin
(a) The license holder must have a staff person assigned
to each of the following key staff positions at all times:
new text end
new text begin
(1) a program director who qualifies as a mental health practitioner. The license holder
must designate the program director as responsible for all aspects of the operation of the
program and the program's compliance with all applicable requirements. The program
director must know and understand the implications of this chapter; chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; Minnesota Rules, chapter 9544; and all other
applicable requirements. The license holder must document in the program director's
personnel file how the program director demonstrates knowledge of these requirements.
The program director may also serve as the treatment director of the program, if qualified;
new text end
new text begin
(2) a treatment director who qualifies as a mental health professional. The treatment
director must be responsible for overseeing treatment services for clients and the treatment
supervision of all staff persons; and
new text end
new text begin
(3) a registered nurse who qualifies as a mental health practitioner. The registered nurse
must:
new text end
new text begin
(i) work at the program location a minimum of eight hours per week;
new text end
new text begin
(ii) provide monitoring and supervision of staff persons as defined in section 148.171,
subdivisions 8a and 23;
new text end
new text begin
(iii) be responsible for the review and approval of health service and medication policies
and procedures under section 245I.03, subdivision 5; and
new text end
new text begin
(iv) oversee the license holder's provision of health services to clients, medication storage,
and medication administration to clients.
new text end
new text begin
(b) Within five business days of a change in a key staff position, the license holder must
notify the commissioner of the staffing change. The license holder must notify the
commissioner of the staffing change on a form approved by the commissioner and include
the name of the staff person now assigned to the key staff position and the staff person's
qualifications.
new text end
new text begin Subd. 10. new text end
new text begin Minimum treatment team staffing levels and ratios. new text end
new text begin
(a) The license holder
must maintain a treatment team staffing level sufficient to:
new text end
new text begin
(1) provide continuous daily coverage of all shifts;
new text end
new text begin
(2) follow each client's treatment plan and meet each client's needs as identified in the
client's treatment plan;
new text end
new text begin
(3) implement program requirements; and
new text end
new text begin
(4) safely monitor and guide the activities of each client, taking into account the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerabilities.
new text end
new text begin
(b) The license holder must ensure that treatment team members:
new text end
new text begin
(1) remain awake during all work hours; and
new text end
new text begin
(2) are available to monitor and guide the activities of each client whenever clients are
present in the program.
new text end
new text begin
(c) On each shift, the license holder must maintain a treatment team staffing ratio of at
least one treatment team member to nine clients. If the license holder is serving nine or
fewer clients, at least one treatment team member on the day shift must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
If the license holder is serving more than nine clients, at least one of the treatment team
members working during both the day and evening shifts must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
new text end
new text begin
(d) If the license holder provides residential crisis stabilization to clients and is serving
at least one client in residential crisis stabilization and more than four clients in residential
crisis stabilization and intensive residential treatment services, the license holder must
maintain a treatment team staffing ratio on each shift of at least two treatment team members
during the client's first 48 hours in residential crisis stabilization.
new text end
new text begin Subd. 11. new text end
new text begin Shift exchange. new text end
new text begin
A license holder must ensure that treatment team members
working on different shifts exchange information about a client as necessary to effectively
care for the client and to follow and update a client's treatment plan and individual abuse
prevention plan.
new text end
new text begin Subd. 12. new text end
new text begin Daily documentation. new text end
new text begin
(a) For each day that a client is present in the program,
the license holder must provide a daily summary in the client's file that includes observations
about the client's behavior and symptoms, including any critical incidents in which the client
was involved.
new text end
new text begin
(b) For each day that a client is not present in the program, the license holder must
document the reason for a client's absence in the client's file.
new text end
new text begin Subd. 13. new text end
new text begin
Access to a mental health professional, clinical trainee, certified
rehabilitation specialist, or mental health practitioner.
new text end
new text begin
Treatment team members must
have access in person or by telephone to a mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitioner within 30 minutes. The license
holder must maintain a schedule of mental health professionals, clinical trainees, certified
rehabilitation specialists, or mental health practitioners who will be available and contact
information to reach them. The license holder must keep the schedule current and make the
schedule readily available to treatment team members.
new text end
new text begin Subd. 14. new text end
new text begin Weekly team meetings. new text end
new text begin
(a) The license holder must hold weekly team meetings
and ancillary meetings according to this subdivision.
new text end
new text begin
(b) A mental health professional or certified rehabilitation specialist must hold at least
one team meeting each calendar week and be physically present at the team meeting. All
treatment team members, including treatment team members who work on a part-time or
intermittent basis, must participate in a minimum of one team meeting during each calendar
week when the treatment team member is working for the license holder. The license holder
must document all weekly team meetings, including the names of meeting attendees.
new text end
new text begin
(c) If a treatment team member cannot participate in a weekly team meeting, the treatment
team member must participate in an ancillary meeting. A mental health professional, certified
rehabilitation specialist, clinical trainee, or mental health practitioner who participated in
the most recent weekly team meeting may lead the ancillary meeting. During the ancillary
meeting, the treatment team member leading the ancillary meeting must review the
information that was shared at the most recent weekly team meeting, including revisions
to client treatment plans and other information that the treatment supervisors exchanged
with treatment team members. The license holder must document all ancillary meetings,
including the names of meeting attendees.
new text end
new text begin Subd. 15. new text end
new text begin Intensive residential treatment services admission criteria. new text end
new text begin
(a) An eligible
client for intensive residential treatment services is an individual who:
new text end
new text begin
(1) is age 18 or older;
new text end
new text begin
(2) is diagnosed with a mental illness;
new text end
new text begin
(3) because of a mental illness, has a substantial disability and functional impairment
in three or more areas listed in section 245I.10, subdivision 9, clause (4), that markedly
reduce the individual's self-sufficiency;
new text end
new text begin
(4) has one or more of the following: a history of recurring or prolonged inpatient
hospitalizations during the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services with poor outcomes for the
individual; and
new text end
new text begin
(5) in the written opinion of a mental health professional, needs mental health services
that available community-based services cannot provide, or is likely to experience a mental
health crisis or require a more restrictive setting if the individual does not receive intensive
rehabilitative mental health services.
new text end
new text begin
(b) The license holder must not limit or restrict intensive residential treatment services
to a client based solely on:
new text end
new text begin
(1) the client's substance use;
new text end
new text begin
(2) the county in which the client resides; or
new text end
new text begin
(3) whether the client elects to receive other services for which the client may be eligible,
including case management services.
new text end
new text begin
(c) This subdivision does not prohibit the license holder from restricting admissions of
individuals who present an imminent risk of harm or danger to themselves or others.
new text end
new text begin Subd. 16. new text end
new text begin Residential crisis stabilization services admission criteria. new text end
new text begin
An eligible client
for residential crisis stabilization is an individual who is age 18 or older and meets the
eligibility criteria in section 256B.0624, subdivision 3.
new text end
new text begin Subd. 17. new text end
new text begin Admissions referrals and determinations. new text end
new text begin
(a) The license holder must
identify the information that the license holder needs to make a determination about a
person's admission referral.
new text end
new text begin
(b) The license holder must:
new text end
new text begin
(1) always be available to receive referral information about a person seeking admission
to the license holder's program;
new text end
new text begin
(2) respond to the referral source within eight hours of receiving a referral and, within
eight hours, communicate with the referral source about what information the license holder
needs to make a determination concerning the person's admission;
new text end
new text begin
(3) consider the license holder's staffing ratio and the areas of treatment team members'
competency when determining whether the license holder is able to meet the needs of a
person seeking admission; and
new text end
new text begin
(4) determine whether to admit a person within 72 hours of receiving all necessary
information from the referral source.
new text end
new text begin Subd. 18. new text end
new text begin Discharge standards. new text end
new text begin
(a) When a license holder discharges a client from a
program, the license holder must categorize the discharge as a successful discharge,
program-initiated discharge, or non-program-initiated discharge according to the criteria in
this subdivision. The license holder must meet the standards associated with the type of
discharge according to this subdivision.
new text end
new text begin
(b) To successfully discharge a client from a program, the license holder must ensure
that the following criteria are met:
new text end
new text begin
(1) the client must substantially meet the client's documented treatment plan goals and
objectives;
new text end
new text begin
(2) the client must complete discharge planning with the treatment team; and
new text end
new text begin
(3) the client and treatment team must arrange for the client to receive continuing care
at a less intensive level of care after discharge.
new text end
new text begin
(c) Prior to successfully discharging a client from a program, the license holder must
complete the client's discharge summary and provide the client with a copy of the client's
discharge summary in plain language that includes:
new text end
new text begin
(1) a brief review of the client's problems and strengths during the period that the license
holder provided services to the client;
new text end
new text begin
(2) the client's response to the client's treatment plan;
new text end
new text begin
(3) the goals and objectives that the license holder recommends that the client addresses
during the first three months following the client's discharge from the program;
new text end
new text begin
(4) the recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting;
new text end
new text begin
(5) the client's crisis plan; and
new text end
new text begin
(6) the client's forwarding address and telephone number.
new text end
new text begin
(d) For a non-program-initiated discharge of a client from a program, the following
criteria must be met:
new text end
new text begin
(1)(i) the client has withdrawn the client's consent for treatment; (ii) the license holder
has determined that the client has the capacity to make an informed decision; and (iii) the
client does not meet the criteria for an emergency hold under section 253B.051, subdivision
2;
new text end
new text begin
(2) the client has left the program against staff person advice;
new text end
new text begin
(3) an entity with legal authority to remove the client has decided to remove the client
from the program; or
new text end
new text begin
(4) a source of payment for the services is no longer available.
new text end
new text begin
(e) Within ten days of a non-program-initiated discharge of a client from a program, the
license holder must complete the client's discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) a description of attempts by staff persons to enable the client to continue treatment
or to consent to treatment; and
new text end
new text begin
(3) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin
(f) For a program-initiated discharge of a client from a program, the following criteria
must be met:
new text end
new text begin
(1) the client is competent but has not participated in treatment or has not followed the
program rules and regulations and the client has not participated to such a degree that the
program's level of care is ineffective or unsafe for the client, despite multiple, documented
attempts that the license holder has made to address the client's lack of participation in
treatment;
new text end
new text begin
(2) the client has not made progress toward the client's treatment goals and objectives
despite the license holder's persistent efforts to engage the client in treatment, and the license
holder has no reasonable expectation that the client will make progress at the program's
level of care nor does the client require the program's level of care to maintain the current
level of functioning;
new text end
new text begin
(3) a court order or the client's legal status requires the client to participate in the program
but the client has left the program against staff person advice; or
new text end
new text begin
(4) the client meets criteria for a more intensive level of care and a more intensive level
of care is available to the client.
new text end
new text begin
(g) Prior to a program-initiated discharge of a client from a program, the license holder
must consult the client, the client's family and other natural supports, and the client's case
manager, if applicable, to review the issues involved in the program's decision to discharge
the client from the program. During the discharge review process, which must not exceed
five working days, the license holder must determine whether the license holder, treatment
team, and any interested persons can develop additional strategies to resolve the issues
leading to the client's discharge and to permit the client to have an opportunity to continue
receiving services from the license holder. The license holder may temporarily remove a
client from the program facility during the five-day discharge review period. The license
holder must document the client's discharge review in the client's file.
new text end
new text begin
(h) Prior to a program-initiated discharge of a client from the program, the license holder
must complete the client's discharge summary and provide the client with a copy of the
discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) the alternatives to discharge that the license holder considered or attempted to
implement;
new text end
new text begin
(3) the names of each individual who is involved in the decision to discharge the client
and a description of each individual's involvement; and
new text end
new text begin
(4) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin Subd. 19. new text end
new text begin Program facility. new text end
new text begin
(a) The license holder must be licensed or certified as a
board and lodging facility, supervised living facility, or a boarding care home by the
Department of Health.
new text end
new text begin
(b) The license holder must have a capacity of five to 16 beds and the program must not
be declared as an institution for mental disease.
new text end
new text begin
(c) The license holder must furnish each program location to meet the psychological,
emotional, and developmental needs of clients.
new text end
new text begin
(d) The license holder must provide one living room or lounge area per program location.
There must be space available to provide services according to each client's treatment plan,
such as an area for learning recreation time skills and areas for learning independent living
skills, such as laundering clothes and preparing meals.
new text end
new text begin
(e) The license holder must ensure that each program location allows each client to have
privacy. Each client must have privacy during assessment interviews and counseling sessions.
Each client must have a space designated for the client to see outside visitors at the program
facility.
new text end
new text begin Subd. 20. new text end
new text begin Physical separation of services. new text end
new text begin
If the license holder offers services to
individuals who are not receiving intensive residential treatment services or residential
stabilization at the program location, the license holder must inform the commissioner and
submit a plan for approval to the commissioner about how and when the license holder will
provide services. The license holder must only provide services to clients who are not
receiving intensive residential treatment services or residential crisis stabilization in an area
that is physically separated from the area in which the license holder provides clients with
intensive residential treatment services or residential crisis stabilization.
new text end
new text begin Subd. 21. new text end
new text begin Dividing staff time between locations. new text end
new text begin
A license holder must obtain approval
from the commissioner prior to providing intensive residential treatment services or
residential crisis stabilization to clients in more than one program location under one license
and dividing one staff person's time between program locations during the same work period.
new text end
new text begin Subd. 22. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures in section 245I.03, the license holder must establish, enforce, and maintain
the policies and procedures in this subdivision.
new text end
new text begin
(b) The license holder must have policies and procedures for receiving referrals and
making admissions determinations about referred persons under subdivisions 14 to 16.
new text end
new text begin
(c) The license holder must have policies and procedures for discharging clients under
subdivision 17. In the policies and procedures, the license holder must identify the staff
persons who are authorized to discharge clients from the program.
new text end
new text begin Subd. 23. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) A license holder must develop
a written quality assurance and improvement plan that includes a plan to:
new text end
new text begin
(1) encourage ongoing consultation between members of the treatment team;
new text end
new text begin
(2) obtain and evaluate feedback about services from clients, family and other natural
supports, referral sources, and staff persons;
new text end
new text begin
(3) measure and evaluate client outcomes in the program;
new text end
new text begin
(4) review critical incidents in the program;
new text end
new text begin
(5) examine the quality of clinical services in the program; and
new text end
new text begin
(6) self-monitor the license holder's compliance with this chapter.
new text end
new text begin
(b) At least annually, the license holder must review, evaluate, and update the license
holder's quality assurance and improvement plan. The license holder's review must:
new text end
new text begin
(1) document the actions that the license holder will take in response to the information
that the license holder obtains from the monitoring activities in the plan; and
new text end
new text begin
(2) establish goals for improving the license holder's services to clients during the next
year.
new text end
new text begin Subd. 24. new text end
new text begin Application. new text end
new text begin
When an applicant requests licensure to provide intensive
residential treatment services, residential crisis stabilization, or both to clients, the applicant
must submit, on forms that the commissioner provides, any documents that the commissioner
requires.
new text end
Sec. 17.
new text begin
[256B.0671] COVERED MENTAL HEALTH SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical trainee" means a staff person who is qualified
under section 245I.04, subdivision 6.
new text end
new text begin
(b) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(c) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) An individual, organization, or government entity providing
mental health services to a client under this section must obtain a criminal background study
of each staff person or volunteer who is providing direct contact services to a client.
new text end
new text begin
(b) An individual, organization, or government entity providing mental health services
to a client under this section must comply with all responsibilities that chapter 245I assigns
to a license holder, except section 245I.011, subdivision 1, unless all of the individual's,
organization's, or government entity's treatment staff are qualified as mental health
professionals.
new text end
new text begin
(c) An individual, organization, or government entity providing mental health services
to a client under this section must comply with the following requirements if all of the
license holder's treatment staff are qualified as mental health professionals:
new text end
new text begin
(1) provider qualifications and scopes of practice under section 245I.04;
new text end
new text begin
(2) maintaining and updating personnel files under section 245I.07;
new text end
new text begin
(3) documenting under section 245I.08;
new text end
new text begin
(4) maintaining and updating client files under section 245I.09;
new text end
new text begin
(5) completing client assessments and treatment planning under section 245I.10;
new text end
new text begin
(6) providing clients with health services and medications under section 245I.11; and
new text end
new text begin
(7) respecting and enforcing client rights under section 245I.12.
new text end
new text begin Subd. 3. new text end
new text begin Adult day treatment services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers adult day treatment (ADT) services that are provided under contract with
the county board. Adult day treatment payment is subject to the conditions in paragraphs
(b) to (e). The provider must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments, protocols, and forms approved by
the commissioner.
new text end
new text begin
(b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness on a client to enable the client to benefit from a lower level of
care and to live and function more independently in the community. Adult day treatment
services must be provided to a client to stabilize the client's mental health and to improve
the client's independent living and socialization skills. Adult day treatment must consist of
at least one hour of group psychotherapy and must include group time focused on
rehabilitative interventions or other therapeutic services that a multidisciplinary team provides
to each client. Adult day treatment services are not a part of inpatient or residential treatment
services. The following providers may apply to become adult day treatment providers:
new text end
new text begin
(1) a hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
new text end
new text begin
(2) a community mental health center under section 256B.0625, subdivision 5; or
new text end
new text begin
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4712, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475.
new text end
new text begin
(c) An adult day treatment (ADT) services provider must:
new text end
new text begin
(1) ensure that the commissioner has approved of the organization as an adult day
treatment provider organization;
new text end
new text begin
(2) ensure that a multidisciplinary team provides ADT services to a group of clients. A
mental health professional must supervise each multidisciplinary staff person who provides
ADT services;
new text end
new text begin
(3) make ADT services available to the client at least two days a week for at least three
consecutive hours per day. ADT services may be longer than three hours per day, but medical
assistance may not reimburse a provider for more than 15 hours per week;
new text end
new text begin
(4) provide ADT services to each client that includes group psychotherapy by a mental
health professional or clinical trainee and daily rehabilitative interventions by a mental
health professional, clinical trainee, or mental health practitioner; and
new text end
new text begin
(5) include ADT services in the client's individual treatment plan, when appropriate.
The adult day treatment provider must:
new text end
new text begin
(i) complete a functional assessment of each client under section 245I.10, subdivision
9;
new text end
new text begin
(ii) notwithstanding section 245I.10, subdivision 8, review the client's progress and
update the individual treatment plan at least every 90 days until the client is discharged
from the program; and
new text end
new text begin
(iii) include a discharge plan for the client in the client's individual treatment plan.
new text end
new text begin
(d) To be eligible for adult day treatment, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) not reside in a nursing facility, hospital, institute of mental disease, or state-operated
treatment center unless the client has an active discharge plan that indicates a move to an
independent living setting within 180 days;
new text end
new text begin
(3) have the capacity to engage in rehabilitative programming, skills activities, and
psychotherapy in the structured, therapeutic setting of an adult day treatment program and
demonstrate measurable improvements in functioning resulting from participation in the
adult day treatment program;
new text end
new text begin
(4) have a level of care assessment under section 245I.02, subdivision 19, recommending
that the client participate in services with the level of intensity and duration of an adult day
treatment program; and
new text end
new text begin
(5) have the recommendation of a mental health professional for adult day treatment
services. The mental health professional must find that adult day treatment services are
medically necessary for the client.
new text end
new text begin
(e) Medical assistance does not cover the following services as adult day treatment
services:
new text end
new text begin
(1) services that are primarily recreational or that are provided in a setting that is not
under medical supervision, including sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
new text end
new text begin
(2) social or educational services that do not have or cannot reasonably be expected to
have a therapeutic outcome related to the client's mental illness;
new text end
new text begin
(3) consultations with other providers or service agency staff persons about the care or
progress of a client;
new text end
new text begin
(4) prevention or education programs that are provided to the community;
new text end
new text begin
(5) day treatment for clients with a primary diagnosis of a substance use disorder;
new text end
new text begin
(6) day treatment provided in the client's home;
new text end
new text begin
(7) psychotherapy for more than two hours per day; and
new text end
new text begin
(8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
new text end
new text begin Subd. 4. new text end
new text begin Explanation of findings. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers an explanation of findings that a mental health professional or clinical trainee provides
when the provider has obtained the authorization from the client or the client's representative
to release the information.
new text end
new text begin
(b) A mental health professional or clinical trainee provides an explanation of findings
to assist the client or related parties in understanding the results of the client's testing or
diagnostic assessment and the client's mental illness, and provides professional insight that
the client or related parties need to carry out a client's treatment plan. Related parties may
include the client's family and other natural supports and other service providers working
with the client.
new text end
new text begin
(c) An explanation of findings is not paid for separately when a mental health professional
or clinical trainee explains the results of psychological testing or a diagnostic assessment
to the client or the client's representative as part of the client's psychological testing or a
diagnostic assessment.
new text end
new text begin Subd. 5. new text end
new text begin Family psychoeducation services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers family psychoeducation services provided to a child up to age 21 with a
diagnosed mental health condition when identified in the child's individual treatment plan
and provided by a mental health professional or a clinical trainee who has determined it
medically necessary to involve family members in the child's care.
new text end
new text begin
(b) "Family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family in understanding a child's
symptoms of mental illness, the impact on the child's development, and needed components
of treatment and skill development so that the individual, family, or group can help the child
to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental
health and long-term resilience.
new text end
new text begin Subd. 6. new text end
new text begin Dialectical behavior therapy. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers intensive mental health outpatient treatment for dialectical behavior therapy for
adults. A dialectical behavior therapy provider must make reasonable and good faith efforts
to report individual client outcomes to the commissioner using instruments and protocols
that are approved by the commissioner.
new text end
new text begin
(b) "Dialectical behavior therapy" means an evidence-based treatment approach that a
mental health professional or clinical trainee provides to a client or a group of clients in an
intensive outpatient treatment program using a combination of individualized rehabilitative
and psychotherapeutic interventions. A dialectical behavior therapy program involves:
individual dialectical behavior therapy, group skills training, telephone coaching, and team
consultation meetings.
new text end
new text begin
(c) To be eligible for dialectical behavior therapy, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) have mental health needs that available community-based services cannot meet or
that the client must receive concurrently with other community-based services;
new text end
new text begin
(3) have either:
new text end
new text begin
(i) a diagnosis of borderline personality disorder; or
new text end
new text begin
(ii) multiple mental health diagnoses, exhibit behaviors characterized by impulsivity or
intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction in multiple areas of the client's life;
new text end
new text begin
(4) be cognitively capable of participating in dialectical behavior therapy as an intensive
therapy program and be able and willing to follow program policies and rules to ensure the
safety of the client and others; and
new text end
new text begin
(5) be at significant risk of one or more of the following if the client does not receive
dialectical behavior therapy:
new text end
new text begin
(i) having a mental health crisis;
new text end
new text begin
(ii) requiring a more restrictive setting such as hospitalization;
new text end
new text begin
(iii) decompensating; or
new text end
new text begin
(iv) engaging in intentional self-harm behavior.
new text end
new text begin
(d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat a client's suicidal and other dysfunctional behaviors
and to reinforce a client's use of adaptive skillful behaviors. A mental health professional
or clinical trainee must provide individual dialectical behavior therapy to a client. A mental
health professional or clinical trainee providing dialectical behavior therapy to a client must:
new text end
new text begin
(1) identify, prioritize, and sequence the client's behavioral targets;
new text end
new text begin
(2) treat the client's behavioral targets;
new text end
new text begin
(3) assist the client in applying dialectical behavior therapy skills to the client's natural
environment through telephone coaching outside of treatment sessions;
new text end
new text begin
(4) measure the client's progress toward dialectical behavior therapy targets;
new text end
new text begin
(5) help the client manage mental health crises and life-threatening behaviors; and
new text end
new text begin
(6) help the client learn and apply effective behaviors when working with other treatment
providers.
new text end
new text begin
(e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas: (1) mindfulness; (2) interpersonal
effectiveness; (3) emotional regulation; and (4) distress tolerance.
new text end
new text begin
(f) Group skills training must be provided by two mental health professionals or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner.
Individual skills training must be provided by a mental health professional, a clinical trainee,
or a mental health practitioner.
new text end
new text begin
(g) Before a program provides dialectical behavior therapy to a client, the commissioner
must certify the program as a dialectical behavior therapy provider. To qualify for
certification as a dialectical behavior therapy provider, a provider must:
new text end
new text begin
(1) allow the commissioner to inspect the provider's program;
new text end
new text begin
(2) provide evidence to the commissioner that the program's policies, procedures, and
practices meet the requirements of this subdivision and chapter 245I;
new text end
new text begin
(3) be enrolled as a MHCP provider; and
new text end
new text begin
(4) have a manual that outlines the program's policies, procedures, and practices that
meet the requirements of this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Mental health clinical care consultation. new text end
new text begin
(a) Subject to federal approval,
medical assistance covers clinical care consultation for a person up to age 21 who is
diagnosed with a complex mental health condition or a mental health condition that co-occurs
with other complex and chronic conditions, when described in the person's individual
treatment plan and provided by a mental health professional or a clinical trainee.
new text end
new text begin
(b) "Clinical care consultation" means communication from a treating mental health
professional to other providers or educators not under the treatment supervision of the
treating mental health professional who are working with the same client to inform, inquire,
and instruct regarding the client's symptoms; strategies for effective engagement, care, and
intervention needs; and treatment expectations across service settings and to direct and
coordinate clinical service components provided to the client and family.
new text end
new text begin Subd. 8. new text end
new text begin Neuropsychological assessment. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers a client's neuropsychological assessment.
new text end
new text begin
(b) Neuropsychological assessment" means a specialized clinical assessment of the
client's underlying cognitive abilities related to thinking, reasoning, and judgment that is
conducted by a qualified neuropsychologist. A neuropsychological assessment must include
a face-to-face interview with the client, interpretation of the test results, and preparation
and completion of a report.
new text end
new text begin
(c) A client is eligible for a neuropsychological assessment if the client meets at least
one of the following criteria:
new text end
new text begin
(1) the client has a known or strongly suspected brain disorder based on the client's
medical history or the client's prior neurological evaluation, including a history of significant
head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative
disorder, significant exposure to neurotoxins, central nervous system infection, metabolic
or toxic encephalopathy, fetal alcohol syndrome, or congenital malformation of the brain;
or
new text end
new text begin
(2) the client has cognitive or behavioral symptoms that suggest that the client has an
organic condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. The client's
symptoms may include:
new text end
new text begin
(i) having a poor memory or impaired problem solving;
new text end
new text begin
(ii) experiencing change in mental status evidenced by lethargy, confusion, or
disorientation;
new text end
new text begin
(iii) experiencing a deteriorating level of functioning;
new text end
new text begin
(iv) displaying a marked change in behavior or personality;
new text end
new text begin
(v) in a child or an adolescent, having significant delays in acquiring academic skill or
poor attention relative to peers;
new text end
new text begin
(vi) in a child or an adolescent, having reached a significant plateau in expected
development of cognitive, social, emotional, or physical functioning relative to peers; and
new text end
new text begin
(vii) in a child or an adolescent, significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, emotional, or physical
demands.
new text end
new text begin
(d) The neuropsychological assessment must be completed by a neuropsychologist who:
new text end
new text begin
(1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
new text end
new text begin
(2) earned a doctoral degree in psychology from an accredited university training program
and:
new text end
new text begin
(i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
new text end
new text begin
(ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
new text end
new text begin
(iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
new text end
new text begin
(3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
new text end
new text begin
(4) was approved by the commissioner as an eligible provider of neuropsychological
assessments prior to December 31, 2010.
new text end
new text begin Subd. 9. new text end
new text begin Neuropsychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers neuropsychological testing for clients.
new text end
new text begin
(b) "Neuropsychological testing" means administering standardized tests and measures
designed to evaluate the client's ability to attend to, process, interpret, comprehend,
communicate, learn, and recall information and use problem solving and judgment.
new text end
new text begin
(c) Medical assistance covers neuropsychological testing of a client when the client:
new text end
new text begin
(1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
new text end
new text begin
(2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
new text end
new text begin
(3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, physical, or emotional
demands; or
new text end
new text begin
(4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
new text end
new text begin
(i) traumatic brain injury;
new text end
new text begin
(ii) stroke;
new text end
new text begin
(iii) brain tumor;
new text end
new text begin
(iv) substance use disorder;
new text end
new text begin
(v) cerebral anoxic or hypoxic episode;
new text end
new text begin
(vi) central nervous system infection or other infectious disease;
new text end
new text begin
(vii) neoplasms or vascular injury of the central nervous system;
new text end
new text begin
(viii) neurodegenerative disorders;
new text end
new text begin
(ix) demyelinating disease;
new text end
new text begin
(x) extrapyramidal disease;
new text end
new text begin
(xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
new text end
new text begin
(xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosus,
or celiac disease;
new text end
new text begin
(xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
new text end
new text begin
(xiv) severe or prolonged nutrition or malabsorption syndromes; or
new text end
new text begin
(xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not improved the client's neurocognitive functioning; or another disorder, including autism,
selective mutism, anxiety disorder, or reactive attachment disorder.
new text end
new text begin
(d) Neuropsychological testing must be administered or clinically supervised by a
qualified neuropsychologist under subdivision 8, paragraph (c).
new text end
new text begin
(e) Medical assistance does not cover neuropsychological testing of a client when the
testing is:
new text end
new text begin
(1) primarily for educational purposes;
new text end
new text begin
(2) primarily for vocational counseling or training;
new text end
new text begin
(3) for personnel or employment testing;
new text end
new text begin
(4) a routine battery of psychological tests given to the client at the client's inpatient
admission or during a client's continued inpatient stay; or
new text end
new text begin
(5) for legal or forensic purposes.
new text end
new text begin Subd. 10. new text end
new text begin Psychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers psychological testing of a client.
new text end
new text begin
(b) "Psychological testing" means the use of tests or other psychometric instruments to
determine the status of a client's mental, intellectual, and emotional functioning.
new text end
new text begin
(c) The psychological testing must:
new text end
new text begin
(1) be administered or supervised by a licensed psychologist qualified under section
245I.04, subdivision 2, clause (3), who is competent in the area of psychological testing;
and
new text end
new text begin
(2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical trainee in psychology under the treatment supervision of a licensed psychologist
under section 245I.06.
new text end
new text begin
(d) A licensed psychologist must supervise the administration, scoring, and interpretation
of a client's psychological tests when a clinical psychology trainee, technician, psychometrist,
or psychological assistant or a computer-assisted psychological testing program completes
the psychological testing of the client. The report resulting from the psychological testing
must be signed by the licensed psychologist who conducts the face-to-face interview with
the client. The licensed psychologist or a staff person who is under treatment supervision
must place the client's psychological testing report in the client's record and release one
copy of the report to the client and additional copies to individuals authorized by the client
to receive the report.
new text end
new text begin Subd. 11. new text end
new text begin Psychotherapy. new text end
new text begin
(a) Subject to federal approval, medical assistance covers
psychotherapy for a client.
new text end
new text begin
(b) "Psychotherapy" means treatment of a client with mental illness that applies to the
most appropriate psychological, psychiatric, psychosocial, or interpersonal method that
conforms to prevailing community standards of professional practice to meet the mental
health needs of the client. Medical assistance covers psychotherapy if a mental health
professional or a clinical trainee provides psychotherapy to a client.
new text end
new text begin
(c) "Individual psychotherapy" means psychotherapy that a mental health professional
or clinical trainee designs for a client.
new text end
new text begin
(d) "Family psychotherapy" means psychotherapy that a mental health professional or
clinical trainee designs for a client and one or more of the client's family members or primary
caregiver whose participation is necessary to accomplish the client's treatment goals. Family
members or primary caregivers participating in a therapy session do not need to be eligible
for medical assistance for medical assistance to cover family psychotherapy. For purposes
of this paragraph, "primary caregiver whose participation is necessary to accomplish the
client's treatment goals" excludes shift or facility staff persons who work at the client's
residence. Medical assistance payments for family psychotherapy are limited to face-to-face
sessions during which the client is present throughout the session, unless the mental health
professional or clinical trainee believes that the client's exclusion from the family
psychotherapy session is necessary to meet the goals of the client's individual treatment
plan. If the client is excluded from a family psychotherapy session, a mental health
professional or clinical trainee must document the reason for the client's exclusion and the
length of time that the client is excluded. The mental health professional must also document
any reason that a member of the client's family is excluded from a psychotherapy session.
new text end
new text begin
(e) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can benefit from treatment in a group
setting. For a group of three to eight clients, at least one mental health professional or clinical
trainee must provide psychotherapy to the group. For a group of nine to 12 clients, a team
of at least two mental health professionals or two clinical trainees or one mental health
professional and one clinical trainee must provide psychotherapy to the group. Medical
assistance will cover group psychotherapy for a group of no more than 12 persons.
new text end
new text begin
(f) A multiple-family group psychotherapy session is eligible for medical assistance if
a mental health professional or clinical trainee designs the psychotherapy session for at least
two but not more than five families. A mental health professional or clinical trainee must
design multiple-family group psychotherapy sessions to meet the treatment needs of each
client. If the client is excluded from a psychotherapy session, the mental health professional
or clinical trainee must document the reason for the client's exclusion and the length of time
that the client was excluded. The mental health professional or clinical trainee must document
any reason that a member of the client's family was excluded from a psychotherapy session.
new text end
new text begin Subd. 12. new text end
new text begin Partial hospitalization. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers a client's partial hospitalization.
new text end
new text begin
(b) "Partial hospitalization" means a provider's time-limited, structured program of
psychotherapy and other therapeutic services, as defined in United States Code, title 42,
chapter 7, subchapter XVIII, part E, section 1395x(ff), that a multidisciplinary staff person
provides in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services to a client.
new text end
new text begin
(c) Partial hospitalization is an appropriate alternative to inpatient hospitalization for a
client who is experiencing an acute episode of mental illness who meets the criteria for an
inpatient hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who
has family and community resources that support the client's residence in the community.
Partial hospitalization consists of multiple intensive short-term therapeutic services for a
client that a multidisciplinary staff person provides to a client to treat the client's mental
illness.
new text end
new text begin Subd. 13. new text end
new text begin Diagnostic assessments. new text end
new text begin
Subject to federal approval, medical assistance covers
a client's diagnostic assessments that a mental health professional or clinical trainee completes
under section 245I.10.
new text end
Sec. 18. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders including
counties, tribes, managed care organizations, provider organizations, advocacy groups, and
clients and clients' families, shall develop recommendations to develop a single
comprehensive licensing structure for mental health service programs, including outpatient
and residential services for adults and children. The recommendations must prioritize
program integrity, the welfare of clients and clients' families, improved integration of mental
health and substance use disorder services, and the reduction of administrative burden on
providers.
new text end
Sec. 19. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2022, 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
ARTICLE 10
CRISIS RESPONSE SERVICES
Section 1.
Minnesota Statutes 2020, section 245.469, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
deleted text begin By July 1, 1988,deleted text end new text begin (a)new text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adultsnew text begin , children, and familiesnew text end in the county who are experiencing an emotional crisis or
mental illness. deleted text begin Clients may be required to pay a fee according to section deleted text end deleted text begin .deleted text end new text begin Emergency
service providers must not delay the timely provision of emergency services to a client
because of the unwillingness or inability of the client to pay for services. new text end Emergency services
must include assessment, crisis intervention, and appropriate case disposition. Emergency
services must:
(1) promote the safety and emotional stability of deleted text begin adults with mental illness or emotional
crisesdeleted text end new text begin each clientnew text end ;
(2) minimize further deterioration of deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each
clientnew text end ;
(3) help deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each clientnew text end to obtain ongoing care
and treatment; deleted text begin and
deleted text end
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) provide support, psychoeducation, and referrals to each client's family members,
service providers, and other third parties on behalf of the client in need of emergency
services.
new text end
new text begin
(b) If a county provides engagement services under section 253B.041, the county's
emergency service providers must refer clients to engagement services when the client
meets the criteria for engagement services.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245.469, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional, deleted text begin adeleted text end new text begin clinical trainee, ornew text end mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .
(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:
(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;
(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency
services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services deleted text begin reviewed by the state advisory
council on mental health and thendeleted text end approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services deleted text begin reviewed by
the state advisory council on mental health and thendeleted text end approved by the commissioner;
(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.
Sec. 3.
Minnesota Statutes 2020, section 245.4879, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
County boards must provide or
contract for deleted text begin enoughdeleted text end mental health emergency services deleted text begin within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition. Emergency services
must:deleted text end new text begin according to section 245.469.
new text end
deleted text begin
(1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;
deleted text end
deleted text begin
(2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;
deleted text end
deleted text begin
(3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; and
deleted text end
deleted text begin
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needs.
deleted text end
Sec. 4.
Minnesota Statutes 2020, section 256B.0624, is amended to read:
256B.0624 deleted text begin ADULTdeleted text end CRISIS RESPONSE SERVICES COVERED.
Subdivision 1.
Scope.
deleted text begin Medical assistance covers adult mental health crisis response
services as defined in subdivision 2, paragraphs (c) to (e),deleted text end new text begin (a) new text end Subject to federal approval,
deleted text begin if provided to a recipient as defined in subdivision 3 and provided by a qualified provider
entity as defined in this section and by a qualified individual provider working within the
provider's scope of practice and as defined in this subdivision and identified in the recipient's
individual crisis treatment plan as defined in subdivision 11 and if determined to be medically
necessarydeleted text end new text begin medical assistance covers medically necessary crisis response services when the
services are provided according to the standards in this sectionnew text end .
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary residential
crisis stabilization for adults when the services are provided by an entity licensed under and
meeting the standards in section 245I.23 or an entity with an adult foster care license meeting
the standards in this section.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments and protocols approved by the
commissioner.
new text end
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
deleted text begin
(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.
deleted text end
deleted text begin
(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.
deleted text end
deleted text begin
A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or crisis mental health
practitioner with input from the recipient whenever possible.
deleted text end
new text begin
(a) "Certified rehabilitation specialist" means a staff person who is qualified under section
245I.04, subdivision 8.
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
(c) "deleted text begin Mental healthdeleted text end Crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests that the
adult may be experiencing a mental health crisis or mental health emergency situation. It
includes, when feasible, assessing whether the person might be willing to voluntarily accept
treatment, determining whether the person has an advance directive, and obtaining
information and history from involved family members or caretakersdeleted text end new text begin a qualified member
of a crisis team, as described in subdivision 6anew text end .
(d) "deleted text begin Mental health mobiledeleted text end Crisis intervention deleted text begin servicesdeleted text end " means face-to-face, short-term
intensive mental health services initiated during a mental health crisis deleted text begin or mental health
emergencydeleted text end to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. deleted text begin The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.
deleted text end
deleted text begin
(1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.
deleted text end
deleted text begin
(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.
deleted text end
deleted text begin
(3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.
deleted text end
deleted text begin
(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.
deleted text end
deleted text begin
(5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.
deleted text end
deleted text begin
(6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.
deleted text end
new text begin
(e) "Crisis screening" means a screening of a client's potential mental health crisis
situation under subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "deleted text begin Mental healthdeleted text end Crisis stabilization deleted text begin servicesdeleted text end " means individualized mental health
services provided to a recipient deleted text begin following crisis intervention servicesdeleted text end which are designed
to restore the recipient to the recipient's prior functional level. deleted text begin Mental healthdeleted text end Crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, deleted text begin ordeleted text end a short-term supervised, licensed
residential programnew text begin , or an emergency departmentnew text end . deleted text begin Mental health crisis stabilization does
not include partial hospitalization or day treatment. Mental healthdeleted text end Crisis stabilization services
includes family psychoeducation.
new text begin
(g) "Crisis team" means the staff of a provider entity who are supervised and prepared
to provide mobile crisis services to a client in a potential mental health crisis situation.
new text end
new text begin
(h) "Mental health certified family peer specialist" means a staff person who is qualified
under section 245I.04, subdivision 12.
new text end
new text begin
(i) "Mental health certified peer specialist" means a staff person who is qualified under
section 245I.04, subdivision 10.
new text end
new text begin
(j) "Mental health crisis" is a behavioral, emotional, or psychiatric situation that, without
the provision of crisis response services, would likely result in significantly reducing the
recipient's levels of functioning in primary activities of daily living, in an emergency situation
under section 62Q.55, or in the placement of the recipient in a more restrictive setting,
including but not limited to inpatient hospitalization.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified under
section 245I.04, subdivision 14.
new text end
new text begin
(n) "Mobile crisis services" means screening, assessment, intervention, and community
based stabilization, excluding residential crisis stabilization, that is provided to a recipient.
new text end
Subd. 3.
Eligibility.
deleted text begin
An eligible recipient is an individual who:
deleted text end
deleted text begin
(1) is age 18 or older;
deleted text end
deleted text begin
(2) is screened as possibly experiencing a mental health crisis or emergency where a
mental health crisis assessment is needed; and
deleted text end
deleted text begin
(3) is assessed as experiencing a mental health crisis or emergency, and mental health
crisis intervention or crisis intervention and stabilization services are determined to be
medically necessary.
deleted text end
new text begin
(a) A recipient is eligible for crisis assessment services when the recipient has screened
positive for a potential mental health crisis during a crisis screening.
new text end
new text begin
(b) A recipient is eligible for crisis intervention services and crisis stabilization services
when the recipient has been assessed during a crisis assessment to be experiencing a mental
health crisis.
new text end
Subd. 4.
Provider entity standards.
