HF 2553

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/20/2023 04:51pm

A bill for an act
relating to behavioral health; modifying mental health provider staffing,
documentation, and diagnostic assessment requirements; requiring the commissioner
of human services to establish a medical assistance mental health service provider
certification process; modifying assertive community treatment staff requirements;
modifying adult rehabilitative mental health services provider entity standards;
modifying behavioral health home services staff qualifications; modifying managed
care contract requirements for mental health and substance use disorder treatment
services; modifying school-linked behavioral health grant data and outcome
reporting requirements; modifying family peer support services eligibility; requiring
a report; amending Minnesota Statutes 2022, sections 245.4901, subdivision 4;
245I.05, subdivision 3; 245I.08, subdivision 3; 245I.10, subdivisions 2, 6; 245I.11,
subdivision 3; 245I.20, subdivision 5; 256B.0616, subdivision 3; 256B.0622,
subdivisions 7a, 7b, 7c; 256B.0623, subdivision 4; 256B.0757, subdivision 4c;
256B.69, subdivision 5a; proposing coding for new law in Minnesota Statutes,
chapter 256B.

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

Section 1.

Minnesota Statutes 2022, section 245.4901, subdivision 4, is amended to read:

Subd. 4.

Data collection and outcome measurement.

Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked
behavioral health grant program new text begin , no more frequently than twice per year new text end . new text begin Data provided by
grantees shall include the number of clients served, client demographics, payment
information, duration and frequency of services and client-related clinic ancillary services
including hours of direct client services, and hours of ancillary direct and indirect support
services. Qualitative data may also be collected to demonstrate impact from client and school
personnel perspectives.
new text end

Sec. 2.

Minnesota Statutes 2022, section 245I.05, subdivision 3, is amended to read:

Subd. 3.

Initial training.

(a) A staff person must receive training about:

(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and

(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.

(b) Before providing direct contact services to a client, a staff person must receive training
about:

(1) client rights and protections under section 245I.12;

(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;

(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;

(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;

(5) professional boundaries that the staff person must maintain; and

(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, and physical
and mental abilities.

(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner required to receive the
training according to section 245I.04, subdivision 4, must receive 30 hours of training about:

(1) mental illnesses;

(2) client recovery and resiliency;

(3) mental health de-escalation techniques;

(4) co-occurring mental illness and substance use disorders; and

(5) psychotropic medications and medication side effects.

(d) Within 90 days of first providing direct contact services to an adult client, a deleted text begin clinical
trainee, deleted text end mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:

(1) trauma-informed care and secondary trauma;

(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;

(3) co-occurring substance use disorders; and

(4) culturally responsive treatment practices.

(e) Within 90 days of first providing direct contact services to a child client, a deleted text begin clinical
trainee, deleted text end 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:

(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);

(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;

(3) mental illness and co-occurring substance use disorders in family systems;

(4) culturally responsive treatment practices; and

(5) child development, including cognitive functioning, and physical and mental abilities.

(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.

Sec. 3.

Minnesota Statutes 2022, section 245I.08, subdivision 3, is amended to read:

Subd. 3.

Documenting approval.

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 deleted text begin five deleted text end new text begin 30 new text end business days of initial completion by the staff person
under treatment supervision.

Sec. 4.

Minnesota Statutes 2022, section 245I.10, subdivision 2, is amended to read:

Subd. 2.

Generally.

(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.

(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:

(1) an explanation of findings;

(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;

(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;

(4) crisis assessment services according to section 256B.0624; and

(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245I.23, subdivision 7.

(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:

(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and

(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.

(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.

(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:

(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

(2) up to five days of day treatment services or partial hospitalization.

(f) A license holder must new text begin update a client's standard diagnostic assessment or new text end complete
a new standard diagnostic assessment of a client:

(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;

(2) deleted text begin at least annually following the client's initial diagnostic assessment deleted text end if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;

(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; deleted text begin or
deleted text end

(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis deleted text begin . deleted text end new text begin ; or
new text end

new text begin (5) upon the client's request.
new text end

(g) For an existing client, the license holder must ensure that a deleted text begin new deleted text end standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client deleted text begin , 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 deleted text end .

Sec. 5.

Minnesota Statutes 2022, section 245I.10, subdivision 6, is amended to read:

Subd. 6.

Standard diagnostic assessment; required elements.

(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.

(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:

(1) the client's age;

(2) the client's current living situation, including the client's housing status and household
members;

(3) the status of the client's basic needs;

(4) the client's education level and employment status;

(5) the client's current medications;

(6) any immediate risks to the client's health and safety;

(7) the client's perceptions of the client's condition;

(8) the client's description of the client's symptoms, including the reason for the client's
referral;

(9) the client's history of mental health treatment; and

(10) cultural influences on the client.

(c) If the assessor cannot obtain the information that this paragraph 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:

(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;

(2) the client's strengths and resources, including the extent and quality of the client's
social networks;

(3) important developmental incidents in the client's life;

(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;

(5) the client's history of or exposure to alcohol and drug usage and treatment; and

(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.