(a) A deleted text begin provider entity is an entity that meets the
standards listed in paragraph (c) anddeleted text end new text begin mobile crisis provider must benew text end :
(1) deleted text begin isdeleted text end a county board operated entity; deleted text begin or
deleted text end
new text begin
(2) an Indian health services facility or facility owned and operated by a tribe or tribal
organization operating under United States Code, title 325, section 450f; or
new text end
deleted text begin (2) isdeleted text end new text begin (3)new text end a provider entity that is under contract with the county board in the county
where the potential crisis or emergency is occurring. To provide services under this section,
the provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.
new text begin
(b) A mobile crisis provider must meet the following standards:
new text end
new text begin
(1) must ensure that crisis screenings, crisis assessments, and crisis intervention services
are available to a recipient 24 hours a day, seven days a week;
new text end
new text begin
(2) must be able to respond to a call for services in a designated service area or according
to a written agreement with the local mental health authority for an adjacent area;
new text end
new text begin
(3) must have at least one mental health professional on staff at all times and at least
one additional staff member capable of leading a crisis response in the community; and
new text end
new text begin
(4) must provide the commissioner with information about the number of requests for
service, the number of people that the provider serves face-to-face, outcomes, and the
protocols that the provider uses when deciding when to respond in the community.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (a)deleted text begin ,
clauses (1) and (2)deleted text end new text begin to (b)new text end , but must meet all other requirements of this subdivision.
deleted text begin (c) The adult mental healthdeleted text end new text begin (d) Anew text end crisis deleted text begin responsedeleted text end services provider deleted text begin entitydeleted text end must have the
capacity to meet and carry out the new text begin standards in section 245I.011, subdivision 5, and the
new text end following standards:
(1) deleted text begin has the capacity to recruit, hire, and manage and train mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin ensures that staff persons provide support for a
recipient's family and natural supports, by enabling the recipient's family and natural supports
to observe and participate in the recipient's treatment, assessments, and planning servicesnew text end ;
(2) has adequate administrative ability to ensure availability of services;
deleted text begin
(3) is able to ensure adequate preservice and in-service training;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;
deleted text begin (5)deleted text end new text begin (4)new text end is able to ensure that staff are deleted text begin capable ofdeleted text end implementing culturally specific treatment
identified in the deleted text begin individualdeleted text end new text begin crisisnew text end treatment plan that is meaningful and appropriate as
determined by the recipient's culture, beliefs, values, and language;
deleted text begin (6)deleted text end new text begin (5)new text end is able to ensure enough flexibility to respond to the changing intervention and
care needs of a recipient as identified by the recipient new text begin or family membernew text end during the service
partnership between the recipient and providers;
deleted text begin (7)deleted text end new text begin (6)new text end is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin
staffnew text end have the communication tools and procedures to communicate and consult promptly
about crisis assessment and interventions as services occur;
deleted text begin (8)deleted text end new text begin (7)new text end is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcementnew text begin , engagement
servicesnew text end , and mental health crisis services through regularly scheduled interagency meetings;
deleted text begin
(9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;
deleted text end
deleted text begin (10)deleted text end new text begin (8)new text end is able to ensure that services are coordinated with other deleted text begin mentaldeleted text end new text begin behavioralnew text end
health service providers, county mental health authorities, or federally recognized American
Indian authorities and others as necessary, with the consent of the deleted text begin adultdeleted text end new text begin recipient or parent
or guardiannew text end . Services must also be coordinated with the recipient's case manager if the deleted text begin adultdeleted text end new text begin
recipientnew text end is receiving case management services;
deleted text begin (11)deleted text end new text begin (9)new text end is able to ensure that crisis intervention services are provided in a manner
consistent with sections 245.461 to 245.486new text begin and 245.487 to 245.4879new text end ;
deleted text begin
(12) is able to submit information as required by the state;
deleted text end
deleted text begin
(13) maintains staff training and personnel files;
deleted text end
new text begin
(10) is able to coordinate detoxification services for the recipient according to Minnesota
Rules, parts 9530.6605 to 9530.6655, or withdrawal management according to chapter 245F;
new text end
deleted text begin (14)deleted text end new text begin (11)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfaction;new text begin and
new text end
deleted text begin
(15) is able to keep records as required by applicable laws;
deleted text end
deleted text begin
(16) is able to comply with all applicable laws and statutes;
deleted text end
deleted text begin (17)deleted text end new text begin (12)new text end is an enrolled medical assistance providerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(18) develops and maintains written policies and procedures regarding service provision
and administration of the provider entity, including safety of staff and recipients in high-risk
situations.
deleted text end
Subd. 4a.
Alternative provider standards.
If a county new text begin or tribe new text end demonstrates that, due
to geographic or other barriers, it is not feasible to provide mobile crisis intervention services
according to the standards in subdivision 4, paragraph deleted text begin (c), clause (9)deleted text end new text begin (b)new text end , the commissioner
may approve deleted text begin a crisis response provider based ondeleted text end an alternative plan proposed by a county
or deleted text begin group of countiesdeleted text end new text begin tribenew text end . The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of new text begin mobile
new text end crisis services;
(2) provide mobile new text begin crisis new text end services outside of the usual nine-to-five office hours and on
weekends and holidays; and
(3) comply with standards for emergency mental health services in section 245.469.
Subd. 5.
deleted text begin Mobiledeleted text end Crisis new text begin assessment and new text end intervention staff qualifications.
deleted text begin For provision
of adult mental health mobile crisis intervention services, a mobile crisis intervention team
is comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6), or a combination of at least one mental health professional
and one mental health practitioner as defined in section 245.462, subdivision 17, with the
required mental health crisis training and under the clinical supervision of a mental health
professional on the team. The team must have at least two people with at least one member
providing on-site crisis intervention services when needed.deleted text end new text begin (a) Qualified individual staff of
a qualified provider entity must provide crisis assessment and intervention services to a
recipient. A staff member providing crisis assessment and intervention services to a recipient
must be qualified as a:
new text end
new text begin
(1) mental health professional;
new text end
new text begin
(2) clinical trainee;
new text end
new text begin
(3) mental health practitioner;
new text end
new text begin
(4) mental health certified family peer specialist; or
new text end
new text begin
(5) mental health certified peer specialist.
new text end
new text begin
(b) When crisis assessment and intervention services are provided to a recipient in the
community, a mental health professional, clinical trainee, or mental health practitioner must
lead the response.
new text end
new text begin
(c) The 30 hours of ongoing training required by section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to children and adults and include training
about evidence-based practices identified by the commissioner of health to reduce the
recipient's risk of suicide and self-injurious behavior.
new text end
new text begin (d) new text end Team members must be experienced in deleted text begin mental healthdeleted text end new text begin crisisnew text end assessment, crisis
intervention techniques, treatment engagement strategies, working with families, and clinical
decision-making under emergency conditions and have knowledge of local services and
resources. deleted text begin The team must recommend and coordinate the team's services with appropriate
local resources such as the county social services agency, mental health services, and local
law enforcement when necessary.
deleted text end
Subd. 6.
Crisis deleted text begin assessment and mobile intervention treatment planningdeleted text end new text begin screeningnew text end .
(a)
deleted text begin Prior to initiating mobile crisis intervention services, a screening of the potential crisis
situation must be conducted.deleted text end The new text begin crisis new text end screening may use the resources of deleted text begin crisis assistance
anddeleted text end emergency services as defined in deleted text begin sections 245.462, subdivision 6, anddeleted text end new text begin sectionnew text end 245.469,
subdivisions 1 and 2. The new text begin crisis new text end screening must gather information, determine whether a
new text begin mental health new text end crisis situation exists, identify parties involved, and determine an appropriate
response.
new text begin
(b) When conducting the crisis screening of a recipient, a provider must:
new text end
new text begin
(1) employ evidence-based practices to reduce the recipient's risk of suicide and
self-injurious behavior;
new text end
new text begin
(2) work with the recipient to establish a plan and time frame for responding to the
recipient's mental health crisis, including responding to the recipient's immediate need for
support by telephone or text message until the provider can respond to the recipient
face-to-face;
new text end
new text begin
(3) document significant factors in determining whether the recipient is experiencing a
mental health crisis, including prior requests for crisis services, a recipient's recent
presentation at an emergency department, known calls to 911 or law enforcement, or
information from third parties with knowledge of a recipient's history or current needs;
new text end
new text begin
(4) accept calls from interested third parties and consider the additional needs or potential
mental health crises that the third parties may be experiencing;
new text end
new text begin
(5) provide psychoeducation, including means reduction, to relevant third parties
including family members or other persons living with the recipient; and
new text end
new text begin
(6) consider other available services to determine which service intervention would best
address the recipient's needs and circumstances.
new text end
new text begin
(c) For the purposes of this section, the following situations indicate a positive screen
for a potential mental health crisis and the provider must prioritize providing a face-to-face
crisis assessment of the recipient, unless a provider documents specific evidence to show
why this was not possible, including insufficient staffing resources, concerns for staff or
recipient safety, or other clinical factors:
new text end
new text begin
(1) the recipient presents at an emergency department or urgent care setting and the
health care team at that location requested crisis services; or
new text end
new text begin
(2) a peace officer requested crisis services for a recipient who is potentially subject to
transportation under section 253B.051.
new text end
new text begin
(d) A provider is not required to have direct contact with the recipient to determine that
the recipient is experiencing a potential mental health crisis. A mobile crisis provider may
gather relevant information about the recipient from a third party to establish the recipient's
need for services and potential safety factors.
new text end
new text begin Subd. 6a. new text end
new text begin Crisis assessment. new text end
deleted text begin (b)deleted text end new text begin (a)new text end If a deleted text begin crisis existsdeleted text end new text begin recipient screens positive for
potential mental health crisisnew text end , a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which deleted text begin emergencydeleted text end services are needed and, as time
permits, the recipient's current life situation, new text begin health information, including current
medications, new text end sources of stress, mental health problems and symptoms, strengths, cultural
considerations, support network, vulnerabilities, current functioning, and the recipient's
preferences as communicated directly by the recipient, or as communicated in a health care
directive as described in chapters 145C and 253B, the new text begin crisis new text end treatment plan described under
deleted text begin paragraph (d)deleted text end new text begin subdivision 11new text end , a crisis prevention plan, or a wellness recovery action plan.
new text begin
(b) A provider must conduct a crisis assessment at the recipient's location whenever
possible.
new text end
new text begin
(c) Whenever possible, the assessor must attempt to include input from the recipient and
the recipient's family and other natural supports to assess whether a crisis exists.
new text end
new text begin
(d) A crisis assessment includes determining: (1) whether the recipient is willing to
voluntarily engage in treatment or (2) has an advance directive and (3) gathering the
recipient's information and history from involved family or other natural supports.
new text end
new text begin
(e) A crisis assessment must include coordinated response with other health care providers
if the assessment indicates that a recipient needs detoxification, withdrawal management,
or medical stabilization in addition to crisis response services. If the recipient does not need
an acute level of care, a team must serve an otherwise eligible recipient who has a
co-occurring substance use disorder.
new text end
new text begin
(f) If, after completing a crisis assessment of a recipient, a provider refers a recipient to
an intensive setting, including an emergency department, inpatient hospitalization, or
residential crisis stabilization, one of the crisis team members who completed or conferred
about the recipient's crisis assessment must immediately contact the referral entity and
consult with the triage nurse or other staff responsible for intake at the referral entity. During
the consultation, the crisis team member must convey key findings or concerns that led to
the recipient's referral. Following the immediate consultation, the provider must also send
written documentation upon completion. The provider must document if these releases
occurred with authorization by the recipient, the recipient's legal guardian, or as allowed
by section 144.293, subdivision 5.
new text end
new text begin Subd. 6b. new text end
new text begin Crisis intervention services. new text end
deleted text begin (c)deleted text end new text begin (a)new text end If the crisis assessment determines mobile
crisis intervention services are needed, the new text begin crisis new text end intervention services must be provided
promptly. As opportunity presents during the intervention, at least two members of the
mobile crisis intervention team must confer directly or by telephone about the new text begin crisis
new text end assessment, new text begin crisis new text end treatment plan, and actions taken and needed. At least one of the team
members must be deleted text begin on sitedeleted text end providing new text begin face-to-face new text end crisis intervention services. If providing
deleted text begin on-sitedeleted text end crisis intervention services, a new text begin clinical trainee or new text end mental health practitioner must seek
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required in subdivision 9.
new text begin
(b) If a provider delivers crisis intervention services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin (d)deleted text end new text begin (c)new text end The mobile crisis intervention team must develop deleted text begin an initial, briefdeleted text end new text begin anew text end crisis treatment
plan deleted text begin as soon as appropriate but no later than 24 hours after the initial face-to-face interventiondeleted text end new text begin
according to subdivision 11new text end . deleted text begin The plan must address the needs and problems noted in the
crisis assessment and include deleted text end deleted text begin measurable short-term goals, cultural considerations, and
frequency and type of services to be provided to achieve the goals and reduce or eliminate
the crisis. The treatment plan must be updated as needed to reflect current goals and services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The new text begin mobile crisis intervention new text end team must document which deleted text begin short-term goalsdeleted text end new text begin crisis
treatment plan goals and objectivesnew text end have been met and when no further crisis intervention
services are required.
deleted text begin (f)deleted text end new text begin (e)new text end If the recipient's new text begin mental health new text end crisis is stabilized, but the recipient needs a referral
to other services, the team must provide referrals to these services. If the recipient has a
case manager, planning for other services must be coordinated with the case manager. If
the recipient is unable to follow up on the referral, the team must link the recipient to the
service and follow up to ensure the recipient is receiving the service.
deleted text begin (g)deleted text end new text begin (f)new text end If the recipient's new text begin mental health new text end crisis is stabilized and the recipient does not have
an advance directive, the case manager or crisis team shall offer to work with the recipient
to develop one.
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis deleted text begin stabilizationdeleted text end treatment plan must be developed deleted text begin whichdeleted text end new text begin thatnew text end meets the criteria
in subdivision 11;
(2) staff must be qualified as defined in subdivision 8; deleted text begin and
deleted text end
(3) new text begin crisis stabilization new text end services must be delivered according to the new text begin crisis new text end treatment plan
and include face-to-face contact with the recipient by qualified staff for further assessment,
help with referrals, updating of the crisis deleted text begin stabilizationdeleted text end treatment plan, deleted text begin supportive counseling,deleted text end
skills training, and collaboration with other service providers in the communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) if a provider delivers crisis stabilization services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end If crisis stabilization services are provided in a supervised, licensed residential
setting that serves no more than four adult residents, and one or more individuals are present
at the setting to receive residential crisis stabilization deleted text begin servicesdeleted text end , the residential staff must
include, for at least eight hours per day, at least one deleted text begin individual who meets the qualifications
in subdivision 8, paragraph (a), clause (1) or (2)deleted text end new text begin mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end .
deleted text begin
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
deleted text end
Subd. 8.
deleted text begin Adultdeleted text end Crisis stabilization staff qualifications.
(a) deleted text begin Adultdeleted text end Mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. deleted text begin Individual provider staff must have the following qualificationsdeleted text end new text begin A staff member
providing crisis stabilization services to a recipient must be qualified as anew text end :
(1) deleted text begin be adeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;
(2) deleted text begin be adeleted text end new text begin certified rehabilitation specialist;
new text end
new text begin
(3) clinical trainee;
new text end
new text begin (4)new text end mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end ;
new text begin
(5) mental health certified family peer specialist;
new text end
deleted text begin (3) be adeleted text end new text begin (6) mental healthnew text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or
deleted text begin (4) be adeleted text end new text begin (7)new text end mental health rehabilitation worker deleted text begin who meets the criteria in section
256B.0623, subdivision 5, paragraph (a), clause (4); works under the direction of a mental
health practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professionaldeleted text end .
(b) deleted text begin Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during the
past two years.deleted text end new text begin The 30 hours of ongoing training required in section 245I.05, subdivision
4, paragraph (b), must be specific to providing crisis services to children and adults and
include training about evidence-based practices identified by the commissioner of health
to reduce a recipient's risk of suicide and self-injurious behavior.
new text end
Subd. 9.
Supervision.
new text begin Clinical trainees and new text end mental health practitioners may provide
crisis assessment and deleted text begin mobiledeleted text end crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services
provided;
(2) the mental health professional of the provider entitydeleted text begin , who is an employee or under
contract with the provider entity,deleted text end must be immediately available by phone or in person for
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;
(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a new text begin clinical trainee or new text end mental health practitioner provides deleted text begin on-site servicedeleted text end new text begin
crisis assessment or crisis intervention servicesnew text end ;new text begin and
new text end
(4) the mental health professional must:
(i) review and approvenew text begin , as defined in section 245I.02, subdivision 2,new text end of the tentative
crisis assessment and crisis treatment plannew text begin within 24 hours of first providing services to the
recipient, notwithstanding section 245I.08, subdivision 3new text end ;new text begin and
new text end
(ii) document the consultationnew text begin required in clause (3).new text end deleted text begin ; and
deleted text end
deleted text begin
(iii) sign the crisis assessment and treatment plan within the next business day;
deleted text end
deleted text begin
(5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
deleted text end
deleted text begin
(6) the on-site observation must be documented in the recipient's record and signed by
the mental health professional.
deleted text end
deleted text begin Subd. 10. deleted text end
deleted text begin Recipient file. deleted text end
deleted text begin
Providers of mobile crisis intervention or crisis stabilization
services must maintain a file for each recipient containing the following information:
deleted text end
deleted text begin
(1) individual crisis treatment plans signed by the recipient, mental health professional,
and mental health practitioner who developed the crisis treatment plan, or if the recipient
refused to sign the plan, the date and reason stated by the recipient as to why the recipient
would not sign the plan;
deleted text end
deleted text begin
(2) signed release forms;
deleted text end
deleted text begin
(3) recipient health information and current medications;
deleted text end
deleted text begin
(4) emergency contacts for the recipient;
deleted text end
deleted text begin
(5) case records which document the date of service, place of service delivery, signature
of the person providing the service, and the nature, extent, and units of service. Direct or
telephone contact with the recipient's family or others should be documented;
deleted text end
deleted text begin
(6) required clinical supervision by mental health professionals;
deleted text end
deleted text begin
(7) summary of the recipient's case reviews by staff;
deleted text end
deleted text begin
(8) any written information by the recipient that the recipient wants in the file; and
deleted text end
deleted text begin
(9) an advance directive, if there is one available.
deleted text end
deleted text begin
Documentation in the file must comply with all requirements of the commissioner.
deleted text end
Subd. 11.
new text begin Crisis new text end treatment plan.
deleted text begin
The individual crisis stabilization treatment plan must
include, at a minimum:
deleted text end
deleted text begin
(1) a list of problems identified in the assessment;
deleted text end
deleted text begin
(2) a list of the recipient's strengths and resources;
deleted text end
deleted text begin
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;
deleted text end
deleted text begin
(4) specific objectives directed toward the achievement of each one of the goals;
deleted text end
deleted text begin
(5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;
deleted text end
deleted text begin
(6) planned frequency and type of services initiated;
deleted text end
deleted text begin
(7) a crisis response action plan if a crisis should occur;
deleted text end
deleted text begin
(8) clear progress notes on outcome of goals;
deleted text end
deleted text begin
(9) a written plan must be completed within 24 hours of beginning services with the
recipient; and
deleted text end
deleted text begin
(10) a treatment plan must be developed by a mental health professional or mental health
practitioner under the clinical supervision of a mental health professional. The mental health
professional must approve and sign all treatment plans.
deleted text end
new text begin
(a) Within 24 hours of the recipient's admission, the provider entity must complete the
recipient's crisis treatment plan. The provider entity must:
new text end
new text begin
(1) base the recipient's crisis treatment plan on the recipient's crisis assessment;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the recipient in the
past;
new text end
new text begin
(3) for a child recipient, use a child-centered, family-driven, and culturally appropriate
planning process that allows the recipient's parents and guardians to observe or participate
in the recipient's individual and family treatment services, assessment, and treatment
planning;
new text end
new text begin
(4) for an adult recipient, use a person-centered, culturally appropriate planning process
that allows the recipient's family and other natural supports to observe or participate in
treatment services, assessment, and treatment planning;
new text end
new text begin
(5) identify the participants involved in the recipient's treatment planning. The recipient,
if possible, must be a participant;
new text end
new text begin
(6) identify the recipient's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the recipient engage in treatment;
new text end
new text begin
(7) include documentation of referral to and scheduling of services, including specific
providers where applicable;
new text end
new text begin
(8) ensure that the recipient or the recipient's legal guardian approves under section
245I.02, subdivision 2, of the recipient's crisis treatment plan unless a court orders the
recipient's treatment plan under chapter 253B. If the recipient or the recipient's legal guardian
disagrees with the crisis treatment plan, the license holder must document in the client file
the reasons why the recipient disagrees with the crisis treatment plan; and
new text end
new text begin
(9) ensure that a treatment supervisor approves under section 245I.02, subdivision 2, of
the recipient's treatment plan within 24 hours of the recipient's admission if a mental health
practitioner or clinical trainee completes the crisis treatment plan, notwithstanding section
245I.08, subdivision 3.
new text end
new text begin
(b) The provider entity must provide the recipient and the recipient's legal guardian with
a copy of the recipient's crisis treatment plan.
new text end
Subd. 12.
Excluded services.
The following services are excluded from reimbursement
under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) recipient transportation costs may be covered under other medical assistance
provisions, but transportation services are not an adult mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical
assistance to provide adult mental health crisis response services;
(5) services performed by volunteers;
(6) direct billing of time spent "on call" when not delivering services to a recipient;
(7) provider service time included in case management reimbursement. When a provider
is eligible to provide more than one type of medical assistance service, the recipient must
have a choice of provider for each service, unless otherwise provided for by law;
(8) outreach services to potential recipients; deleted text begin and
deleted text end
(9) a mental health service that is not medically necessarydeleted text begin .deleted text end new text begin ;
new text end
new text begin
(10) services that a residential treatment center licensed under Minnesota Rules, chapter
2960, provides to a client;
new text end
new text begin
(11) partial hospitalization or day treatment; and
new text end
new text begin
(12) a crisis assessment that a residential provider completes when a daily rate is paid
for the recipient's crisis stabilization.
new text end
Sec. 5. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2022, 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
ARTICLE 11
MENTAL HEALTH UNIFORM SERVICE STANDARDS; CONFORMING
CHANGES
Section 1.
Minnesota Statutes 2020, section 62A.152, subdivision 3, is amended to read:
Subd. 3.
Provider discrimination prohibited.
All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professionaldeleted text begin ,
as defined in sections 245.462, subdivision 18, clauses (1) to (5); and 245.4871, subdivision
27, clauses (1) to (5)deleted text end new text begin qualified according to section 245I.04, subdivision 2new text end , to the extent that
the services and treatment are within the scope of mental health professional licensure.
This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.
Sec. 2.
Minnesota Statutes 2020, section 62A.3094, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.
(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.
(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.
(d) "Mental health professional" means a mental health professional deleted text begin as defined in section
245.4871, subdivision 27deleted text end new text begin who is qualified according to section 245I.04, subdivision 2new text end ,
clause (1), (2), (3), (4), or (6), who has training and expertise in autism spectrum disorder
and child development.
Sec. 3.
Minnesota Statutes 2020, section 62Q.096, is amended to read:
62Q.096 CREDENTIALING OF PROVIDERS.
If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:
(1) is authorized to bill under section 256B.0625, subdivision 5;
(2) deleted text begin meets the requirements of Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin is a mental
health clinic certified under section 245I.20new text end ;
(3) is designated an essential community provider under section 62Q.19; and
(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.
A health plan company shall not refuse to credential these providers on the grounds that
their provider network has a sufficient number of providers of that type.
Sec. 4.
Minnesota Statutes 2020, section 144.651, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For the purposes of this section, "patient" means a person who is
admitted to an acute care inpatient facility for a continuous period longer than 24 hours, for
the purpose of diagnosis or treatment bearing on the physical or mental health of that person.
For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a
person who receives health care services at an outpatient surgical center or at a birth center
licensed under section 144.615. "Patient" also means a minor who is admitted to a residential
program as defined in section 253C.01. For purposes of subdivisions 1, 3 to 16, 18, 20 and
30, "patient" also means any person who is receiving mental health treatment on an outpatient
basis or in a community support program or other community-based program. "Resident"
means a person who is admitted to a nonacute care facility including extended care facilities,
nursing homes, and boarding care homes for care required because of prolonged mental or
physical illness or disability, recovery from injury or disease, or advancing age. For purposes
of all subdivisions except subdivisions 28 and 29, "resident" also means a person who is
admitted to a facility licensed as a board and lodging facility under Minnesota Rules, parts
4625.0100 to 4625.2355, new text begin a boarding care home under sections 144.50 to 144.56, new text end or a
supervised living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which
operates a rehabilitation program licensed under chapter 245G new text begin or 245I, new text end or Minnesota Rules,
parts 9530.6510 to 9530.6590.
Sec. 5.
Minnesota Statutes 2020, section 144D.01, subdivision 4, is amended to read:
Subd. 4.
Housing with services establishment or establishment.
(a) "Housing with
services establishment" or "establishment" means:
(1) an establishment providing sleeping accommodations to one or more adult residents,
at least 80 percent of which are 55 years of age or older, and offering or providing, for a
fee, one or more regularly scheduled health-related services or two or more regularly
scheduled supportive services, whether offered or provided directly by the establishment
or by another entity arranged for by the establishment; or
(2) an establishment that registers under section 144D.025.
(b) Housing with services establishment does not include:
(1) a nursing home licensed under chapter 144A;
(2) a hospital, certified boarding care home, or supervised living facility licensed under
sections 144.50 to 144.56;
(3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules,
parts 9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(4) a board and lodging establishment which serves as a shelter for battered women or
other similar purpose;
(5) a family adult foster care home licensed by the Department of Human Services;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) residential settings for persons with developmental disabilities in which the services
are licensed under chapter 245D;
(8) a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person in
exchange for services or rent, or both;
(9) a duly organized condominium, cooperative, common interest community, or owners'
association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units;
(10) services for persons with developmental disabilities that are provided under a license
under chapter 245D; or
(11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593.
Sec. 6.
Minnesota Statutes 2020, section 144G.08, subdivision 7, as amended by Laws
2020, Seventh Special Session chapter 1, article 6, section 5, is amended to read:
Subd. 7.
Assisted living facility.
"Assisted living facility" means a facility that provides
sleeping accommodations and assisted living services to one or more adults. Assisted living
facility includes assisted living facility with dementia care, and does not include:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) a private home in which the residents are related by kinship, law, or affinity with the
provider of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593;
(9) a setting offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011;
(14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b); or
(15) any establishment that exclusively or primarily serves as a shelter or temporary
shelter for victims of domestic or any other form of violence.
Sec. 7.
Minnesota Statutes 2020, section 148B.5301, subdivision 2, is amended to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional deleted text begin as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2new text end , or by a board-approved supervisor, who has at
least two years of postlicensure experience in the delivery of clinical services in the diagnosis
and treatment of mental illnesses and disorders. All supervisors must meet the supervisor
requirements in Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
Sec. 8.
Minnesota Statutes 2020, section 148E.120, subdivision 2, is amended to read:
Subd. 2.
Alternate supervisors.
(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a deleted text begin licenseddeleted text end mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:
(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;
(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;
(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or
(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or
(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.
(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:
(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and
(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.
Sec. 9.
Minnesota Statutes 2020, section 148F.11, subdivision 1, is amended to read:
Subdivision 1.
Other professionals.
(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, paragraph
(a), clauses (1) deleted text begin and (2)deleted text end new text begin to (6)new text end , providing deleted text begin integrated dual diagnosisdeleted text end new text begin co-occurring substance
use disordernew text end treatment in adult mental health rehabilitative programs certified new text begin or licensed
new text end by the Department of Human Services under section new text begin 245I.23, new text end 256B.0622new text begin ,new text end or 256B.0623.
(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).
Sec. 10.
Minnesota Statutes 2020, section 245.462, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
The definitions in this section apply to sections 245.461 to
deleted text begin 245.486deleted text end new text begin 245.4863new text end .
Sec. 11.
Minnesota Statutes 2020, section 245.462, subdivision 6, is amended to read:
Subd. 6.
Community support services program.
"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.
Sec. 12.
Minnesota Statutes 2020, section 245.462, subdivision 8, is amended to read:
Subd. 8.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a 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; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week 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 part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described by section
256B.0671, subdivision 3new text end .
Sec. 13.
Minnesota Statutes 2020, section 245.462, subdivision 9, is amended to read:
Subd. 9.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given in
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
deleted text begin
(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
deleted text end
Sec. 14.
Minnesota Statutes 2020, section 245.462, subdivision 14, is amended to read:
Subd. 14.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the formulation
of planned services that are responsive to the needs and goals of a client. An individual
treatment plan must be completed according to section 245I.10, subdivisions 7 and 8new text end .
Sec. 15.
Minnesota Statutes 2020, section 245.462, subdivision 16, is amended to read:
Subd. 16.
Mental health funds.
"Mental health funds" are funds expended under sections
245.73 and 256E.12, federal mental health block grant funds, and funds expended under
section 256D.06 to facilities licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670.
Sec. 16.
Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
deleted text begin (a)deleted text end "Mental health practitioner" means a new text begin staff
new text end person deleted text begin providing services to adults with mental illness or children with emotional disturbance
who is qualified in at least one of the ways described in paragraphs (b) to (g). A mental
health practitioner for a child client must have training working with children. A mental
health practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end .
deleted text begin
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
deleted text end
deleted text begin
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
deleted text end
deleted text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
deleted text end
deleted text begin
(3) is working in a day treatment program under section 245.4712, subdivision 2; or
deleted text end
deleted text begin
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
deleted text end
deleted text begin
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
deleted text end
deleted text begin
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
deleted text end
deleted text begin
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
deleted text end
deleted text begin
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
deleted text end
deleted text begin
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
deleted text end
deleted text begin
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
deleted text end
deleted text begin
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
deleted text end
deleted text begin
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
deleted text end
deleted text begin
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
deleted text end
deleted text begin
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
deleted text end
deleted text begin
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 245.462, subdivision 18, is amended to read:
Subd. 18.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin who is qualified according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
deleted text end
deleted text begin
(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
deleted text end
deleted text begin
(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
deleted text end
deleted text begin
(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
deleted text end
deleted text begin
(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
deleted text end
deleted text begin
(4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry, or an
osteopathic physician licensed under chapter 147 and certified by the American Osteopathic
Board of Neurology and Psychiatry or eligible for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness; or
deleted text end
deleted text begin
(7) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
deleted text end
Sec. 18.
Minnesota Statutes 2020, section 245.462, subdivision 21, is amended to read:
Subd. 21.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.
Sec. 19.
Minnesota Statutes 2020, section 245.462, subdivision 23, is amended to read:
Subd. 23.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under new text begin chapter 245I, new text end Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted
by the commissioner.
Sec. 20.
Minnesota Statutes 2020, section 245.462, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245.4661, subdivision 5, is amended to read:
Subd. 5.
Planning for pilot projects.
(a) Each local plan for a pilot project, with the
exception of the placement of a Minnesota specialty treatment facility as defined in paragraph
(c), must be developed under the direction of the county board, or multiple county boards
acting jointly, as the local mental health authority. The planning process for each pilot shall
include, but not be limited to, mental health consumers, families, advocates, local mental
health advisory councils, local and state providers, representatives of state and local public
employee bargaining units, and the department of human services. As part of the planning
process, the county board or boards shall designate a managing entity responsible for receipt
of funds and management of the pilot project.
(b) For Minnesota specialty treatment facilities, the commissioner shall issue a request
for proposal for regions in which a need has been identified for services.
(c) For purposes of this section, "Minnesota specialty treatment facility" is defined as
an intensive residential treatment service new text begin licensed new text end under deleted text begin section 256B.0622, subdivision 2,
paragraph (b)deleted text end new text begin chapter 245Inew text end .
Sec. 22.
Minnesota Statutes 2020, section 245.4662, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given them.
(b) "Community partnership" means a project involving the collaboration of two or more
eligible applicants.
(c) "Eligible applicant" means an eligible county, Indian tribe, mental health service
provider, hospital, or community partnership. Eligible applicant does not include a
state-operated direct care and treatment facility or program under chapter 246.
(d) "Intensive residential treatment services" has the meaning given in section 256B.0622deleted text begin ,
subdivision 2deleted text end .
(e) "Metropolitan area" means the seven-county metropolitan area, as defined in section
473.121, subdivision 2.
Sec. 23.
Minnesota Statutes 2020, section 245.467, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services
governed by this section must complete a diagnostic assessment according to the standards
of section 245I.10, subdivisions 4 to 6.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245.467, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. Providers of day treatment services must develop the individual
treatment plan before the completion of five working days in which service is provided or
within 30 days after the diagnostic assessment is completed or obtained, whichever occurs
first. Providers of outpatient services must develop the individual treatment plan within 30
days after the diagnostic assessment is completed or obtained or by the end of the second
session of an outpatient service, not including the session in which the diagnostic assessment
was provided, whichever occurs first. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services
governed by this section must complete an individual treatment plan according to the
standards of section 245I.10, subdivisions 7 and 8.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245.470, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved by the
commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter 245Inew text end ;
by contract with privately operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved
by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter
245Inew text end ; by contract with hospital mental health outpatient programs certified by the Joint
Commission on Accreditation of Hospital Organizations; or by contract with a deleted text begin licenseddeleted text end
mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6)deleted text end .
Clients may be required to pay a fee according to section 245.481. Outpatient services
include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating an adult's mental health needs through therapy;
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and
(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.
Sec. 26.
Minnesota Statutes 2020, section 245.4712, subdivision 2, is amended to read:
Subd. 2.
Day treatment services provided.
(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:
(1) provide a structured environment for treatment;
(2) provide support for residing in the community;
(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;
(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and
(5) operate on a continuous basis throughout the year.
(b) deleted text begin For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of clinical supervision specified in
Minnesota Rules, part 9505.0371, subpart 4. The clinical supervision must be performed
by a qualified supervisor who satisfies the requirements of Minnesota Rules, part 9505.0371,
subpart 5.deleted text end new text begin An adult day treatment program must comply with medical assistance requirements
in section 256B.0671, subdivision 3.
new text end
deleted text begin
A day treatment program must demonstrate compliance with this clinical supervision
requirement by the commissioner's review and approval of the program according to
Minnesota Rules, part 9505.0372, subpart 8.
deleted text end
(c) County boards may request a waiver from including day treatment services if they
can document that:
(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;
(2) day treatment, if included, would be duplicative of other components of the
community support services; and
(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.
Sec. 27.
Minnesota Statutes 2020, section 245.472, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
Providers of residential services must be licensed under
new text begin chapter 245I or new text end applicable rules adopted by the commissioner deleted text begin and must be clinically
supervised by a mental health professional. Persons employed in facilities licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director as of
July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may be
allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670deleted text end .new text begin Residential services must be provided under treatment supervision.
new text end
Sec. 28.
Minnesota Statutes 2020, section 245.4863, is amended to read:
245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.
(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.
(b) Notwithstanding paragraph (a), screening is not required when:
(1) the presence of co-occurring disorders was documented for the client in the past 12
months;
(2) the client is currently receiving co-occurring disorders treatment;
(3) the client is being referred for co-occurring disorders treatment; or
(4) a mental health professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0370, subpart
18,deleted text end who is competent to perform diagnostic assessments of co-occurring disorders is
performing a diagnostic assessment deleted text begin that meets the requirements in Minnesota Rules, part
9533.0090, subpart 5,deleted text end to identify whether the client may have co-occurring mental health
and chemical dependency disorders. If an individual is identified to have co-occurring
mental health and substance use disorders, the assessing mental health professional must
document what actions will be taken to address the client's co-occurring disorders.
(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.
(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.
Sec. 29.
Minnesota Statutes 2020, section 245.4871, subdivision 9a, is amended to read:
Subd. 9a.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .
"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatmentdeleted text end new text begin the development of a written plan to assist a child and the child's family in
preventing and addressing a potential crisis and is distinct from mobile crisis services defined
in section 256B.0624. The plan must address prevention, deescalation, and intervention
strategies to be used in a crisis. The plan identifies factors that might precipitate a crisis,
behaviors or symptoms related to the emergence of a crisis, and the resources available to
resolve a crisis. The plan must address the following potential needs: (1) acute carenew text end ; (2)
crisis placement; (3) community resources for follow-up; and (4) emotional support to the
family during crisis. new text begin When appropriate for the child's needs, the plan must include strategies
to reduce the child's risk of suicide and self-injurious behavior.new text end Crisis deleted text begin assistancedeleted text end new text begin planningnew text end
does not include services designed to secure the safety of a child who is at risk of abuse or
neglect or necessary emergency services.
Sec. 30.
Minnesota Statutes 2020, 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; deleted text begin or
deleted text end
(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 boarddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) a program certified under section 256B.0943.
new text end
Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.
A day treatment service must be available to a child up to 15 hours 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. 31.
Minnesota Statutes 2020, section 245.4871, subdivision 11a, is amended to read:
Subd. 11a.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given
in deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
Sec. 32.
Minnesota Statutes 2020, section 245.4871, subdivision 17, is amended to read:
Subd. 17.
Family community support services.
"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:
(1) client outreach to each child with severe emotional disturbance and the child's family;
(2) medication monitoring where necessary;
(3) assistance in developing independent living skills;
(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;
(5) assistance with leisure and recreational activities;
(6) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis placement and respite care;
(7) professional home-based family treatment;
(8) foster care with therapeutic supports;
(9) day treatment;
(10) assistance in locating respite care and special needs day care; and
(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.
Sec. 33.
Minnesota Statutes 2020, section 245.4871, subdivision 21, is amended to read:
Subd. 21.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the formulation of planned services that are responsive to
the needs and goals of a client. An individual treatment plan must be completed according
to section 245I.10, subdivisions 7 and 8new text end .
Sec. 34.
Minnesota Statutes 2020, section 245.4871, subdivision 26, is amended to read:
Subd. 26.
Mental health practitioner.
"Mental health practitioner" deleted text begin has the meaning
given in section 245.462, subdivision 17deleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
Sec. 35.
Minnesota Statutes 2020, section 245.4871, subdivision 27, is amended to read:
Subd. 27.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing, the mental health professional must be a registered nurse who
is licensed under sections 148.171 to 148.285 and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences or
related fields from an accredited college or university or its equivalent, with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
deleted text end
deleted text begin
(2) in clinical social work, the mental health professional must be a person licensed as
an independent clinical social worker under chapter 148D, or a person with a master's degree
in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders;
deleted text end
deleted text begin
(3) in psychology, the mental health professional must be an individual licensed by the
board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
deleted text end
deleted text begin
(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatry or an osteopathic physician licensed under chapter 147
and certified by the American Osteopathic Board of Neurology and Psychiatry or eligible
for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders or emotional disturbances;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders or emotional disturbances; or
deleted text end
deleted text begin
(7) in allied fields, the mental health professional must be a person with a master's degree
from an accredited college or university in one of the behavioral sciences or related fields,
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of emotional disturbances.
deleted text end
Sec. 36.
Minnesota Statutes 2020, section 245.4871, subdivision 29, is amended to read:
Subd. 29.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.
Sec. 37.
Minnesota Statutes 2020, section 245.4871, subdivision 31, is amended to read:
Subd. 31.
Professional home-based family treatment.
"Professional home-based family
treatment" means intensive mental health services provided to children because of an
emotional disturbance (1) who are at risk of out-of-home placement; (2) who are in
out-of-home placement; or (3) who are returning from out-of-home placement. Services
are provided to the child and the child's family primarily in the child's home environment.
Services may also be provided in the child's school, child care setting, or other community
setting appropriate to the child. Services must be provided on an individual family basis,
must be child-oriented and family-oriented, and must be designed using information from
diagnostic and functional assessments to meet the specific mental health needs of the child
and the child's family. Examples of services are: (1) individual therapy; (2) family therapy;
(3) client outreach; (4) assistance in developing individual living skills; (5) assistance in
developing parenting skills necessary to address the needs of the child; (6) assistance with
leisure and recreational services; (7) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis respite care
and arranging for crisis placement; and (8) assistance in locating respite and child care.
Services must be coordinated with other services provided to the child and family.
Sec. 38.
Minnesota Statutes 2020, section 245.4871, subdivision 32, is amended to read:
Subd. 32.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.
Sec. 39.
Minnesota Statutes 2020, section 245.4871, subdivision 34, is amended to read:
Subd. 34.
Therapeutic support of foster care.
"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end
Sec. 40.
Minnesota Statutes 2020, section 245.4871, is amended by adding a subdivision
to read:
new text begin Subd. 36. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 41.
Minnesota Statutes 2020, section 245.4876, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 245I.10, subdivisions
4 to 6.
new text end
Sec. 42.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intake, except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9.
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
245I.10, subdivisions 7 and 8.
new text end
Sec. 43.
Minnesota Statutes 2020, section 245.488, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated deleted text begin mental health centers ordeleted text end mental
health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting
the standards of chapter 245Inew text end ; by contract with privately operated deleted text begin mental health centers ordeleted text end
mental health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin
meeting the standards of chapter 245Inew text end ; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.4871,
subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to pay a fee
based in accordance with section 245.481. Outpatient services include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating the child's mental health needs through therapy; and
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.
(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.
Sec. 44.
Minnesota Statutes 2020, section 245.4901, subdivision 2, is amended to read:
Subd. 2.
Eligible applicants.
An eligible applicant for school-linked mental health grants
is an entity that is:
(1) new text begin a mental health clinic new text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
section 245I.20new text end ;
(2) a community mental health center under section 256B.0625, subdivision 5;
(3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
(4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
(5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section deleted text begin 245I.16deleted text end new text begin 245I.04new text end , subdivision 2, or two alcohol and drug counselors
licensed or exempt from licensure under chapter 148F who are qualified to provide clinical
services to children and families.
Sec. 45.
Minnesota Statutes 2020, section 245.62, subdivision 2, is amended to read:
Subd. 2.
Definition.
A community mental health center is a private nonprofit corporation
or public agency approved under the deleted text begin rules promulgated by the commissioner pursuant to
subdivision 4deleted text end new text begin standards of section 256B.0625, subdivision 5new text end .
Sec. 46.
Minnesota Statutes 2020, section 245A.04, subdivision 5, is amended to read:
Subd. 5.
Commissioner's right of access.
(a) When the commissioner is exercising the
powers conferred by this chapter, deleted text begin sections 245.69 anddeleted text end new text begin sectionnew text end 626.557, and chapter 260E,
the commissioner must be given access to:
(1) the physical plant and grounds where the program is provided;
(2) documents and records, including records maintained in electronic format;
(3) persons served by the program; and
(4) staff and personnel records of current and former staff whenever the program is in
operation and the information is relevant to inspections or investigations conducted by the
commissioner. Upon request, the license holder must provide the commissioner verification
of documentation of staff work experience, training, or educational requirements.
The commissioner must be given access without prior notice and as often as the
commissioner considers necessary if the commissioner is investigating alleged maltreatment,
conducting a licensing inspection, or investigating an alleged violation of applicable laws
or rules. In conducting inspections, the commissioner may request and shall receive assistance
from other state, county, and municipal governmental agencies and departments. The
applicant or license holder shall allow the commissioner to photocopy, photograph, and
make audio and video tape recordings during the inspection of the program at the
commissioner's expense. The commissioner shall obtain a court order or the consent of the
subject of the records or the parents or legal guardian of the subject before photocopying
hospital medical records.
(b) Persons served by the program have the right to refuse to consent to be interviewed,
photographed, or audio or videotaped. Failure or refusal of an applicant or license holder
to fully comply with this subdivision is reasonable cause for the commissioner to deny the
application or immediately suspend or revoke the license.
Sec. 47.
Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
$200 |
|
| greater than $10,000 but less than or equal to $25,000 |
$300 |
|
| greater than $25,000 but less than or equal to $50,000 |
$400 |
|
| greater than $50,000 but less than or equal to $100,000 |
$500 |
|
| greater than $100,000 but less than or equal to $150,000 |
$600 |
|
| greater than $150,000 but less than or equal to $200,000 |
$800 |
|
| greater than $200,000 but less than or equal to $250,000 |
$1,000 |
|
| greater than $250,000 but less than or equal to $300,000 |
$1,200 |
|
| greater than $300,000 but less than or equal to $350,000 |
$1,400 |
|
| greater than $350,000 but less than or equal to $400,000 |
$1,600 |
|
| greater than $400,000 but less than or equal to $450,000 |
$1,800 |
|
| greater than $450,000 but less than or equal to $500,000 |
$2,000 |
|
| greater than $500,000 but less than or equal to $600,000 |
$2,250 |
|
| greater than $600,000 but less than or equal to $700,000 |
$2,500 |
|
| greater than $700,000 but less than or equal to $800,000 |
$2,750 |
|
| greater than $800,000 but less than or equal to $900,000 |
$3,000 |
|
| greater than $900,000 but less than or equal to $1,000,000 |
$3,250 |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
$3,500 |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
$3,750 |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
$4,000 |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
$4,250 |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
$4,500 |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
$4,750 |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
$5,000 |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
$5,500 |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
$6,000 |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
$6,500 |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
$7,000 |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
$8,500 |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
$10,000 |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
$14,000 |
|
| greater than $15,000,000 |
$18,000 |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670, to serve persons with mental illness shall pay an annual
nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A deleted text begin mental health center ordeleted text end mental health clinic deleted text begin requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin certified under section 245I.20new text end , shall pay deleted text begin adeleted text end new text begin an annual nonrefundablenew text end certification
fee of $1,550 deleted text begin per yeardeleted text end . If the deleted text begin mentaldeleted text end deleted text begin health center ordeleted text end mental health clinic provides services
at a primary location with satellite facilities, the satellite facilities shall be certified with the
primary location without an additional charge.
Sec. 48.
Minnesota Statutes 2020, section 245A.65, subdivision 2, is amended to read:
Subd. 2.
Abuse prevention plans.
All license holders shall establish and enforce ongoing
written program abuse prevention plans and individual abuse prevention plans as required
under section 626.557, subdivision 14.
(a) The scope of the program abuse prevention plan is limited to the population, physical
plant, and environment within the control of the license holder and the location where
licensed services are provided. In addition to the requirements in section 626.557, subdivision
14, the program abuse prevention plan shall meet the requirements in clauses (1) to (5).
(1) The assessment of the population shall include an evaluation of the following factors:
age, gender, mental functioning, physical and emotional health or behavior of the client;
the need for specialized programs of care for clients; the need for training of staff to meet
identified individual needs; and the knowledge a license holder may have regarding previous
abuse that is relevant to minimizing risk of abuse for clients.
(2) The assessment of the physical plant where the licensed services are provided shall
include an evaluation of the following factors: the condition and design of the building as
it relates to the safety of the clients; and the existence of areas in the building which are
difficult to supervise.
(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following factors:
the location of the program in a particular neighborhood or community; the type of grounds
and terrain surrounding the building; the type of internal programming; and the program's
staffing patterns.
(4) The license holder shall provide an orientation to the program abuse prevention plan
for clients receiving services. If applicable, the client's legal representative must be notified
of the orientation. The license holder shall provide this orientation for each new person
within 24 hours of admission, or for persons who would benefit more from a later orientation,
the orientation may take place within 72 hours.
(5) The license holder's governing body or the governing body's delegated representative
shall review the plan at least annually using the assessment factors in the plan and any
substantiated maltreatment findings that occurred since the last review. The governing body
or the governing body's delegated representative shall revise the plan, if necessary, to reflect
the review results.
(6) A copy of the program abuse prevention plan shall be posted in a prominent location
in the program and be available upon request to mandated reporters, persons receiving
services, and legal representatives.
(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).
(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within the
scope of the licensed services, and will identify referrals made when the vulnerable adult
is susceptible to abuse outside the scope or control of the licensed services. When the
assessment indicates that the vulnerable adult does not need specific risk reduction measures
in addition to those identified in the program abuse prevention plan, the individual abuse
prevention plan shall document this determination.
(2) An individual abuse prevention plan shall be developed for each new person as part
of the initial individual program plan or service plan required under the applicable licensing
rulenew text begin or statutenew text end . The review and evaluation of the individual abuse prevention plan shall be
done as part of the review of the program plan deleted text begin ordeleted text end new text begin ,new text end service plannew text begin , or treatment plannew text end . The person
receiving services shall participate in the development of the individual abuse prevention
plan to the full extent of the person's abilities. If applicable, the person's legal representative
shall be given the opportunity to participate with or for the person in the development of
the plan. The interdisciplinary team shall document the review of all abuse prevention plans
at least annually, using the individual assessment and any reports of abuse relating to the
person. The plan shall be revised to reflect the results of this review.
Sec. 49.
Minnesota Statutes 2020, section 245D.02, subdivision 20, is amended to read:
Subd. 20.
Mental health crisis intervention team.
"Mental health crisis intervention
team" means a mental health crisis response provider as identified in section 256B.0624deleted text begin ,
subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision 1, paragraph
(d), for childrendeleted text end .
Sec. 50.
Minnesota Statutes 2020, section 256B.0615, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified peer specialist
services, as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
are provided by a new text begin mental health new text end certified peer specialist who has completed the training
under subdivision 5new text begin and is qualified according to section 245I.04, subdivision 10new text end .
Sec. 51.
Minnesota Statutes 2020, section 256B.0615, subdivision 5, is amended to read:
Subd. 5.
Certified peer specialist training and certification.
The commissioner of
human services shall develop a training and certification process for certified peer specialistsdeleted text begin ,
who must be at least 21 years of agedeleted text end . The candidates must have had a primary diagnosis of
mental illness, be a current or former consumer of mental health services, and must
demonstrate leadership and advocacy skills and a strong dedication to recovery. The training
curriculum must teach participating consumers specific skills relevant to providing peer
support to other consumers. In addition to initial training and certification, the commissioner
shall develop ongoing continuing educational workshops on pertinent issues related to peer
support counseling.
Sec. 52.
Minnesota Statutes 2020, section 256B.0616, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified family peer
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245, and are provided by a new text begin mental health new text end certified family peer specialist who has
completed the training under subdivision 5new text begin and is qualified according to section 245I.04,
subdivision 12new text end . A family peer specialist cannot provide services to the peer specialist's
family.
Sec. 53.
Minnesota Statutes 2020, section 256B.0616, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment, new text begin intensive new text end treatment
new text begin in new text end foster care, day treatment, children's therapeutic services and supports, or crisis services.
Sec. 54.
Minnesota Statutes 2020, section 256B.0616, subdivision 5, is amended to read:
Subd. 5.
Certified family peer specialist training and certification.
The commissioner
shall develop a training and certification process for certified family peer specialists deleted text begin who
must be at least 21 years of agedeleted text end . The candidates must have raised or be currently raising a
child with a mental illness, have had experience navigating the children's mental health
system, and must demonstrate leadership and advocacy skills and a strong dedication to
family-driven and family-focused services. The training curriculum must teach participating
family peer specialists specific skills relevant to providing peer support to other parents. In
addition to initial training and certification, the commissioner shall develop ongoing
continuing educational workshops on pertinent issues related to family peer support
counseling.
Sec. 55.
Minnesota Statutes 2020, section 256B.0622, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin (a) new text end Subject to federal approval, medical assistance covers medically
necessary, assertive community treatment deleted text begin for clients as defined in subdivision 2a and
intensive residential treatment services for clients as defined in subdivision 3,deleted text end when the
services are provided by an entity new text begin certified under and new text end meeting the standards in this section.
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary, intensive
residential treatment services when the services are provided by an entity licensed under
and meeting the standards in section 245I.23.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner, using instruments and protocols approved by the
commissioner.
new text end
Sec. 56.
Minnesota Statutes 2020, section 256B.0622, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them.
(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.
(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.
(d) "Individual treatment plan" means deleted text begin the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomesdeleted text end new text begin a plan described by section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(e) "Assertive engagement" means the use of collaborative strategies to engage clients
to receive services.
deleted text end
deleted text begin
(f) "Benefits and finance support" means assisting clients in capably managing financial
affairs. Services include, but are not limited to, assisting clients in applying for benefits;
assisting with redetermination of benefits; providing financial crisis management; teaching
and supporting budgeting skills and asset development; and coordinating with a client's
representative payee, if applicable.
deleted text end
deleted text begin
(g) "Co-occurring disorder treatment" means the treatment of co-occurring mental illness
and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages of
change, such as outreach and motivational interviewing techniques to work with clients in
earlier stages of change readiness and cognitive behavioral approaches and relapse prevention
to work with clients in later stages of change; and facilitating access to community supports.
deleted text end
deleted text begin (h)deleted text end new text begin (e)new text end "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2deleted text begin , paragraphs (c) to (e)deleted text end .
deleted text begin
(i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing individual
client preferences and strengths; ensuring employment services are integrated with mental
health services; conducting rapid job searches and systematic job development according
to client preferences and choices; providing benefits counseling; and offering all services
in an individualized and time-unlimited manner. Services shall also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the work place, and managing work relationships.
deleted text end
deleted text begin
(j) "Family psychoeducation and support" means services provided to the client's family
and other natural supports to restore and strengthen the client's unique social and family
relationships. Services include, but are not limited to, individualized psychoeducation about
the client's illness and the role of the family and other significant people in the therapeutic
process; family intervention to restore contact, resolve conflict, and maintain relationships
with family and other significant people in the client's life; ongoing communication and
collaboration between the ACT team and the family; introduction and referral to family
self-help programs and advocacy organizations that promote recovery and family
engagement, individual supportive counseling, parenting training, and service coordination
to help clients fulfill parenting responsibilities; coordinating services for the child and
restoring relationships with children who are not in the client's custody; and coordinating
with child welfare and family agencies, if applicable. These services must be provided with
the client's agreement and consent.
deleted text end
deleted text begin
(k) "Housing access support" means assisting clients to find, obtain, retain, and move
to safe and adequate housing of their choice. Housing access support includes, but is not
limited to, locating housing options with a focus on integrated independent settings; applying
for housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation.
deleted text end
deleted text begin (l)deleted text end new text begin (f)new text end "Individual treatment team" means a minimum of three members of the ACT team
who are responsible for consistently carrying out most of a client's assertive community
treatment services.
deleted text begin
(m) "Intensive residential treatment services treatment team" means all staff who provide
intensive residential treatment services under this section to clients. At a minimum, this
includes the clinical supervisor; mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6); mental health practitioners as defined in section 245.462,
subdivision 17; mental health rehabilitation workers under section 256B.0623, subdivision
5, paragraph (a), clause (4); and mental health certified peer specialists under section
256B.0615.
deleted text end
deleted text begin
(n) "Intensive residential treatment services" means short-term, time-limited services
provided in a residential setting to clients who are in need of more restrictive settings and
are at risk of significant functional deterioration if they do not receive these services. Services
are designed to develop and enhance psychiatric stability, personal and emotional adjustment,
self-sufficiency, and skills to live in a more independent setting. Services must be directed
toward a targeted discharge date with specified client outcomes.
deleted text end
deleted text begin
(o) "Medication assistance and support" means assisting clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. This includes the prescription, administration, and order of medication
by appropriate medical staff.
deleted text end
deleted text begin
(p) "Medication education" means educating clients on the role and effects of medications
in treating symptoms of mental illness and the side effects of medications.
deleted text end
deleted text begin
(q) "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.
deleted text end
deleted text begin
(r) "Mental health certified peer specialist services" has the meaning given in section
256B.0615.
deleted text end
deleted text begin
(s) "Physical health services" means any service or treatment to meet the physical health
needs of the client to support the client's mental health recovery. Services include, but are
not limited to, education on primary health issues, including wellness education; medication
administration and monitoring; providing and coordinating medical screening and follow-up;
scheduling routine and acute medical and dental care visits; tobacco cessation strategies;
assisting clients in attending appointments; communicating with other providers; and
integrating all physical and mental health treatment.
deleted text end
deleted text begin (t)deleted text end new text begin (g)new text end "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.
deleted text begin
(u) "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text end
deleted text begin
(v) "Symptom management" means supporting clients in identifying and targeting the
symptoms and occurrence patterns of their mental illness and developing strategies to reduce
the impact of those symptoms.
deleted text end
deleted text begin
(w) "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure therapy,
acceptance and commitment therapy, interpersonal therapy, and motivational interviewing.
deleted text end
deleted text begin
(x) "Wellness self-management and prevention" means a combination of approaches to
working with the client to build and apply skills related to recovery, and to support the client
in participating in leisure and recreational activities, civic participation, and meaningful
structure.
deleted text end
new text begin
(h) "Certified rehabilitation specialist" means a staff person who is qualified according
to section 245I.04, subdivision 8.
new text end
new text begin
(i) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
new text begin
(j) "Mental health certified peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 10.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified according
to section 245I.04, subdivision 14.
new text end
Sec. 57.
Minnesota Statutes 2020, section 256B.0622, subdivision 3a, is amended to read:
Subd. 3a.
Provider certification and contract requirements for assertive community
treatment.
(a) The assertive community treatment provider must:
(1) have a contract with the host county to provide assertive community treatment
services; and
(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , the standards in chapter 245I as required in section 245I.011, subdivision 5, andnew text end
minimum program fidelity standards as measured by a nationally recognized fidelity tool
approved by the commissioner. Recertification must occur at least every three years.
(b) An ACT team certified under this subdivision must meet the following standards:
(1) have capacity to recruit, hire, manage, and train required ACT team members;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and ongoing training for staff;
deleted text end
deleted text begin
(4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;
deleted text begin
(6) develop and maintain client files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(7) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(8) submit information as required by the state;
deleted text end
deleted text begin (9)deleted text end new text begin (4)new text end keep all necessary records required by law;
deleted text begin
(10) comply with all applicable laws;
deleted text end
deleted text begin (11)deleted text end new text begin (5)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (12)deleted text end new text begin (6)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(13) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.
Sec. 58.
Minnesota Statutes 2020, section 256B.0622, subdivision 4, is amended to read:
Subd. 4.
Provider entity licensure and contract requirements for intensive residential
treatment services.
deleted text begin
(a) The intensive residential treatment services provider entity must:
deleted text end
deleted text begin
(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
deleted text end
deleted text begin
(2) not exceed 16 beds per site; and
deleted text end
deleted text begin
(3) comply with the additional standards in this section.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end The commissioner shall develop procedures for counties and providers to submit
other documentation as needed to allow the commissioner to determine whether the standards
in this section are met.
deleted text begin (c)deleted text end new text begin (b)new text end A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.
deleted text begin (d)deleted text end new text begin (c)new text end A provider entity must submit documentation that the provider entity requested
a statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.
Sec. 59.
Minnesota Statutes 2020, section 256B.0622, subdivision 7, is amended to read:
Subd. 7.
Assertive community treatment service standards.
(a) ACT teams must offer
and have the capacity to directly provide the following services:
(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;
(2) benefits and finance supportnew text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicablenew text end ;
(3) co-occurring new text begin substance use new text end disorder treatmentnew text begin as defined in section 245I.02,
subdivision 11new text end ;
(4) crisis assessment and intervention;
(5) employment servicesnew text begin that assist clients to work at jobs of the clients' choosing.
Services must follow the principles of the individual placement and support employment
model, including focusing on competitive employment, emphasizing individual client
preferences and strengths, ensuring employment services are integrated with mental health
services, conducting rapid job searches and systematic job development according to client
preferences and choices, providing benefits counseling, and offering all services in an
individualized and time-unlimited manner. Services must also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the workplace, workplace accommodations, and managing work
relationshipsnew text end ;
(6) family psychoeducation and supportnew text begin provided to the client's family and other natural
supports to restore and strengthen the client's unique social and family relationships. Services
include but are not limited to individualized psychoeducation about the client's illness and
the role of the family and other significant people in the therapeutic process; family
intervention to restore contact, resolve conflict, and maintain relationships with family and
other significant people in the client's life; ongoing communication and collaboration between
the ACT team and the family; introduction and referral to family self-help programs and
advocacy organizations that promote recovery and family engagement, individual supportive
counseling, parenting training, and service coordination to help clients fulfill parenting
responsibilities; coordinating services for the child and restoring relationships with children
who are not in the client's custody; and coordinating with child welfare and family agencies,
if applicable. These services must be provided with the client's agreement and consentnew text end ;
(7) housing access supportnew text begin that assists clients to find, obtain, retain, and move to safe
and adequate housing of their choice. Housing access support includes but is not limited to
locating housing options with a focus on integrated independent settings; applying for
housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocationnew text end ;
(8) medication assistance and supportnew text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staffnew text end ;
(9) medication educationnew text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medicationsnew text end ;
(10) mental health certified peer specialists servicesnew text begin according to section 256B.0615new text end ;
(11) physical health servicesnew text begin to meet the physical health needs of the client to support
the client's mental health recovery. Services include but are not limited to education on
primary health and wellness issues, medication administration and monitoring, providing
and coordinating medical screening and follow-up, scheduling routine and acute medical
and dental care visits, tobacco cessation strategies, assisting clients in attending appointments,
communicating with other providers, and integrating all physical and mental health treatmentnew text end ;
(12) rehabilitative mental health servicesnew text begin as defined in section 245I.02, subdivision 33new text end ;
(13) symptom managementnew text begin that supports clients in identifying and targeting the symptoms
and occurrence patterns of their mental illness and developing strategies to reduce the impact
of those symptomsnew text end ;
(14) therapeutic interventionsnew text begin to address specific symptoms and behaviors such as
anxiety, psychotic symptoms, emotional dysregulation, and trauma symptoms. Interventions
include empirically supported psychotherapies including but not limited to cognitive
behavioral therapy, exposure therapy, acceptance and commitment therapy, interpersonal
therapy, and motivational interviewingnew text end ;
(15) wellness self-management and preventionnew text begin that includes a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structurenew text end ; and
(16) other services based on client needs as identified in a client's assertive community
treatment individual treatment plan.
(b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.
Sec. 60.
Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end of services in conjunction with the psychiatrist or psychiatric
care provider, and supervising team members to ensure delivery of best and ethical practices;
and
(iv) must be available to provide overall deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end to the
ACT team after regular business hours and on weekends and holidays. The team leader may
delegate this duty to another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a deleted text begin licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item Adeleted text end new text begin mental health
professional permitted to prescribe psychiatric medications as part of the mental health
professional's scope of practicenew text end . The psychiatric care provider must have demonstrated
clinical experience working with individuals with serious and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may not provide specific roles and responsibilities by telemedicine unless approved
by the commissioner; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) deleted text begin shoulddeleted text end new text begin mustnew text end not refer individuals to receive any type of vocational services or linkage
by providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; new text begin clinical trainees; certified rehabilitation specialists; new text end mental health practitioners deleted text begin as defined
in section 245.462, subdivision 17; a mental health practitioner working as a clinical trainee
according to Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end ; or mental health
rehabilitation workers deleted text begin as defined in section 256B.0623, subdivision 5, paragraph (a), clause
(4)deleted text end . These individuals shall have the knowledge, skills, and abilities required by the
population served to carry out rehabilitation and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 61.
Minnesota Statutes 2020, section 256B.0622, subdivision 7b, is amended to read:
Subd. 7b.
Assertive community treatment program size and opportunities.
(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:
(1) a small ACT team must:
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
(ii) serve an annual average maximum of no more than 50 clients;
(iii) ensure at least one full-time equivalent position for every eight clients served;
(iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least one additional full-time ACT team member
who has mental health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or
new text begin mental health new text end practitioner status; and
(2) a midsize ACT team shall:
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end
specialist, one full-time equivalent mental health certified peer specialist, one full-time
vocational specialist, one full-time program assistant, and at least 1.5 to two additional
full-time equivalent ACT members, with at least one dedicated full-time staff member with
mental health professional status. Remaining team members may have mental health
professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or new text begin mental health new text end practitioner
status;
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
(iii) serve an annual average maximum caseload of 51 to 74 clients;
(iv) ensure at least one full-time equivalent position for every nine clients served;
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
(3) a large ACT team must:
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one full-time equivalent
mental health certified peer specialist, one full-time vocational specialist, one full-time
program assistant, and at least two additional full-time equivalent ACT team members, with
at least one dedicated full-time staff member with mental health professional status.
Remaining team members may have mental health professional or mental health practitioner
status;
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
(iii) serve an annual average maximum caseload of 75 to 100 clients;
(iv) ensure at least one full-time equivalent position for every nine individuals served;
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
Sec. 62.
Minnesota Statutes 2020, section 256B.0622, subdivision 7d, is amended to read:
Subd. 7d.
Assertive community treatment assessment and individual treatment
plan.
(a) An initial assessmentdeleted text begin , including a diagnostic assessment that meets the requirements
of Minnesota Rules, part 9505.0372, subpart 1, and a 30-day treatment plandeleted text end shall be
completed the day of the client's admission to assertive community treatment by the ACT
team leader or the psychiatric care provider, with participation by designated ACT team
members and the client. new text begin The initial assessment must include obtaining or completing a
standard diagnostic assessment according to section 245I.10, subdivision 6, and completing
a 30-day individual treatment plan. new text end The team leader, psychiatric care provider, or other
mental health professional designated by the team leader or psychiatric care provider, must
update the client's diagnostic assessment at least annually.
(b) deleted text begin An initialdeleted text end new text begin Anew text end functional assessment must be completed deleted text begin within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes firstdeleted text end new text begin according to section 245I.10, subdivision 9new text end .
deleted text begin
(c) Within 30 days of the client's assertive community treatment admission, the ACT
team shall complete an in-depth assessment of the domains listed under section 245.462,
subdivision 11a.
deleted text end
deleted text begin (d)deleted text end Each part of the deleted text begin in-depthdeleted text end new text begin functionalnew text end assessment areas shall be completed by each
respective team specialist or an ACT team member with skill and knowledge in the area
being assessed. deleted text begin The assessments are based upon all available information, including that
from client interview family and identified natural supports, and written summaries from
other agencies, including police, courts, county social service agencies, outpatient facilities,
and inpatient facilities, where applicable.
deleted text end
deleted text begin (e)deleted text end new text begin (c)new text end Between 30 and 45 days after the client's admission to assertive community
treatment, the entire ACT team must hold a comprehensive case conference, where all team
members, including the psychiatric provider, present information discovered from the
completed deleted text begin in-depthdeleted text end assessments and provide treatment recommendations. The conference
must serve as the basis for the first deleted text begin six-monthdeleted text end new text begin individualnew text end treatment plan, which must be
written by the primary team member.
deleted text begin (f)deleted text end new text begin (d)new text end The client's psychiatric care provider, primary team member, and individual
treatment team members shall assume responsibility for preparing the written narrative of
the results from the psychiatric and social functioning history timeline and the comprehensive
assessment.
deleted text begin (g)deleted text end new text begin (e)new text end The primary team member and individual treatment team members shall be
assigned by the team leader in collaboration with the psychiatric care provider by the time
of the first treatment planning meeting or 30 days after admission, whichever occurs first.
deleted text begin (h)deleted text end new text begin (f)new text end Individual treatment plans must be developed through the following treatment
planning process:
(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.
(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.
(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.
(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.
(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.
(6) The individual treatment plan and review must be deleted text begin signeddeleted text end new text begin approvednew text end or acknowledged
by the client, the primary team member, the team leader, the psychiatric care provider, and
all individual treatment team members. A copy of the deleted text begin signeddeleted text end new text begin approvednew text end individual treatment
plan deleted text begin isdeleted text end new text begin must benew text end made available to the client.
Sec. 63.
Minnesota Statutes 2020, section 256B.0623, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin Subject to federal approval, new text end medical assistance covers new text begin medically
necessary new text end adult rehabilitative mental health services deleted text begin as defined in subdivision 2, subject to
federal approval, if provided to recipients as defined in subdivision 3 and provided by a
qualified provider entity meeting the standards in this section and by a qualified individual
provider working within the provider's scope of practice and identified in the recipient's
individual treatment plan as defined in section 245.462, subdivision 14, and if determined
to be medically necessary according to section 62Q.53deleted text end new text begin when the services are provided by
an entity meeting the standards in this sectionnew text end .new text begin The provider entity must make reasonable
and good faith efforts to report individual client outcomes to the commissioner, using
instruments and protocols approved by the commissioner.
new text end
Sec. 64.
Minnesota Statutes 2020, section 256B.0623, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Adult rehabilitative mental health services" means deleted text begin mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these servicesdeleted text end new text begin the
services described in section 245I.02, subdivision 33new text end .
deleted text begin
(1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
deleted text end
deleted text begin
(2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
deleted text end
(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and 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, advanced
practice registered nurses, pharmacists, physician assistants, or registered nurses.
(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program deleted text begin under Minnesota Rules, chapter
9505deleted text end , board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.
Sec. 65.
Minnesota Statutes 2020, section 256B.0623, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is age 18 or older;
(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;
(3) has substantial disability and functional impairment in three or more of the areas
listed in section deleted text begin 245.462, subdivision 11adeleted text end new text begin 245I.10, subdivision 9, clause (4)new text end , so that
self-sufficiency is markedly reduced; and
(4) has had a recent new text begin standard new text end diagnostic assessment deleted text begin or an adult diagnostic assessment
updatedeleted text end by a qualified professional that documents adult rehabilitative mental health services
are medically necessary to address identified disability and functional impairments and
individual recipient goals.
Sec. 66.
Minnesota Statutes 2020, section 256B.0623, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.
(b) The certification process is a determination as to whether the entity meets the standards
in this deleted text begin subdivisiondeleted text end new text begin section and chapter 245I, as required in section 245I.011, subdivision 5new text end .
The certification must specify which adult rehabilitative mental health services the entity
is qualified to provide.
(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.
(d) new text begin State-level new text end recertification must occur at least every three years.
(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.
(f) The adult rehabilitative mental health services provider entity must meet the following
standards:
(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and inservice and ongoing training for staff;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staffnew text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;
deleted text begin
(5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;
deleted text begin
(7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;
deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;
deleted text begin
(10) develop and maintain recipient files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(11) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(12) submit information as required by the state;
deleted text end
deleted text begin
(13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
deleted text end
deleted text begin (14)deleted text end new text begin (7)new text end keep all necessary records required by law;
deleted text begin (15)deleted text end new text begin (8)new text end deliver services as required by section 245.461;
deleted text begin
(16) comply with all applicable laws;
deleted text end
deleted text begin (17)deleted text end new text begin (9)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (18)deleted text end new text begin (10)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(19) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
Sec. 67.
Minnesota Statutes 2020, section 256B.0623, subdivision 5, is amended to read:
Subd. 5.
Qualifications of provider staff.
deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin under one of the following criteriadeleted text end new text begin asnew text end :
(1) a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitionerdeleted text end new text begin
who is qualified according to section 245I.04, subdivision 2new text end ;
(2)new text begin a certified rehabilitation specialist who is qualified according to section 245I.04,
subdivision 8;
new text end
new text begin
(3) a clinical trainee who is qualified according to section 245I.04, subdivision 6;
new text end
new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.04, subdivision 4new text end ;
deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin who
is qualified according to section 245I.04, subdivision 10new text end ; or
deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin who is qualified according to section 245I.04,
subdivision 14new text end . deleted text begin A mental health rehabilitation worker means a staff person working under
the direction of a mental health practitioner or mental health professional and under the
clinical supervision of a mental health professional in the implementation of rehabilitative
mental health services as identified in the recipient's individual treatment plan who:
deleted text end
deleted text begin
(i) is at least 21 years of age;
deleted text end
deleted text begin
(ii) has a high school diploma or equivalent;
deleted text end
deleted text begin
(iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and
deleted text end
deleted text begin
(iv) meets the qualifications in paragraph (b).
deleted text end
deleted text begin
(b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):
deleted text end
deleted text begin
(1) has an associates of arts degree, two years of full-time postsecondary education, or
a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields; is
a registered nurse; or within the previous ten years has:
deleted text end
deleted text begin
(i) three years of personal life experience with serious mental illness;
deleted text end
deleted text begin
(ii) three years of life experience as a primary caregiver to an adult with a serious mental
illness, traumatic brain injury, substance use disorder, or developmental disability; or
deleted text end
deleted text begin
(iii) 2,000 hours of supervised work experience in the delivery of mental health services
to adults with a serious mental illness, traumatic brain injury, substance use disorder, or
developmental disability;
deleted text end
deleted text begin
(2)(i) is fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
deleted text end
deleted text begin
(ii) receives during the first 2,000 hours of work, monthly documented individual clinical
supervision by a mental health professional;
deleted text end
deleted text begin
(iii) has 18 hours of documented field supervision by a mental health professional or
mental health practitioner during the first 160 hours of contact work with recipients, and at
least six hours of field supervision quarterly during the following year;
deleted text end
deleted text begin
(iv) has review and cosignature of charting of recipient contacts during field supervision
by a mental health professional or mental health practitioner; and
deleted text end
deleted text begin
(v) has 15 hours of additional continuing education on mental health topics during the
first year of employment and 15 hours during every additional year of employment; or
deleted text end
deleted text begin
(3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:
deleted text end
deleted text begin
(i) satisfies clause (2), items (ii) to (iv); and
deleted text end
deleted text begin
(ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.
deleted text end
deleted text begin
(c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).
deleted text end
deleted text begin
(d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.
deleted text end
Sec. 68.
Minnesota Statutes 2020, section 256B.0623, subdivision 6, is amended to read:
Subd. 6.
Required deleted text begin training anddeleted text end supervision.
deleted text begin
(a) Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d).
deleted text end
deleted text begin
(b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
deleted text end
deleted text begin
(c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.
A mental health professional providing clinical supervision of staff delivering adult
rehabilitative mental health services must provide the following guidance:
deleted text end
deleted text begin
(1) review the information in the recipient's file;
deleted text end
deleted text begin
(2) review and approve initial and updates of individual treatment plans;
deleted text end
new text begin
(a) A treatment supervisor providing treatment supervision required by section 245I.06
must:
new text end
deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving treatment supervisionnew text end at least monthly to discuss treatment
topics of interest deleted text begin to the workers and practitioners;
deleted text end
deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly to discussdeleted text end new text begin andnew text end treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;new text begin and
new text end
deleted text begin (5)deleted text end new text begin (2)new text end meet at least monthly with the directing new text begin clinical trainee or new text end mental health
practitioner, if there is one, to review needs of the adult rehabilitative mental health services
program, review staff on-site observations and evaluate mental health rehabilitation workers,
plan staff training, review program evaluation and development, and consult with the
directing new text begin clinical trainee or mental health new text end practitionerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end An adult rehabilitative mental health services provider entity must have a treatment
director who is a deleted text begin mental health practitioner ordeleted text end mental health professionalnew text begin clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end . The treatment director must
deleted text begin ensure the followingdeleted text end :
(1) deleted text begin while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker worksdeleted text end new text begin ensure the direct
observation of mental health rehabilitation workers required by section 245I.06, subdivision
3, is providednew text end ;
deleted text begin
(2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
deleted text end
deleted text begin
(3) progress notes are reviewed from on-site service observation prepared by the mental
health rehabilitation worker and mental health practitioner for accuracy and consistency
with actual recipient contact and the individual treatment plan and goals;
deleted text end
deleted text begin (4)deleted text end new text begin (2) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or a mental health
practitioner to the mental health rehabilitation deleted text begin servicesdeleted text end worker during service provision;
deleted text begin
(5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
deleted text end
deleted text begin (6)deleted text end new text begin (3)new text end model service practices which: respect the recipient, include the recipient in
planning and implementation of the individual treatment plan, recognize the recipient's
strengths, collaborate and coordinate with other involved parties and providers;
deleted text begin (7)deleted text end new text begin (4)new text end ensure that new text begin clinical trainees, new text end mental health practitionersnew text begin ,new text end and mental health
rehabilitation workers are able to effectively communicate with the recipients, significant
others, and providers; and
deleted text begin (8)deleted text end new text begin (5)new text end oversee the record of the results of deleted text begin on-sitedeleted text end new text begin directnew text end observation deleted text begin and chartingdeleted text end new text begin , progress
notenew text end evaluationnew text begin ,new text end and corrective actions taken to modify the work of the new text begin clinical trainees,
new text end mental health practitionersnew text begin ,new text end and mental health rehabilitation workers.
deleted text begin (e)deleted text end new text begin (c)new text end A new text begin clinical trainee or new text end mental health practitioner who is providing treatment direction
for a provider entity must receive new text begin treatment new text end supervision at least monthly deleted text begin from a mental
health professionaldeleted text end to:
(1) identify and plan for general needs of the recipient population served;
(2) identify and plan to address provider entity program needs and effectiveness;
(3) identify and plan provider entity staff training and personnel needs and issues; and
(4) plan, implement, and evaluate provider entity quality improvement programs.
Sec. 69.
Minnesota Statutes 2020, section 256B.0623, subdivision 9, is amended to read:
Subd. 9.
Functional assessment.
new text begin (a) new text end Providers of adult rehabilitative mental health
services must complete a written functional assessment deleted text begin as defined in section 245.462,
subdivision 11adeleted text end new text begin according to section 245I.10, subdivision 9new text end , for each recipient. deleted text begin The functional
assessment must be completed within 30 days of intake, and reviewed and updated at least
every six months after it is developed, unless there is a significant change in the functioning
of the recipient. If there is a significant change in functioning, the assessment must be
updated. A single functional assessment can meet case management and adult rehabilitative
mental health services requirements if agreed to by the recipient. Unless the recipient refuses,
the recipient must have significant participation in the development of the functional
assessment.
deleted text end
new text begin
(b) When a provider of adult rehabilitative mental health services completes a written
functional assessment, the provider must also complete a level of care assessment as defined
in section 245I.02, subdivision 19, for the recipient.
new text end
Sec. 70.
Minnesota Statutes 2020, section 256B.0623, subdivision 12, is amended to read:
Subd. 12.
Additional requirements.
(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.
(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36)new text begin , or section
245I.23new text end , or an acute care hospital.
(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and new text begin individual new text end treatment plan. A group
is defined as two to ten clients, at least one of whom is a recipient, who is concurrently
receiving a service which is identified in this section. The service and group must be specified
in the recipient's new text begin individual new text end treatment plan. No more than two qualified staff may bill
Medicaid for services provided to the same group of recipients. If two adult rehabilitative
mental health workers bill for recipients in the same group session, they must each bill for
different recipients.
new text begin
(d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
new text end
new text begin
(e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
new text end
new text begin
(f) Community intervention, including consultation with relatives, guardians, friends,
employers, treatment providers, and other significant individuals, is appropriate when
directed exclusively to the treatment of the client.
new text end
Sec. 71.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
Telemedicine services.
(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f). Telemedicine services shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, a community paramedic as defined
under section 144E.001, subdivision 5f, deleted text begin ordeleted text end new text begin a clinical trainee who is qualified according to
section 245I.04, subdivision 6,new text end a mental health practitioner deleted text begin defined under section 245.462,
subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a
mental health professionaldeleted text end new text begin qualified according to section 245I.04, subdivision 4new text end , and a
community health worker who meets the criteria under subdivision 49, paragraph (a); "health
care provider" is defined under section 62A.671, subdivision 3; and "originating site" is
defined under section 62A.671, subdivision 7.
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
Sec. 72.
Minnesota Statutes 2020, section 256B.0625, subdivision 5, is amended to read:
Subd. 5.
Community mental health center services.
Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).
(a) The provider deleted text begin is licensed under Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin must
be certified as a mental health clinic under section 245I.20new text end .
(b) deleted text begin The provider provides mental health services under the clinical supervision of adeleted text end new text begin In
addition to the policies and procedures required by section 245I.03, the provider must
establish, enforce, and maintain the policies and procedures for clinical oversight of services
by anew text end mental health professional who is new text begin a psychologistnew text end licensed for independent practice at
the doctoral level deleted text begin or by a board-certified deleted text end deleted text begin psychiatristdeleted text end or a psychiatrist who is deleted text begin eligible for
board certificationdeleted text end new text begin qualified according to section 245I.04, subdivision 2, clause (4)new text end . deleted text begin Clinical
supervision has the meaning given in Minnesota Rules, part 9505.0370, subpart 6.
deleted text end
(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.
(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.
(e) At a minimum, the provider must provide the following outpatient mental health
services: diagnostic assessment; explanation of findings; family, group, and individual
psychotherapy, including crisis intervention psychotherapy services, deleted text begin multiple family group
psychotherapydeleted text end , psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.
(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are deleted text begin diagnosed with bothdeleted text end new text begin dually diagnosed withnew text end mental illness or emotional
disturbance, and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individualsnew text begin who arenew text end
dually diagnosed with a mental illness or emotional disturbance and developmental disability.
(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.
(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).
(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.
(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.
new text begin
(k) The commissioner may require the provider to annually attest that the provider meets
the requirements in this subdivision using a form that the commissioner provides.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (e), (f), and (k) are effective the day following final
enactment.
new text end
Sec. 73.
Minnesota Statutes 2020, section 256B.0625, subdivision 19c, is amended to
read:
Subd. 19c.
Personal care.
Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.
"Qualified professional" means a mental health professional deleted text begin as defined in section 245.462,
subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.
Sec. 74.
Minnesota Statutes 2020, section 256B.0625, subdivision 28a, is amended to
read:
Subd. 28a.
Licensed physician assistant services.
(a) Medical assistance covers services
performed by a licensed physician assistant if the service is otherwise covered under this
chapter as a physician service and if the service is within the scope of practice of a licensed
physician assistant as defined in section 147A.09.
(b) Licensed physician assistants, who are supervised by a physician certified by the
American Board of Psychiatry and Neurology or eligible for board certification in psychiatry,
may bill for medication management and evaluation and management services provided to
medical assistance enrollees in inpatient hospital settings, and in outpatient settings after
the licensed physician assistant completes 2,000 hours of clinical experience in the evaluation
and treatment of mental health, consistent with their authorized scope of practice, as defined
in section 147A.09, with the exception of performing psychotherapy or diagnostic
assessments or providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision.
Sec. 75.
Minnesota Statutes 2020, section 256B.0625, subdivision 42, is amended to read:
Subd. 42.
Mental health professional.
Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional deleted text begin shall include a person
who isdeleted text end qualified deleted text begin as specified indeleted text end new text begin according tonew text end section deleted text begin 245.462, subdivision 18, clauses (1) to
(6); or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end , for the purpose
of this section and Minnesota Rules, parts 9505.0170 to 9505.0475.
Sec. 76.
Minnesota Statutes 2020, section 256B.0625, subdivision 48, is amended to read:
Subd. 48.
Psychiatric consultation to primary care practitioners.
Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5)deleted text end new text begin mental health professional
who is qualified according to section 245I.04, subdivision 2, except a licensed professional
clinical counselor licensed under section 148B.5301new text end , via telephone, e-mail, facsimile, or
other means of communication to primary care practitioners, including pediatricians. The
need for consultation and the receipt of the consultation must be documented in the patient
record maintained by the primary care practitioner. If the patient consents, and subject to
federal limitations and data privacy provisions, the consultation may be provided without
the patient present.
Sec. 77.
Minnesota Statutes 2020, section 256B.0625, subdivision 49, is amended to read:
Subd. 49.
Community health worker.
(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin :
deleted text end
deleted text begin (1)deleted text end received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
deleted text end
deleted text begin
Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
deleted text end
(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6), and section
245.4871, subdivision 27, clauses (1) to (5)deleted text end , or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.
(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.
Sec. 78.
Minnesota Statutes 2020, section 256B.0625, subdivision 56a, is amended to
read:
Subd. 56a.
Officer-involved community-based care coordination.
(a) Medical
assistance covers officer-involved community-based care coordination for an individual
who:
(1) has screened positive for benefiting from treatment for a mental illness or substance
use disorder using a tool approved by the commissioner;
(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;
(3) meets the eligibility requirements in section 256B.056; and
(4) has agreed to participate in officer-involved community-based care coordination.
(b) Officer-involved community-based care coordination means navigating services to
address a client's mental health, chemical health, social, economic, and housing needs, or
any other activity targeted at reducing the incidence of jail utilization and connecting
individuals with existing covered services available to them, including, but not limited to,
targeted case management, waiver case management, or care coordination.
(c) Officer-involved community-based care coordination must be provided by an
individual who is an employee of or is under contract with a county, or is an employee of
or under contract with an Indian health service facility or facility owned and operated by a
tribe or a tribal organization operating under Public Law 93-638 as a 638 facility to provide
officer-involved community-based care coordination and is qualified under one of the
following criteria:
(1) a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18,
clauses (1) to (6)deleted text end ;
(2)new text begin a clinical trainee who is qualified according to section 245I.04, subdivision 6, working
under the treatment supervision of a mental health professional according to section 245I.06;
new text end
new text begin (3)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17deleted text end new text begin who is
qualified according to section 245I.04, subdivision 4new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision of a mental health professionalnew text begin according to section 245I.06new text end ;
deleted text begin (3)deleted text end new text begin (4)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615deleted text end new text begin who is qualified
according to section 245I.04, subdivision 10new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;
(4) an individual qualified as an alcohol and drug counselor under section 245G.11,
subdivision 5; or
(5) a recovery peer qualified under section 245G.11, subdivision 8, working under the
supervision of an individual qualified as an alcohol and drug counselor under section
245G.11, subdivision 5.
(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.
(e) Providers of officer-involved community-based care coordination shall annually
report to the commissioner on the number of individuals served, and number of the
community-based services that were accessed by recipients. The commissioner shall ensure
that services and payments provided under officer-involved community-based care
coordination do not duplicate services or payments provided under section 256B.0625,
subdivision 20, 256B.0753, 256B.0755, or 256B.0757.
(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
officer-involved community-based care coordination services shall be provided by the
county providing the services, from sources other than federal funds or funds used to match
other federal funds.
Sec. 79.
Minnesota Statutes 2020, section 256B.0757, subdivision 4c, is amended to read:
Subd. 4c.
Behavioral health home services staff qualifications.
(a) A behavioral health
home services provider must maintain staff with required professional qualifications
appropriate to the setting.
(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.
(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1)
to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(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 deleted text begin as defined
indeleted text end new text begin who is qualified according tonew text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.04, subdivision 4new text end , or
a community health worker as defined in section 256B.0625, subdivision 49.
(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:
(1) a new text begin mental health certified new text end peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0615deleted text end new text begin 245I.04, subdivision 10new text end ;
(2) a new text begin mental health certified new text end family peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0616deleted text end new text begin 245I.04, subdivision 12new text end ;
(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
(4) a mental health rehabilitation worker deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 256B.0623, subdivision 5, clause (4)deleted text end new text begin 245I.04, subdivision 14new text end ;
(5) a community paramedic as defined in section 144E.28, subdivision 9;
(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
(7) a community health worker as defined in section 256B.0625, subdivision 49.
Sec. 80.
Minnesota Statutes 2020, section 256B.0941, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:
(1) before admission, services are determined to be medically necessary according to
Code of Federal Regulations, title 42, section 441.152;
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
(7) was referred for treatment in a psychiatric residential treatment facility by a deleted text begin qualifieddeleted text end
mental health professional deleted text begin licensed as defined indeleted text end new text begin who is qualified according tonew text end section
deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The commissioner shall provide oversight and review the use of referrals for clients
admitted to psychiatric residential treatment facilities to ensure that eligibility criteria,
clinical services, and treatment planning reflect clinical, state, and federal standards for
psychiatric residential treatment facility level of care. The commissioner shall coordinate
the production of a statewide list of children and youth who meet the medical necessity
criteria for psychiatric residential treatment facility level of care and who are awaiting
admission. The commissioner and any recipient of the list shall not use the statewide list to
direct admission of children and youth to specific facilities.