(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.

(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.

(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.

deleted 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.
deleted text end

deleted 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.
deleted text end

deleted text begin (5) deleted text end new text begin (3) new text end 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.

(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:

(1) the client's mental status examination;

(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;

(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.

(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.

Sec. 6.

Minnesota Statutes 2022, section 245I.11, subdivision 3, is amended to read:

Subd. 3.

Storing and accounting for medications.

(a) If a license holder stores client
medications, the license holder must:

(1) store client medications in original containers in a locked location;

(2) store refrigerated client medications in special trays or containers that are separate
from food;

(3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;

(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;

(5) ensure that only authorized staff persons have access to stored client medications;

(6) new text begin for a license holder providing residential services, new text end follow a documentation procedure
on each shift new text begin , and for a license holder providing nonresidential services, follow a
documentation procedure once every 30 days new text end to account for all scheduled drugs; and

(7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.

(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.

Sec. 7.

Minnesota Statutes 2022, section 245I.20, subdivision 5, is amended to read:

Subd. 5.

Treatment supervision specified.

deleted text begin (a) deleted text end 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.

deleted 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 and document 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.
deleted text end

Sec. 8.

Minnesota Statutes 2022, section 256B.0616, subdivision 3, is amended to read:

Subd. 3.

Eligibility.

Family peer support services deleted text begin may deleted text end new text begin shall new text end be provided to recipients
deleted text begin of inpatient hospitalization, partial hospitalization, residential treatment, children's intensive
behavioral health services, day treatment, children's therapeutic services and supports, or
crisis services deleted text end new text begin eligible under medical assistance, upon a determination of medical necessity
by a licensed mental health professional new text end .

Sec. 9.

new text begin [256B.0617] MENTAL HEALTH SERVICES PROVIDER CERTIFICATION.
new text end

new text begin (a) The commissioner of human services shall establish an initial provider entity
application and certification process and recertification process to determine whether a
provider entity has administrative and clinical infrastructures that meet the requirements to
be certified, for the following services:
new text end

new text begin (1) assertive community treatment under section 256B.0622, subdivision 3a;
new text end

new text begin (2) adult rehabilitative mental health services under section 256B.0623;
new text end

new text begin (3) mobile crisis team services under section 256B.0624;
new text end

new text begin (4) children's therapeutic services and supports under section 256B.0943;
new text end

new text begin (5) children's intensive behavioral health services under section 256B.0946; and
new text end

new text begin (6) intensive nonresidential rehabilitative mental health services under section 256B.0947.
new text end

new text begin (b) The commissioner shall recertify a provider entity every three years using the
individual provider's certification anniversary or the calendar year end. The commissioner
may approve a recertification extension in the interest of sustaining services when a certain
date for recertification is identified.
new text end

new text begin (c) 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.
new text end

new text begin (d) The commissioner must provide the following to provider entities for the certification,
recertification, and decertification processes:
new text end

new text begin (1) a structured listing of required provider certification criteria;
new text end

new text begin (2) a formal written letter with a determination of certification, recertification, or
decertification, signed by the commissioner or the appropriate division director; and
new text end

new text begin (3) a formal written communication outlining the process for necessary corrective action
and follow-up by the commissioner signed by the commissioner or appropriate division
director, if applicable.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, and the commissioner of
human services must implement all requirements of this section by September 1, 2023.
new text end

Sec. 10.

Minnesota Statutes 2022, 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 mental health professional. Individuals who are not licensed but who are
eligible for licensure and are otherwise qualified may also fulfill this role deleted text begin but must obtain
full licensure within 24 months of assuming the role of team leader deleted text end ;

(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 deleted text begin , providing treatment
supervision of services in conjunction with the psychiatrist or psychiatric care provider, deleted text end and
supervising team members to ensure delivery of best and ethical practices; and

(iv) must be available to provide overall treatment supervision to the ACT team after
regular business hours and on weekends and holidays. The team leader may new text begin at any time
new text end delegate this duty to another qualified deleted text begin member of the ACT team deleted text end new text begin licensed professional new text end ;

(2) the psychiatric care provider:

(i) must be a mental health professional permitted to prescribe psychiatric medications
as part of the mental health professional's scope of practice. 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
treatment 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; and

(vi) 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) must 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. 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 mental
health professionals; clinical trainees; certified rehabilitation specialists; mental health
practitioners; or mental health rehabilitation workers. 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. 11.

Minnesota Statutes 2022, 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 deleted text begin for at least eight-hour shift coverage deleted text end 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 co-occurring disorder 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 professional, certified rehabilitation specialist, clinical trainee, or mental health
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 co-occurring disorder 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 professional, certified rehabilitation
specialist, clinical trainee, or mental health 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 co-occurring disorder 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. 12.