Sec. 81.
Minnesota Statutes 2020, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
deleted text begin
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" means a deleted text begin mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin staff person who is qualified
according to section 245I.04, subdivision 6new text end .
deleted text begin (d)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a. deleted text begin Crisis assistance entails the development of a written plan to assist a child's family to
contend with a potential crisis and is distinct from the immediate provision of crisis
intervention services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
deleted text begin (f)deleted text end new text begin (e)new text end "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a deleted text begin multidisciplinarydeleted text end team, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professional.
deleted text begin (g)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described in 245I.10, subdivision 6new text end .
deleted text begin (h)deleted text end new text begin (g)new text end "Direct service time" means the time that a mental health professional, clinical
trainee, mental health practitioner, or mental health behavioral aide spends face-to-face with
a client and the client's family or providing covered telemedicine services. Direct service
time includes time in which the provider obtains a client's history, develops a client's
treatment plan, records individual treatment outcomes, or provides service components of
children's therapeutic services and supports. Direct service time does not include time doing
work before and after providing direct services, including scheduling or maintaining clinical
records.
deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end or mental health practitioner in guiding the mental
health behavioral aide in providing services to a client. The direction of a mental health
behavioral aide must be based on the client's deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan and
meet the requirements in subdivision 6, paragraph (b), clause (5).
deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.
deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional new text begin or a clinical trainee new text end or mental health
practitionerdeleted text begin ,deleted text end under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, to
guide the work of the mental health behavioral aide. The individual behavioral plan may
be incorporated into the child's individual treatment plan so long as the behavioral plan is
separately communicable to the mental health behavioral aide.
deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a deleted text begin trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3)deleted text end new text begin mental health behavioral aide qualified according to section 245I.04,
subdivision 16new text end , to assist a child retain or generalize psychosocial skills as previously trained
by a mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner and as described
in the child's individual treatment plan and individual behavior plan. Activities involve
working directly with the child or child's family as provided in subdivision 9, paragraph
(b), clause (4).
new text begin
(m) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
(n) "Mental health practitioner" deleted text begin has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
deleted text end deleted text begin services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experiencedeleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7,deleted text end including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and
(2) administering new text begin and reporting the new text end standardized outcome deleted text begin measurement instruments,
determined and updated by the commissionerdeleted text end new text begin measurements in section 245I.10, subdivision
6, paragraph (d), clauses (3) and (4), and other standardized outcome measurements approved
by the commissionernew text end , as periodically needed to evaluate the effectiveness of treatment deleted text begin for
children receiving clinical services and reporting outcome measures, as required by the
commissionerdeleted text end .
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment deleted text begin of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plandeleted text end new text begin described in section 256B.0671, subdivision 11new text end .
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
new text begin coordinated new text end psychotherapy to address internal psychological, emotional, and intellectual
processing deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
new text begin
(u) "Treatment supervision" means the supervision described in section 245I.06.
new text end
Sec. 82.
Minnesota Statutes 2020, section 256B.0943, subdivision 2, is amended to read:
Subd. 2.
Covered service components of children's therapeutic services and
supports.
(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports deleted text begin as defined in this section thatdeleted text end new text begin when the services
are provided bynew text end an eligible provider entity certified under deleted text begin subdivision 4 provides to a client
eligible under subdivision 3deleted text end new text begin and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) The service components of children's therapeutic services and supports are:
(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;
(2) individual, family, or group skills training provided by a mental health professionalnew text begin ,
clinical trainee,new text end or mental health practitioner;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;
(4) mental health behavioral aide services;
(5) direction of a mental health behavioral aide;
(6) mental health service plan development; and
(7) children's day treatment.
Sec. 83.
Minnesota Statutes 2020, section 256B.0943, subdivision 3, is amended to read:
Subd. 3.
Determination of client eligibility.
new text begin (a) new text end A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a new text begin standard
new text end diagnostic assessment by a mental health professional or a deleted text begin mental health practitioner who
meets the requirements of a clinical trainee as defined in Minnesota Rules, part 9505.0371,
subpart 5, item C,deleted text end new text begin clinical traineenew text end that is performed within one year before the initial start
of service. The new text begin standard new text end diagnostic assessment must deleted text begin meet the requirements for a standard
or extended diagnostic assessment as defined in Minnesota Rules, part 9505.0372, subpart
1, items B and C, anddeleted text end :
deleted text begin
(1) include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or, for
children under age five, as specified in the current edition of the Diagnostic Classification
of Mental Health Disorders of Infancy and Early Childhood;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a child under age 18 has a diagnosis of emotional disturbance
or, if the person is between the ages of 18 and 21, whether the person has a mental illness;
deleted text begin (3)deleted text end new text begin (2)new text end document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals;new text begin and
new text end
deleted text begin (4)deleted text end new text begin (3)new text end be used in the development of the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plandeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) be completed annually until age 18. For individuals between age 18 and 21, unless
a client's mental health condition has changed markedly since the client's most recent
diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
deleted text end
new text begin
(b) Notwithstanding paragraph (a), a client may be determined to be eligible for up to
five days of day treatment under this section based on a hospital's medical history and
presentation examination of the client.
new text end
Sec. 84.
Minnesota Statutes 2020, section 256B.0943, subdivision 4, is amended to read:
Subd. 4.
Provider entity certification.
(a) 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. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity and shall require corrective
action, medical assistance repayment, or decertification of a provider entity that no longer
meets the requirements in this section or that fails to meet the clinical quality standards or
administrative standards provided by the commissioner in the application and certification
process.
(b) For purposes of this section, a provider entity must new text begin meet the standards in this section
and chapter 245I, as required by section 245I.011, subdivision 5, and new text end 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 certified by the state.
Sec. 85.
Minnesota Statutes 2020, section 256B.0943, subdivision 5, is amended to read:
Subd. 5.
Provider entity administrative infrastructure requirements.
(a) deleted text begin To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement.deleted text end An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. deleted text begin The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.
deleted text end
(b) deleted text begin The administrative infrastructure writtendeleted text end new text begin In addition to the policies and procedures
required in section 245I.03, thenew text end policies and procedures must include:
deleted text begin
(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteria, training criteria under subdivision 8, and clinical
supervision or direction of a mental health behavioral aide requirements under subdivision
6;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end fiscal procedures, including internal fiscal control practices and a process for
collecting revenue that is compliant with federal and state laws;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (2)new text end a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017, to be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and
deleted text end
deleted text begin
(4) a process to establish and maintain individual client records. The client's records
must include:
deleted text end
deleted text begin
(i) the client's personal information;
deleted text end
deleted text begin
(ii) forms applicable to data privacy;
deleted text end
deleted text begin
(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
deleted text end
deleted text begin
(iv) documentation of service delivery as specified under subdivision 6;
deleted text end
deleted text begin
(v) telephone contacts;
deleted text end
deleted text begin
(vi) discharge plan; and
deleted text end
deleted text begin
(vii) if applicable, insurance information.
deleted text end
(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.
Sec. 86.
Minnesota Statutes 2020, section 256B.0943, subdivision 5a, is amended to read:
Subd. 5a.
Background studies.
The requirements for background studies under deleted text begin thisdeleted text end
section new text begin 245I.011, subdivision 4, paragraph (d), new text end may be met by a children's therapeutic
services and supports services agency through the commissioner's NETStudy system as
provided under sections 245C.03, subdivision 7, and 245C.10, subdivision 8.
Sec. 87.
Minnesota Statutes 2020, 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, deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plans, 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,
and update as necessary, the clinical policies and procedures every three years, must distribute
the policies and procedures to staff initially and upon each subsequent update, and must
train staff accordingly.
(b) The clinical infrastructure written policies and procedures must include policies and
procedures fornew text begin meeting the requirements in this subdivisionnew text end :
(1) providing or obtaining a client's new text begin standard new text end diagnostic assessment, including a new text begin standard
new text end diagnostic assessment deleted text begin performed by an outside or independent clinician, that identifies acute
and chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.deleted text end
When required components of the new text begin standard new text end diagnostic assessmentdeleted text begin , such as baseline measures,deleted text end
are not provided in an outside or independent assessment or deleted text begin when baseline measuresdeleted text end cannot
be attained deleted text begin in a one-session standard diagnostic assessmentdeleted text end new text begin immediatelynew text end , the provider entity
must determine the missing information within 30 days and amend the child's new text begin standard
new text end diagnostic assessment or incorporate the deleted text begin baselinesdeleted text end new text begin informationnew text end into the child's individual
treatment plan;
(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin ;
new text end
deleted text begin
(i) is based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(iii) is 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;
deleted text end
deleted text begin
(iv) is 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, assessment, and treatment planning;
deleted text end
deleted text begin
(v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
deleted text end
deleted text begin
(vi) is 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;
deleted text end
(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:
(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;
(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;
(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) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans for deleted text begin mental health practitioners and
mental health behavioral aides. 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. The clinical supervisor also shall
document supervisee-specific supervision in the supervisee's personnel file. Clinicaldeleted text end new text begin staff
according to section 245I.06. Treatmentnew text end supervision does not include the authority to make
or terminate court-ordered placements of the child. A deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be
available for urgent consultation as required by the individual client's needs or the situationdeleted text begin .
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
servicesdeleted text end ;
(4a) meeting day treatment program conditions in items (i) deleted text begin to (iii)deleted text end new text begin and (ii)new text end :
(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;new text begin and
new text end
deleted text begin
(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
clinical supervisor; and
deleted text end
deleted text begin (iii)deleted text end new text begin (ii)new text end every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;
(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:
deleted text begin
(i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
deleted text end
deleted text begin
(ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
deleted text end
deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the new text begin clinical trainee, new text end mental health
practitionernew text begin ,new text end or mental health behavioral aide is providing CTSS services; and
deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, 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 deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan, and instruct the mental health
behavioral aide on how to implement therapeutic activities and interventions that will lead
to goal attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end 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 or demonstrate 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 deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the deleted text begin individualizeddeleted text end new text begin individualnew text end
treatment plan and the deleted text begin individualizeddeleted text end new text begin individualnew text end behavior plan. When providing direction,
the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end 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
deleted text begin professional or practitionerdeleted text end new text begin staffnew text end 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; deleted text begin and
deleted text end
(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;new text begin and
new text end
new text begin
(vi) ensure the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
new text end
(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 each of the goals and objectives in the 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. deleted text begin 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 clinical supervisor and 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.
deleted text end
Sec. 88.
Minnesota Statutes 2020, section 256B.0943, subdivision 7, is amended to read:
Subd. 7.
Qualifications of individual and team providers.
(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.
(b) An individual provider must be qualified asnew text begin anew text end :
(1) deleted text begin adeleted text end mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end
(2) deleted text begin adeleted text end new text begin clinical trainee;
new text end
new text begin (3)new text end mental health practitioner deleted text begin or clinical trainee. The mental health practitioner or clinical
trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end
new text begin
(4) mental health certified family peer specialist; or
new text end
deleted text begin (3) adeleted text end new text begin (5)new text end mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.
deleted text end
deleted text begin
(A) A level I mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements under subdivision 8.
deleted text end
deleted text begin
(B) A level II mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements in subdivision 8.
deleted text end
(c) A day treatment deleted text begin multidisciplinarydeleted text end team must include at least one mental health
professional or clinical trainee and one mental health practitioner.
Sec. 89.
Minnesota Statutes 2020, 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) deleted text begin 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.deleted text end 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 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; and
(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
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
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.
(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
(1) deleted text begin patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6.deleted text end psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;
(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:
(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;
(iv) skills training delivered to the child's family must teach skills needed by parents to
enhance the child's skill development, to help the child utilize daily life skills taught by a
mental health professional, clinical trainee, or mental health practitioner, and to develop or
maintain a home environment that supports the child's progressive use of skills;
(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(A) one mental health professional deleted text begin or onedeleted text end new text begin ,new text end clinical traineenew text begin ,new text end or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or
(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;
(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;
(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3),deleted text end and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;new text begin and
new text end
deleted text begin
(5) direction of a mental health behavioral aide must include the following:
deleted text end
deleted text begin
(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child 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
deleted text end
deleted text begin
(ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end mental health service plan development must be performed in consultation with
the child's family and, when appropriate, with other key participants in the child's life by
the child's treating mental health professional or clinical trainee or by a mental health
practitioner and approved by the treating mental health professional. Treatment plan drafting
consists of development, review, and revision by face-to-face or electronic communication.
The provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7,deleted text end Medical assistance
covers service plan development before completion of the child's individual treatment plan.
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
deleted text end
Sec. 90.
Minnesota Statutes 2020, section 256B.0943, subdivision 11, is amended to read:
Subd. 11.
Documentation and billing.
deleted text begin (a)deleted text end A provider entity must document the services
it provides under this section. The provider entity must ensure that documentation complies
with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section
that are not documented according to this subdivision shall be subject to monetary recovery
by the commissioner. Billing for covered service components under subdivision 2, paragraph
(b), must not include anything other than direct service time.
deleted text begin
(b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
deleted text end
deleted text begin
(1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
deleted text end
deleted text begin
(2) the name, dated signature, and credentials of the person who delivered the service;
deleted text end
deleted text begin
(3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
deleted text end
deleted text begin
(4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
deleted text end
deleted text begin
(5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
deleted text end
deleted text begin
(6) the date when services are discontinued and reasons for discontinuation of services.
deleted text end
Sec. 91.
Minnesota Statutes 2020, section 256B.0946, subdivision 1, is amended to read:
Subdivision 1.
Required covered service components.
(a) deleted text begin Effective May 23, 2013,
anddeleted text end Subject to federal approval, medical assistance covers medically necessary intensive
treatment services deleted text begin described under paragraph (b) thatdeleted text end new text begin when the servicesnew text end are provided by a
provider entity deleted text begin eligible under subdivision 3 to a client eligible under subdivision 2 who is
placed in a foster home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or
placed in a foster home licensed under the regulations established by a federally recognized
Minnesota tribedeleted text end new text begin certified under and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (5)
are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;
(2) crisis deleted text begin assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943deleted text end new text begin planningnew text end ;
(3) individual, family, and group psychoeducation servicesdeleted text begin , defined in subdivision 1a,
paragraph (q),deleted text end provided by a mental health professional or a clinical trainee;
(4) clinical care consultationdeleted text begin , as defined in subdivision 1a, anddeleted text end provided by a mental
health professional or a clinical trainee; and
(5) service delivery payment requirements as provided under subdivision 4.
Sec. 92.
Minnesota Statutes 2020, section 256B.0946, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For the purposes of this section, the following terms have the
meanings given them.
(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.
deleted text begin
(b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.
deleted text end
deleted text begin
(c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item C;deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9adeleted text begin , including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis interventiondeleted text end .
deleted text begin (f)deleted text end new text begin (d)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influencesdeleted text begin , as defined in Minnesota Rules, part 9505.0370,
subpart 9,deleted text end into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
deleted text begin (g)deleted text end new text begin (e)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.
deleted text begin (h)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means the assessment described in section 245I.10, subdivision 6new text end .
deleted text begin (i)deleted text end new text begin (g)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.
deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(m) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, and a mental health practitioner working as a clinical trainee according to Minnesota
Rules, part 9505.0371, subpart 5, item C.
deleted text end
new text begin
(k) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
deleted text begin (n)deleted text end new text begin (l)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245I.02, subdivision 29new text end .
deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.
deleted text begin (q)deleted text end new text begin (o)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.
deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" deleted text begin has the meaning given in Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin means the treatment described in section 256B.0671, subdivision 11new text end .
deleted text begin (s)deleted text end new text begin (q)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.
new text begin
(r) "Trauma" has the meaning given in section 245I.02, subdivision 38.
new text end
new text begin
(s) "Treatment supervision" means the supervision described under section 245I.06.
new text end
Sec. 93.
Minnesota Statutes 2020, section 256B.0946, subdivision 2, is amended to read:
Subd. 2.
Determination of client eligibility.
An eligible recipient is an individual, from
birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, new text begin or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota tribe, new text end and has receivednew text begin : (1)new text end a
new text begin standard new text end diagnostic assessment deleted text begin and an evaluation of level of care needed, as defined in
paragraphs (a) and (b).deleted text end new text begin within 180 days before the start of service that documents that
intensive treatment services are medically necessary within a foster family setting to
ameliorate identified symptoms and functional impairments; and (2) a level of care
assessment as defined in section 245I.02, subdivision 19, that demonstrates that the individual
requires intensive intervention without 24-hour medical monitoring, and a functional
assessment as defined in section 245I.02, subdivision 17. The level of care assessment and
the functional assessment must include information gathered from the placing county, tribe,
or case manager.
new text end
deleted text begin
(a) The diagnostic assessment must:
deleted text end
deleted text begin
(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
deleted text end
deleted text begin
(2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
deleted text end
deleted text begin
(3) document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;
deleted text end
deleted text begin
(4) be performed within 180 days before the start of service; and
deleted text end
deleted text begin
(5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
deleted text end
deleted text begin
(b) The evaluation of level of care must be conducted by the placing county, tribe, or
case manager in conjunction with the diagnostic assessment as described by Minnesota
Rules, part 9505.0372, subpart 1, item B, using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.
deleted text end
Sec. 94.
Minnesota Statutes 2020, section 256B.0946, subdivision 3, is amended to read:
Subd. 3.
Eligible mental health services providers.
(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the standards in chapter 245I, as required in section 245I.011, subdivision 5new text end .
(b) For purposes of this section, a provider agency must be:
(1) a county-operated entity certified by the state;
(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
(3) a noncounty entity.
(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.
Sec. 95.
Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (l)new text end .
deleted text begin
(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
deleted text end
deleted text begin
(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
new text begin standard new text end diagnostic assessment and team consultation and treatment planning review process.
deleted text begin (e)deleted text end new text begin (c)new text end Each client receiving treatment must be assessed for a trauma history, and the
client's treatment plan must document how the results of the assessment will be incorporated
into treatment.
new text begin
(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.
new text end
deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning processdeleted text begin , as defined in subdivision 1a, paragraph (s)deleted text end .
deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultationdeleted text begin , as defined in subdivision 1a, paragraph (a),deleted text end must be
provided in accordance with the client's individual treatment plan.
deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.
deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end Location of service delivery must be in the client's home, day care setting, school,
or other community-based setting that is specified on the client's individualized treatment
plan.
deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.
deleted text begin (l)deleted text end new text begin (k)new text end Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.
deleted text begin (m)deleted text end new text begin (l)new text end Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.
deleted text begin (n)deleted text end new text begin (m)new text end Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's permanency
plan and postdischarge mental health service needs.
Sec. 96.
Minnesota Statutes 2020, section 256B.0946, subdivision 6, is amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ; deleted text begin and
deleted text end
(7) transportationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) mental health certified family peer specialist services under section 256B.0616.
new text end
(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section deleted text begin 256B.0625, subdivision 35bdeleted text end new text begin 256B.0943new text end ;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5) room and board costs as defined in section 256I.03, subdivision 6.
Sec. 97.
Minnesota Statutes 2020, section 256B.0947, subdivision 1, is amended to read:
Subdivision 1.
Scope.
deleted text begin Effective November 1, 2011, anddeleted text end Subject to federal approval,
medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services deleted text begin as defined in subdivision 2, for recipients as defined in subdivision 3,deleted text end when
the services are provided by an entity meeting the standards in this section.new text begin The provider
entity must make reasonable and good faith efforts to report individual client outcomes to
the commissioner, using instruments and protocols approved by the commissioner.
new text end
Sec. 98.
Minnesota Statutes 2020, 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 with a serious mental illness or co-occurring mental illness and
substance abuse addictiondeleted text end 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 deleted text begin abuse addictiondeleted text end new text begin use disordernew text end " 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) "new text begin Standard new text end diagnostic assessment" deleted text begin 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 commissionerdeleted text end new text begin means the
assessment described in section 245I.10, subdivision 6new text end .
deleted text begin
(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.
deleted text end
deleted text begin
(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.
deleted text end
deleted text begin
(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.
deleted text end
deleted text begin (g)deleted text end new text begin (d)new text end "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.
deleted text begin
(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:
deleted text end
deleted text begin
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
deleted text end
deleted text begin
(2) assists younger peers to identify and achieve specific life goals;
deleted text end
deleted text begin
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
deleted text end
deleted text begin
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
deleted text end
deleted text begin
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
deleted text end
deleted text begin
(6) meets the following criteria:
deleted text end
deleted text begin
(i) is at least 22 years of age;
deleted text end
deleted text begin
(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;
deleted text end
deleted text begin
(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;
deleted text end
deleted text begin
(iv) has at least a high school diploma or equivalent;
deleted text end
deleted text begin
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
deleted text end
deleted text begin
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
deleted text end
deleted text begin
(vii) must be free of substance use problems for at least one year.
deleted text end
new text begin
(e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
deleted text begin (i)deleted text end new text begin (f)new text end "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
deleted text begin (j)deleted text end new text begin (g)new text end "Substance use disorders" means one or more of the disorders defined in the
diagnostic and statistical manual of mental disorders, current edition.
deleted text begin (k)deleted text end new text begin (h)new text end "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.
deleted text begin (l)deleted text end new text begin (i)new text end "Treatment team" means all staff who provide services to recipients under this
section.
deleted text begin (m)deleted text end new text begin (j)new text end "Family peer specialist" means a staff person new text begin who is new text end qualified under section
256B.0616.
Sec. 99.
Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is age 16, 17, 18, 19, or 20; and
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
deleted text begin abuse addictiondeleted text end new text begin use disordernew text end , for which intensive nonresidential rehabilitative mental health
services are needed;
(3) has received a deleted text begin level-of-care determination, using an instrument approved by the
commissionerdeleted text end new text begin level of care assessment as defined in section 245I.02, subdivision 19new text end , that
indicates a need for intensive integrated intervention without 24-hour medical monitoring
and a need for extensive collaboration among multiple providers;
(4) hasnew text begin receivednew text end anew text begin functional assessment as defined in section 245I.02, subdivision 17,
that indicatesnew text end functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system within the next two years; and
(5) has had a recent new text begin standard new text end diagnostic assessmentdeleted text begin , 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,deleted text end 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. 100.
Minnesota Statutes 2020, section 256B.0947, subdivision 3a, is amended to
read:
Subd. 3a.
Required service components.
deleted text begin
(a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities new text begin are new text end covered by deleted text begin thedeleted text end new text begin anew text end single daily rate per client must include the following,
as needed by the individual client:
(1) individual, family, and group psychotherapy;
(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section 245.4871, subdivision 9adeleted text begin , which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end ;
(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;
(5) mental health case management as provided in section 256B.0625, subdivision 20;
(6) medication education services as defined in this section;
(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;
(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;
(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;
(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ;
deleted text begin
(11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
deleted text end
deleted text begin (12)deleted text end new text begin (11)new text end transition services deleted text begin as defined in this sectiondeleted text end ;
deleted text begin (13) integrated dual disorders treatment as defined in this sectiondeleted text end new text begin (12) co-occurring
substance use disorder treatment as defined in section 245I.02, subdivision 11new text end ; and
deleted text begin (14)deleted text end new text begin (13)new text end housing access supportnew text begin that assists clients to find, obtain, retain, and move to
safe and adequate housing. Housing access support does not provide monetary assistance
for rent, damage deposits, or application feesnew text end .
deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:
deleted text begin (1)deleted text end client access to crisis intervention services, as defined in section deleted text begin 256B.0944deleted text end new text begin
256B.0624new text end , and available 24 hours per day and seven days per weekdeleted text begin ;deleted text end new text begin .
new text end
deleted text begin
(2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
deleted text end
deleted text begin
(3) determination of the client's needed level of care using an instrument approved and
periodically updated by the commissioner.
deleted text end
Sec. 101.
Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must deleted text begin be provided by a provider entity as provided in subdivision 4deleted text end new text begin meet the standards in
this section and chapter 245I as required in section 245I.011, subdivision 5new text end .
(b) 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) deleted text begin 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.deleted text end 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 new text begin minimally new text end includedeleted text begin , but is not limited todeleted text end :
(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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 new text begin mental health certified new text end peer specialist deleted text begin as defined in subdivision 2, paragraph (h)deleted text end new text begin
who is qualified according to section 245I.04, subdivision 10, and is also a former children's
mental health consumernew text end .
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialistnew text begin with knowledge and experience working with youth on
special education requirements and goals, special education plans, and coordination of
educational activities with health care activitiesnew text end ;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v)new text begin a clinical trainee who is qualified according to section 245I.04, subdivision 6;
new text end
new text begin (vi)new text end a mental health practitionerdeleted text begin , as defined in section 245.4871, subdivision 26deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end ;
deleted text begin (vi)deleted text end new text begin (vii)new text end a case management service provider, as defined in section 245.4871, subdivision
4;
deleted text begin (vii)deleted text end new text begin (viii)new text end a housing access specialist; and
deleted text begin (viii)deleted text end new text begin (ix)new text end a family peer specialist as defined in subdivision 2, paragraph (m).
(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 deleted text begin abusedeleted text end new text begin usenew text end 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.
(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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 deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.
(d) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(e) 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.
(f) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitionernew text begin , clinical trainee,new text end 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 ensure the health and safety of clients.
(g) 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.
(h) A regional treatment team may serve multiple counties.
Sec. 102.
Minnesota Statutes 2020, 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 must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The deleted text begin initial functional assessment must be completed within ten days of intake anddeleted text end new text begin
level of care assessment as defined in section 245I.02, subdivision 19, and functional
assessment as defined in section 245I.02, subdivision 17, must benew text end updated at least every deleted text begin six
monthsdeleted text end new text begin 90 days new text end or prior to discharge from the service, whichever comes first.
(e) new text begin The treatment team must complete new text end an individual treatment plan deleted text begin mustdeleted text end new text begin for each client,
according to section 245I.10, subdivisions 7 and 8, and the individual treatment plan mustnew text end :
deleted text begin
(1) be based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted 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;
deleted text end
deleted 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;
deleted text end
deleted 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;
deleted text end
deleted 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;
deleted text end
deleted 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;
deleted text end
deleted text begin (7)deleted text end new text begin (1)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. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
deleted text begin (8)deleted text end new text begin (2)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;
new text begin (ii)new text end develop a schedule for accomplishingnew text begin substance use disordernew text end treatment goals and
objectives; and
new text begin (iii)new text end identify the individuals responsible for providingnew text begin substance use disordernew text end treatment
services and supports;
deleted text begin
(ii) be reviewed at least once every 90 days and revised, if necessary;
deleted text end
deleted text begin
(9) 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 end
deleted text begin (10)deleted text end new text begin (3)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" servicesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) notwithstanding section 245I.10, subdivision 8, be reviewed at least every 90 days
and revised to document treatment progress or, if progress is not documented, to document
changes in treatment.
new text end
(f) 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.
(g) 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.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 103.
Minnesota Statutes 2020, section 256B.0947, subdivision 7, is amended to read:
Subd. 7.
Medical assistance payment and rate setting.
(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end .
(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.
(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:
(1) the cost for similar services in the health care trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each client;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.
Sec. 104.
Minnesota Statutes 2020, section 256B.0949, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) The terms used in this section have the meanings given in this
subdivision.
(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
(1) is severe and chronic;
(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
(3) requires treatment or services similar to those required for a person with ASD; and
(4) results in substantial functional limitations in three core developmental deficits of
ASD: social or interpersonal interaction; functional communication, including nonverbal
or social communication; and restrictive or repetitive behaviors or hyperreactivity or
hyporeactivity to sensory input; and may include deficits or a high level of support in one
or more of the following domains:
(i) behavioral challenges and self-regulation;
(ii) cognition;
(iii) learning and play;
(iv) self-care; or
(v) safety.
(d) "Person" means a person under 21 years of age.
(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.
(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
(h) "Department" means the Department of Human Services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved and
published by the commissioner that are based in behavioral and developmental science
consistent with best practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.
(k) "Incident" means when any of the following occur:
(1) an illness, accident, or injury that requires first aid treatment;
(2) a bump or blow to the head; or
(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
(n) "Mental health professional" deleted text begin has the meaning given indeleted text end new text begin means a staff person who is
qualified according tonew text end section deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04,
subdivision 2new text end .
(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
Sec. 105.
Minnesota Statutes 2020, section 256B.0949, subdivision 4, is amended to read:
Subd. 4.
Diagnosis.
(a) A diagnosis of ASD or a related condition must:
(1) be based upon current DSM criteria including direct observations of the person and
information from the person's legal representative or primary caregivers;
(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and
(3) meet the requirements of deleted text begin Minnesota Rules, part 9505.0372, subpart 1, items B and
Cdeleted text end new text begin a standard diagnostic assessment according to section 245I.10, subdivision 6new text end .
(b) Additional assessment information may be considered to complete a diagnostic
assessment including specialized tests administered through special education evaluations
and licensed school personnel, and from professionals licensed in the fields of medicine,
speech and language, psychology, occupational therapy, and physical therapy. A diagnostic
assessment may include treatment recommendations.
Sec. 106.
Minnesota Statutes 2020, section 256B.0949, subdivision 5a, is amended to
read:
Subd. 5a.
Comprehensive multidisciplinary evaluation provider qualification.
A
CMDE provider must:
(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a deleted text begin mental health practitioner who meets the requirements of adeleted text end clinical trainee
deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin who is qualified according
to section 245I.04, subdivision 6new text end ;
(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and
(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.
Sec. 107.
Minnesota Statutes 2020, section 256B.25, subdivision 3, is amended to read:
Subd. 3.
Payment exceptions.
The limitation in subdivision 2 shall not apply to:
(1) payment of Minnesota supplemental assistance funds to recipients who reside in
facilities which are involved in litigation contesting their designation as an institution for
treatment of mental disease;
(2) payment or grants to a boarding care home or supervised living facility licensed by
the Department of Human Services under Minnesota Rules, parts 2960.0130 to 2960.0220
deleted text begin ordeleted text end new text begin ,new text end 2960.0580 to 2960.0700,new text begin ornew text end 9520.0500 to 9520.0670, or new text begin under new text end chapter 245Gnew text begin or 245Inew text end ,
or payment to recipients who reside in these facilities;
(3) payments or grants to a boarding care home or supervised living facility which are
ineligible for certification under United States Code, title 42, sections 1396-1396p;
(4) payments or grants otherwise specifically authorized by statute or rule.
Sec. 108.
Minnesota Statutes 2020, section 256B.761, is amended to read:
256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.
(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.
deleted text begin
(c) The commissioner shall establish three levels of payment for mental health diagnostic
assessment, based on three levels of complexity. The aggregate payment under the tiered
rates must not exceed the projected aggregate payments for mental health diagnostic
assessment under the previous single rate. The new rate structure is effective January 1,
2011, or upon federal approval, whichever is later.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.
deleted text begin (e)deleted text end new text begin (d)new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
Sec. 109.
Minnesota Statutes 2020, section 256B.763, is amended to read:
256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment
rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:
(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
(2) community mental health centers under section 256B.0625, subdivision 5; and
(3) mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin section 245I.20new text end , or hospital outpatient psychiatric departments that are
designated as essential community providers under section 62Q.19.
(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.
(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated
with the county, rates that are established by the federal government, or rates that increased
between January 1, 2004, and January 1, 2005.
(d) The commissioner shall adjust rates paid to prepaid health plans under contract with
the commissioner to reflect the rate increases provided in paragraphs (a), (e), and (f). The
prepaid health plan must pass this rate increase to the providers identified in paragraphs (a),
(e), (f), and (g).
(e) Payment rates shall be increased by 23.7 percent over the rates in effect on December
31, 2007, for:
(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and
(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943 and
not already included in paragraph (a), payment rates shall be increased by 23.7 percent over
the rates in effect on December 31, 2007.
(g) Payment rates shall be increased by 2.3 percent over the rates in effect on December
31, 2007, for individual and family skills training provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(h) For services described in paragraphs (b), (e), and (g) and rendered on or after July
1, 2017, payment rates for mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules,
parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end , that are not designated as essential community
providers under section 62Q.19 shall be equal to payment rates for mental health clinics
deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end ,
that are designated as essential community providers under section 62Q.19. In order to
receive increased payment rates under this paragraph, a provider must demonstrate a
commitment to serve low-income and underserved populations by:
(1) charging for services on a sliding-fee schedule based on current poverty income
guidelines; and
(2) not restricting access or services because of a client's financial limitation.
Sec. 110.
Minnesota Statutes 2020, section 256P.01, subdivision 6a, is amended to read:
Subd. 6a.
Qualified professional.
(a) For illness, injury, or incapacity, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, physical therapist, occupational therapist, or licensed chiropractor, according to their
scope of practice.
(b) For developmental disability, learning disability, and intelligence testing, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, licensed independent clinical social worker, licensed psychologist, certified school
psychologist, or certified psychometrist working under the supervision of a licensed
psychologist.
(c) For mental health, a "qualified professional" means a licensed physician, advanced
practice registered nurse, or qualified mental health professional under section deleted text begin 245.462,
subdivision 18, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(d) For substance use disorder, a "qualified professional" means a licensed physician, a
qualified mental health professional under section 245.462, subdivision 18, clauses (1) to
(6), or an individual as defined in section 245G.11, subdivision 3, 4, or 5.
Sec. 111.
Minnesota Statutes 2020, section 295.50, subdivision 9b, is amended to read:
Subd. 9b.
Patient services.
(a) "Patient services" means inpatient and outpatient services
and other goods and services provided by hospitals, surgical centers, or health care providers.
They include the following health care goods and services provided to a patient or consumer:
(1) bed and board;
(2) nursing services and other related services;
(3) use of hospitals, surgical centers, or health care provider facilities;
(4) medical social services;
(5) drugs, biologicals, supplies, appliances, and equipment;
(6) other diagnostic or therapeutic items or services;
(7) medical or surgical services;
(8) items and services furnished to ambulatory patients not requiring emergency care;
and
(9) emergency services.
(b) "Patient services" does not include:
(1) services provided to nursing homes licensed under chapter 144A;
(2) examinations for purposes of utilization reviews, insurance claims or eligibility,
litigation, and employment, including reviews of medical records for those purposes;
(3) services provided to and by community residential mental health facilities licensed
under new text begin section 245I.23 or new text end Minnesota Rules, parts 9520.0500 to 9520.0670, and to and by
residential treatment programs for children with severe emotional disturbance licensed or
certified under chapter 245A;
(4) services provided under the following programs: day treatment services as defined
in section 245.462, subdivision 8; assertive community treatment as described in section
256B.0622; adult rehabilitative mental health services as described in section 256B.0623;
deleted text begin adultdeleted text end crisis response services as described in section 256B.0624; new text begin and new text end children's therapeutic
services and supports as described in section 256B.0943; deleted text begin and children's mental health crisis
response services as described in section 256B.0944;
deleted text end
(5) services provided to and by community mental health centers as defined in section
245.62, subdivision 2;
(6) services provided to and by assisted living programs and congregate housing
programs;
(7) hospice care services;
(8) home and community-based waivered services under chapter 256S and sections
256B.49 and 256B.501;
(9) targeted case management services under sections 256B.0621; 256B.0625,
subdivisions 20, 20a, 33, and 44; and 256B.094; and
(10) services provided to the following: supervised living facilities for persons with
developmental disabilities licensed under Minnesota Rules, parts 4665.0100 to 4665.9900;
housing with services establishments required to be registered under chapter 144D; board
and lodging establishments providing only custodial services that are licensed under chapter
157 and registered under section 157.17 to provide supportive services or health supervision
services; adult foster homes as defined in Minnesota Rules, part 9555.5105; day training
and habilitation services for adults with developmental disabilities as defined in section
252.41, subdivision 3; boarding care homes as defined in Minnesota Rules, part 4655.0100;
adult day care services as defined in section 245A.02, subdivision 2a; and home health
agencies as defined in Minnesota Rules, part 9505.0175, subpart 15, or licensed under
chapter 144A.
Sec. 112.
Minnesota Statutes 2020, section 325F.721, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given them.
(b) "Covered setting" means an unlicensed setting providing sleeping accommodations
to one or more adult residents, at least 80 percent of which are 55 years of age or older, and
offering or providing, for a fee, supportive services. For the purposes of this section, covered
setting does not mean:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) temporary family health care dwellings as defined in sections 394.307 and 462.3593;
(9) settings offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011; or
(14) an assisted living facility licensed under chapter 144G.
(c) "'I'm okay' check services" means providing a service to, by any means, check on
the safety of a resident.
(d) "Resident" means a person entering into written contract for housing and services
with a covered setting.
(e) "Supportive services" means:
(1) assistance with laundry, shopping, and household chores;
(2) housekeeping services;
(3) provision of meals or assistance with meals or food preparation;
(4) help with arranging, or arranging transportation to, medical, social, recreational,
personal, or social services appointments; or
(5) provision of social or recreational services.
Arranging for services does not include making referrals or contacting a service provider
in an emergency.
Sec. 113. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 245.462, subdivision 4a; 245.4879, subdivision
2; 245.62, subdivisions 3 and 4; 245.69, subdivision 2; 256B.0615, subdivision 2; 256B.0616,
subdivision 2; 256B.0622, subdivisions 3 and 5a; 256B.0623, subdivisions 7, 8, 10, and 11;
256B.0625, subdivisions 5l, 35a, 35b, 61, 62, and 65; 256B.0943, subdivisions 8 and 10;
256B.0944; and 256B.0946, subdivision 5,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750;
9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820;
9520.0830; 9520.0840; 9520.0850; 9520.0860; and 9520.0870,
new text end
new text begin
are repealed.
new text end
Sec. 114. new text begin EFFECTIVE DATE.
new text end
new text begin
Unless otherwise stated, this article is effective July 1, 2022, 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
ARTICLE 12
FORECAST ADJUSTMENTS
Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2019, First Special
Session chapter 9, article 14, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2021" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2021.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2021 new text end |
||||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(816,996,000) new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(745,266,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
(36,893,000) new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,837,000) new text end |
|
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
|||||
|
new text begin
(a) Minnesota Family Investment Program (MFIP)/Diversionary Work Program (DWP) new text end |
|||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
59,004,000 new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,843,000) new text end |
|
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(54,158,000) new text end |
|||||
|
new text begin
(c) General Assistance new text end |
new text begin
3,925,000 new text end |
|||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
3,849,000 new text end |
|||||
|
new text begin
(e) Housing Support new text end |
new text begin
3,022,000 new text end |
|||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(8,639,000) new text end |
|||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(36,893,000) new text end |
|||||
new text begin
This appropriation is from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(694,938,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
|
|
new text begin
(i) Alternative Care new text end |
new text begin
247,000 new text end |
|||||
|
new text begin
(j) Consolidated Chemical Dependency Treatment Fund (CCDTF) Entitlement new text end |
new text begin
(57,578,000) new text end |
|||||
new text begin Subd. 3. new text end
new text begin
Technical Activities
|
new text begin
6,000 new text end |
|||||
new text begin
This appropriation is from the federal TANF
fund.
new text end
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
Sections 1 and 2 are effective the day following final enactment.
new text end
ARTICLE 13
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2022" and "2023" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2022, or June 30, 2023, respectively.
"The first year" is fiscal year 2022. "The second year" is fiscal year 2023. "The biennium"
is fiscal years 2022 and 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
8,944,696,000 new text end |
new text begin
$ new text end |
new text begin
9,423,461,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
7,786,104,000 new text end |
new text begin
8,289,809,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,299,000 new text end |
new text begin
4,299,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
867,214,000 new text end |
new text begin
845,520,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
282,623,000 new text end |
new text begin
278,803,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,896,000 new text end |
new text begin
1,896,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,560,000 new text end |
new text begin
2,560,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
TANF Maintenance of Effort
|
||||||
new text begin
(a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
new text end
new text begin
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end
new text begin
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end
new text begin
(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end
new text begin
(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
new text end
new text begin
(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end
new text begin
(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
new text end
new text begin
(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end
new text begin
(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end
new text begin
(b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end
new text begin
(c) Certain Expenditures Required. The
commissioner shall ensure that the MOE used
by the commissioner of management and
budget for the February and November
forecasts required under Minnesota Statutes,
section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 16
percent of the total required under Code of
Federal Regulations, title 45, section 263.1.
new text end
new text begin
(d) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
new text end
new text begin
(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end
new text begin
(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end
new text begin
(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section
261.43(a)(2).
new text end
new text begin
(e) Supplemental Expenditures. For the
purposes of paragraph (d), the commissioner
may supplement the MOE claim with working
family credit expenditures or other qualified
expenditures to the extent such expenditures
are otherwise available after considering the
expenditures allowed in this subdivision.
new text end
new text begin
(f) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
new text end
new text begin
(g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
new text end
new text begin
(i) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2022 and 2023 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
new text end
new text begin Subd. 3. new text end
new text begin
Information Technology
|
||||||
new text begin
(a) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(b) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
174,080,000 new text end |
new text begin
167,456,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,174,000 new text end |
new text begin
4,174,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
16,966,000 new text end |
new text begin
16,966,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
100,000 new text end |
new text begin
100,000 new text end |
new text begin
(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end
new text begin
(1) Minnesota Statutes, section 125A.744,
subdivision 3;
new text end
new text begin
(2) Minnesota Statutes, section 245.495,
paragraph (b);
new text end
new text begin
(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end
new text begin
(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end
new text begin
(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
new text end
new text begin
(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end
new text begin
(b) Background Studies. (1) $2,074,000 in
fiscal year 2022 is from the general fund to
provide a credit to providers who paid for
emergency background studies in NETStudy
2.0.
new text end
new text begin
(2) $2,061,000 in fiscal year 2022 is from the
general fund to cover the costs of reprocessing
emergency studies conducted under
interagency agreements with other agencies.
new text end
new text begin
(c) Personal Care Assistance Compensation
for Services Provided by a Parent or
Spouse. $349,000 in fiscal year 2022 is from
the general fund for compensation for personal
care assistance services provided by a parent
or spouse under Laws 2020, Fifth Special
Session chapter 3, article 10, section 3, as
amended.
new text end
new text begin
(d) Family Foster Setting Background
Studies. $338,000 in fiscal year 2022 and
$349,000 in fiscal year 2023 are from the
general fund for costs related to implementing
and administering licensed family foster
setting background study requirements.
new text end
new text begin
(e) Cultural and Ethnic Communities
Leadership Council. $18,000 in fiscal year
2022 and $62,000 in fiscal year 2023 are from
the general fund for the Cultural and Ethnic
Communities Leadership Council.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is $162,024,000 in fiscal year 2024 and
$162,255,000 in fiscal year 2025.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Children and Families
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,382,000 new text end |
new text begin
18,407,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
2,582,000 new text end |
new text begin
2,582,000 new text end |
new text begin
(a) Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 each
year in fiscal year 2022 and fiscal year 2023
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $18,692,000 in fiscal year 2024 and
$18,692,000 in fiscal year 2025.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
26,005,000 new text end |
new text begin
23,992,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
28,168,000 new text end |
new text begin
28,168,000 new text end |
new text begin
(a) new text begin Case Management Benefit Study for
American Indians.new text end $200,000 in fiscal year
2022 is from the general fund for a contract
to conduct fiscal analysis and development of
standards for a targeted case management
benefit for American Indians. The
commissioner of human services must consult
the Minnesota Indian Affairs Council in the
development of any request for proposal and
in the evaluation of responses. This is a
onetime appropriation. Any unencumbered
balance remaining from the first year does not
cancel and is available for the second year of
the biennium.
new text end
new text begin
(b) Integrated Care for High-Risk Pregnant
Women Grant Program. $106,000 in fiscal
year 2022 and $122,000 in fiscal year 2023
are from the general fund for administration
of the integrated care for high-risk pregnant
women grant program under Minnesota
Statutes, section 256B.79.
new text end
new text begin
(c) Studies on Health Care Delivery.
$700,000 in fiscal year 2022 and $300,000 in
fiscal year 2023 are from the general fund for
the commissioner of human services to
develop a legislative proposal for a public
option program and to compare and report to
the legislature on delivery and payment system
models to deliver services to MinnesotaCare
enrollees and certain medical assistance
enrollees.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is $24,036,000 in fiscal year 2024 and
$24,004,000 in fiscal year 2025.
new text end
new text begin Subd. 7. new text end
new text begin
Central Office; Continuing Care for
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,873,000 new text end |
new text begin
18,900,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
125,000 new text end |
new text begin
125,000 new text end |
new text begin
(a) Assisted Living Survey. $2,593,000 in
fiscal year 2022 and $2,593,000 in fiscal year
2023 are from the general fund for
development and administration of a resident
experience survey and family survey for all
assisted living facilities according to
Minnesota Statutes, section 256B.439,
subdivision 3c. These appropriations are
available in either year of the biennium.
new text end
new text begin
(b) new text begin Base Level Adjustment.new text end The general fund
base is $18,830,000 in fiscal year 2024 and
$18,900,000 in fiscal year 2025.
new text end
new text begin Subd. 8. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
35,294,000 new text end |
new text begin
35,846,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
163,000 new text end |
new text begin
163,000 new text end |
|
new text begin
Opioid Epidemic Response new text end |
new text begin
60,000 new text end |
new text begin
60,000 new text end |
new text begin
(a) Study of Self Directed Tiered Wage
Structure. $25,000 in fiscal year 2022 is from
the general fund for a study of the feasibility
of a tiered wage structure for individual
providers. This is a onetime appropriation.
This appropriation is available only if the labor
agreement between the state of Minnesota and
the Service Employees International Union
Healthcare Minnesota under Minnesota
Statutes, section 179A.54, is approved under
Minnesota Statutes, section 3.855.
new text end
new text begin
(b) Substance Use Disorder Treatment
Paperwork Reduction. $234,000 in fiscal
year 2022 and $201,000 in fiscal year 2023
are from the general fund for a contract with
a vendor to develop, assess, and recommend
systems improvements to minimize regulatory
paperwork and improve systems for licensed
substance use disorder programs. This is a
onetime appropriation.
new text end
new text begin
(c) Case Management and Substance Use
Disorder Treatment Rate Methodology
Analysis. $500,000 in fiscal year 2022 and
$200,000 in fiscal year 2023 are from the
general fund for the fiscal analysis needed to
establish federally compliant payment
methodologies for all medical
assistance-funded case management services,
including substance use disorder treatment
rates. This is a onetime appropriation.
new text end
new text begin
(d) Substance Use Disorder Community of
Practice. $250,000 in fiscal year 2022 and
$250,000 in fiscal year 2023 are from the
general fund for the commissioner of human
services to establish and administer the
substance use disorder community of practice,
including providing compensation for
community of practice participants.
new text end
new text begin
(e) Sober Housing Program
Recommendations Development. $90,000
in fiscal year 2022 is from the general fund
for developing recommendations related to
sober housing programs and completing and
submitting a report on the recommendations
to the legislature.
new text end
new text begin
(f) new text begin Base Level Adjustment.new text end The general fund
base is $34,634,000 in fiscal year 2024 and
$34,666,000 in fiscal year 2025. The opiate
epidemic response fund base is $60,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
92,588,000 new text end |
new text begin
91,668,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
104,285,000 new text end |
new text begin
104,410,000 new text end |
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; MFIP Child
|
new text begin
146,000 new text end |
new text begin
569,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; General
|
new text begin
53,574,000 new text end |
new text begin
52,835,000 new text end |
||||
new text begin
(a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
new text end
new text begin
(b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2022 and $6,729,812
in fiscal year 2023. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
new text end
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
51,779,000 new text end |
new text begin
52,486,000 new text end |
||||
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
184,005,000 new text end |
new text begin
191,966,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Forecasted Programs; Northstar Care
|
new text begin
110,583,000 new text end |
new text begin
121,246,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
207,437,000 new text end |
new text begin
184,822,000 new text end |
||||
new text begin
new text begin Generally.new text end This appropriation is from the
health care access fund.
new text end
new text begin Subd. 16. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
6,058,378,000 new text end |
new text begin
6,557,536,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
611,178,000 new text end |
new text begin
612,099,000 new text end |
new text begin
Behavioral Health Services. $1,000,000 in
fiscal year 2022 and $1,000,000 in fiscal year
2023 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
new text end
new text begin Subd. 17. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
45,669,000 new text end |
new text begin
45,656,000 new text end |
||||
new text begin
new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end
new text begin Subd. 18. new text end
new text begin
Forecasted Programs; Behavioral
|
new text begin
132,377,000 new text end |
new text begin
116,706,000 new text end |
||||
new text begin
(a) Grants to Tribal Governments.
$28,873,377 in fiscal year 2022 is from the
general fund to satisfy the value of
overpayments owed by the Leech Lake Band
of Ojibwe and White Earth Band of Chippewa
to repay overpayments for medication-assisted
treatment services between fiscal year 2014
and fiscal year 2019. The grant to the Leech
Lake Band of Ojibwe shall be $14,666,122
and the grant to the White Earth Band of
Chippewa shall be $14,207,215. This is a
onetime appropriation.
new text end
new text begin
(b) Institutions for Mental Disease
Payments. $8,328,000 in fiscal year 2022 is
from the general fund for the commissioner
of human services to reimburse counties for
the amount identified by the commissioner for
the statewide county share of costs for which
federal funds were claimed, but were not
eligible for federal funding for substance use
disorder services provided in institutions for
mental disease, for claims paid between
January 1, 2014, and June 30, 2019. The
commissioner of human services shall allocate
this appropriation between counties in the
amount identified by the department that is
owed by each county. Prior to a county
receiving reimbursement, the county must pay
in full any unpaid consolidated chemical
dependency treatment fund invoiced county
share. This is a onetime appropriation.
new text end
new text begin Subd. 19. new text end
new text begin
Grant Programs; Support Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
8,715,000 new text end |
new text begin
8,715,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
96,312,000 new text end |
new text begin
96,311,000 new text end |
new text begin Subd. 20. new text end
new text begin
Grant Programs; BSF Child Care
|
new text begin
(17,000) new text end |
new text begin
(23,000) new text end |
||||
new text begin Subd. 21. new text end
new text begin
Grant Programs; Child Support
|
new text begin
50,000 new text end |
new text begin
50,000 new text end |
||||
new text begin Subd. 22. new text end
new text begin
Grant Programs; Children's Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
52,133,000 new text end |
new text begin
51,848,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
140,000 new text end |
new text begin
140,000 new text end |
new text begin
(a) new text begin Title IV-E Adoption Assistance.new text end The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
new text end
new text begin
(b) Indian Child Welfare Training.
$1,012,000 in fiscal year 2022 and $993,000
in fiscal year 2023 are from the general fund
for the establishment and operation of the
Tribal Training and Certification Partnership
at the University of Minnesota-Duluth to
provide training, establish federal Indian Child
Welfare Act and Minnesota Family
Preservation Act training requirements for
county child welfare workers, and develop
indigenous child welfare training for American
Indian Tribes. The base for this appropriation
is $1,053,000 in fiscal year 2024 and
$1,053,000 in fiscal year 2025.
new text end
new text begin
(c) Parent Support for Better Outcomes
Grants. $150,000 in fiscal year 2022 and
$150,000 in fiscal year 2023 are from the
general fund for grants to Minnesota One-Stop
for Communities to provide mentoring,
guidance, and support services to parents
navigating the child welfare system in
Minnesota, in order to promote the
development of safe, stable, and healthy
families. Grant money may be used for parent
mentoring, peer-to-peer support groups,
housing support services, training, staffing,
and administrative costs.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Children and
|
new text begin
60,251,000 new text end |
new text begin
60,856,000 new text end |
||||
new text begin Subd. 24. new text end
new text begin
Grant Programs; Children and
|
new text begin
34,240,000 new text end |
new text begin
34,240,000 new text end |
||||
new text begin
(a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2022 do not
cancel but are available for this purpose in
fiscal year 2023.
new text end
new text begin
(b) Emergency Shelters. $2,500,000 in fiscal
year 2022 and $2,500,000 in fiscal year 2023
are for short-term housing facilities to increase
the supply and improve the condition of
shelters for individuals and families without
a permanent residence. The commissioner
shall ensure that a portion of the funds are
expended to provide for short-term housing
facilities for tribes and shall ensure equitable
geographic distribution of funds. This
appropriation is available until June 30, 2026.
new text end
new text begin
(c) Emergency Services Grants. $9,000,000
in fiscal year 2022 and $9,000,000 in fiscal
year 2023 are to provide emergency services
grants under Minnesota Statutes, section
256E.36.
new text end
new text begin Subd. 25. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
4,811,000 new text end |
new text begin
4,811,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
3,465,000 new text end |
new text begin
3,465,000 new text end |
new text begin
Integrated Care for High Risk Pregnancies
Initiative. $1,100,000 in fiscal year 2022 and
$1,100,000 in fiscal year 2023 are from the
general fund for the commissioner of human
services to enter into a contract with the
Integrated Care for High Risk Pregnancies
(ICHRP) initiative to provide support to the
integrated care for high-risk pregnant women
grant program under Minnesota Statutes,
section 256B.79.
new text end
new text begin Subd. 26. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
1,925,000 new text end |
new text begin
1,925,000 new text end |
||||
new text begin Subd. 27. new text end
new text begin
Grant Programs; Aging and Adult
|
new text begin
32,495,000 new text end |
new text begin
32,495,000 new text end |
||||
new text begin Subd. 28. new text end
new text begin
Grant Programs; Deaf and
|
new text begin
2,886,000 new text end |
new text begin
2,886,000 new text end |
||||
new text begin Subd. 29. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
20,251,000 new text end |
new text begin
18,863,000 new text end |
||||
new text begin
Training Stipends for Direct Support
Services Providers. $1,000,000 in fiscal year
2022 is from the general fund for stipends for
individual providers of direct support services
as defined in Minnesota Statutes, section
256B.0711, subdivision 1. These stipends are
available to individual providers who have
completed designated voluntary trainings
made available through the State-Provider
Cooperation Committee formed by the State
of Minnesota and the Service Employees
International Union Healthcare Minnesota.
Any unspent appropriation in fiscal year 2022
is available in fiscal year 2023. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
new text end
new text begin Subd. 30. new text end
new text begin
Grant Programs; Housing Support
|
new text begin
11,364,000 new text end |
new text begin
11,364,000 new text end |
||||
new text begin
Long-Term Homeless Supportive Services.
$1,000,000 in fiscal year 2022 and $1,000,000
in fiscal year 2023 are for long-term homeless
supportive services under Minnesota Statutes,
section 256K.26.
new text end
new text begin Subd. 31. new text end
new text begin
Grant Programs; Adult Mental Health
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
84,073,000 new text end |
new text begin
84,074,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,000,000 new text end |
new text begin
2,000,000 new text end |
new text begin
(a) Culturally and Linguistically
Appropriate Services Implementation
Grants. $750,000 in fiscal year 2022 and
$750,000 in fiscal year 2023 are from the
general fund for grants to substance use
disorder treatment providers to implement
culturally and linguistically appropriate
services standards, according to the
implementation and transition plan developed
by the commissioner. This is a onetime
appropriation.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $82,324,000 in fiscal year 2024 and
$82,324,000 in fiscal year 2025. The opiate
epidemic response fund base is $2,000,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 32. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
28,703,000 new text end |
new text begin
28,703,000 new text end |
||||
new text begin
(a) Children's Residential Facilities.
$3,000,000 in fiscal year 2022 and $3,000,000
in fiscal year 2023 are to reimburse counties
for a portion of the costs of treatment in
children's residential facilities. The
commissioner shall distribute the appropriation
on an annual basis to counties proportionally
based on a methodology developed by the
commissioner. Of this appropriation, $100,000
each year is available to the commissioner for
administrative expenses.
new text end
new text begin
(b) new text begin Base Level Adjustment.new text end The general fund
base is $28,726,000 in fiscal year 2024 and
$28,726,000 in fiscal year 2025.
new text end
new text begin Subd. 33. new text end
new text begin
Grant Programs; Chemical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
2,846,000 new text end |
new text begin
2,845,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,733,000 new text end |
new text begin
1,733,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
500,000 new text end |
new text begin
500,000 new text end |
new text begin
(a) Problem Gambling. $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
new text end
new text begin
(b) Recovery Community Organization
Grants. $573,000 in fiscal year 2022 and
$571,000 in fiscal year 2023 are from the
general fund for grants to recovery community
organizations, as defined in Minnesota
Statutes, section 254B.01, subdivision 8, to
provide for costs and community-based peer
recovery support services that are not
otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05, as part
of the continuum of care for substance use
disorders.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $2,636,000 in fiscal year 2024 and
$2,636,000 in fiscal year 2025. The opiate
epidemic response fund base is $500,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 34. new text end
new text begin
Direct Care and Treatment -
|
||||||
new text begin
new text begin Transfer Authority.new text end Money appropriated to
budget activities under this subdivision and
subdivisions 35 to 39 may be transferred
between budget activities and between years
of the biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 35. new text end
new text begin
Direct Care and Treatment - Mental
|
new text begin
139,946,000 new text end |
new text begin
144,103,000 new text end |
||||
new text begin
(a) Transfer Authority. Money appropriated
to support the continued operations of the
Community Addiction Recovery Enterprise
(C.A.R.E.) program may be transferred to the
enterprise fund for C.A.R.E.
new text end
new text begin
(b) Operating Adjustment. $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 are for the Community Addiction
Recovery Enterprise program. The
commissioner may transfer $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 to the enterprise fund for Community
Addiction Recovery Enterprise.
new text end
new text begin Subd. 36. new text end
new text begin
Direct Care and Treatment -
|
new text begin
18,771,000 new text end |
new text begin
19,752,000 new text end |
||||
new text begin
(a) Transfer Authority. Money appropriated
to support the continued operations of the
Minnesota State Operated Community
Services (MSOCS) program may be
transferred to the enterprise fund for MSOCS.
new text end
new text begin
(b) Operating Adjustment. $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 are for the Minnesota State Operated
Community Services program. The
commissioner may transfer $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 to the enterprise fund for Minnesota State
Operated Community Services.
new text end
new text begin Subd. 37. new text end
new text begin
Direct Care and Treatment - Forensic
|
new text begin
119,854,000 new text end |
new text begin
122,206,000 new text end |
||||
new text begin Subd. 38. new text end
new text begin
Direct Care and Treatment - Sex
|
new text begin
97,570,000 new text end |
new text begin
99,917,000 new text end |
||||
new text begin
new text begin Transfer Authority.new text end Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 39. new text end
new text begin
Direct Care and Treatment -
|
new text begin
63,504,000 new text end |
new text begin
65,910,000 new text end |
||||
new text begin Subd. 40. new text end
new text begin
Technical Activities
|
new text begin
79,204,000 new text end |
new text begin
78,260,000 new text end |
||||
new text begin
(a) Generally. This appropriation is from the
federal TANF fund.
new text end
new text begin
(b) Base Level Adjustment. The TANF fund
base is $71,493,000 in fiscal year 2024 and
$71,493,000 in fiscal year 2025.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
258,989,000 new text end |
new text begin
$ new text end |
new text begin
251,881,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
155,953,000 new text end |
new text begin
150,554,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
54,465,000 new text end |
new text begin
53,356,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,858,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
113,697,000 new text end |
new text begin
112,692,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
9,103,000 new text end |
new text begin
7,777,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,858,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2022 and $3,579,000 in fiscal year
2023 are from the TANF fund for home
visiting and nutritional services listed under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
new text end
new text begin
(2) $2,000,000 in fiscal year 2022 and
$2,000,000 in fiscal year 2023 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
new text end
new text begin
(3) $4,978,000 in fiscal year 2022 and
$4,978,000 in fiscal year 2023 are from the
TANF fund for the family home visiting grant
program according to Minnesota Statutes,
section 145A.17. $4,000,000 of the funding
in each fiscal year must be distributed to
community health boards according to
Minnesota Statutes, section 145A.131,
subdivision 1. $978,000 of the funding in each
fiscal year must be distributed to tribal
governments according to Minnesota Statutes,
section 145A.14, subdivision 2a;
new text end
new text begin
(4) $1,156,000 in fiscal year 2022 and
$1,156,000 in fiscal year 2023 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
new text end
new text begin
(5) the commissioner may use up to 6.23
percent of the funds appropriated from the
TANF fund each fiscal year to conduct the
ongoing evaluations required under Minnesota
Statutes, section 145A.17, subdivision 7, and
training and technical assistance as required
under Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end
new text begin
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
new text end
new text begin
(c) Maternal Morbidity and Death Studies.
$198,000 in fiscal year 2022 and $198,000 in
fiscal year 2023 are from the general fund to
be used to conduct maternal morbidity and
death studies under Minnesota Statutes,
sections 145.901 and 145.9013.
new text end
new text begin
(d) Comprehensive Advanced Life Support
Educational Program. $100,000 in fiscal
year 2022 and $100,000 in fiscal year 2023
are from the general fund for the
comprehensive advanced life support
educational program under Minnesota Statutes,
section 144.6062. This is a onetime
appropriation.
new text end
new text begin
(e) Local Public Health Grants. $2,978,000
in fiscal year 2022 and $2,978,000 in fiscal
year 2023 are from the general fund for local
public health grants under Minnesota Statutes,
section 145A.131. The base for this
appropriation is $2,500,000 in fiscal year 2024
and $2,500,000 in fiscal year 2025.
new text end
new text begin
(f) Public Health Infrastructure and Health
Equity and Outreach. $5,000,000 in fiscal
year 2022 and $5,000,000 in fiscal year 2023
are from the general fund for purposes of
Minnesota Statutes, sections 144.067 to
144.069, and to build public health
infrastructure at the state and local levels to
address current and future public health
emergencies, conduct outreach to underserved
communities in the state experiencing health
disparities, and build systems at the state and
local levels with the goals of reducing and
eliminating health disparities in these
communities.
new text end
new text begin
(g) Mental Health Cultural Community
Continuing Education. $500,000 in fiscal
year 2022 and $500,000 in fiscal year 2023
are from the general fund for the mental health
cultural community continuing education grant
program.
new text end
new text begin
(h) Health Professional Education Loan
Forgiveness Program. $3,000,000 in fiscal
year 2022 and $3,000,000 in fiscal year 2023
are from the general fund for loan forgiveness
under the health professional education loan
forgiveness program under Minnesota Statutes,
section 144.1501, for individuals who: (1) are
eligible alcohol and drug counselors or eligible
mental health professionals, as defined in
Minnesota Statutes, section 144.1501,
subdivision 1; and (2) are Black, indigenous,
or people of color, or members of an
underrepresented community as defined in
Minnesota Statutes, section 148E.010,
subdivision 20. Loan forgiveness shall be
provided according to this paragraph
notwithstanding the priorities and distribution
requirements for loan forgiveness in
Minnesota Statutes, section 144.1501.
new text end
new text begin
(i) Birth Records; Homeless Youth. $72,000
in fiscal year 2022 and $32,000 in fiscal year
2023 are from the general fund for
administration and issuance of certified birth
records and statements of no vital record found
to homeless youth under Minnesota Statutes,
section 144.2255.
new text end
new text begin
(j) Trauma-Informed Gun Violence
Reduction Pilot Program. $100,000 in fiscal
year 2022 is from the general fund for the
trauma-informed gun violence reduction pilot
program.
new text end
new text begin
(k) Home Visiting for Pregnant Women and
Families with Young Children. $2,500,000
in fiscal year 2022 and $2,500,000 in fiscal
year 2023 are from the general fund for grants
for home visiting services under Minnesota
Statutes, section 145.87.
new text end
new text begin
(l) Supporting Healthy Development of
Babies During Pregnancy and Postpartum.
$279,000 in fiscal year 2022 and $279,000 in
fiscal year 2023 are from the general fund for
a grant to the Amherst H. Wilder Foundation
for the African American Babies Coalition
initiative for community-driven training and
education on best practices to support healthy
development of babies during pregnancy and
postpartum. Grant funds must be used to build
capacity in, train, educate, or improve
practices among individuals, from youth to
elders, serving families with members who
are Black, indigenous, or people of color,
during pregnancy and postpartum. Of this
appropriation, $19,000 in fiscal year 2022 and
$19,000 in fiscal year 2023 are for the
commissioner to use for administration. This
is a onetime appropriation. Any unexpended
balance in the first year of the biennium does
not cancel and is available in the second year
of the biennium.
new text end
new text begin
(m) Dignity in Pregnancy and Childbirth.
$1,695,000 in fiscal year 2022 and $908,000
in fiscal year 2023 are from the general fund
for purposes of Minnesota Statutes, section
144.1461. Of this appropriation, $845,000 in
fiscal year 2022 is for a grant to the University
of Minnesota School of Public Health's Center
for Antiracism Research for Health Equity, to
develop a model curriculum on anti-racism
and implicit bias for use by hospitals with
obstetric care and birth centers to provide
continuing education to staff caring for
pregnant or postpartum women. The model
curriculum must be evidence-based and must
meet the criteria in Minnesota Statutes, section
144.1461, subdivision 2, paragraph (a). The
base for this appropriation is $907,000 in fiscal
year 2024 and $860,000 in fiscal year 2025.
new text end
new text begin
(n) Recommendations to Expand Access to
Data from the All-Payer Claims Database.
$55,000 in fiscal year 2022 is from the general
fund for the commissioner to develop
recommendations to expand access to data
from the all-payer claims database under
Minnesota Statutes, section 62U.04, to
additional outside entities for public health or
research purposes.
new text end
new text begin
(o) Base Level Adjustments. The general
fund base is $110,895,000 in fiscal year 2024
and $111,787,000 in fiscal year 2025. The
state government special revenue fund base is
$7,777,000 in fiscal year 2024 and $7,777,000
in fiscal year 2025. The health care access
fund base is $36,858,000 in fiscal year 2024
and $36,258,000 in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
30,686,000 new text end |
new text begin
26,283,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
45,362,000 new text end |
new text begin
45,579,000 new text end |
new text begin
(a) Lead Risk Assessments and Lead
Orders. $1,530,000 in fiscal year 2022 and
$1,314,000 in fiscal year 2023 are from the
general fund for implementation of the
requirements for conducting lead risk
assessments under Minnesota Statutes, section
144.9504, subdivision 2, and for issuance of
lead orders under Minnesota Statutes, section
144.9504, subdivision 5.
new text end
new text begin
(b) Hospital Closure or Curtailment of
Operations. $10,000 in fiscal year 2022 and
$1,000 in fiscal year 2023 are from the general
fund for purposes of Minnesota Statutes,
section 144.555, subdivisions 1a, 1b, and 2.
new text end
new text begin
(c) Transfer; Public Health Response
Contingency Account. The commissioner
shall transfer $500,000 in fiscal year 2022
from the general fund to the public health
response contingency account established in
Minnesota Statutes, section 144.4199. This is
a onetime transfer.
new text end
new text begin
(d) Skin Lightening Products Public
Awareness and Education Grant Program.
$100,000 in fiscal year 2022 and $100,000 in
fiscal year 2023 are from the general fund for
a skin lightening products public awareness
and education grant program. This is a onetime
appropriation.
new text end
new text begin
(e) Base Level Adjustments. The general
fund base is $26,183,000 in fiscal year 2024
and $26,183,000 in fiscal year 2025. The state
government special revenue fund base is
$45,579,000 in fiscal year 2024 and
$45,579,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Health Operations
|
new text begin
11,570,000 new text end |
new text begin
11,579,000 new text end |
||||
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
27,535,000 new text end |
new text begin
$ new text end |
new text begin
26,960,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
State Government Special Revenue new text end |
new text begin
27,459,000 new text end |
new text begin
26,884,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Behavioral Health and
|
new text begin
877,000 new text end |
new text begin
875,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Chiropractic Examiners
|
new text begin
666,000 new text end |
new text begin
666,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Dentistry
|
new text begin
4,228,000 new text end |
new text begin
3,753,000 new text end |
||||
new text begin
(a) Administrative Services Unit - Operating
Costs. Of this appropriation, $2,738,000 in
fiscal year 2022 and $2,263,000 in fiscal year
2023 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end
new text begin
(b) Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2022
and $150,000 in fiscal year 2023 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end
new text begin
(c) Administrative Services Unit -
Retirement Costs. Of this appropriation,
$475,000 in fiscal year 2022 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.
new text end
new text begin
(d) Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2022
and $200,000 in fiscal year 2023 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
new text end
new text begin Subd. 5. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
164,000 new text end |
new text begin
164,000 new text end |
||||
new text begin Subd. 6. new text end
new text begin
Board of Executives for Long Term
|
new text begin
693,000 new text end |
new text begin
635,000 new text end |
||||
new text begin Subd. 7. new text end
new text begin
Board of Marriage and Family Therapy
|
new text begin
413,000 new text end |
new text begin
410,000 new text end |
||||
new text begin Subd. 8. new text end
new text begin
Board of Medical Practice
|
new text begin
5,912,000 new text end |
new text begin
5,868,000 new text end |
||||
new text begin
Health Professional Services Program. This
appropriation includes $1,002,000 in fiscal
year 2022 and $1,002,000 in fiscal year 2023
for the health professional services program.
new text end
new text begin Subd. 9. new text end
new text begin
Board of Nursing
|
new text begin
5,345,000 new text end |
new text begin
5,355,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Board of Occupational Therapy
|
new text begin
456,000 new text end |
new text begin
456,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Board of Optometry
|
new text begin
238,000 new text end |
new text begin
238,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Board of Pharmacy
|
new text begin
4,479,000 new text end |
new text begin
4,479,000 new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
State Government Special Revenue new text end |
new text begin
4,403,000 new text end |
new text begin
4,403,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
Base Level Adjustment. The health care
access fund base is $76,000 in fiscal year
2024, $38,000 in fiscal year 2025, and $0 in
fiscal year 2026.
new text end
new text begin Subd. 13. new text end
new text begin
Board of Physical Therapy
|
new text begin
564,000 new text end |
new text begin
564,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Board of Podiatric Medicine
|
new text begin
214,000 new text end |
new text begin
214,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Board of Psychology
|
new text begin
1,362,000 new text end |
new text begin
1,360,000 new text end |
||||
new text begin Subd. 16. new text end
new text begin
Board of Social Work
|
new text begin
1,561,000 new text end |
new text begin
1,560,000 new text end |
||||
new text begin Subd. 17. new text end
new text begin
Board of Veterinary Medicine
|
new text begin
363,000 new text end |
new text begin
363,000 new text end |
||||
Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
4,453,000 new text end |
new text begin
$ new text end |
new text begin
3,829,000 new text end |
||
new text begin
(a) Cooper/Sams Volunteer Ambulance
Program. $950,000 in fiscal year 2022 and
$950,000 in fiscal year 2023 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
new text end
new text begin
(1) Of this amount, $861,000 in fiscal year
2022 and $861,000 in fiscal year 2023 are for
the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40.
new text end
new text begin
(2) Of this amount, $89,000 in fiscal year 2022
and $89,000 in fiscal year 2023 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
new text end
new text begin
(b) EMSRB Operations. $1,880,000 in fiscal
year 2022 and $1,880,000 in fiscal year 2023
are for board operations.
new text end
new text begin
(c) Regional Grants. $585,000 in fiscal year
2022 and $585,000 in fiscal year 2023 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.
new text end
new text begin
(d) Ambulance Training Grant. $361,000
in fiscal year 2022 and $361,000 in fiscal year
2023 are for training grants under Minnesota
Statutes, section 144E.35.
new text end
new text begin
(e) Grants to Regional Emergency Medical
Services Programs. $650,000 in fiscal year
2022 is for grants to regional emergency
medical services programs, to be distributed
among the eight emergency medical services
regions according to Minnesota Statutes,
section 144E.50.
new text end
Sec. 6. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
1,022,000 new text end |
new text begin
$ new text end |
new text begin
1,038,000 new text end |
||
Sec. 7. new text begin OMBUDSMAN FOR MENTAL
|
new text begin
$ new text end |
new text begin
2,487,000 new text end |
new text begin
$ new text end |
new text begin
2,536,000 new text end |
||
new text begin
Department of Psychiatry Monitoring.
$100,000 in fiscal year 2022 and $100,000 in
fiscal year 2023 are for monitoring the
Department of Psychiatry at the University of
Minnesota.
new text end
Sec. 8. new text begin OMBUDSPERSONS FOR FAMILIES
|
new text begin
$ new text end |
new text begin
733,000 new text end |
new text begin
$ new text end |
new text begin
744,000 new text end |
||
Sec. 9. new text begin ATTORNEY GENERAL
|
new text begin
$ new text end |
new text begin
200,000 new text end |
new text begin
$ new text end |
new text begin
200,000 new text end |
||
new text begin
Excessive Drug Price Increases. This
appropriation is for costs of expert witnesses
and investigations under Minnesota Statutes,
section 62J.844. This is a onetime
appropriation.
new text end
Sec. 10.
Laws 2019, First Special Session chapter 9, article 14, section 3, as amended by
Laws 2019, First Special Session chapter 12, section 6, is amended to read:
Sec. 3. COMMISSIONER OF HEALTH
|
||||||
Subdivision 1.Total Appropriation
|
$ |
231,829,000 |
$ |
deleted text begin
236,188,000
deleted text end
new text begin
233,584,000 new text end |
||
| Appropriations by Fund |
||
| 2020 |
2021 |
|
| General |
124,381,000 |
deleted text begin 126,276,000deleted text end new text begin 125,881,000 new text end |
| State Government Special Revenue |
58,450,000 |
deleted text begin
61,367,000
deleted text end
new text begin
59,158,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
Subd. 2.Health Improvement
|
||||||
| Appropriations by Fund |
||
| General |
94,980,000 |
deleted text begin 96,117,000deleted text end new text begin 95,722,000 new text end |
| State Government Special Revenue |
7,614,000 |
deleted text begin
7,558,000
deleted text end
new text begin
6,924,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2020 and $3,579,000 in fiscal year
2021 are from the TANF fund for home
visiting and nutritional services under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
(2) $2,000,000 in fiscal year 2020 and
$2,000,000 in fiscal year 2021 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
(3) $4,978,000 in fiscal year 2020 and
$4,978,000 in fiscal year 2021 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 of the funding in each
fiscal year must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding in each fiscal year must be
distributed to tribal governments according to
Minnesota Statutes, section 145A.14,
subdivision 2a;
(4) $1,156,000 in fiscal year 2020 and
$1,156,000 in fiscal year 2021 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
(5) The commissioner may use up to 6.23
percent of the amounts appropriated from the
TANF fund each year to conduct the ongoing
evaluations required under Minnesota Statutes,
section 145A.17, subdivision 7, and training
and technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
(c) Comprehensive Suicide Prevention.
$2,730,000 in fiscal year 2020 and $2,730,000
in fiscal year 2021 are from the general fund
for a comprehensive, community-based suicide
prevention strategy. The funds are allocated
as follows:
(1) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are for community-based
suicide prevention grants authorized in
Minnesota Statutes, section 145.56,
subdivision 2. Specific emphasis must be
placed on those communities with the greatest
disparities. The base for this appropriation is
$1,291,000 in fiscal year 2022 and $1,291,000
in fiscal year 2023;
(2) $683,000 in fiscal year 2020 and $683,000
in fiscal year 2021 are to support
evidence-based training for educators and
school staff and purchase suicide prevention
curriculum for student use statewide, as
authorized in Minnesota Statutes, section
145.56, subdivision 2. The base for this
appropriation is $913,000 in fiscal year 2022
and $913,000 in fiscal year 2023;
(3) $137,000 in fiscal year 2020 and $137,000
in fiscal year 2021 are to implement the Zero
Suicide framework with up to 20 behavioral
and health care organizations each year to treat
individuals at risk for suicide and support
those individuals across systems of care upon
discharge. The base for this appropriation is
$205,000 in fiscal year 2022 and $205,000 in
fiscal year 2023;
(4) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are to develop and fund a
Minnesota-based network of National Suicide
Prevention Lifeline, providing statewide
coverage. The base for this appropriation is
$1,321,000 in fiscal year 2022 and $1,321,000
in fiscal year 2023; and
(5) the commissioner may retain up to 18.23
percent of the appropriation under this
paragraph to administer the comprehensive
suicide prevention strategy.
(d) Statewide Tobacco Cessation. $1,598,000
in fiscal year 2020 and $2,748,000 in fiscal
year 2021 are from the general fund for
statewide tobacco cessation services under
Minnesota Statutes, section 144.397. The base
for this appropriation is $2,878,000 in fiscal
year 2022 and $2,878,000 in fiscal year 2023.
(e) Health Care Access Survey. $225,000 in
fiscal year 2020 and $225,000 in fiscal year
2021 are from the health care access fund to
continue and improve the Minnesota Health
Care Access Survey. These appropriations
may be used in either year of the biennium.
(f) Community Solutions for Healthy Child
Development Grant Program. $1,000,000
in fiscal year 2020 and $1,000,000 in fiscal
year 2021 are for the community solutions for
healthy child development grant program to
promote health and racial equity for young
children and their families under article 11,
section 107. The commissioner may use up to
23.5 percent of the total appropriation for
administration. The base for this appropriation
is $1,000,000 in fiscal year 2022, $1,000,000
in fiscal year 2023, and $0 in fiscal year 2024.
(g) Domestic Violence and Sexual Assault
Prevention Program. $375,000 in fiscal year
2020 and $375,000 in fiscal year 2021 are
from the general fund for the domestic
violence and sexual assault prevention
program under article 11, section 108. This is
a onetime appropriation.
(h) Skin Lightening Products Public
Awareness Grant Program. $100,000 in
fiscal year 2020 and $100,000 in fiscal year
2021 are from the general fund for a skin
lightening products public awareness and
education grant program. This is a onetime
appropriation.
(i) Cannabinoid Products Workgroup.
$8,000 in fiscal year 2020 is from the state
government special revenue fund for the
cannabinoid products workgroup. This is a
onetime appropriation.
(j) Base Level Adjustments. The general fund
base is $96,742,000 in fiscal year 2022 and
$96,742,000 in fiscal year 2023. The health
care access fund base is $37,432,000 in fiscal
year 2022 and $36,832,000 in fiscal year 2023.
Subd. 3.Health Protection
|
||||||
| Appropriations by Fund |
||
| General |
18,803,000 |
19,774,000 |
| State Government Special Revenue |
50,836,000 |
deleted text begin
53,809,000
deleted text end
new text begin
52,234,000 new text end |
(a) Public Health Laboratory Equipment.
$840,000 in fiscal year 2020 and $655,000 in
fiscal year 2021 are from the general fund for
equipment for the public health laboratory.
This is a onetime appropriation and is
available until June 30, 2023.
(b) Base Level Adjustment. The general fund
base is $19,119,000 in fiscal year 2022 and
$19,119,000 in fiscal year 2023. The state
government special revenue fund base is
$53,782,000 in fiscal year 2022 and
$53,782,000 in fiscal year 2023.
Subd. 4.Health Operations
|
10,598,000 |
10,385,000 |
||||
Base Level Adjustment. The general fund
base is $10,912,000 in fiscal year 2022 and
$10,912,000 in fiscal year 2023.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
the reductions in subdivisions 1 to 3 are onetime reductions.
new text end
Sec. 11. new text begin APPROPRIATION; MINNESOTA FAMILY INVESTMENT PROGRAM
SUPPLEMENTAL PAYMENT.
new text end
new text begin
$24,235,000 in fiscal year 2021 is appropriated from the TANF fund to the commissioner
of human services to provide a onetime cash benefit of up to $750 for each household
enrolled in the Minnesota family investment program or diversionary work program under
Minnesota Statutes, chapter 256J, at the time that the cash benefit is distributed. The
commissioner shall distribute these funds through existing systems and in a manner that
minimizes the burden to families. This is a onetime appropriation.
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. 12. new text begin APPROPRIATION; REFINANCING OF EMERGENCY CHILD CARE
GRANTS; CANCELLATION.
new text end
new text begin
$26,622,626 in fiscal year 2021 is appropriated from the coronavirus relief federal fund
to the commissioner of human services for fiscal year 2020 to replace a portion of the general
fund appropriation in Laws 2020, chapter 71, article 1, section 2, subdivision 9. The general
fund appropriation that is replaced by coronavirus relief funds under this section is canceled
to the general fund. This is a onetime appropriation.
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 CANCELLATION; TRANSFER FROM STATE GOVERNMENT SPECIAL
REVENUE FUND TO GENERAL FUND.
new text end
new text begin
The $77,000 transfer each year from the state government special revenue fund to the
general fund under Laws 2008, chapter 364, section 17, paragraph (b), is canceled. This
section does not expire.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 30, 2021.
new text end
Sec. 14. new text begin FEDERAL FUNDS FOR VACCINE ACTIVITIES; APPROPRIATION.
new text end
new text begin
Federal funds made available to the commissioner of health for vaccine activities are
appropriated to the commissioner for that purpose and shall be used to support work under
Minnesota Statutes, sections 144.067 to 144.069.
new text end
Sec. 15. new text begin FEDERAL FUNDS REPLACEMENT; APPROPRIATION.
new text end
new text begin
Notwithstanding any law to the contrary, the commissioner of management and budget
must determine whether the expenditures authorized under this act are eligible uses of federal
funding received under the Coronavirus State Fiscal Recovery Fund or any other federal
funds received by the state under the American Rescue Plan Act, Public Law 117-2. If the
commissioner of management and budget determines an expenditure is eligible for funding
under Public Law 117-2, the amount of the eligible expenditure is appropriated from the
account where those amounts have been deposited and the corresponding general fund
amounts appropriated under this act are canceled to the general fund.
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. 16. new text begin TRANSFERS; HUMAN SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Grants. new text end
new text begin
The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2023, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid program, group residential housing
program, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health Finance and Policy Committee and Human Services
Finance and Policy Committee quarterly about transfers made under this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
Positions, salary money, and nonsalary administrative money
may be transferred within the Department of Human Services as the commissioners consider
necessary, with the advance approval of the commissioner of management and budget. The
commissioner shall inform the chairs and ranking minority members of the senate Health
and Human Services Finance Division and the house of representatives Health Finance and
Policy Committee and Human Services Finance and Policy Committee quarterly about
transfers made under this subdivision.
new text end
Sec. 17. new text begin TRANSFERS; HEALTH.
new text end
new text begin
Positions, salary money, and nonsalary administrative money may be transferred within
the Department of Health as the commissioner considers necessary, with the advance
approval of the commissioner of management and budget. The commissioner shall inform
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services finance quarterly about transfers made under this section.
new text end
Sec. 18. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end
new text begin
The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
new text end
Sec. 19. new text begin APPROPRIATION ENACTED MORE THAN ONCE.
new text end
new text begin
If an appropriation in this act is enacted more than once in the 2021 legislative session,
the appropriation must be given effect only once.
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. 20. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2023, unless a
different expiration date is explicit.
new text end
Sec. 21. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 16A.724, subdivision 2,
new text end
new text begin
is repealed effective June 30,
2025.
new text end
Sec. 22. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2021, unless a different effective date is specified.
new text end
APPENDIX
Repealed Minnesota Statutes: H2127-1
16A.724 HEALTH CARE ACCESS FUND.
Subd. 2.
Transfers.
(a) Notwithstanding section 295.581, to the extent available resources in the health care access fund exceed expenditures in that fund, effective for the biennium beginning July 1, 2007, the commissioner of management and budget shall transfer the excess funds from the health care access fund to the general fund on June 30 of each year, provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet the rate increase required under section 256B.04, subdivision 25.
(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if necessary, the commissioner shall reduce these transfers from the health care access fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer sufficient funds from the general fund to the health care access fund to meet annual MinnesotaCare expenditures.
245.462 DEFINITIONS.
Subd. 4a.
Clinical supervision.
"Clinical supervision" means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager. Clinical supervision must be accomplished by full or part-time employment of or contracts with mental health professionals. Clinical supervision must be documented by the mental health professional cosigning individual treatment plans and by entries in the client's record regarding supervisory activities.
245.4871 DEFINITIONS.
Subd. 32a.
Responsible social services agency.
"Responsible social services agency" is defined in section 260C.007, subdivision 27a.
245.4879 EMERGENCY SERVICES.
Subd. 2.
Specific requirements.
(a) The county board shall require that all service providers of emergency services to the child with an emotional disturbance provide immediate direct access to a mental health professional during regular business hours. For evenings, weekends, and holidays, the service may be by direct toll-free telephone access to a mental health professional, a mental health practitioner, or until January 1, 1991, a designated person with training in human services who receives clinical supervision from a mental health professional.
(b) The commissioner may waive the requirement in paragraph (a) that the evening, weekend, and holiday service be provided by a mental health professional or mental health practitioner after January 1, 1991, if the county documents that:
(1) mental health professionals or mental health practitioners are unavailable to provide this service;
(2) services are provided by a designated person with training in human services who receives clinical supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the evening, weekend, and holiday service not be provided by the provider of fire and public safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least eight hours of training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive at least four hours of continued training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(3) the local social service agency has provided public education about available emergency mental health services and can assure potential users of emergency services that their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) When emergency service during nonbusiness hours is provided by anyone other than a mental health professional, a mental health professional must be available on call for an emergency assessment and crisis intervention services, and must be available for at least telephone consultation within 30 minutes.
245.62 COMMUNITY MENTAL HEALTH CENTER.
Subd. 3.
Clinical supervisor.
All community mental health center services shall be provided under the clinical supervision of a licensed psychologist licensed under sections 148.88 to 148.98, or a physician who is board certified or eligible for board certification in psychiatry, and who is licensed under section 147.02.
Subd. 4.
Rules.
The commissioner shall promulgate rules to establish standards for the designation of an agency as a community mental health center. These standards shall include, but are not limited to:
(1) provision of mental health services in the prevention, identification, treatment and aftercare of emotional disorders, chronic and acute mental illness, developmental disabilities, and alcohol and drug abuse and dependency, including the services listed in section 245.61 except detoxification services;
(2) establishment of a community mental health center board pursuant to section 245.66; and
(3) approval pursuant to section 245.69, subdivision 2.
245.69 ADDITIONAL DUTIES OF COMMISSIONER.
Subd. 2.
Approval of centers and clinics.