Minnesota Statutes 2022, section 256B.0622, subdivision 7c, is amended to read:

Subd. 7c.

Assertive community treatment program organization and communication
requirements.

(a) An ACT team shall provide at least 75 percent of all services in the
community in non-office-based or non-facility-based settings.

(b) ACT team members must know all clients receiving services, and interventions must
be carried out with consistency and follow empirically supported practice.

(c) Each ACT team client shall be assigned an individual treatment team that is
determined by a variety of factors, including team members' expertise and skills, rapport,
and other factors specific to the individual's preferences. The majority of clients shall see
at least three ACT team members in a given month.

(d) The ACT team shall have the capacity to rapidly increase service intensity to a client
when the client's status requires it, regardless of geography, new text begin and new text end provide flexible service in
an individualized manner deleted text begin , and see clients on average three times per week for at least 120
minutes per week deleted text end new text begin at a frequency that meets the client's needs new text end . Services must be available
at times that meet client needs.

(e) ACT teams shall make deliberate efforts to assertively engage clients in services.
Input of family members, natural supports, and previous and subsequent treatment providers
is required in developing engagement strategies. ACT teams shall include the client, identified
family, and other support persons in the admission, initial assessment, and planning process
as primary stakeholders, meet with the client in the client's environment at times of the day
and week that honor the client's preferences, and meet clients at home and in jails or prisons,
streets, homeless shelters, or hospitals.

(f) ACT teams shall ensure that a process is in place for identifying individuals in need
of more or less assertive engagement. Interventions are monitored to determine the success
of these techniques and the need to adapt the techniques or approach accordingly.

(g) ACT teams shall conduct daily team meetings to systematically update clinically
relevant information, briefly discuss the status of assertive community treatment clients
over the past 24 hours, problem solve emerging issues, plan approaches to address and
prevent crises, and plan the service contacts for the following 24-hour period or weekend.
All team members scheduled to work shall attend this meeting.

(h) ACT teams shall maintain a clinical log that succinctly documents important clinical
information and develop a daily team schedule for the day's contacts based on a central file
of the clients' weekly or monthly schedules, which are derived from interventions specified
within the individual treatment plan. The team leader must have a record to ensure that all
assigned contacts are completed.

Sec. 13.

Minnesota Statutes 2022, 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 section and chapter 245I, as required in section 245I.011, subdivision 5. The
certification must specify which adult rehabilitative mental health services the entity is
qualified to provide.

deleted text begin (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.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end State-level recertification must occur deleted text begin at least deleted text end every three years.

deleted text begin (e) deleted text end new text begin (d) new text end 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.

deleted text begin (f) deleted text end new text begin (e) new text end The adult rehabilitative mental health services provider entity must meet the
following standards:

(1) have capacity to recruit, hire, manage, and train qualified staff;

(2) have adequate administrative ability to ensure availability of services;

(3) ensure that staff are skilled in the delivery of the specific adult rehabilitative mental
health services provided to the individual eligible recipient;

(4) 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;

(5) assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;

(6) 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;

(7) keep all necessary records required by law;

(8) deliver services as required by section 245.461;

(9) be an enrolled Medicaid provider; and

(10) maintain a quality assurance plan to determine specific service outcomes and the
recipient's satisfaction with services.

Sec. 14.

Minnesota Statutes 2022, 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 deleted text begin registered deleted text end new text begin licensed new text end nurse deleted text begin licensed under the Minnesota Nurse
Practice Act, sections 148.171 to 148.285 deleted text end new text begin , as defined in section 148.171, subdivision 9 new text end .

(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional who is qualified according to section 245I.04,
subdivision 2.

(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 who is
qualified according to section 245I.04, subdivision 4, 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 mental health certified peer specialist who is qualified according to section 245I.04,
subdivision 10;

(2) a mental health certified family peer specialist who is qualified according to section
245I.04, subdivision 12;

(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 who is qualified according to section 245I.04,
subdivision 14;

(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. 15.

Minnesota Statutes 2022, 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:

(1) 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.0659 and
community first services and supports under section 256B.85; and

(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.

(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 (n) Effective for services rendered on or after January 1, 2024, the commissioner shall
require, as part of a contract, that all managed care plans use timely claim filing timelines
of twelve months and use remittance advice and prior authorizations timelines consistent
with those used under medical assistance fee-for-service for mental health and substance
use disorder treatment services. A managed care plan under this section may not take back
funds the managed care plan paid to a mental health and substance use disorder treatment
provider once six months have elapsed from the date the funds were paid.
new text end

Sec. 16. new text begin DIRECTION TO THE COMMISSIONER.
new text end

new text begin By October 1, 2023, the commissioner of human services shall report to the chairs and
ranking minority members of the committees with jurisdiction over behavioral health on
the completed implementation of the requirements under Minnesota Statutes, section
256B.0617. The report shall outline the completed components related to certification,
recertification, and decertification and provide templates of all required documents developed
pursuant to that section.
new text end