The commissioner of human services has the authority to approve or disapprove public and private mental health centers and public and private mental health clinics for the purposes of section 62A.152, subdivision 2. For the purposes of this subdivision the commissioner shall promulgate rules in accordance with sections 14.001 to 14.69. The rules shall require each applicant to pay a fee to cover costs of processing applications and determining compliance with the rules and this subdivision. The commissioner may contract with any state agency, individual, corporation or association to which the commissioner shall delegate all but final approval and disapproval authority to determine compliance or noncompliance.
(a) Each approved mental health center and each approved mental health clinic shall have a multidisciplinary team of professional staff persons as required by rule. A mental health center or mental health clinic may provide the staffing required by rule by means of written contracts with professional persons or with other health care providers. Any personnel qualifications developed by rule shall be consistent with any personnel standards developed pursuant to chapter 214.
(b) Each approved mental health clinic and each approved mental health center shall establish a written treatment plan for each outpatient for whom services are reimbursable through insurance or public assistance. The treatment plan shall be developed in accordance with the rules and shall include a patient history, treatment goals, a statement of diagnosis and a treatment strategy. The clinic or center shall provide access to hospital admission as a bed patient as needed by any outpatient. The clinic or center shall ensure ongoing consultation among and availability of all members of the multidisciplinary team.
(c) As part of the required consultation, members of the multidisciplinary team shall meet at least twice monthly to conduct case reviews, peer consultations, treatment plan development and in-depth case discussion. Written minutes of these meetings shall be kept at the clinic or center for three years.
(d) Each approved center or clinic shall establish mechanisms for quality assurance and submit documentation concerning the mechanisms to the commissioner as required by rule, including:
(1) continuing education of each professional staff person;
(2) an ongoing internal utilization and peer review plan and procedures;
(3) mechanisms of staff supervision; and
(4) procedures for review by the commissioner or a delegate.
(e) The commissioner shall disapprove an applicant, or withdraw approval of a clinic or center, which the commissioner finds does not comply with the requirements of the rules or this subdivision. A clinic or center which is disapproved or whose approval is withdrawn is entitled to a contested case hearing and judicial review pursuant to sections 14.01 to 14.69.
(f) Data on individuals collected by approved clinics and centers, including written minutes of team meetings, is private data on individuals within the welfare system as provided in chapter 13.
(g) Each center or clinic that is approved and in compliance with the commissioner's existing rule on July 1, 1980, is approved for purposes of section 62A.152, subdivision 2, until rules are promulgated to implement this section.
245.735 EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROJECT.
Subdivision 1.
Excellence in Mental Health demonstration project.
The commissioner shall develop and execute projects to reform the mental health system by participating in the Excellence in Mental Health demonstration project.
Subd. 2.
Federal proposal.
The commissioner shall develop and submit to the United States Department of Health and Human Services a proposal for the Excellence in Mental Health demonstration project. The proposal shall include any necessary state plan amendments, waivers, requests for new funding, realignment of existing funding, and other authority necessary to implement the projects specified in subdivision 3.
Subd. 4.
Public participation.
In developing and implementing CCBHCs under subdivision 3, the commissioner shall consult, collaborate, and partner with stakeholders, including but not limited to mental health providers, substance use disorder treatment providers, advocacy organizations, licensed mental health professionals, counties, tribes, hospitals, other health care providers, and Minnesota public health care program enrollees who receive mental health services and their families.
256B.0596 MENTAL HEALTH CASE MANAGEMENT.
Counties shall contract with eligible providers willing to provide mental health case management services under section 256B.0625, subdivision 20. In order to be eligible, in addition to general provider requirements under this chapter, the provider must:
(1) be willing to provide the mental health case management services; and
(2) have a minimum of at least one contact with the client per week. This section is not intended to limit the ability of a county to provide its own mental health case management services.
256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified peer specialist program model, which:
(1) provides nonclinical peer support counseling by certified peer specialists;
(2) provides a part of a wraparound continuum of services in conjunction with other community mental health services;
(3) is individualized to the consumer; and
(4) promotes socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.
256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified family peer specialists program model which:
(1) provides nonclinical family peer support counseling, building on the strengths of families and helping them achieve desired outcomes;
(2) collaborates with others providing care or support to the family;
(3) provides nonadversarial advocacy;
(4) promotes the individual family culture in the treatment milieu;
(5) links parents to other parents in the community;
(6) offers support and encouragement;
(7) assists parents in developing coping mechanisms and problem-solving skills;
(8) promotes resiliency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services;
(9) establishes and provides peer-led parent support groups; and
(10) increases the child's ability to function better within the child's home, school, and community by educating parents on community resources, assisting with problem solving, and educating parents on mental illnesses.
256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.
Subd. 3.
Eligibility for intensive residential treatment services.
An eligible client for intensive residential treatment services is an individual who:
(1) is age 18 or older;
(2) is eligible for medical assistance;
(3) is diagnosed with a mental illness;
(4) because of a mental illness, has substantial disability and functional impairment in three or more of the areas listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced;
(5) has one or more of the following: a history of recurring or prolonged inpatient hospitalizations in the past year, significant independent living instability, homelessness, or very frequent use of mental health and related services yielding poor outcomes; and
(6) in the written opinion of a licensed mental health professional, has the need for mental health services that cannot be met with other available community-based services, or is likely to experience a mental health crisis or require a more restrictive setting if intensive rehabilitative mental health services are not provided.
Subd. 5a.
Standards for intensive residential rehabilitative mental health services.
(a) The standards in this subdivision apply to intensive residential mental health services.
(b) The provider of intensive residential treatment services must have sufficient staff to provide 24-hour-per-day coverage to deliver the rehabilitative services described in the treatment plan and to safely supervise and direct the activities of clients, given the client's level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider must have the capacity within the facility to provide integrated services for chemical dependency, illness management services, and family education, when appropriate.
(c) At a minimum:
(1) staff must provide direction and supervision whenever clients are present in the facility;
(2) staff must remain awake during all work hours;
(3) there must be a staffing ratio of at least one to nine clients for each day and evening shift. If more than nine clients are present at the residential site, there must be a minimum of two staff during day and evening shifts, one of whom must be a mental health practitioner or mental health professional;
(4) if services are provided to clients who need the services of a medical professional, the provider shall ensure that these services are provided either by the provider's own medical staff or through referral to a medical professional; and
(5) the provider must ensure the timely availability of a licensed registered nurse, either directly employed or under contract, who is responsible for ensuring the effectiveness and safety of medication administration in the facility and assessing clients for medication side effects and drug interactions.
(d) Services must be provided by qualified staff as defined in section 256B.0623, subdivision 5, who are trained and supervised according to section 256B.0623, subdivision 6, except that mental health rehabilitation workers acting as overnight staff are not required to comply with section 256B.0623, subdivision 5, paragraph (a), clause (4), item (iv).
(e) The clinical supervisor must be an active member of the intensive residential services treatment team. The team must meet with the clinical supervisor at least weekly to discuss clients' progress and make rapid adjustments to meet clients' needs. The team meeting shall include client-specific case reviews and general treatment discussions among team members. Client-specific case reviews and planning must be documented in the client's treatment record.
(f) Treatment staff must have prompt access in person or by telephone to a mental health practitioner or mental health professional. The provider must have the capacity to promptly and appropriately respond to emergent needs and make any necessary staffing adjustments to ensure the health and safety of clients.
(g) The initial functional assessment must be completed within ten days of intake and updated at least every 30 days, or prior to discharge from the service, whichever comes first.
(h) The initial individual treatment plan must be completed within 24 hours of admission. Within ten days of admission, the initial treatment plan must be refined and further developed, except for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180. The individual treatment plan must be reviewed with the client and updated at least monthly.
256B.0623 ADULT REHABILITATIVE MENTAL HEALTH SERVICES COVERED.
Subd. 7.
Personnel file.
The adult rehabilitative mental health services provider entity must maintain a personnel file on each staff. Each file must contain:
(1) an annual performance review;
(2) a summary of on-site service observations and charting review;
(3) a criminal background check of all direct service staff;
(4) evidence of academic degree and qualifications;
(5) a copy of professional license;
(6) any job performance recognition and disciplinary actions;
(7) any individual staff written input into own personnel file;
(8) all clinical supervision provided; and
(9) documentation of compliance with continuing education requirements.
Subd. 8.
Diagnostic assessment.
Providers of adult rehabilitative mental health services must complete a diagnostic assessment as defined in section 245.462, subdivision 9, within five days after the recipient's second visit or within 30 days after intake, whichever occurs first. In cases where a diagnostic assessment is available that reflects the recipient's current status, and has been completed within three years preceding admission, an adult diagnostic assessment update must be completed. An update shall include a face-to-face interview with the recipient and a written summary by a mental health professional of the recipient's current mental health status and service needs. If the recipient's mental health status has changed significantly since the adult's most recent diagnostic assessment, a new diagnostic assessment is required.
Subd. 10.
Individual treatment plan.
All providers of adult rehabilitative mental health services must develop and implement an individual treatment plan for each recipient. The provisions in clauses (1) and (2) apply:
(1) Individual treatment plan means a plan of intervention, treatment, and services for an individual recipient written by a mental health professional or by a mental health practitioner under the clinical supervision of a mental health professional. The individual treatment plan must be based on diagnostic and functional assessments. To the extent possible, the development and implementation of a treatment plan must be a collaborative process involving the recipient, and with the permission of the recipient, the recipient's family and others in the recipient's support system. Providers of adult rehabilitative mental health services must develop the individual treatment plan within 30 calendar days of intake. The treatment plan must be updated at least every six months thereafter, or more often when there is significant change in the recipient's situation or functioning, or in services or service methods to be used, or at the request of the recipient or the recipient's legal guardian.
(2) The individual treatment plan must include:
(i) a list of problems identified in the assessment;
(ii) the recipient's strengths and resources;
(iii) concrete, measurable goals to be achieved, including time frames for achievement;
(iv) specific objectives directed toward the achievement of each one of the goals;
(v) documentation of participants in the treatment planning. The recipient, if possible, must be a participant. The recipient or the recipient's legal guardian must sign the treatment plan, or documentation must be provided why this was not possible. A copy of the plan must be given to the recipient or legal guardian. Referral to formal services must be arranged, including specific providers where applicable;
(vi) cultural considerations, resources, and needs of the recipient must be included;
(vii) planned frequency and type of services must be initiated; and
(viii) clear progress notes on outcome of goals.
(3) The individual community support plan defined in section 245.462, subdivision 12, may serve as the individual treatment plan if there is involvement of a mental health case manager, and with the approval of the recipient. The individual community support plan must include the criteria in clause (2).
Subd. 11.
Recipient file.
Providers of adult rehabilitative mental health services must maintain a file for each recipient that contains the following information:
(1) diagnostic assessment or verification of its location that is current and that was reviewed by a mental health professional who is employed by or under contract with the provider entity;
(2) functional assessments;
(3) individual treatment plans signed by the recipient and the mental health professional, or if the recipient refused to sign the plan, the date and reason stated by the recipient as to why the recipient would not sign the plan;
(4) recipient history;
(5) signed release forms;
(6) recipient health information and current medications;
(7) emergency contacts for the recipient;
(8) case records which document the date of service, the place of service delivery, signature of the person providing the service, nature, extent and units of service, and place of service delivery;
(9) contacts, direct or by telephone, with recipient's family or others, other providers, or other resources for service coordination;
(10) summary of recipient case reviews by staff; and
(11) written information by the recipient that the recipient requests be included in the file.
256B.0625 COVERED SERVICES.
Subd. 5l.
Intensive mental health outpatient treatment.
Medical assistance covers intensive mental health outpatient treatment for dialectical behavioral therapy. The commissioner shall establish:
(1) certification procedures to ensure that providers of these services are qualified; and
(2) treatment protocols including required service components and criteria for admission, continued treatment, and discharge.
Subd. 35a.
Children's mental health crisis response services.
Medical assistance covers children's mental health crisis response services according to section 256B.0944.
Subd. 35b.
Children's therapeutic services and supports.
Medical assistance covers children's therapeutic services and supports according to section 256B.0943.
Subd. 61.
Family psychoeducation services.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers family psychoeducation services provided to a child up to age 21 with a diagnosed mental health condition when identified in the child's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who has determined it medically necessary to involve family members in the child's care. For the purposes of this subdivision, "family psychoeducation services" means information or demonstration provided to an individual or family as part of an individual, family, multifamily group, or peer group session to explain, educate, and support the child and family in understanding a child's symptoms of mental illness, the impact on the child's development, and needed components of treatment and skill development so that the individual, family, or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental health and long-term resilience.
Subd. 62.
Mental health clinical care consultation.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers clinical care consultation for a person up to age 21 who is diagnosed with a complex mental health condition or a mental health condition that co-occurs with other complex and chronic conditions, when described in the person's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the purposes of this subdivision, "clinical care consultation" means communication from a treating mental health professional to other providers or educators not under the clinical supervision of the treating mental health professional who are working with the same client to inform, inquire, and instruct regarding the client's symptoms; strategies for effective engagement, care, and intervention needs; and treatment expectations across service settings; and to direct and coordinate clinical service components provided to the client and family.
Subd. 65.
Outpatient mental health services.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy according to Minnesota Rules, part 9505.0372, when the mental health services are performed by a mental health practitioner working as a clinical trainee according to section 245.462, subdivision 17, paragraph (g).
256B.0916 EXPANSION OF HOME AND COMMUNITY-BASED SERVICES.
Subd. 2.
Distribution of funds; partnerships.
(a) Beginning with fiscal year 2000, the commissioner shall distribute all funding available for home and community-based waiver services for persons with developmental disabilities to individual counties or to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals. The commissioner shall encourage counties to form partnerships that have a sufficient number of recipients and funding to adequately manage the risk and maximize use of available resources.
(b) Counties must submit a request for funds and a plan for administering the program as required by the commissioner. The plan must identify the number of clients to be served, their ages, and their priority listing based on:
(1) requirements in Minnesota Rules, part 9525.1880; and
(2) statewide priorities identified in section 256B.092, subdivision 12.
The plan must also identify changes made to improve services to eligible persons and to improve program management.
(c) In allocating resources to counties, priority must be given to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals and to counties determined by the commissioner to have sufficient waiver capacity to maximize resource use.
(d) Within 30 days after receiving the county request for funds and plans, the commissioner shall provide a written response to the plan that includes the level of resources available to serve additional persons.
(e) Counties are eligible to receive medical assistance administrative reimbursement for administrative costs under criteria established by the commissioner.
(f) The commissioner shall manage waiver allocations in such a manner as to fully use available state and federal waiver appropriations.
Subd. 3.
Failure to develop partnerships or submit a plan.
(a) By October 1 of each year the commissioner shall notify the county board if any county determined by the commissioner to have insufficient capacity to maximize use of available resources fails to develop a partnership with other counties or fails to submit a plan as required in subdivision 2. The commissioner shall provide needed technical assistance to a county or group of counties that fails to form a partnership or submit a plan. If a county has not joined a county partnership or submitted a plan within 30 days following the notice by the commissioner of its failure, the commissioner shall require and assist that county to develop a plan or contract with another county or group of counties to plan and administer the waiver services program in that county.
(b) Counties may request technical assistance, management information, and administrative support from the commissioner at any time. The commissioner shall respond to county requests within 30 days. Priority shall be given to activities that support the administrative needs of newly formed county partnerships.
Subd. 4.
Allowed reserve.
Counties or groups of counties participating in partnerships that have submitted a plan under this section may develop an allowed reserve amount to meet crises and other unmet needs of current home and community-based waiver recipients. The amount of the allowed reserve shall be a county specific amount based upon documented past experience and projected need for the coming year described in an allowed reserve plan submitted for approval to the commissioner with the allocation request for the fiscal year.
Subd. 5.
Allocation of new diversions and priorities for reassignment of resources for developmental disabilities.
(a) The commissioner shall monitor county utilization of allocated resources and, as appropriate, reassign resources not utilized.
(b) Effective July 1, 2002, the commissioner shall authorize the spending of new diversion resources beginning January 1 of each year.
(c) Effective July 1, 2002, the commissioner shall manage the reassignment of waiver resources that occur from persons who have left the waiver in a manner that results in the cost reduction equivalent to delaying the reuse of those waiver resources by 180 days.
(d) Priority consideration for reassignment of resources shall be given to counties that form partnerships. In addition to the priorities listed in Minnesota Rules, part 9525.1880, the commissioner shall also give priority consideration to persons whose living situations are unstable due to the age or incapacity of the primary caregiver and to children to avoid out-of-home placement.
Subd. 8.
Financial and wait-list data reporting.
(a) The commissioner shall make available financial and waiting list information on the department's website.
(b) The financial information must include:
(1) the most recent end of session forecast available for the disability home and community-based waiver programs authorized under sections 256B.092 and 256B.49; and
(2) the most current financial information, updated at least monthly for the disability home and community-based waiver program authorized under section 256B.092 and three disability home and community-based waiver programs authorized under section 256B.49 for each county and tribal agency, including:
(i) the amount of resources allocated;
(ii) the amount of resources authorized for participants; and
(iii) the amount of allocated resources not authorized and the amount not used as provided in subdivision 12, and section 256B.49, subdivision 27.
(c) The waiting list information must be provided quarterly beginning August 1, 2016, and must include at least:
(1) the number of persons screened and waiting for services listed by urgency category, the number of months on the wait list, age group, and the type of services requested by those waiting;
(2) the number of persons beginning waiver services who were on the waiting list, and the number of persons beginning waiver services who were not on the waiting list;
(3) the number of persons who left the waiting list but did not begin waiver services; and
(4) the number of persons on the waiting list with approved funding but without a waiver service agreement and the number of days from funding approval until a service agreement is effective for each person.
(d) By December 1 of each year, the commissioner shall compile a report posted on the department's website that includes:
(1) the financial information listed in paragraph (b) for the most recently completed allocation period;
(2) for the previous four quarters, the waiting list information listed in paragraph (c);
(3) for a 12-month period ending October 31, a list of county and tribal agencies required to submit a corrective action plan under subdivisions 11 and 12, and section 256B.49, subdivisions 26 and 27; and
(4) for a 12-month period ending October 31, a list of the county and tribal agencies from which resources were moved as authorized in section 256B.092, subdivision 12, and section 256B.49, subdivision 11a, the amount of resources taken from each agency, the counties that were given increased resources as a result, and the amounts provided.
Subd. 11.
Excess spending.
County and tribal agencies are responsible for spending in excess of the allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, they must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct their overspending for the two years following the period when the overspending occurred. The commissioner shall recoup spending in excess of the allocation only in cases where statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to them for that purpose.
Subd. 12.
Use of waiver allocations.
County and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services. If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county's or tribe's available allocation and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.
256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.
Subd. 8.
Required preservice and continuing education.
(a) A provider entity shall establish a plan to provide preservice and continuing education for staff. The plan must clearly describe the type of training necessary to maintain current skills and obtain new skills and that relates to the provider entity's goals and objectives for services offered.
(b) A provider that employs a mental health behavioral aide under this section must require the mental health behavioral aide to complete 30 hours of preservice training. The preservice training must include parent team training. The preservice training must include 15 hours of in-person training of a mental health behavioral aide in mental health services delivery and eight hours of parent team training. Curricula for parent team training must be approved in advance by the commissioner. Components of parent team training include:
(1) partnering with parents;
(2) fundamentals of family support;
(3) fundamentals of policy and decision making;
(4) defining equal partnership;
(5) complexities of the parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses;
(6) sibling impacts;
(7) support networks; and
(8) community resources.
(c) A provider entity that employs a mental health practitioner and a mental health behavioral aide to provide children's therapeutic services and supports under this section must require the mental health practitioner and mental health behavioral aide to complete 20 hours of continuing education every two calendar years. The continuing education must be related to serving the needs of a child with emotional disturbance in the child's home environment and the child's family.
(d) The provider entity must document the mental health practitioner's or mental health behavioral aide's annual completion of the required continuing education. The documentation must include the date, subject, and number of hours of the continuing education, and attendance records, as verified by the staff member's signature, job title, and the instructor's name. The provider entity must keep documentation for each employee, including records of attendance at professional workshops and conferences, at a central location and in the employee's personnel file.
Subd. 10.
Service authorization.
Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.
256B.0944 CHILDREN'S MENTAL HEALTH CRISIS RESPONSE SERVICES.
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 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.
Subd. 2.
Medical assistance coverage.
Medical assistance covers medically necessary children's mental health crisis response services, subject to federal approval, if provided to an eligible recipient under subdivision 3, by a qualified provider entity under subdivision 4 or a qualified individual provider working within the provider's scope of practice, and identified in the recipient's individual crisis treatment plan under subdivision 8.
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is eligible for medical assistance;
(2) is under age 18 or between the ages of 18 and 21;
(3) is screened as possibly experiencing a mental health crisis or mental health emergency where a mental health crisis assessment is needed;
(4) is assessed as experiencing a mental health crisis or mental health emergency, and mental health mobile crisis intervention or mental health crisis stabilization services are determined to be medically necessary; and
(5) meets the criteria for emotional disturbance or mental illness.
Subd. 4.
Provider entity standards.
(a) A crisis intervention and crisis stabilization provider entity must meet the administrative and clinical standards specified in section 256B.0943, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:
(1) an Indian health service facility or facility owned and operated by a tribe or a tribal organization operating under Public Law 93-638 as a 638 facility;
(2) a county board-operated entity; or
(3) a provider entity that is under contract with the county board in the county where the potential crisis or emergency is occurring.
(b) The children's mental health crisis response services provider entity must:
(1) ensure that mental health crisis assessment and mobile crisis intervention services are available 24 hours a day, seven days a week;
(2) directly provide the services or, if services are subcontracted, the provider entity must maintain clinical responsibility for services and billing;
(3) ensure that crisis intervention services are provided in a manner consistent with sections 245.487 to 245.4889; and
(4) develop and maintain written policies and procedures regarding service provision that include safety of staff and recipients in high-risk situations.
Subd. 4a.
Alternative provider standards.
If a provider entity demonstrates that, due to geographic or other barriers, it is not feasible to provide mobile crisis intervention services 24 hours a day, seven days a week, according to the standards in subdivision 4, paragraph (b), clause (1), the commissioner may approve a crisis response provider based on an alternative plan proposed by a provider entity. The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of crisis services; and
(2) provide mobile services outside of the usual nine-to-five office hours and on weekends and holidays.
Subd. 5.
Mobile crisis intervention staff qualifications.
(a) To provide children's mental health mobile crisis intervention services, a mobile crisis intervention team must include:
(1) at least two mental health professionals as defined in section 256B.0943, subdivision 1, paragraph (o); or
(2) a combination of at least one mental health professional and one mental health practitioner as defined in section 245.4871, subdivision 26, with the required mental health crisis training and under the clinical supervision of a mental health professional on the team.
(b) The team must have at least two people with at least one member providing on-site crisis intervention services when needed. Team members must be experienced in mental health assessment, crisis intervention techniques, and clinical decision making under emergency conditions and have knowledge of local services and resources. The team must recommend and coordinate the team's services with appropriate local resources, including the county social services agency, mental health service providers, and local law enforcement, if necessary.
Subd. 6.
Initial screening and crisis assessment planning.
(a) Before initiating mobile crisis intervention services, a screening of the potential crisis situation must be conducted. The screening may use the resources of crisis assistance and emergency services as defined in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The screening must gather information, determine whether a crisis situation exists, identify the parties involved, and determine an appropriate response.
(b) If a crisis exists, a crisis assessment must be completed. A crisis assessment must evaluate any immediate needs for which emergency services are needed and, as time permits, the recipient's current life situation, sources of stress, mental health problems and symptoms, strengths, cultural considerations, support network, vulnerabilities, and current functioning.
(c) If the crisis assessment determines mobile crisis intervention services are needed, the intervention services must be provided promptly. As the opportunity presents itself during the intervention, at least two members of the mobile crisis intervention team must confer directly or by telephone about the assessment, treatment plan, and actions taken and needed. At least one of the team members must be on site providing crisis intervention services. If providing on-site crisis intervention services, a mental health practitioner must seek clinical supervision as required under subdivision 9.
(d) The mobile crisis intervention team must develop an initial, brief crisis treatment plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention. The plan must address the needs and problems noted in the crisis assessment and include measurable short-term goals, cultural considerations, and frequency and type of services to be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan must be updated as needed to reflect current goals and services. The team must involve the client and the client's family in developing and implementing the plan.
(e) The team must document in progress notes which short-term goals have been met and when no further crisis intervention services are required.
(f) If the client's crisis is stabilized, but the client needs a referral for mental health crisis stabilization services or to other services, the team must provide a referral to these services. If the recipient has a case manager, planning for other services must be coordinated with the case manager.
Subd. 7.
Crisis stabilization services.
Crisis stabilization services must be provided by a mental health professional or a mental health practitioner, as defined in section 245.462, subdivision 17, who works under the clinical supervision of a mental health professional and for a crisis stabilization services provider entity and must meet the following standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in subdivision 8;
(2) services must be delivered according to the treatment plan and include face-to-face contact with the recipient by qualified staff for further assessment, help with referrals, updating the crisis stabilization treatment plan, supportive counseling, skills training, and collaboration with other service providers in the community; and
(3) mental health practitioners must have completed at least 30 hours of training in crisis intervention and stabilization during the past two years.
Subd. 8.
Treatment plan.
(a) The individual crisis stabilization treatment plan must include, at a minimum:
(1) a list of problems identified in the assessment;
(2) a list of the recipient's strengths and resources;
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames for achievement of the goals;
(4) specific objectives directed toward the achievement of each goal;
(5) documentation of the participants involved in the service planning;
(6) planned frequency and type of services initiated;
(7) a crisis response action plan if a crisis should occur; and
(8) clear progress notes on the outcome of goals.
(b) The client, if clinically appropriate, must be a participant in the development of the crisis stabilization treatment plan. The client or the client's legal guardian must sign the service plan or documentation must be provided why this was not possible. A copy of the plan must be given to the client and the client's legal guardian. The plan should include services arranged, including specific providers where applicable.
(c) A treatment plan must be developed by a mental health professional or mental health practitioner under the clinical supervision of a mental health professional. A written plan must be completed within 24 hours of beginning services with the client.
Subd. 9.
Supervision.
(a) A mental health practitioner may provide crisis assessment and mobile crisis intervention services if the following clinical supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services provided;
(2) the mental health professional of the provider entity, who is an employee or under contract with the provider entity, must be immediately available by telephone or in person for clinical supervision;
(3) the mental health professional is consulted, in person or by telephone, during the first three hours when a mental health practitioner provides on-site service; and
(4) the mental health professional must review and approve the tentative crisis assessment and crisis treatment plan, document the consultation, and sign the crisis assessment and treatment plan within the next business day.
(b) If the mobile crisis intervention services continue into a second calendar day, a mental health professional must contact the client face-to-face on the second day to provide services and update the crisis treatment plan. The on-site observation must be documented in the client's record and signed by the mental health professional.
Subd. 10.
Client record.
The provider must maintain a file for each client that complies with the requirements under section 256B.0943, subdivision 11, and contains the following information:
(1) individual crisis treatment plans signed by the recipient, mental health professional, and mental health practitioner who developed the crisis treatment plan, or if the recipient refused to sign the plan, the date and reason stated by the recipient for not signing the plan;
(2) signed release of information forms;
(3) recipient health information and current medications;
(4) emergency contacts for the recipient;
(5) case records that document the date of service, place of service delivery, signature of the person providing the service, and the nature, extent, and units of service. Direct or telephone contact with the recipient's family or others should be documented;
(6) required clinical supervision by mental health professionals;
(7) summary of the recipient's case reviews by staff; and
(8) any written information by the recipient that the recipient wants in the file.
Subd. 11.
Excluded services.
The following services are excluded from reimbursement under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) transportation services under children's mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical assistance to provide children's mental health crisis response services;
(5) crisis response services provided by a residential treatment center to clients in their facility;
(6) services performed by volunteers;
(7) direct billing of time spent "on call" when not delivering services to a recipient;
(8) provider service time included in case management reimbursement;
(9) outreach services to potential recipients; and
(10) a mental health service that is not medically necessary.
256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
Subd. 5.
Service authorization.
The commissioner will administer authorizations for services under this section in compliance with section 256B.0625, subdivision 25.
256B.097 STATE QUALITY ASSURANCE, QUALITY IMPROVEMENT, AND LICENSING SYSTEM.
Subdivision 1.
Scope.
(a) In order to improve the quality of services provided to Minnesotans with disabilities and to meet the requirements of the federally approved home and community-based waivers under section 1915c of the Social Security Act, a State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving disability services is enacted. This system is a partnership between the Department of Human Services and the State Quality Council established under subdivision 3.
(b) This system is a result of the recommendations from the Department of Human Services' licensing and alternative quality assurance study mandated under Laws 2005, First Special Session chapter 4, article 7, section 57, and presented to the legislature in February 2007.
(c) The disability services eligible under this section include:
(1) the home and community-based services waiver programs for persons with developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, including brain injuries and services for those who qualify for nursing facility level of care or hospital facility level of care and any other services licensed under chapter 245D;
(2) home care services under section 256B.0651;
(3) family support grants under section 252.32;
(4) consumer support grants under section 256.476;
(5) semi-independent living services under section 252.275; and
(6) services provided through an intermediate care facility for the developmentally disabled.
(d) For purposes of this section, the following definitions apply:
(1) "commissioner" means the commissioner of human services;
(2) "council" means the State Quality Council under subdivision 3;
(3) "Quality Assurance Commission" means the commission under section 256B.0951; and
(4) "system" means the State Quality Assurance, Quality Improvement and Licensing System under this section.
Subd. 2.
Duties of commissioner of human services.
(a) The commissioner of human services shall establish the State Quality Council under subdivision 3.
(b) The commissioner shall initially delegate authority to perform licensing functions and activities according to section 245A.16 to a host county in Region 10. The commissioner must not license or reimburse a participating facility, program, or service located in Region 10 if the commissioner has received notification from the host county that the facility, program, or service has failed to qualify for licensure.
(c) The commissioner may conduct random licensing inspections based on outcomes adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services eligible under this section. The role of the random inspections is to verify that the system protects the safety and well-being of persons served and maintains the availability of high-quality services for persons with disabilities.
(d) The commissioner shall ensure that the federal home and community-based waiver requirements are met and that incidents that may have jeopardized safety and health or violated services-related assurances, civil and human rights, and other protections designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and acted upon in a timely manner.
(e) The commissioner shall seek a federal waiver by July 1, 2012, to allow intermediate care facilities for persons with developmental disabilities to participate in this system.
Subd. 3.
State Quality Council.
(a) There is hereby created a State Quality Council which must define regional quality councils, and carry out a community-based, person-directed quality review component, and a comprehensive system for effective incident reporting, investigation, analysis, and follow-up.
(b) By August 1, 2011, the commissioner of human services shall appoint the members of the initial State Quality Council. Members shall include representatives from the following groups:
(1) disability service recipients and their family members;
(2) during the first four years of the State Quality Council, there must be at least three members from the Region 10 stakeholders. As regional quality councils are formed under subdivision 4, each regional quality council shall appoint one member;
(3) disability service providers;
(4) disability advocacy groups; and
(5) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(c) Members of the council who do not receive a salary or wages from an employer for time spent on council duties may receive a per diem payment when performing council duties and functions.
(d) The State Quality Council shall:
(1) assist the Department of Human Services in fulfilling federally mandated obligations by monitoring disability service quality and quality assurance and improvement practices in Minnesota;
(2) establish state quality improvement priorities with methods for achieving results and provide an annual report to the legislative committees with jurisdiction over policy and funding of disability services on the outcomes, improvement priorities, and activities undertaken by the commission during the previous state fiscal year;
(3) identify issues pertaining to financial and personal risk that impede Minnesotans with disabilities from optimizing choice of community-based services; and
(4) recommend to the chairs and ranking minority members of the legislative committees with jurisdiction over human services and civil law by January 15, 2014, statutory and rule changes related to the findings under clause (3) that promote individualized service and housing choices balanced with appropriate individualized protection.
(e) The State Quality Council, in partnership with the commissioner, shall:
(1) approve and direct implementation of the community-based, person-directed system established in this section;
(2) recommend an appropriate method of funding this system, and determine the feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
(3) approve measurable outcomes in the areas of health and safety, consumer evaluation, education and training, providers, and systems;
(4) establish variable licensure periods not to exceed three years based on outcomes achieved; and
(5) in cooperation with the Quality Assurance Commission, design a transition plan for licensed providers from Region 10 into the alternative licensing system.
(f) The State Quality Council shall notify the commissioner of human services that a facility, program, or service has been reviewed by quality assurance team members under subdivision 4, paragraph (b), clause (13), and qualifies for a license.
(g) The State Quality Council, in partnership with the commissioner, shall establish an ongoing review process for the system. The review shall take into account the comprehensive nature of the system which is designed to evaluate the broad spectrum of licensed and unlicensed entities that provide services to persons with disabilities. The review shall address efficiencies and effectiveness of the system.
(h) The State Quality Council may recommend to the commissioner certain variances from the standards governing licensure of programs for persons with disabilities in order to improve the quality of services so long as the recommended variances do not adversely affect the health or safety of persons being served or compromise the qualifications of staff to provide services.
(i) The safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make recommendations to the commissioner or to the legislature in the report required under paragraph (c) regarding alternatives or modifications to the safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c).
(j) The State Quality Council may hire staff to perform the duties assigned in this subdivision.
Subd. 4.
Regional quality councils.
(a) The commissioner shall establish, as selected by the State Quality Council, regional quality councils of key stakeholders, including regional representatives of:
(1) disability service recipients and their family members;
(2) disability service providers;
(3) disability advocacy groups; and
(4) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(b) Each regional quality council shall:
(1) direct and monitor the community-based, person-directed quality assurance system in this section;
(2) approve a training program for quality assurance team members under clause (13);
(3) review summary reports from quality assurance team reviews and make recommendations to the State Quality Council regarding program licensure;
(4) make recommendations to the State Quality Council regarding the system;
(5) resolve complaints between the quality assurance teams, counties, providers, persons receiving services, their families, and legal representatives;
(6) analyze and review quality outcomes and critical incident data reporting incidents of life safety concerns immediately to the Department of Human Services licensing division;
(7) provide information and training programs for persons with disabilities and their families and legal representatives on service options and quality expectations;
(8) disseminate information and resources developed to other regional quality councils;
(9) respond to state-level priorities;
(10) establish regional priorities for quality improvement;
(11) submit an annual report to the State Quality Council on the status, outcomes, improvement priorities, and activities in the region;
(12) choose a representative to participate on the State Quality Council and assume other responsibilities consistent with the priorities of the State Quality Council; and
(13) recruit, train, and assign duties to members of quality assurance teams, taking into account the size of the service provider, the number of services to be reviewed, the skills necessary for the team members to complete the process, and ensure that no team member has a financial, personal, or family relationship with the facility, program, or service being reviewed or with anyone served at the facility, program, or service. Quality assurance teams must be comprised of county staff, persons receiving services or the person's families, legal representatives, members of advocacy organizations, providers, and other involved community members. Team members must complete the training program approved by the regional quality council and must demonstrate performance-based competency. Team members may be paid a per diem and reimbursed for expenses related to their participation in the quality assurance process.
(c) The commissioner shall monitor the safety standards, rights, and procedural protections for the monitoring of psychotropic medications and those identified under sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause (7); and 626.557; and chapter 260E.
(d) The regional quality councils may hire staff to perform the duties assigned in this subdivision.
(e) The regional quality councils may charge fees for their services.
(f) The quality assurance process undertaken by a regional quality council consists of an evaluation by a quality assurance team of the facility, program, or service. The process must include an evaluation of a random sample of persons served. The sample must be representative of each service provided. The sample size must be at least five percent but not less than two persons served. All persons must be given the opportunity to be included in the quality assurance process in addition to those chosen for the random sample.
(g) A facility, program, or service may contest a licensing decision of the regional quality council as permitted under chapter 245A.
Subd. 5.
Annual survey of service recipients.
The commissioner, in consultation with the State Quality Council, shall conduct an annual independent statewide survey of service recipients, randomly selected, to determine the effectiveness and quality of disability services. The survey must be consistent with the system performance expectations of the Centers for Medicare and Medicaid Services (CMS) Quality Framework. The survey must analyze whether desired outcomes for persons with different demographic, diagnostic, health, and functional needs, who are receiving different types of services in different settings and with different costs, have been achieved. Annual statewide and regional reports of the results must be published and used to assist regions, counties, and providers to plan and measure the impact of quality improvement activities.
Subd. 6.
Mandated reporters.
Members of the State Quality Council under subdivision 3, the regional quality councils under subdivision 4, and quality assurance team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as defined in sections 260E.06, subdivision 1, and 626.5572, subdivision 16.
256B.49 HOME AND COMMUNITY-BASED SERVICE WAIVERS FOR PERSONS WITH DISABILITIES.
Subd. 26.
Excess allocations.
Effective July 1, 2018, county and tribal agencies will be responsible for spending in excess of the annual allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct its overspending for the two years following the period when the overspending occurred. The commissioner shall recoup funds spent in excess of the allocation only in cases when statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county or tribe's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to it for that purpose.
Subd. 27.
Use of waiver allocations.
(a) Effective until June 30, 2018, county and tribal agencies are responsible for authorizing the annual allocation made by the commissioner. In the event a county or tribal agency authorizes less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.
(b) Effective July 1, 2018, county and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.
(c) If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county or tribe's available allocation, and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.
256D.051 SNAP EMPLOYMENT AND TRAINING PROGRAM.
Subdivision 1.
SNAP employment and training program.
The commissioner shall implement a SNAP employment and training program in order to meet the SNAP employment and training participation requirements of the United States Department of Agriculture. Unless exempt under subdivision 3a, each adult recipient in the unit must participate in the SNAP employment and training program each month that the person is eligible for SNAP benefits. The person's participation in SNAP employment and training services must begin no later than the first day of the calendar month following the determination of eligibility for SNAP benefits. With the county agency's consent, and to the extent of available resources, the person may voluntarily continue to participate in SNAP employment and training services for up to three additional consecutive months immediately following termination of SNAP benefits in order to complete the provisions of the person's employability development plan.
Subd. 1a.
Notices and sanctions.
(a) At the time the county agency notifies the household that it is eligible for SNAP benefits, the county agency must inform all mandatory employment and training services participants as identified in subdivision 1 in the household that they must comply with all SNAP employment and training program requirements each month, including the requirement to attend an initial orientation to the SNAP employment and training program and that SNAP eligibility will end unless the participants comply with the requirements specified in the notice.
(b) A participant who fails without good cause to comply with SNAP employment and training program requirements of this section, including attendance at orientation, will lose SNAP eligibility for the following periods:
(1) for the first occurrence, for one month or until the person complies with the requirements not previously complied with, whichever is longer;
(2) for the second occurrence, for three months or until the person complies with the requirements not previously complied with, whichever is longer; or
(3) for the third and any subsequent occurrence, for six months or until the person complies with the requirements not previously complied with, whichever is longer.
If the participant is not the SNAP head of household, the person shall be considered an ineligible household member for SNAP purposes. If the participant is the SNAP head of household, the entire household is ineligible for SNAP as provided in Code of Federal Regulations, title 7, section 273.7(g). "Good cause" means circumstances beyond the control of the participant, such as illness or injury, illness or injury of another household member requiring the participant's presence, a household emergency, or the inability to obtain child care for children between the ages of six and 12 or to obtain transportation needed in order for the participant to meet the SNAP employment and training program participation requirements.
(c) The county agency shall mail or hand deliver a notice to the participant not later than five days after determining that the participant has failed without good cause to comply with SNAP employment and training program requirements which specifies the requirements that were not complied with, the factual basis for the determination of noncompliance, and the right to reinstate eligibility upon a showing of good cause for failure to meet the requirements. The notice must ask the reason for the noncompliance and identify the participant's appeal rights. The notice must request that the participant inform the county agency if the participant believes that good cause existed for the failure to comply and must state that the county agency intends to terminate eligibility for SNAP benefits due to failure to comply with SNAP employment and training program requirements.
(d) If the county agency determines that the participant did not comply during the month with all SNAP employment and training program requirements that were in effect, and if the county agency determines that good cause was not present, the county must provide a ten-day notice of termination of SNAP benefits. The amount of SNAP benefits that are withheld from the household and determination of the impact of the sanction on other household members is governed by Code of Federal Regulations, title 7, section 273.7.
(e) The participant may appeal the termination of SNAP benefits under the provisions of section 256.045.
Subd. 2.
County agency duties.
(a) The county agency shall provide to SNAP benefit recipients a SNAP employment and training program. The program must include:
(1) orientation to the SNAP employment and training program;
(2) an individualized employability assessment and an individualized employability development plan that includes assessment of literacy, ability to communicate in the English language, educational and employment history, and that estimates the length of time it will take the participant to obtain employment. The employability assessment and development plan must be completed in consultation with the participant, must assess the participant's assets, barriers, and strengths, and must identify steps necessary to overcome barriers to employment. A copy of the employability development plan must be provided to the registrant;
(3) referral to available accredited remedial or skills training programs designed to address participant's barriers to employment;
(4) referral to available programs that provide subsidized or unsubsidized employment as necessary;
(5) a job search program, including job seeking skills training; and
(6) other activities, to the extent of available resources designed by the county agency to prepare the participant for permanent employment.
In order to allow time for job search, the county agency may not require an individual to participate in the SNAP employment and training program for more than 32 hours a week. The county agency shall require an individual to spend at least eight hours a week in job search or other SNAP employment and training program activities.
(b) The county agency shall prepare an annual plan for the operation of its SNAP employment and training program. The plan must be submitted to and approved by the commissioner of employment and economic development. The plan must include:
(1) a description of the services to be offered by the county agency;
(2) a plan to coordinate the activities of all public entities providing employment-related services in order to avoid duplication of effort and to provide services more efficiently;
(3) a description of the factors that will be taken into account when determining a client's employability development plan; and
(4) provisions to ensure that the county agency's employment and training service provider provides each recipient with an orientation, employability assessment, and employability development plan as specified in paragraph (a), clauses (1) and (2), within 30 days of the recipient's eligibility for assistance.
Subd. 2a.
Duties of commissioner.
In addition to any other duties imposed by law, the commissioner shall:
(1) based on this section and section 256D.052 and Code of Federal Regulations, title 7, section 273.7, supervise the administration of SNAP employment and training services to county agencies;
(2) disburse money appropriated for SNAP employment and training services to county agencies based upon the county's costs as specified in section 256D.051, subdivision 6c;
(3) accept and supervise the disbursement of any funds that may be provided by the federal government or from other sources for use in this state for SNAP employment and training services;
(4) cooperate with other agencies including any agency of the United States or of another state in all matters concerning the powers and duties of the commissioner under this section and section 256D.052; and
(5) in cooperation with the commissioner of employment and economic development, ensure that each component of an employment and training program carried out under this section is delivered through a statewide workforce development system, unless the component is not available locally through such a system.
Subd. 3.
Participant duties.
In order to receive SNAP assistance, a registrant shall: (1) cooperate with the county agency in all aspects of the SNAP employment and training program; (2) accept any suitable employment, including employment offered through the Job Training Partnership Act, and other employment and training options; and (3) participate in SNAP employment and training activities assigned by the county agency. The county agency may terminate assistance to a registrant who fails to cooperate in the SNAP employment and training program, as provided in subdivision 1a.
Subd. 3a.
Requirement to register work.
(a) To the extent required under Code of Federal Regulations, title 7, section 273.7(a), each applicant for and recipient of SNAP benefits is required to register for work as a condition of eligibility for SNAP benefits. Applicants and recipients are registered by signing an application or annual reapplication for SNAP benefits, and must be informed that they are registering for work by signing the form.
(b) The commissioner shall determine, within federal requirements, persons required to participate in the SNAP employment and training program.
(c) The following SNAP benefit recipients are exempt from mandatory participation in SNAP employment and training services:
(1) recipients of benefits under the Minnesota family investment program, Minnesota supplemental aid program, or the general assistance program;
(2) a child;
(3) a recipient over age 55;
(4) a recipient who has a mental or physical illness, injury, or incapacity which is expected to continue for at least 30 days and which impairs the recipient's ability to obtain or retain employment as evidenced by professional certification or the receipt of temporary or permanent disability benefits issued by a private or government source;
(5) a parent or other household member responsible for the care of either a dependent child in the household who is under age six or a person in the household who is professionally certified as having a physical or mental illness, injury, or incapacity. Only one parent or other household member may claim exemption under this provision;
(6) a recipient receiving unemployment insurance or who has applied for unemployment insurance and has been required to register for work with the Department of Employment and Economic Development as part of the unemployment insurance application process;
(7) a recipient participating each week in a drug addiction or alcohol abuse treatment and rehabilitation program, provided the operators of the treatment and rehabilitation program, in consultation with the county agency, recommend that the recipient not participate in the SNAP employment and training program;
(8) a recipient employed or self-employed for 30 or more hours per week at employment paying at least minimum wage, or who earns wages from employment equal to or exceeding 30 hours multiplied by the federal minimum wage; or
(9) a student enrolled at least half time in any school, training program, or institution of higher education. When determining if a student meets this criteria, the school's, program's or institution's criteria for being enrolled half time shall be used.
Subd. 3b.
Orientation.
The county agency or its employment and training service provider must provide an orientation to SNAP employment and training services to each nonexempt SNAP benefit recipient within 30 days of the date that SNAP eligibility is determined. The orientation must inform the participant of the requirement to participate in services, the date, time, and address to report to for services, the name and telephone number of the SNAP employment and training service provider, the consequences for failure without good cause to comply, the services and support services available through SNAP employment and training services and other providers of similar services, and must encourage the participant to view the SNAP benefits program as a temporary means of supplementing the family's food needs until the family achieves self-sufficiency through employment. The orientation may be provided through audio-visual methods, but the participant must have the opportunity for face-to-face interaction with county agency staff.
Subd. 6b.
Federal reimbursement.
(a) Federal financial participation from the United States Department of Agriculture for SNAP employment and training expenditures that are eligible for reimbursement through the SNAP employment and training program are dedicated funds and are annually appropriated to the commissioner of human services for the operation of the SNAP employment and training program.
(b) The appropriation must be used for skill attainment through employment, training, and support services for SNAP participants.
(c) Federal financial participation for the nonstate portion of SNAP employment and training costs must be paid to the county agency or service provider that incurred the costs.
Subd. 6c.
Program funding.
Within the limits of available resources, the commissioner shall reimburse the actual costs of county agencies and their employment and training service providers for the provision of SNAP employment and training services, including participant support services, direct program services, and program administrative activities. The cost of services for each county's SNAP employment and training program shall not exceed the annual allocated amount. No more than 15 percent of program funds may be used for administrative activities. The county agency may expend county funds in excess of the limits of this subdivision without state reimbursement.
Program funds shall be allocated based on the county's average number of SNAP eligible cases as compared to the statewide total number of such cases. The average number of cases shall be based on counts of cases as of March 31, June 30, September 30, and December 31 of the previous calendar year. The commissioner may reallocate unexpended money appropriated under this section to those county agencies that demonstrate a need for additional funds.
Subd. 7.
Registrant status.
A registrant under this section is not an employee for the purposes of workers' compensation, unemployment benefits, retirement, or civil service laws, and shall not perform work ordinarily performed by a regular public employee.
Subd. 8.
Voluntary quit.
A person who is required to participate in SNAP employment and training services is not eligible for SNAP benefits if, without good cause, the person refuses a legitimate offer of, or quits, suitable employment within 60 days before the date of application. A person who is required to participate in SNAP employment and training services and, without good cause, voluntarily quits suitable employment or refuses a legitimate offer of suitable employment while receiving SNAP benefits shall be terminated from the SNAP program as specified in subdivision 1a.
Subd. 9.
Subcontractors.
A county agency may, at its option, subcontract any or all of the duties under this section to a public or private entity approved by the commissioner of employment and economic development.
Subd. 18.
Work experience placements.
(a) To the extent of available resources, each county agency must establish and operate a work experience component in the SNAP employment and training program for recipients who are subject to a federal limit of three months of SNAP eligibility in any 36-month period. The purpose of the work experience component is to enhance the participant's employability, self-sufficiency, and to provide meaningful, productive work activities.
(b) The commissioner shall assist counties in the design and implementation of these components. The commissioner must ensure that job placements under a work experience component comply with section 256J.72. Written or oral concurrence with job duties of persons placed under the community work experience program shall be obtained from the appropriate exclusive bargaining representative.
(c) Worksites developed under this section are limited to projects that serve a useful public service such as health, social service, environmental protection, education, urban and rural development and redevelopment, welfare, recreation, public facilities, public safety, community service, services to aged citizens or citizens with a disability, and child care. To the extent possible, the prior training, skills, and experience of a recipient must be used in making appropriate work experience assignments.
(d) Structured, supervised volunteer work with an agency or organization that is monitored by the county service provider may, with the approval of the county agency, be used as a work experience placement.
(e) As a condition of placing a person receiving SNAP benefits in a program under this subdivision, the county agency shall first provide the recipient the opportunity:
(1) for placement in suitable subsidized or unsubsidized employment through participation in job search under section 256D.051; or
(2) for placement in suitable employment through participation in on-the-job training, if such employment is available.
(f) The county agency shall limit the maximum monthly number of hours that any participant may work in a work experience placement to a number equal to the amount of the family's monthly SNAP benefit allotment divided by the greater of the federal minimum wage or the applicable state minimum wage.
After a participant has been assigned to a position for nine months, the participant may not continue in that assignment unless the maximum number of hours a participant works is no greater than the amount of the SNAP benefit divided by the rate of pay for individuals employed in the same or similar occupations by the same employer at the same site.
(g) The participant's employability development plan must include the length of time needed in the work experience program, the need to continue job seeking activities while participating in work experience, and the participant's employment goals.
(h) After each six months of a recipient's participation in a work experience job placement, and at the conclusion of each work experience assignment under this section, the county agency shall reassess and revise, as appropriate, the participant's employability development plan.
(i) A participant has good cause for failure to cooperate with a work experience job placement if, in the judgment of the employment and training service provider, the reason for failure is reasonable and justified. Good cause for purposes of this section is defined in subdivision 1a, paragraph (b).
(j) A recipient who has failed without good cause to participate in or comply with the work experience job placement shall be terminated from participation in work experience job activities. If the recipient is not exempt from mandatory SNAP employment and training program participation under subdivision 3a, the recipient will be assigned to other mandatory program activities. If the recipient is exempt from mandatory participation but is participating as a volunteer, the person shall be terminated from the SNAP employment and training program.
256D.052 LITERACY TRAINING FOR RECIPIENTS.
Subd. 3.
Participant literacy transportation costs.
Within the limits of the state appropriation the county agency must provide transportation to enable Supplemental Nutrition Assistance Program (SNAP) employment and training participants to participate in literacy training under this section. The state shall reimburse county agencies for the costs of providing transportation under this section up to the amount of the state appropriation. Counties must make every effort to ensure that child care is available as needed by recipients who are pursuing literacy training.
256J.08 DEFINITIONS.
Subd. 10.
Budget month.
"Budget month" means the calendar month which the county agency uses to determine the income or circumstances of an assistance unit to calculate the amount of the assistance payment in the payment month.
Subd. 61.
Monthly income test.
"Monthly income test" means the test used to determine ongoing eligibility and the assistance payment amount according to section 256J.21.
Subd. 62.
Nonrecurring income.
"Nonrecurring income" means a form of income which is received:
(1) only one time or is not of a continuous nature; or
(2) in a prospective payment month but is no longer received in the corresponding retrospective payment month.
Subd. 81.
Retrospective budgeting.
"Retrospective budgeting" means a method of determining the amount of the assistance payment in which the payment month is the second month after the budget month.
Subd. 83.
Significant change.
"Significant change" means a decline in gross income of the amount of the disregard as defined in section 256P.03 or more from the income used to determine the grant for the current month.
256J.21 INCOME LIMITATIONS.
Subdivision 1.
Income inclusions.
To determine MFIP eligibility, the county agency must evaluate income received by members of an assistance unit, or by other persons whose income is considered available to the assistance unit, and only count income that is available to the member of the assistance unit. Income is available if the individual has legal access to the income. All payments, unless specifically excluded in subdivision 2, must be counted as income. The county agency shall verify the income of all MFIP recipients and applicants.
Subd. 2.
Income exclusions.
The following must be excluded in determining a family's available income:
(1) payments for basic care, difficulty of care, and clothing allowances received for providing family foster care to children or adults under Minnesota Rules, parts 9555.5050 to 9555.6265, 9560.0521, and 9560.0650 to 9560.0654, payments for family foster care for children under section 260C.4411 or chapter 256N, and payments received and used for care and maintenance of a third-party beneficiary who is not a household member;
(2) reimbursements for employment training received through the Workforce Investment Act of 1998, United States Code, title 20, chapter 73, section 9201;
(3) reimbursement for out-of-pocket expenses incurred while performing volunteer services, jury duty, employment, or informal carpooling arrangements directly related to employment;
(4) all educational assistance, except the county agency must count graduate student teaching assistantships, fellowships, and other similar paid work as earned income and, after allowing deductions for any unmet and necessary educational expenses, shall count scholarships or grants awarded to graduate students that do not require teaching or research as unearned income;
(5) loans, regardless of purpose, from public or private lending institutions, governmental lending institutions, or governmental agencies;
(6) loans from private individuals, regardless of purpose, provided an applicant or participant documents that the lender expects repayment;
(7)(i) state income tax refunds; and
(ii) federal income tax refunds;
(8)(i) federal earned income credits;
(ii) Minnesota working family credits;
(iii) state homeowners and renters credits under chapter 290A; and
(iv) federal or state tax rebates;
(9) funds received for reimbursement, replacement, or rebate of personal or real property when these payments are made by public agencies, awarded by a court, solicited through public appeal, or made as a grant by a federal agency, state or local government, or disaster assistance organizations, subsequent to a presidential declaration of disaster;
(10) the portion of an insurance settlement that is used to pay medical, funeral, and burial expenses, or to repair or replace insured property;
(11) reimbursements for medical expenses that cannot be paid by medical assistance;
(12) payments by a vocational rehabilitation program administered by the state under chapter 268A, except those payments that are for current living expenses;
(13) in-kind income, including any payments directly made by a third party to a provider of goods and services;
(14) assistance payments to correct underpayments, but only for the month in which the payment is received;
(15) payments for short-term emergency needs under section 256J.626, subdivision 2;
(16) funeral and cemetery payments as provided by section 256.935;
(17) nonrecurring cash gifts of $30 or less, not exceeding $30 per participant in a calendar month;
(18) any form of energy assistance payment made through Public Law 97-35, Low-Income Home Energy Assistance Act of 1981, payments made directly to energy providers by other public and private agencies, and any form of credit or rebate payment issued by energy providers;
(19) Supplemental Security Income (SSI), including retroactive SSI payments and other income of an SSI recipient;
(20) Minnesota supplemental aid, including retroactive payments;
(21) proceeds from the sale of real or personal property;
(22) adoption or kinship assistance payments under chapter 256N or 259A and Minnesota permanency demonstration title IV-E waiver payments;
(23) state-funded family subsidy program payments made under section 252.32 to help families care for children with developmental disabilities, consumer support grant funds under section 256.476, and resources and services for a disabled household member under one of the home and community-based waiver services programs under chapter 256B;
(24) interest payments and dividends from property that is not excluded from and that does not exceed the asset limit;
(25) rent rebates;
(26) income earned by a minor caregiver, minor child through age 6, or a minor child who is at least a half-time student in an approved elementary or secondary education program;
(27) income earned by a caregiver under age 20 who is at least a half-time student in an approved elementary or secondary education program;
(28) MFIP child care payments under section 119B.05;
(29) all other payments made through MFIP to support a caregiver's pursuit of greater economic stability;
(30) income a participant receives related to shared living expenses;
(31) reverse mortgages;
(32) benefits provided by the Child Nutrition Act of 1966, United States Code, title 42, chapter 13A, sections 1771 to 1790;
(33) benefits provided by the women, infants, and children (WIC) nutrition program, United States Code, title 42, chapter 13A, section 1786;
(34) benefits from the National School Lunch Act, United States Code, title 42, chapter 13, sections 1751 to 1769e;
(35) relocation assistance for displaced persons under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, United States Code, title 42, chapter 61, subchapter II, section 4636, or the National Housing Act, United States Code, title 12, chapter 13, sections 1701 to 1750jj;
(36) benefits from the Trade Act of 1974, United States Code, title 19, chapter 12, part 2, sections 2271 to 2322;
(37) war reparations payments to Japanese Americans and Aleuts under United States Code, title 50, sections 1989 to 1989d;
(38) payments to veterans or their dependents as a result of legal settlements regarding Agent Orange or other chemical exposure under Public Law 101-239, section 10405, paragraph (a)(2)(E);
(39) income that is otherwise specifically excluded from MFIP consideration in federal law, state law, or federal regulation;
(40) security and utility deposit refunds;
(41) American Indian tribal land settlements excluded under Public Laws 98-123, 98-124, and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech Lake, and Mille Lacs reservations and payments to members of the White Earth Band, under United States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;
(42) all income of the minor parent's parents and stepparents when determining the grant for the minor parent in households that include a minor parent living with parents or stepparents on MFIP with other children;
(43) income of the minor parent's parents and stepparents equal to 200 percent of the federal poverty guideline for a family size not including the minor parent and the minor parent's child in households that include a minor parent living with parents or stepparents not on MFIP when determining the grant for the minor parent. The remainder of income is deemed as specified in section 256J.37, subdivision 1b;
(44) payments made to children eligible for relative custody assistance under section 257.85;
(45) vendor payments for goods and services made on behalf of a client unless the client has the option of receiving the payment in cash;
(46) the principal portion of a contract for deed payment;
(47) cash payments to individuals enrolled for full-time service as a volunteer under AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps National, and AmeriCorps NCCC;
(48) housing assistance grants under section 256J.35, paragraph (a); and
(49) child support payments of up to $100 for an assistance unit with one child and up to $200 for an assistance unit with two or more children.
256J.30 APPLICANT AND PARTICIPANT REQUIREMENTS AND RESPONSIBILITIES.
Subd. 5.
Monthly MFIP household reports.
Each assistance unit with a member who has earned income or a recent work history, and each assistance unit that has income deemed to it from a financially responsible person must complete a monthly MFIP household report form. "Recent work history" means the individual received earned income in the report month or any of the previous three calendar months even if the earnings are excluded. To be complete, the MFIP household report form must be signed and dated by the caregivers no earlier than the last day of the reporting period. All questions required to determine assistance payment eligibility must be answered, and documentation of earned income must be included.
Subd. 7.
Due date of MFIP household report form.
An MFIP household report form must be received by the county agency by the eighth calendar day of the month following the reporting period covered by the form. When the eighth calendar day of the month falls on a weekend or holiday, the MFIP household report form must be received by the county agency the first working day that follows the eighth calendar day.
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the county agency must immediately return the incomplete form and clearly state what the caregiver must do for the form to be complete.
(c) The automated eligibility system must send a notice of proposed termination of assistance to the assistance unit if a complete MFIP household report form is not received by a county agency. The automated notice must be mailed to the caregiver by approximately the 16th of the month. When a caregiver submits an incomplete form on or after the date a notice of proposed termination has been sent, the termination is valid unless the caregiver submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered to have continued its application for assistance if a complete MFIP household report form is received within a calendar month after the month in which the form was due and assistance shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements under subdivision 5 when any of the following factors cause a caregiver to fail to provide the county agency with a completed MFIP household report form before the end of the month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable care which prevents the caregiver from providing a completed MFIP household report form before the end of the month in which the form is due.
256J.33 PROSPECTIVE AND RETROSPECTIVE MFIP ELIGIBILITY.
Subd. 3.
Retrospective eligibility.
After the first two months of MFIP eligibility, a county agency must continue to determine whether an assistance unit is prospectively eligible for the payment month by looking at all factors other than income and then determine whether the assistance unit is retrospectively income eligible by applying the monthly income test to the income from the budget month. When the monthly income test is not satisfied, the assistance payment must be suspended when ineligibility exists for one month or ended when ineligibility exists for more than one month.
Subd. 4.
Monthly income test.
A county agency must apply the monthly income test retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when the countable income equals or exceeds the MFIP standard of need or the family wage level for the assistance unit. The income applied against the monthly income test must include:
(1) gross earned income from employment, prior to mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36, unless the employment income is specifically excluded under section 256J.21, subdivision 2;
(2) gross earned income from self-employment less deductions for self-employment expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or business state and federal income taxes, personal FICA, personal health and life insurance, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36;
(3) unearned income after deductions for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36, unless the income has been specifically excluded in section 256J.21, subdivision 2;
(4) gross earned income from employment as determined under clause (1) which is received by a member of an assistance unit who is a minor child or minor caregiver and less than a half-time student;
(5) child support received by an assistance unit, excluded under section 256J.21, subdivision 2, clause (49), or section 256P.06, subdivision 3, clause (2), item (xvi);
(6) spousal support received by an assistance unit;
(7) the income of a parent when that parent is not included in the assistance unit;
(8) the income of an eligible relative and spouse who seek to be included in the assistance unit; and
(9) the unearned income of a minor child included in the assistance unit.
Subd. 5.
When to terminate assistance.
When an assistance unit is ineligible for MFIP assistance for two consecutive months, the county agency must terminate MFIP assistance.
256J.34 CALCULATING ASSISTANCE PAYMENTS.
Subdivision 1.
Prospective budgeting.
A county agency must use prospective budgeting to calculate the assistance payment amount for the first two months for an applicant who has not received assistance in this state for at least one payment month preceding the first month of payment under a current application. Notwithstanding subdivision 3, paragraph (a), clause (2), a county agency must use prospective budgeting for the first two months for a person who applies to be added to an assistance unit. Prospective budgeting is not subject to overpayments or underpayments unless fraud is determined under section 256.98.
(a) The county agency must apply the income received or anticipated in the first month of MFIP eligibility against the need of the first month. The county agency must apply the income received or anticipated in the second month against the need of the second month.
(b) When the assistance payment for any part of the first two months is based on anticipated income, the county agency must base the initial assistance payment amount on the information available at the time the initial assistance payment is made.
(c) The county agency must determine the assistance payment amount for the first two months of MFIP eligibility by budgeting both recurring and nonrecurring income for those two months.
Subd. 2.
Retrospective budgeting.
The county agency must use retrospective budgeting to calculate the monthly assistance payment amount after the payment for the first two months has been made under subdivision 1.
Subd. 3.
Additional uses of retrospective budgeting.
Notwithstanding subdivision 1, the county agency must use retrospective budgeting to calculate the monthly assistance payment amount for the first two months under paragraphs (a) and (b).
(a) The county agency must use retrospective budgeting to determine the amount of the assistance payment in the first two months of MFIP eligibility:
(1) when an assistance unit applies for assistance for the same month for which assistance has been interrupted, the interruption in eligibility is less than one payment month, the assistance payment for the preceding month was issued in this state, and the assistance payment for the immediately preceding month was determined retrospectively; or
(2) when a person applies in order to be added to an assistance unit, that assistance unit has received assistance in this state for at least the two preceding months, and that person has been living with and has been financially responsible for one or more members of that assistance unit for at least the two preceding months.
(b) Except as provided in clauses (1) to (4), the county agency must use retrospective budgeting and apply income received in the budget month by an assistance unit and by a financially responsible household member who is not included in the assistance unit against the MFIP standard of need or family wage level to determine the assistance payment to be issued for the payment month.
(1) When a source of income ends prior to the third payment month, that income is not considered in calculating the assistance payment for that month. When a source of income ends prior to the fourth payment month, that income is not considered when determining the assistance payment for that month.
(2) When a member of an assistance unit or a financially responsible household member leaves the household of the assistance unit, the income of that departed household member is not budgeted retrospectively for any full payment month in which that household member does not live with that household and is not included in the assistance unit.
(3) When an individual is removed from an assistance unit because the individual is no longer a minor child, the income of that individual is not budgeted retrospectively for payment months in which that individual is not a member of the assistance unit, except that income of an ineligible child in the household must continue to be budgeted retrospectively against the child's needs when the parent or parents of that child request allocation of their income against any unmet needs of that ineligible child.
(4) When a person ceases to have financial responsibility for one or more members of an assistance unit, the income of that person is not budgeted retrospectively for the payment months which follow the month in which financial responsibility ends.
Subd. 4.
Significant change in gross income.
The county agency must recalculate the assistance payment when an assistance unit experiences a significant change, as defined in section 256J.08, resulting in a reduction in the gross income received in the payment month from the gross income received in the budget month. The county agency must issue a supplemental assistance payment based on the county agency's best estimate of the assistance unit's income and circumstances for the payment month. Supplemental assistance payments that result from significant changes are limited to two in a 12-month period regardless of the reason for the change. Notwithstanding any other statute or rule of law, supplementary assistance payments shall not be made when the significant change in income is the result of receipt of a lump sum, receipt of an extra paycheck, business fluctuation in self-employment income, or an assistance unit member's participation in a strike or other labor action.
256J.37 TREATMENT OF INCOME AND LUMP SUMS.
Subd. 10.
Treatment of lump sums.
(a) The agency must treat lump-sum payments as earned or unearned income. If the lump-sum payment is included in the category of income identified in subdivision 9, it must be treated as unearned income. A lump sum is counted as income in the month received and budgeted either prospectively or retrospectively depending on the budget cycle at the time of receipt. When an individual receives a lump-sum payment, that lump sum must be combined with all other earned and unearned income received in the same budget month, and it must be applied according to paragraphs (a) to (c). A lump sum may not be carried over into subsequent months. Any funds that remain in the third month after the month of receipt are counted in the asset limit.
(b) For a lump sum received by an applicant during the first two months, prospective budgeting is used to determine the payment and the lump sum must be combined with other earned or unearned income received and budgeted in that prospective month.
(c) For a lump sum received by a participant after the first two months of MFIP eligibility, the lump sum must be combined with other income received in that budget month, and the combined amount must be applied retrospectively against the applicable payment month.
(d) When a lump sum, combined with other income under paragraphs (b) and (c), is less than the MFIP transitional standard for the appropriate payment month, the assistance payment must be reduced according to the amount of the countable income. When the countable income is greater than the MFIP standard or family wage level, the assistance payment must be suspended for the payment month.
Repealed Minnesota Rule: H2127-1
9505.0370 DEFINITIONS.
Subpart 1.
Scope.
For parts 9505.0370 to 9505.0372, the following terms have the meanings given them.
Subp. 2.
Adult day treatment.
"Adult day treatment" or "adult day treatment program" means a structured program of treatment and care.
Subp. 4.
Client.
"Client" means an eligible recipient who is determined to have or who is being assessed for a mental illness as specified in part 9505.0371.
Subp. 5.
Clinical summary.
"Clinical summary" means a written description of a clinician's formulation of the cause of the client's mental health symptoms, the client's prognosis, and the likely consequences of the symptoms; how the client meets the criteria for the diagnosis by describing the client's symptoms, the duration of symptoms, and functional impairment; an analysis of the client's other symptoms, strengths, relationships, life situations, cultural influences, and health concerns and their potential interaction with the diagnosis and formulation of the client's mental health condition; and alternative diagnoses that were considered and ruled out.
Subp. 6.
Clinical supervision.
"Clinical supervision" means the documented time a clinical supervisor and supervisee spend together to discuss the supervisee's work, to review individual client cases, and for the supervisee's professional development. It includes the documented oversight and supervision responsibility for planning, implementation, and evaluation of services for a client's mental health treatment.
Subp. 7.
Clinical supervisor.
"Clinical supervisor" means the mental health professional who is responsible for clinical supervision.
Subp. 8.
Cultural competence or culturally competent.
"Cultural competence" or "culturally competent" means the mental health provider's:
A.
awareness of the provider's own cultural background, and the related assumptions, values, biases, and preferences that influence assessment and intervention processes;
B.
ability and will to respond to the unique needs of an individual client that arise from the client's culture;
C.
ability to utilize the client's culture as a resource and as a means to optimize mental health care; and
D.
willingness to seek educational, consultative, and learning experiences to expand knowledge of and increase effectiveness with culturally diverse populations.
Subp. 9.
Cultural influences.
"Cultural influences" means historical, geographical, and familial factors that affect assessment and intervention processes. Cultural influences that are relevant to the client may include the client's:
Subp. 10.
Culture.
"Culture" means the distinct ways of living and understanding the world that are used by a group of people and are transmitted from one generation to another or adopted by an individual.
Subp. 11.
Diagnostic assessment.
"Diagnostic assessment" means a written assessment that documents a clinical and functional face-to-face evaluation of the client's mental health, including the nature, severity and impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies the client's strengths and resources.
Subp. 12.
Dialectical behavior therapy.
"Dialectical behavior therapy" means an evidence-based treatment approach provided in an intensive outpatient treatment program using a combination of individualized rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program is certified by the commissioner and involves the following service components: individual dialectical behavior therapy, group skills training, telephone coaching, and team consultation meetings.
Subp. 13.
Explanation of findings.
"Explanation of findings" means the explanation of a client's diagnostic assessment, psychological testing, treatment program, and consultation with culturally informed mental health consultants as required under parts 9520.0900 to 9520.0926, or other accumulated data and recommendations to the client, client's family, primary caregiver, or other responsible persons.
Subp. 14.
Family.
"Family" means a person who is identified by the client or the client's parent or guardian as being important to the client's mental health treatment. Family may include, but is not limited to, parents, children, spouse, committed partners, former spouses, persons related by blood or adoption, or persons who are presently residing together as a family unit.
Subp. 15.
Individual treatment plan.
"Individual treatment plan" means a written plan that outlines and defines the course of treatment. It delineates the goals, measurable objectives, target dates for achieving specific goals, main participants in treatment process, and recommended services that are based on the client's diagnostic assessment and other meaningful data that are needed to aid the client's recovery and enhance resiliency.
Subp. 16.
Medication management.
"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a person who is qualified according to part 9505.0371, subpart 5, items B and C, and provides mental health services to a client with a mental illness under the clinical supervision of a mental health professional.
Subp. 18.
Mental health professional.
"Mental health professional" means a person who is enrolled to provide medical assistance services and is qualified according to part 9505.0371, subpart 5, item A.
Subp. 19.
Mental health telemedicine.
"Mental health telemedicine" has the meaning given in Minnesota Statutes, section 256B.0625, subdivision 46.
Subp. 20.
Mental illness.
"Mental illness" has the meaning given in Minnesota Statutes, section 245.462, subdivision 20. "Mental illness" includes "emotional disturbance" as defined in Minnesota Statutes, section 245.4871, subdivision 15.
Subp. 21.
Multidisciplinary staff.
"Multidisciplinary staff" means a group of individuals from diverse disciplines who come together to provide services to clients under part 9505.0372, subparts 8, 9, and 10.
Subp. 22.
Neuropsychological assessment.
"Neuropsychological assessment" means a specialized clinical assessment of the client's underlying cognitive abilities related to thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist.
Subp. 23.
Neuropsychological testing.
"Neuropsychological testing" means administering standardized tests and measures designed to evaluate the client's ability to attend to, process, interpret, comprehend, communicate, learn and recall information; and use problem-solving and judgment.
Subp. 24.
Partial hospitalization program.
"Partial hospitalization program" means a provider's time-limited, structured program of psychotherapy and other therapeutic services, as defined in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x, (ff), that is provided in an outpatient hospital facility or community mental health center that meets Medicare requirements to provide partial hospitalization services.
Subp. 25.
Primary caregiver.
"Primary caregiver" means a person, other than the facility staff, who has primary legal responsibility for providing the client with food, clothing, shelter, direction, guidance, and nurturance.
Subp. 26.
Psychological testing.
"Psychological testing" means the use of tests or other psychometric instruments to determine the status of the recipient's mental, intellectual, and emotional functioning.
Subp. 27.
Psychotherapy.
"Psychotherapy" means treatment of a client with mental illness that applies the most appropriate psychological, psychiatric, psychosocial, or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the client.
9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.
Subpart 1.
Purpose.
This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.
Subp. 2.
Client eligibility for mental health services.
The following requirements apply to mental health services:
A.
The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:
(1)
prior to completion of a client's initial diagnostic assessment, a client is eligible for:
(c)
either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and
(2)
for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.
B.
A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:
(1)
may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:
(b)
an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and
(2)
may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and
(3)
must not be used for:
(a)
a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or
(b)
more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.
C.
For a child, a new standard or extended diagnostic assessment must be completed:
(3)
when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or
(4)
when the child's current mental health condition does not meet criteria of the child's current diagnosis.
D.
For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:
(1)
when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;
(2)
at least every three years following the initial diagnostic assessment for an adult who receives mental health services;
(3)
when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or
(4)
when the adult's current mental health condition does not meet criteria of the current diagnosis.
E.
An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.
Subp. 3.
Authorization for mental health services.
Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.
Subp. 4.
Clinical supervision.
A.
Clinical supervision must be based on each supervisee's written supervision plan and must:
(3)
promote cultural competency by:
(a)
developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;
(b)
addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;
(c)
developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and
(d)
emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;
(4)
recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and
(5)
monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.
B.
Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.
(2)
Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.
C.
The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:
(1)
the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;
(3)
the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;
(4)
the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;
D.
Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:
E.
Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.
Subp. 5.
Qualified providers.
Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.
A.
A mental health professional must be qualified in one of the following ways:
(1)
in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;
(2)
in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;
(3)
in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;
(4)
in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;
(5)
in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;
(6)
a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or
(7)
in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:
(b)
for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or
(c)
for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.
B.
A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be qualified in at least one of the following ways:
(1)
holds a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university; and
(a)
has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or
(b)
is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioner's clients belong, completes 40 hours of training in the delivery of services to clients with mental illness, and receives clinical supervision from a mental health professional at least once a week until the requirements of 2,000 hours of supervised experience are met;
(2)
has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;
(3)
is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;
(4)
holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or
(5)
is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.
C.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:
(1)
the mental health practitioner is:
(a)
complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or
(b)
a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional defined in item A; and
(2)
the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:
D.
A clinical supervisor must:
(2)
hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;
(3)
be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;
(4)
be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;
(5)
not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;
(6)
have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:
(d)
ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and
(7)
accept full professional liability for a supervisee's direction of a client's mental health services;
(8)
instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;
(9)
review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;
(10)
review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;
(14)
ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;
(15)
establish an evaluation process that identifies the performance and competence of each supervisee; and
(16)
document clinical supervision of each supervisee and securely maintain the documentation record.
Subp. 6.
Release of information.
Providers who receive a request for client information and providers who request client information must:
A.
comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and
B.
subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.
Subp. 7.
Individual treatment plan.
Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:
B.
developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and
C.
reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.
Subp. 8.
Documentation.
To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:
A.
in the client's mental health record:
(1)
each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and
(2)
all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;
B.
the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and
C.
dates that treatment begins and ends and reason for the discontinuation of the mental health service.
Subp. 9.
Service coordination.
The provider must coordinate client services as authorized by the client as follows:
A.
When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.
B.
The mental health provider must coordinate mental health care with the client's physical health provider.
Subp. 10.
Telemedicine services.
Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telemedicine.
9505.0372 COVERED SERVICES.
Subpart 1.
Diagnostic assessment.
Medical assistance covers four types of diagnostic assessments when they are provided in accordance with the requirements in this subpart.
A.
To be eligible for medical assistance payment, a diagnostic assessment must:
(1)
identify a mental health diagnosis and recommended mental health services, which are the factual basis to develop the recipient's mental health services and treatment plan; or
B.
A standard diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The standard diagnostic assessment must be done within the cultural context of the client and must include relevant information about:
(1)
the client's current life situation, including the client's:
(e)
significant personal relationships, including the client's evaluation of relationship quality;
(2)
the reason for the assessment, including the client's:
(g)
health history and family health history, including physical, chemical, and mental health history; and
(4)
the assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(5)
the screenings used to determine the client's substance use, abuse, or dependency and other standardized screening instruments determined by the commissioner;
(6)
assessment methods and use of standardized assessment tools by the provider as determined and periodically updated by the commissioner;
(7)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(8)
the client data that is adequate to support the findings on all axes of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and any differential diagnosis.
C.
An extended diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The face-to-face interview is conducted over three or more assessment appointments because the client's complex needs necessitate significant additional assessment time. Complex needs are those caused by acuity of psychotic disorder; cognitive or neurocognitive impairment; need to consider past diagnoses and determine their current applicability; co-occurring substance abuse use disorder; or disruptive or changing environments, communication barriers, or cultural considerations as documented in the assessment. For child clients, the appointments may be conducted outside the diagnostician's office for face-to-face consultation and information gathering with family members, doctors, caregivers, teachers, and other providers, with or without the child present, and may involve directly observing the child in various settings that the child frequents such as home, school, or care settings. To complete the diagnostic assessment with adult clients, the appointments may be conducted outside of the diagnostician's office for face-to-face assessment with the adult client. The appointment may involve directly observing the adult client in various settings that the adult frequents, such as home, school, job, service settings, or community settings. The appointments may include face-to-face meetings with the adult client and the client's family members, doctors, caregivers, teachers, social support network members, recovery support resource representatives, and other providers for consultation and information gathering for the diagnostic assessment. The components of an extended diagnostic assessment include the following relevant information:
(1)
for children under age 5:
(b)
an early childhood mental status exam that assesses the client's developmental, social, and emotional functioning and style both within the family and with the examiner and includes:
iii.
self-regulation, including sensory regulation, unusual behaviors, activity level, attention span, and frustration tolerance;
iv.
physical aspects, including motor function, muscle tone, coordination, tics, abnormal movements, and seizure activity;
vii.
affect and mood, including modes of expression, range, responsiveness, duration, and intensity;
(2)
for children ages 5 to 18, completion of other assessment standards for children as determined and periodically revised by the commissioner; and
(3)
for adults, completion of other assessment standards for adults as determined and periodically revised by the commissioner.
D.
A brief diagnostic assessment must include a face-to-face interview with the client and a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The professional or practitioner must gather initial background information using the components of a standard diagnostic assessment in item B, subitems (1), (2), unit (b), (3), and (5), and draw a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's immediate needs or presenting problem. Treatment sessions conducted under authorization of a brief assessment may be used to gather additional information necessary to complete a standard diagnostic assessment or an extended diagnostic assessment.
E.
Adult diagnostic assessment update includes a face-to-face interview with the client, and contains a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C, who reviews a standard or extended diagnostic assessment. The adult diagnostic assessment update must update the most recent assessment document in writing in the following areas:
(1)
review of the client's life situation, including an interview with the client about the client's current life situation, and a written update of those parts where significant new or changed information exists, and documentation where there has not been significant change;
(2)
review of the client's presenting problems, including an interview with the client about current presenting problems and a written update of those parts where there is significant new or changed information, and note parts where there has not been significant change;
(3)
screenings for substance use, abuse, or dependency and other screenings as determined by the commissioner;
(5)
assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(6)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary, or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(7)
the client's diagnosis on all axes of the current edition of the Diagnostic and Statistical Manual and any differential diagnosis.
Subp. 2.
Neuropsychological assessment.
A neuropsychological assessment must include a face-to-face interview with the client, the interpretation of the test results, and preparation and completion of a report. A client is eligible for a neuropsychological assessment if at least one of the following criteria is met:
A.
There is a known or strongly suspected brain disorder based on medical history or neurological evaluation such as a history of significant head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative disorders, significant exposure to neurotoxins, central nervous system infections, metabolic or toxic encephalopathy, fetal alcohol syndrome, or congenital malformations of the brain; or
B.
In the absence of a medically verified brain disorder based on medical history or neurological evaluation, there are cognitive or behavioral symptoms that suggest that the client has an organic condition that cannot be readily attributed to functional psychopathology, or suspected neuropsychological impairment in addition to functional psychopathology. Examples include:
(5)
in children or adolescents, significant delays in academic skill acquisition or poor attention relative to peers;
(6)
in children or adolescents, significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers; and
(7)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.
C.
If neither criterion in item A nor B is fulfilled, neuropsychological evaluation is not indicated.
D.
The neuropsychological assessment must be conducted by a neuropsychologist with competence in the area of neuropsychological assessment as stated to the Minnesota Board of Psychology who:
(1)
was awarded a diploma by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or the American Board of Pediatric Neuropsychology;
(2)
earned a doctoral degree in psychology from an accredited university training program:
(a)
completed an internship, or its equivalent, in a clinically relevant area of professional psychology;
(b)
completed the equivalent of two full-time years of experience and specialized training, at least one which is at the postdoctoral level, in the study and practices of clinical neuropsychology and related neurosciences supervised by a clinical neuropsychologist; and
(3)
is licensed or credentialed by another state's board of psychology examiners in the specialty of neuropsychology using requirements equivalent to requirements specified by one of the boards named in subitem (1); or
(4)
was approved by the commissioner as an eligible provider of neuropsychological assessment prior to December 31, 2010.
Subp. 3.
Neuropsychological testing.
A.
Medical assistance covers neuropsychological testing when the client has either:
(1)
a significant mental status change that is not a result of a metabolic disorder that has failed to respond to treatment;
(2)
in children or adolescents, a significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers;
(3)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities, as required to adapt to new or changing cognitive, social, physical, or emotional demands; or
(4)
a significant behavioral change, memory loss, or suspected neuropsychological impairment in addition to functional psychopathology, or other organic brain injury or one of the following:
(k)
exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction;
(l)
systemic medical conditions known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and related hematologic anomalies, and autoimmune disorders such as lupus, erythematosis, or celiac disease;
(m)
congenital genetic or metabolic disorders known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
(o)
a condition presenting in a manner making it difficult for a clinician to distinguish between:
ii.
a major depressive disorder when adequate treatment for major depressive disorder has not resulted in improvement in neurocognitive function, or another disorder such as autism, selective mutism, anxiety disorder, or reactive attachment disorder.
B.
Neuropsychological testing must be administered or clinically supervised by a neuropsychologist qualified as defined in subpart 2, item D.
Subp. 4.
Psychological testing.
Psychological testing must meet the following requirements:
A.
The psychological testing must:
(1)
be administered or clinically supervised by a licensed psychologist with competence in the area of psychological testing as stated to the Minnesota Board of Psychology; and
(2)
be validated in a face-to-face interview between the client and a licensed psychologist or a mental health practitioner working as a clinical psychology trainee as required by part 9505.0371, subpart 5, item C, under the clinical supervision of a licensed psychologist according to part 9505.0371, subpart 5, item A, subitem (2).
B.
The administration, scoring, and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.
Subp. 5.
Explanations of findings.
To be eligible for medical assistance payment, the mental health professional providing the explanation of findings must obtain the authorization of the client or the client's representative to release the information as required in part 9505.0371, subpart 6. Explanation of findings is provided to the client, client's family, and caregivers, or to other providers to help them understand the results of the testing or diagnostic assessment, better understand the client's illness, and provide professional insight needed to carry out a plan of treatment. An explanation of findings is not paid separately when the results of psychological testing or a diagnostic assessment are explained to the client or the client's representative as part of the psychological testing or a diagnostic assessment.
Subp. 6.
Psychotherapy.
Medical assistance covers psychotherapy as conducted by a mental health professional or a mental health practitioner as defined in part 9505.0371, subpart 5, item C, as provided in this subpart.
B.
Family psychotherapy is designed for the client and one or more family members or the client's primary caregiver whose participation is necessary to accomplish the client's treatment goals. Family members or primary caregivers participating in a therapy session do not need to be eligible for medical assistance. For purposes of this subpart, the phrase "whose participation is necessary to accomplish the client's treatment goals" does not include shift or facility staff members at the client's residence. Medical assistance payment for family psychotherapy is limited to face-to-face sessions at which the client is present throughout the family psychotherapy session unless the mental health professional believes the client's absence from the family psychotherapy session is necessary to carry out the client's individual treatment plan. If the client is excluded, the mental health professional must document the reason for and the length of time of the exclusion. The mental health professional must also document the reason or reasons why a member of the client's family is excluded.
C.
Group psychotherapy is appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive mutual benefit from treatment in a group setting. For a group of three to eight persons, one mental health professional or practitioner is required to conduct the group. For a group of nine to 12 persons, a team of at least two mental health professionals or two mental health practitioners or one mental health professional and one mental health practitioner is required to co-conduct the group. Medical assistance payment is limited to a group of no more than 12 persons.
D.
A multiple-family group psychotherapy session is eligible for medical assistance payment if the psychotherapy session is designed for at least two but not more than five families. Multiple-family group psychotherapy is clearly directed toward meeting the identified treatment needs of each client as indicated in client's treatment plan. If the client is excluded, the mental health professional or practitioner must document the reason for and the length of the time of the exclusion. The mental health professional or practitioner must document the reasons why a member of the client's family is excluded.
Subp. 7.
Medication management.
The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse, as defined in Minnesota Statutes, sections 148.171 to 148.285, who is qualified in psychiatric nursing.
Subp. 8.
Adult day treatment.
Adult day treatment payment limitations include the following conditions.
A.
Adult day treatment must consist of at least one hour of group psychotherapy, and must include group time focused on rehabilitative interventions, or other therapeutic services that are provided by a multidisciplinary staff. Adult day treatment is an intensive psychotherapeutic treatment. The services must stabilize the client's mental health status, and develop and improve the client's independent living and socialization skills. The goal of adult day treatment is to reduce or relieve the effects of mental illness so that an individual is able to benefit from a lower level of care and to enable the client to live and function more independently in the community. Day treatment services are not a part of inpatient or residential treatment services.
B.
To be eligible for medical assistance payment, a day treatment program must:
(2)
be provided to a group of clients by a multidisciplinary staff under the clinical supervision of a mental health professional;
(3)
be available to the client at least two days a week for at least three consecutive hours per day. The day treatment may be longer than three hours per day, but medical assistance must not reimburse a provider for more than 15 hours per week;
(4)
include group psychotherapy done by a mental health professional, or mental health practitioner qualified according to part 9505.0371, subpart 5, item C, and rehabilitative interventions done by a mental health professional or mental health practitioner daily;
(5)
be included in the client's individual treatment plan as necessary and appropriate. The individual treatment plan must include attainable, measurable goals as they relate to services and must be completed before the first day treatment session. The vendor must review the recipient's progress and update the treatment plan at least every 30 days until the client is discharged and include an available discharge plan for the client in the treatment plan; and
C.
To be eligible for adult day treatment, a recipient must:
(2)
not be residing in a nursing facility, hospital, institute of mental disease, or regional treatment center, unless the recipient has an active discharge plan that indicates a move to an independent living arrangement within 180 days;
(4)
have the capacity to engage in the rehabilitative nature, the structured setting, and the therapeutic parts of psychotherapy and skills activities of a day treatment program and demonstrate measurable improvements in the recipient's functioning related to the recipient's mental illness that would result from participating in the day treatment program;
(5)
have at least three areas of functional impairment as determined by a functional assessment with the domains prescribed by Minnesota Statutes, section 245.462, subdivision 11a;
(6)
have a level of care determination that supports the need for the level of intensity and duration of a day treatment program; and
(7)
be determined to need day treatment by a mental health professional who must deem the day treatment services medically necessary.
D.
The following services are not covered by medical assistance if they are provided by a day treatment program:
(1)
a service that is primarily recreation-oriented or that is provided in a setting that is not medically supervised. This includes: sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;
(2)
a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's mental illness;
(3)
consultation with other providers or service agency staff about the care or progress of a client;
(8)
participation in meal preparation and eating that is not part of a clinical treatment plan to address the client's eating disorder.
Subp. 9.
Partial hospitalization.
Partial hospitalization is a covered service when it is an appropriate alternative to inpatient hospitalization for a client who is experiencing an acute episode of mental illness that meets the criteria for an inpatient hospital admission as specified in part 9505.0520, subpart 1, and who has the family and community resources necessary and appropriate to support the client's residence in the community. Partial hospitalization consists of multiple intensive short-term therapeutic services provided by a multidisciplinary staff to treat the client's mental illness.
Subp. 10.
Dialectical behavior therapy (DBT).
Dialectical behavior therapy (DBT) treatment services must meet the following criteria:
A.
DBT must be provided according to this subpart and Minnesota Statutes, section 256B.0625, subdivision 5l.
B.
DBT is an outpatient service that is determined to be medically necessary by either: (1) a mental health professional qualified according to part 9505.0371, subpart 5, or (2) a mental health practitioner working as a clinical trainee according to part 9505.0371, subpart 5, item C, who is under the clinical supervision of a mental health professional according to part 9505.0371, subpart 5, item D, with specialized skill in dialectical behavior therapy. The treatment recommendation must be based upon a comprehensive evaluation that includes a diagnostic assessment and functional assessment of the client, and review of the client's prior treatment history. Treatment services must be provided pursuant to the client's individual treatment plan and provided to a client who satisfies the criteria in item C.
C.
To be eligible for DBT, a client must:
(2)
have mental health needs that cannot be met with other available community-based services or that must be provided concurrently with other community-based services;
(3)
meet one of the following criteria:
(b)
have multiple mental health diagnoses and exhibit behaviors characterized by impulsivity, intentional self-harm behavior, and be at significant risk of death, morbidity, disability, or severe dysfunction across multiple life areas;
(4)
understand and be cognitively capable of participating in DBT as an intensive therapy program and be able and willing to follow program policies and rules assuring safety of self and others; and
D.
The treatment components of DBT are individual therapy and group skills as follows:
(1)
Individual DBT combines individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and reinforce the use of adaptive skillful behaviors. The therapist must:
(c)
generalize DBT skills to the client's natural environment through telephone coaching outside of the treatment session;
(f)
help the client learn and apply effective behaviors when working with other treatment providers.
(2)
Individual DBT therapy is provided by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
(3)
Group DBT skills training combines individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce the client's suicidal and other dysfunctional coping behaviors and restore function by teaching the client adaptive skills in the following areas:
(4)
Group DBT skills training is provided by two mental health professionals, or by a mental health professional cofacilitating with a mental health practitioner.
(5)
The need for individual DBT skills training must be determined by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
E.
A program must be certified by the commissioner as a DBT provider. To qualify for certification, a provider must:
(1)
hold current accreditation as a DBT program from a nationally recognized certification body approved by the commissioner or submit to the commissioner's inspection and provide evidence that the DBT program's policies, procedures, and practices will continuously meet the requirements of this subpart;
(4)
have a manual that outlines the DBT program's policies, procedures, and practices which meet the requirements of this subpart.
F.
The DBT treatment team must consist of persons who are trained in DBT treatment. The DBT treatment team may include persons from more than one agency. Professional and clinical affiliations with the DBT team must be delineated:
(1)
A DBT team leader must:
(a)
be a mental health professional employed by, affiliated with, or contracted by a DBT program certified by the commissioner;
(c)
have knowledge of and ability to apply the principles and DBT practices that are consistent with evidence-based practices.
(2)
DBT team members who provide individual DBT or group skills training must:
(a)
be a mental health professional or be a mental health practitioner, who is employed by, affiliated with, or contracted with a DBT program certified by the commissioner;
(b)
have or obtain appropriate competencies and working knowledge of DBT principles and practices within the first six months of becoming a part of the DBT program;
(c)
have or obtain knowledge of and ability to apply the principles and practices of DBT consistently with evidence-based practices within the first six months of working at the DBT program;
(e)
require mental health practitioners to have ongoing clinical supervision by a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices.
Subp. 11.
Noncovered services.
The mental health services in items A to J are not eligible for medical assistance payment under this part:
B.
a neuropsychological assessment carried out by a person other than a neuropsychologist who is qualified according to part 9505.0372, subpart 2, item D;
C.
a service ordered by a court that is solely for legal purposes and not related to the recipient's diagnosis or treatment for mental illness;
D.
services dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health;
E.
a service that is only for a vocational purpose or an educational purpose that is not mental health related;
9520.0010 STATUTORY AUTHORITY AND PURPOSE.
Parts 9520.0010 to 9520.0230 provide methods and procedures relating to the establishment and operation of area-wide, comprehensive, community-based mental health, developmental disability, and chemical dependency programs under state grant-in-aid as provided under Minnesota Statutes, sections 245.61 to 245.69. Minnesota Statutes, sections 245.61 to 245.69 are entitled The Community Mental Health Services Act. For purposes of these parts, "community mental health services" includes services to persons who have mental or emotional disorders or other psychiatric disabilities, developmental disabilities, and chemical dependency, including drug abuse and alcoholism.
9520.0020 BOARD DUTIES.
The community mental health board has the responsibility for ensuring the planning, development, implementation, coordination, and evaluation of the community comprehensive mental health program for the mentally ill/behaviorally disabled, developmentally disabled, and chemically dependent populations in the geographic area it serves. It also has the responsibility for ensuring delivery of services designated by statute.
9520.0030 DEFINITIONS.
Parts 9520.0040 and 9520.0050 also set forth definitions of community mental health centers and community mental health clinics.
9520.0040 COMMUNITY MENTAL HEALTH CENTER.
A community mental health center means an agency which includes all of the following:
B.
Provides as a minimum the following services for individuals with mental or emotional disorders, developmental disabilities, alcoholism, drug abuse, and other psychiatric conditions. The extent of each service to be provided by the center shall be indicated in the program plan, which is to reflect the problems, needs, and resources of the community served:
(1)
collaborative and cooperative services with public health and other groups for programs of prevention of mental illness, developmental disability, alcoholism, drug abuse, and other psychiatric disorders;
(2)
informational and educational services to schools, courts, health and welfare agencies, both public and private;
(4)
consultative services to schools, courts, and health and welfare agencies, both public and private;
(6)
rehabilitative services, particularly for those who have received prior treatment in an inpatient facility.
C.
Provides or contracts for detoxification, evaluation, and referral for chemical dependency services (Minnesota Statutes, section 254A.08).
D.
Provides specific coordination for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. (Minnesota Statutes, sections 254A.07 and 245.61).
E.
Has a competent multidisciplinary mental health/developmental disability/chemical dependency professional team whose members meet the professional standards in their respective fields.
F.
The professional mental health team is qualified by specific mental health training and experience and shall include as a minimum the services of each of the following:
(2)
a doctoral clinical, counseling, or health care psychologist, who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
(3)
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
(4)
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health nursing with mental health major, maternal and child health with mental health major, etc.
G.
The multidisciplinary staff shall be sufficient in number to implement and operate the described program of the center. In addition to the above, this team should include other professionals, paraprofessionals, and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner. If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the center, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and show evidence of how the specialized functions of the required professionals are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0050 COMMUNITY MENTAL HEALTH CLINIC.
Subpart 1.
Definitions.
A community mental health clinic is an agency which devotes, as its major service, at least two-thirds of its resources for outpatient mental health diagnosis, treatment, and consultation by a multidisciplinary professional mental health team. The multidisciplinary professional mental health team is qualified by special mental health training and experience and shall include as a minimum the services of each of the following:
B.
a doctoral clinical, or counseling or health care psychologist who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
C.
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
D.
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health with a mental health major, maternal and child health with a mental health major.
Subp. 2.
Other members of multidisciplinary team.
The multidisciplinary team shall be sufficient in number to implement and operate the described program of the clinic. In addition to the above, this team should include other professionals, paraprofessionals and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner.
Subp. 3.
Efforts to acquire staff.
If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the clinic, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and evidence of how the specialized functions of the required professional positions are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0060 ANNUAL PLAN AND BUDGET.
On or before the date designated by the commissioner, each year the chair of the community mental health board or director of the community mental health program, provided for in Minnesota Statutes, section 245.62, shall submit an annual plan identifying program priorities in accordance with state grant-in-aid guidelines, and a budget on prescribed report forms for the next state fiscal year, together with the recommendations of the community mental health board, to the commissioner of human services for approval as provided under Minnesota Statutes, section 245.63.
9520.0070 FISCAL AFFILIATES.
Other providers of community mental health services may affiliate with the community mental health center and may be approved and eligible for state grant-in-aid funds. The state funding for other community mental health services shall be contingent upon appropriate inclusion in the center's community mental health plan for the continuum of community mental health services and conformity with the state's appropriate disability plan for mental health, developmental disability, or chemical dependency. Fiscal affiliates (funded contracting agencies) providing specialized services under contract must meet all rules and standards that apply to the services they are providing.
9520.0080 OTHER REQUIRED REPORTS.
The program director of the community mental health program shall provide the commissioner of human services with such reports of program activities as the commissioner may require.
9520.0090 FUNDING.
All state community mental health funding shall go directly to the community mental health board or to a human service board established pursuant to Laws of Minnesota 1975, chapter 402, which itself provides or contracts with another agency to provide the community mental health program. Such programs must meet the standards and rules for community mental health programs as enunciated in parts 9520.0010 to 9520.0230 in accordance with Laws of Minnesota 1975, chapter 402.
9520.0100 OPERATION OF OTHER PROGRAMS.
When the governing authority of the community mental health program operates other programs, services, or activities, only the community mental health center program shall be subject to these parts.
9520.0110 APPLICATIONS AND AGREEMENTS BY LOCAL COUNTIES.
New applications for state assistance or applications for renewal of support must be accompanied by an agreement executed by designated signatories on behalf of the participating counties that specifies the involved counties, the amount and source of local funds in each case, and the period of support. The local funds to be used to match state grant-in-aid must be assured in writing on Department of Human Services forms by the local funding authority(ies).
9520.0120 USE OF MATCHING FUNDS.
Funds utilized by the director as authorized by the community mental health board to match a state grant-in-aid must be available to that director for expenditures for the same general purpose as the state grant-in-aid funds.
9520.0130 QUARTERLY REPORTS.
The director of the community mental health program shall, within 20 days after the end of the quarter, submit quarterly prescribed reports to the commissioner of human services (controller's office), containing all receipts, expenditures, and cash balance, subject to an annual audit by the commissioner or his/her designee.
9520.0140 PAYMENTS.
Payments on approved grants will be made subsequent to the department's receipt of the program's quarterly reporting forms, unless the commissioner of human services has determined that funds allocated to a program are not needed for that program. Payments shall be in an amount of at least equal to the quarterly allocation minus any unexpended balance from the previous quarter providing this payment does not exceed the program grant award. In the event the program does not report within the prescribed time, the department will withhold the process of the program's payment until the next quarterly cycle.
9520.0150 FEES.
No fees shall be charged until the director with approval of the community mental health board has established fee schedules for the services rendered and they have been submitted to the commissioner of human services at least two months prior to the effective date thereof and have been approved by him/her. All fees shall conform to the approved schedules, which are accessible to the public.
9520.0160 SUPPLEMENTAL AWARDS.
The commissioner of human services may make supplemental awards to the community mental health boards.
9520.0170 WITHDRAWAL OF FUNDS.
The commissioner of human services may withdraw funds from any program that is not administered in accordance with its approved plan and budget. Written notice of such intended action will be provided to the director and community mental health board. Opportunity for hearing before the commissioner or his/her designee shall be provided.
9520.0180 BUDGET TRANSFERS.
Community mental health boards may make budget transfers within specified limits during any fiscal year without prior approval of the department. The specified limit which can be transferred in any fiscal year between program activity budgets shall be up to ten percent or up to $5,000 whichever is less. Transfers within an activity can be made into or out of line items with a specified limit of up to ten percent or up to $5,000 whichever is less. No line item can be increased or decreased by more than $5,000 or ten percent in a fiscal year without prior approval of the commissioner. Transfers above the specified limits can be made with prior approval from the commissioner. All transfers within and into program budget activities and/or line items must have prior approval by the community mental health board and this approval must be reflected in the minutes of its meeting, it must be reported to the commissioner with the reasons therefor, including a statement of how the transfer will affect program objectives.
9520.0190 BUDGET ADJUSTMENTS.
Budget adjustments made necessary by funding limitations shall be made by the commissioner and provided in writing to the director and board of the community mental health center.
9520.0200 CENTER DIRECTOR.
Every community mental health board receiving state funds for a community mental health program shall have a center director, who is the full-time qualified professional staff member who serves as the executive officer. To be considered qualified, the individual must have professional training to at least the level of graduate degree in his/her clinical and/or administrative discipline, which is relevant to MH-DD-CD and a minimum of two years experience in community mental health programs. The center director is responsible for the planning/design, development, coordination, and evaluation of a comprehensive, area-wide program and for the overall administration of services operated by the board.
The center director shall be appointed by the community mental health board and shall be approved by the commissioner of human services.
9520.0210 DEADLINE FOR APPROVAL OR DENIAL OF REQUEST FOR APPROVAL STATUS.
The commissioner shall approve or deny, in whole or in part, an application for state financial assistance within 90 days of receipt of the grant-in-aid application or by the beginning of the state fiscal year, whichever is the later.
9520.0230 ADVISORY COMMITTEE.
Subpart 1.
Purpose.
To assist the community mental health board in meeting its responsibilities as described in Minnesota Statutes, section 245.68 and to provide opportunity for broad community representation necessary for effective comprehensive mental health, developmental disability, and chemical dependency program planning, each community mental health board shall appoint a separate advisory committee in at least the three disability areas of mental health, developmental disability, and chemical dependency.
Subp. 2.
Membership.
The advisory committees shall consist of residents of the geographic area served who are interested and knowledgeable in the area governed by such committee.
Subp. 3.
Nominations for membership.
Nominations for appointments as members of the advisory committees are to be made to the community mental health board from agencies, organizations, groups, and individuals within the area served by the community mental health center. Appointments to the advisory committees are made by the community mental health board.
Subp. 4.
Board member on committee.
One community mental health board member shall serve on each advisory committee.
Subp. 5.
Nonprovider members.
Each advisory committee shall have at least one-half of its membership composed of individuals who are not providers of services to the three disability groups.
Subp. 6.
Representative membership.
Membership of each advisory committee shall generally reflect the population distribution of the service delivery area of the community mental health center.
Subp. 7.
Chairperson appointed.
The community mental health board shall appoint a chairperson for each advisory committee. The chairperson shall not be a community mental health board member nor a staff member. The power to appoint the chairperson may be delegated by the community mental health board to the individual advisory committee.
Subp. 8.
Committee responsibility to board.
Each advisory committee shall be directly responsible to the community mental health board. Direct communication shall be effected and maintained through contact between the chairperson of the particular advisory committee, or his/her designee, and the chairperson of the community mental health board, or his/her designee.
Subp. 9.
Staff.
Staff shall be assigned by the director to serve the staffing needs of each advisory committee.
Subp. 10.
Study groups and task forces.
Each advisory committee may appoint study groups and task forces upon consultation with the community mental health board. It is strongly recommended that specific attention be given to the aging and children and youth populations.
Subp. 12.
Annual report required.
Each advisory committee must make a formal written and oral report on its work to the community mental health board at least annually.
Subp. 13.
Minutes.
Each advisory committee shall submit copies of minutes of their meetings to the community mental health board and to the Department of Human Services (respective disability group program divisions).
Subp. 14.
Duties of advisory committee.
The advisory committees shall be charged by the community mental health board with assisting in the identification of the community's needs for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. The advisory committee also assists the community mental health board in determining priorities for the community programs. Based on the priorities, each advisory committee shall recommend to the community mental health board ways in which the limited available community resources (work force, facilities, and finances) can be put to maximum and optimal use.
Subp. 15.
Recommendations.
The advisory committee recommendations made to the community mental health board shall be included as a separate section in the grant-in-aid request submitted to the Department of Human Services by the community mental health board.
Subp. 16.
Assessment of programs.
The advisory committees shall assist the community mental health board in assessing the programs carried on by the community mental health board, and make recommendations regarding the reordering of priorities and modifying of programs where necessary.
9520.0750 PURPOSE.
Parts 9520.0750 to 9520.0870 establish standards for approval of mental health centers and mental health clinics for purposes of insurance and subscriber contract reimbursement under Minnesota Statutes, section 62A.152.
9520.0760 DEFINITIONS.
Subpart 1.
Scope.
As used in parts 9520.0760 to 9520.0870, the following terms have the meanings given them.
Subp. 2.
Application.
"Application" means the formal statement by a center to the commissioner, on the forms created for this purpose, requesting recognition as meeting the requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Approval.
"Approval" means the determination by the commissioner that the applicant center has met the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, and is therefore eligible to claim reimbursement for outpatient clinical services under the terms of Minnesota Statutes, section 62A.152. Approval of a center under these parts does not mean approval of a multidisciplinary staff person of such center to claim reimbursement from medical assistance or other third-party payors when practicing privately. Approval of a center under these parts does not mean approval of such center to claim reimbursement from medical assistance.
Subp. 4.
Case review.
"Case review" means a consultation process thoroughly examining a client's condition and treatment. It includes review of the client's reason for seeking treatment, diagnosis and assessment, and the individual treatment plan; review of the appropriateness, duration, and outcome of treatment provided; and treatment recommendations.
Subp. 5.
Center.
"Center" means a public or private health and human services facility which provides clinical services in the treatment of mental illness. It is an abbreviated term used in place of "mental health center" or "mental health clinic" throughout parts 9520.0750 to 9520.0870.
Subp. 6.
Client.
"Client" means a person accepted by the center to receive clinical services in the diagnosis and treatment of mental illness.
Subp. 7.
Clinical services.
"Clinical services" means services provided to a client to diagnose, describe, predict, and explain that client's status relative to a disabling condition or problem, and where necessary, to treat the client to reduce impairment due to that condition. Clinical services also include individual treatment planning, case review, record keeping required for treatment, peer review, and supervision.
Subp. 8.
Commissioner.
"Commissioner" means the commissioner of the Minnesota Department of Human Services or a designated representative.
Subp. 9.
Competent.
"Competent" means having sufficient knowledge of and proficiency in a specific mental illness assessment or treatment service, technique, method, or procedure, documented by experience, education, training, and certification, to be able to provide it to a client with little or no supervision.
Subp. 10.
Consultation.
"Consultation" means the process of deliberating or conferring between multidisciplinary staff regarding a client and the client's treatment.
Subp. 11.
Deferral.
"Deferral" means the determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 and is not approved, but is granted a period of time to comply with these standards and receive a second review without reapplication.
Subp. 13.
Disapproval or withdrawal of approval.
"Disapproval" or "withdrawal of approval" means a determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 14.
Discipline.
"Discipline" means a branch of professional knowledge or skill acquired through a specific course of study and training and usually documented by a specific educational degree or certification of proficiency. Examples of the mental health disciplines include but are not limited to psychiatry, psychology, clinical social work, and psychiatric nursing.
Subp. 15.
Documentation.
"Documentation" means the automatically or manually produced and maintained evidence that can be read by person or machine, and that will attest to the compliance with requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 16.
Individual treatment plan.
"Individual treatment plan" means a written plan of intervention and treatment developed on the basis of assessment results for a specific client, and updated as necessary. The plan specifies the goals and objectives in measurable terms, states the treatment strategy, and identifies responsibilities of multidisciplinary staff.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a staff person providing clinical services in the treatment of mental illness who is qualified in at least one of the following ways:
A.
by having a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and 2,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
B.
by having 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
C.
by being a graduate student in one of the behavioral sciences or related fields formally assigned to the center for clinical training by an accredited college or university; or
D.
by having a master's or other graduate degree in one of the behavioral sciences or related fields from an accredited college or university.
Documentation of compliance with part 9520.0800, subpart 4, item B is required for designation of work as supervised experience in the delivery of clinical services. Documentation of the accreditation of a college or university shall be a listing in Accredited Institutions of Postsecondary Education Programs, Candidates for the year the degree was issued. The master's degree in behavioral sciences or related fields shall include a minimum of 28 semester hours of graduate course credit in mental health theory and supervised clinical training, as documented by an official transcript.
Subp. 18.
Mental health professional.
"Mental health professional" has the meaning given in Minnesota Statutes, section 245.462, subdivision 18.
Subp. 19.
Mental illness.
"Mental illness" means a condition which results in an inability to interpret the environment realistically and in impaired functioning in primary aspects of daily living such as personal relations, living arrangements, work, and recreation, and which is listed in the clinical manual of the International Classification of Diseases (ICD-9-CM), Ninth Revision (1980), code range 290.0-302.99 or 306.0-316, or the corresponding code in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), Third Edition (1980), Axes I, II or III. These publications are available from the State Law Library.
Subp. 20.
Multidisciplinary staff.
"Multidisciplinary staff" means the mental health professionals and mental health practitioners employed by or under contract to the center to provide outpatient clinical services in the treatment of mental illness.
Subp. 21.
Serious violations of policies and procedures.
"Serious violations of policies and procedures" means a violation which threatens the health, safety, or rights of clients or center staff; the repeated nonadherence to center policies and procedures; and the nonadherence to center policies and procedures which result in noncompliance with Minnesota Statutes, section 245.69, subdivision 2 and parts 9520.0760 to 9520.0870.
Subp. 22.
Treatment strategy.
"Treatment strategy" means the particular form of service delivery or intervention which specifically addresses the client's characteristics and mental illness, and describes the process for achievement of individual treatment plan goals.
9520.0770 ORGANIZATIONAL STRUCTURE OF CENTER.
Subpart 1.
Basic unit.
The center or the facility of which it is a unit shall be legally constituted as a partnership, corporation, or government agency. The center shall be either the entire facility or a clearly identified unit within the facility which is administratively and clinically separate from the rest of the facility. All business shall be conducted in the name of the center or facility, except medical assistance billing by individually enrolled providers when the center is not enrolled.
Subp. 2.
Purpose, services.
The center shall document that the prevention, diagnosis, and treatment of mental illness are the main purposes of the center. If the center is a unit within a facility, the rest of the facility shall not provide clinical services in the outpatient treatment of mental illness. The facility may provide services other than clinical services in the treatment of mental illness, including medical services, chemical dependency services, social services, training, and education. The provision of these additional services is not reviewed in granting approval to the center under parts 9520.0760 to 9520.0870.
Subp. 3.
Governing body.
The center shall have a governing body. The governing body shall provide written documentation of its source of authority. The governing body shall be legally responsible for the implementation of the standards set forth in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 through the establishment of written policy and procedures.
Subp. 4.
Chart or statement of organization.
The center shall have an organizational chart or statement which specifies the relationships among the governing body, any administrative and support staff, mental health professional staff, and mental health practitioner staff; their respective areas of responsibility; the lines of authority involved; the formal liaison between administrative and clinical staff; and the relationship of the center to the rest of the facility and any additional services provided.
9520.0780 SECONDARY LOCATIONS.
Subpart 1.
Main and satellite offices.
The center shall notify the commissioner of all center locations. If there is more than one center location, the center shall designate one as the main office and all secondary locations as satellite offices. The main office as a unit and the center as a whole shall be in compliance with part 9520.0810. The main office shall function as the center records and documentation storage area and house most administrative functions for the center. Each satellite office shall:
E.
ensure that a mental health professional is at the satellite office and competent to supervise and intervene in the clinical services provided there, whenever the satellite office is open;
F.
ensure that its multidisciplinary staff have access to and interact with main center staff for consultation, supervision, and peer review; and
G.
ensure that clients have access to all clinical services provided in the treatment of mental illness and the multidisciplinary staff of the center.
Subp. 2.
Noncompliance.
If the commissioner determines that a secondary location is not in compliance with subpart 1, it is not a satellite office. Outpatient clinical services in the treatment of mental illness delivered by the center or facility of which it is a unit shall cease at that location, or the application shall be disapproved.
9520.0790 MINIMUM TREATMENT STANDARDS.
Subpart 1.
Multidisciplinary approach.
The center shall document that services are provided in a multidisciplinary manner. That documentation shall include evidence that staff interact in providing clinical services, that the services provided to a client involve all needed disciplines represented on the center staff, and that staff participate in case review and consultation procedures as described in subpart 6.
Subp. 2.
Intake and case assignment.
The center shall establish an intake or admission procedure which outlines the intake process, including the determination of the appropriateness of accepting a person as a client by reviewing the client's condition and need for treatment, the clinical services offered by the center, and other available resources. The center shall document that case assignment for assessment, diagnosis, and treatment is made to a multidisciplinary staff person who is competent in the service, in the recommended treatment strategy and in treating the individual client characteristics. Responsibility for each case shall remain with a mental health professional.
Subp. 3.
Assessment and diagnostic process.
The center shall establish an assessment and diagnostic process that determines the client's condition and need for clinical services. The assessment of each client shall include clinical consideration of the client's general physical, medical, developmental, family, social, psychiatric, and psychological history and current condition. The diagnostic statement shall include the diagnosis based on the codes in the International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and refer to the pertinent assessment data. The diagnosis shall be by or under the supervision of and signed by a psychiatrist or licensed psychologist. The diagnostic assessment, as defined by Minnesota Statutes, sections 245.462, subdivision 9, for adults, and 245.4871, subdivision 11, for children, must be provided by a licensed mental health professional in accordance with Minnesota Statutes, section 245.467, subdivision 2.
Subp. 4.
Treatment planning.
The individual treatment plan, based upon a diagnostic assessment of mental illness, shall be jointly developed by the client and the mental health professional. This planning procedure shall ensure that the client has been informed in the following areas: assessment of the client condition; treatment alternatives; possible outcomes and side effects of treatment; treatment recommendations; approximate length, cost, and hoped-for outcome of treatment; the client's rights and responsibilities in implementation of the individual treatment plan; staff rights and responsibilities in the treatment process; the Government Data Practices Act; and procedures for reporting grievances and alleged violation of client rights. If the client is considering chemotherapy, hospitalization, or other medical treatment, the appropriate medical staff person shall inform the client of the treatment alternatives, the effects of the medical procedures, and possible side effects. Clinical services shall be appropriate to the condition, age, sex, socioeconomic, and ethnic background of the client, and provided in the least restrictive manner. Clinical services shall be provided according to the individual treatment plan and existing professional codes of ethics.
Subp. 5.
Client record.
The center shall maintain a client record for each client. The record must document the assessment process, the development and updating of the treatment plan, the treatment provided and observed client behaviors and response to treatment, and serve as data for the review and evaluation of the treatment provided to a client. The record shall include:
G.
when necessary, the client's authorization to release private information, and client information obtained from outside sources;
H.
at the closing of the case, a statement of the reason for termination, current client condition, and the treatment outcome; and
Subp. 6.
Consultation; case review.
The center shall establish standards for case review and encourage the ongoing consultation among multidisciplinary staff. The multidisciplinary staff shall attend staff meetings at least twice monthly for a minimum of four hours per month, or a minimum of two hours per month if the multidisciplinary staff person provides clinical services in the treatment of mental illness less than 15 hours per week. The purpose of these meetings shall be case review and consultation. Written minutes of the meeting shall be maintained at the center for at least three years after the meeting.
Subp. 7.
Referrals.
If the necessary treatment or the treatment desired by the client is not available at the center, the center shall facilitate appropriate referrals. The multidisciplinary staff person shall discuss with the client the reason for the referral, potential treatment resources, and what the process will involve. The staff person shall assist in the process to ensure continuity of the planned treatment.
Subp. 8.
Emergency service.
The center shall ensure that clinical services to treat mental illness are available to clients on an emergency basis.
Subp. 9.
Access to hospital.
The center shall document that it has access to hospital admission for psychiatric inpatient care, and shall provide that access when needed by a client. This requirement for access does not require direct hospital admission privileges on the part of qualified multidisciplinary staff.
9520.0800 MINIMUM QUALITY ASSURANCE STANDARDS.
Subpart 1.
Policies and procedures.
The center shall develop written policies and procedures and shall document the implementation of these policies and procedures for each treatment standard and each quality assurance standard in subparts 2 to 7. The policies shall be approved by the governing body. The procedures shall indicate what actions or accomplishments are to be performed, who is responsible for each action, and any documentation or required forms. Multidisciplinary staff shall have access to a copy of the policies and procedures at all times.
Subp. 2.
Peer review.
The center shall have a multidisciplinary peer review system to assess the manner in which multidisciplinary staff provide clinical services in the treatment of mental illness. Peer review shall include the examination of clinical services to determine if the treatment provided was effective, necessary, and sufficient and of client records to determine if the recorded information is necessary and sufficient. The system shall ensure review of a randomly selected sample of five percent or six cases, whichever is less, of the annual caseload of each mental health professional by other mental health professional staff. Peer review findings shall be discussed with staff involved in the case and followed up by any necessary corrective action. Peer review records shall be maintained at the center.
Subp. 3.
Internal utilization review.
The center shall have a system of internal utilization review to examine the quality and efficiency of resource usage and clinical service delivery. The center shall develop and carry out a review procedure consistent with its size and organization which includes collection or review of information, analysis or interpretation of information, and application of findings to center operations. The review procedure shall minimally include, within any three year period of time, review of the appropriateness of intake, the provision of certain patterns of services, and the duration of treatment. Criteria may be established for treatment length and the provision of services for certain client conditions. Utilization review records shall be maintained, with an annual report to the governing body for applicability of findings to center operations.
Subp. 4.
Staff supervision.
Staff supervision:
A.
The center shall have a clinical evaluation and supervision procedure which identifies each multidisciplinary staff person's areas of competence and documents that each multidisciplinary staff person receives the guidance and support needed to provide clinical services for the treatment of mental illness in the areas they are permitted to practice.
B.
A mental health professional shall be responsible for the supervision of the mental health practitioner, including approval of the individual treatment plan and bimonthly case review of every client receiving clinical services from the practitioner. This supervision shall include a minimum of one hour of face-to-face, client-specific supervisory contact for each 40 hours of clinical services in the treatment of mental illness provided by the practitioner.
Subp. 5.
Continuing education.
The center shall require that each multidisciplinary staff person attend a minimum of 36 clock hours every two years of academic or practical course work and training. This education shall augment job-related knowledge, understanding, and skills to update or enhance staff competencies in the delivery of clinical services to treat mental illness. Continued licensure as a mental health professional may be substituted for the continuing education requirement of this subpart.
Subp. 6.
Violations of standards.
The center shall have procedures for the reporting and investigating of alleged unethical, illegal, or grossly negligent acts, and of the serious violation of written policies and procedures. The center shall document that the reported behaviors have been reviewed and that responsible disciplinary or corrective action has been taken if the behavior was substantiated. The procedures shall address both client and staff reporting of complaints or grievances regarding center procedures, staff, and services. Clients and staff shall be informed they may file the complaint with the department if it was not resolved to mutual satisfaction. The center shall have procedures for the reporting of suspected abuse or neglect of clients, in accordance with Minnesota Statutes, sections 611A.32, subdivision 5; 626.556; and 626.557.
Subp. 7.
Data classification.
Client information compiled by the center, including client records and minutes of case review and consultation meetings, shall be protected as private data under the Minnesota Government Data Practices Act.
9520.0810 MINIMUM STAFFING STANDARDS.
Subpart 1.
Required staff.
Required staff:
A.
The multidisciplinary staff of a center shall consist of at least four mental health professionals. At least two of the mental health professionals shall each be employed or under contract for a minimum of 35 hours a week by the center. Those two mental health professionals shall be of different disciplines.
C.
The mental health professional employed or under contract to the center to meet the requirement of item B shall be at the main office of the center and providing clinical services in the treatment of mental illness at least eight hours every two weeks.
Subp. 2.
Additional staff; staffing balance.
Additional mental health professional staff may be employed by or under contract to the center provided that no single mental health discipline or combination of allied fields shall comprise more than 60 percent of the full-time equivalent mental health professional staff. This provision does not apply to a center with fewer than six full-time equivalent mental health professional staff. Mental health practitioners may also be employed by or under contract to a center to provide clinical services for the treatment of mental illness in their documented area of competence. Mental health practitioners shall not comprise more than 25 percent of the full-time equivalent multidisciplinary staff. In determination of full-time equivalence, only time spent in clinical services for the treatment of mental illness shall be considered.
Subp. 3.
Multidisciplinary staff records.
The center shall maintain records sufficient to document that the center has determined and verified the clinical service qualifications of each multidisciplinary staff person, and sufficient to document each multidisciplinary staff person's terms of employment.
9520.0820 APPLICATION PROCEDURES.
Subpart 1.
Form.
A facility seeking approval as a center for insurance reimbursement of its outpatient clinical services in treatment of mental illness must make formal application to the commissioner for such approval. The application form for this purpose may be obtained from the Mental Illness Program Division of the department. The application form shall require only information which is required by statute or rule, and shall require the applicant center to explain and provide documentation of compliance with the minimum standards in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 2.
Fee.
Each application shall be accompanied by payment of the nonrefundable application fee. The fee shall be established and adjusted in accordance with Minnesota Statutes, section 16A.128 to cover the costs to the department in implementing Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Completed application.
The application is considered complete on the date the application fee and all information required in the application form are received by the department.
9520.0830 REVIEW OF APPLICANT CENTERS.
Subpart 1.
Site visit.
The formal review shall begin after the completed application has been received, and shall include an examination of the written application and a visit to the center. The applicant center shall be offered a choice of site visit dates, with at least one date falling within 60 days of the date on which the department receives the complete application. The site visit shall include interviews with multidisciplinary staff and examination of a random sample of client records, consultation minutes, quality assurance reports, and multidisciplinary staff records.
Subp. 2.
Documentation.
If implementation of a procedure is too recent to be reliably documented, a written statement of the planned implementation shall be accepted as documentation on the initial application. The evidence of licensure or accreditation through another regulating body shall be accepted as documentation of a specific procedure when the required minimum standard of that body is the same or higher than a specific provision of parts 9520.0760 to 9520.0870.
9520.0840 DECISION ON APPLICATION.
Subpart 1.
Written report.
Upon completion of the site visit, a report shall be written. The report shall include a statement of findings, a recommendation to approve, defer, or disapprove the application, and the reasons for the recommendation.
Subp. 2.
Written notice to center.
The applicant center shall be sent written notice of approval, deferral, or disapproval within 30 days of the completion of the site visit. If the decision is a deferral or a disapproval, the notice shall indicate the specific areas of noncompliance.
Subp. 3.
Noncompliance with statutes and rules.
An application shall be disapproved or deferred if it is the initial application of a center, when the applicant center is not in compliance with Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 4.
Deferral of application.
If an application is deferred, the length of deferral shall not exceed 180 days. If the areas of noncompliance stated in the deferral notice are not satisfactorily corrected by the end of the deferral period, the application shall be disapproved. The applicant center shall allow the commissioner to inspect the center at any time during the deferral period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center. At any time during the deferral period, the applicant center may submit documentation indicating correction of noncompliance. The application shall then be approved or disapproved. At any time during the deferral period, the applicant center may submit a written request to the commissioner to change the application status to disapproval. The request shall be complied with within 14 days of receiving this written request. The applicant center is not an approved center for purposes of Minnesota Statutes, section 62A.152 during a deferral period.
Subp. 5.
Effective date of decision.
The effective date of a decision is the date the commissioner signs a letter notifying the applicant center of that decision.
9520.0850 APPEALS.
If an application is disapproved or approval is withdrawn, a contested case hearing and judicial review as provided in Minnesota Statutes, sections 14.48 to 14.69, may be requested by the center within 30 days of the commissioner's decision.
9520.0860 POSTAPPROVAL REQUIREMENTS.
Subpart 1.
Duration of approval.
Initial approval of an application is valid for 12 months from the effective date, subsequent approvals for 24 months, except when approval is withdrawn according to the criteria in subpart 4.
Subp. 2.
Reapplication.
The center shall contact the department for reapplication forms, and submit the completed application at least 90 days prior to the expected expiration date. If an approved center has met the conditions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, including reapplication when required, its status as an approved center shall remain in effect pending department processing of the reapplication.
Subp. 3.
Restrictions.
The approval is issued only for the center named in the application and is not transferable or assignable to another center. The approval is issued only for the center location named in the application and is not transferable or assignable to another location. If the commissioner is notified in writing at least 30 days in advance of a change in center location and can determine that compliance with all provisions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 are maintained, the commissioner shall continue the approval of the center at the new location.
Subp. 4.
Noncompliance.
Changes in center organization, staffing, treatment, or quality assurance procedures that affect the ability of the center to comply with the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 shall be reported in writing by the center to the commissioner within 15 days of occurrence. Review of the change shall be conducted by the commissioner. A center with changes resulting in noncompliance in minimum standards shall receive written notice and may have up to 180 days to correct the areas of noncompliance before losing approval status. Interim procedures to resolve the noncompliance on a temporary basis shall be developed and submitted in writing to the commissioner for approval within 30 days of the commissioner's determination of the noncompliance. Nonreporting within 15 days of occurrence of a change that results in noncompliance, failure to develop an approved interim procedure within 30 days of the determination of the noncompliance, or nonresolution of the noncompliance within 180 days shall result in the immediate withdrawal of approval status.
Serious violation of policies or procedures, professional association or board sanctioning or loss of licensure for unethical practices, or the conviction of violating a state or federal statute shall be reported in writing by the center to the commissioner within ten days of the substantiation of such behavior. Review of this report and the action taken by the center shall be conducted by the commissioner. Approval shall be withdrawn immediately unless the commissioner determines that: the center acted with all proper haste and thoroughness in investigating the behavior, the center acted with all proper haste and thoroughness in taking appropriate disciplinary and corrective action, and that no member of the governing body was a party to the behavior. Failure to report such behavior within ten days of its substantiation shall result in immediate withdrawal of approval.
Subp. 5.
Compliance reports.
The center may be required to submit written information to the department during the approval period to document that the center has maintained compliance with the rule and center procedures. The center shall allow the commissioner to inspect the center at any time during the approval period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center.
9520.0870 VARIANCES.
Subpart 1.
When allowed.
The standards and procedures established by parts 9520.0760 to 9520.0860 may be varied by the commissioner. Standards and procedures established by statute shall not be varied.
Subp. 2.
Request procedure.
A request for a variance must be submitted in writing to the commissioner, accompanying or following the submission of a completed application for approval under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870. The request shall state:
B.
the specific reasons why the standard or procedure cannot be or should not be complied with; and
C.
the equivalent standard or procedure the center will establish to achieve the intent of the standard or procedure to be varied.
Subp. 3.
Decision procedure.
Upon receiving the variance request, the commissioner shall consult with a panel of experts in the mental health disciplines regarding the request. Criteria for granting a variance shall be the commissioner's determination that subpart 2, items A to C are met. Hardship shall not be a sufficient reason to grant a variance. No variance shall be granted that would threaten the health, safety, or rights of clients. Variances granted by the commissioner shall specify in writing the alternative standards or procedures to be implemented and any specific conditions or limitations imposed on the variance by the commissioner. Variances denied by the commissioner shall specify in writing the reason for the denial.
Subp. 4.
Notification.
The commissioner shall send the center a written notice granting or not granting the variance within 90 days of receiving the written variance request. This notice shall not be construed as approval or disapproval of the center under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
9530.6800 ASSESSMENT OF NEED FOR TREATMENT PROGRAMS.
Subpart 1.
Assessment of need required for licensure.
Before a license or a provisional license may be issued, the need for the chemical dependency treatment or rehabilitation program must be determined by the commissioner. Need for an additional or expanded chemical dependency treatment program must be determined, in part, based on the recommendation of the county board of commissioners of the county in which the program will be located and the documentation submitted by the applicant at the time of application.
If the county board fails to submit a statement to the commissioner within 60 days of the county board's receipt of the written request from an applicant, as required under part 9530.6810, the commissioner shall determine the need for the applicant's proposed chemical dependency treatment program based on the documentation submitted by the applicant at the time of application.
Subp. 2.
Documentation of need requirements.
An applicant for licensure under parts 9530.2500 to 9530.4000 and Minnesota Statutes, chapter 245G, must submit the documentation in items A and B to the commissioner with the application for licensure:
A.
The applicant must submit documentation that it has requested the county board of commissioners of the county in which the chemical dependency treatment program will be located to submit to the commissioner both a written statement that supports or does not support the need for the program and documentation of the rationale used by the county board to make its determination.
B.
The applicant must submit a plan for attracting an adequate number of clients to maintain its proposed program capacity, including:
(3)
documentation that the capacity or program designs of existing programs are not sufficient to meet the service needs of the chemically abusing or chemically dependent target population if that information is available to the applicant;
(4)
a list of referral sources, with an estimation as to the number of clients the referral source will refer to the applicant's program in the first year of operation; and
(5)
any other information available to the applicant that supports the need for new or expanded chemical dependency treatment capacity.
9530.6810 COUNTY BOARD RESPONSIBILITY TO REVIEW PROGRAM NEED.
When an applicant for licensure under parts 9530.2500 to 9530.4000 or Minnesota Statutes, chapter 245G, requests a written statement of support for a proposed chemical dependency treatment program from the county board of commissioners of the county in which the proposed program is to be located, the county board, or the county board's designated representative, shall submit a statement to the commissioner that either supports or does not support the need for the applicant's program. The county board's statement must be submitted in accordance with items A and B:
A.
the statement must be submitted within 60 days of the county board's receipt of a written request from the applicant for licensure; and