HF 3397

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/11/2024 04:40pm

A bill for an act
relating to behavioral health; modifying requirements for peer recovery support
services and recovery peers; requiring the development of a tiered reimbursement
rate structure for recovery peers; amending Minnesota Statutes 2022, sections
245F.08, subdivision 3; 254B.01, by adding subdivisions; Minnesota Statutes 2023
Supplement, sections 245G.07, subdivision 2; 245I.04, subdivision 19; 254B.05,
subdivisions 1, 5; proposing coding for new law in Minnesota Statutes, chapter
254B.

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

Section 1.

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

Subd. 3.

Peer recovery support services.

deleted text begin (a) Peers in recovery serve as mentors or
recovery-support partners for individuals in recovery, and may provide encouragement,
self-disclosure of recovery experiences, transportation to appointments, assistance with
finding resources that will help locate housing, job search resources, and assistance finding
and participating in support groups.
deleted text end

deleted text begin (b) deleted text end Peer recovery support services deleted text begin are provided by a recovery peer and must be supervised
by the responsible staff person deleted text end new text begin must be provided according to sections 254B.05, subdivision
5, and 254B.052 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 2.

Minnesota Statutes 2023 Supplement, section 245G.07, subdivision 2, is amended
to read:

Subd. 2.

Additional treatment service.

A license holder may provide or arrange the
following additional treatment service as a part of the client's individual treatment plan:

(1) relationship counseling provided by a qualified professional to help the client identify
the impact of the client's substance use disorder on others and to help the client and persons
in the client's support structure identify and change behaviors that contribute to the client's
substance use disorder;

(2) therapeutic recreation to allow the client to participate in recreational activities
without the use of mood-altering chemicals and to plan and select leisure activities that do
not involve the inappropriate use of chemicals;

(3) stress management and physical well-being to help the client reach and maintain an
appropriate level of health, physical fitness, and well-being;

(4) living skills development to help the client learn basic skills necessary for independent
living;

(5) employment or educational services to help the client become financially independent;

(6) socialization skills development to help the client live and interact with others in a
positive and productive manner;

(7) room, board, and supervision at the treatment site to provide the client with a safe
and appropriate environment to gain and practice new skills; and

(8) peer recovery support services new text begin must be new text end provided by deleted text begin an individual in deleted text end new text begin a new text end recovery new text begin peer new text end
qualified according to section 245I.04, subdivision 18. Peer new text begin recovery new text end support services deleted text begin include
education; advocacy; mentoring through self-disclosure of personal recovery experiences;
attending recovery and other support groups with a client; accompanying the client to
appointments that support recovery; assistance accessing resources to obtain housing,
employment, education, and advocacy services; and nonclinical recovery support to assist
the transition from treatment into the recovery community deleted text end new text begin must be provided according to
sections 254B.05, subdivision 5, and 254B.052 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 3.

Minnesota Statutes 2023 Supplement, section 245I.04, subdivision 19, is amended
to read:

Subd. 19.

Recovery peer scope of practice.

new text begin (a) new text end A recovery peer, under the supervision
of deleted text begin an deleted text end new text begin a licensed new text end alcohol and drug counselor new text begin or mental health professional who meets the
qualifications under subdivision 2 new text end , must:

(1) provide individualized peer support new text begin and individual recovery planning new text end to each client;

(2) promote a client's recovery goals, self-sufficiency, self-advocacy, and development
of natural supports; and

(3) support a client's maintenance of skills that the client has learned from other services.

new text begin (b) A licensed alcohol and drug counselor or mental health professional providing
supervision to a recovery peer must meet with the recovery peer face-to-face, either remotely
or in person, at least once per month, in order to provide adequate supervision to the recovery
peer. Supervision must include reviewing individual recovery plans, as defined in section
254B.01, subdivision 4e, for clients, and may include client updates, discussion of ethical
considerations, and any other questions or issues relevant to peer recovery support services.
new text end

Sec. 4.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision to
read:

new text begin Subd. 4e. new text end

new text begin Individual recovery plan. new text end

new text begin "Individual recovery plan" means a person-centered
outline of supports that an eligible vendor of peer recovery support services under section
254B.05, subdivision 1, must develop to respond to an individual's peer recovery support
services needs and goals.
new text end

Sec. 5.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision to
read:

new text begin Subd. 8a. new text end

new text begin Recovery peer. new text end

new text begin "Recovery peer" means a person who is qualified according
to section 245I.04, subdivision 18, to provide peer recovery support services within the
scope of practice provided under section 245I.04, subdivision 19.
new text end

Sec. 6.

Minnesota Statutes 2023 Supplement, section 254B.05, subdivision 1, is amended
to read:

Subdivision 1.

Licensure new text begin or certification new text end required.

(a) Programs licensed by the
commissioner are eligible vendors. Hospitals may apply for and receive licenses to be
eligible vendors, notwithstanding the provisions of section 245A.03. American Indian
programs that provide substance use disorder treatment, extended care, transitional residence,
or outpatient treatment services, and are licensed by tribal government are eligible vendors.

(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment and assessment summary provided according to
section 245G.05, and treatment services provided according to sections 245G.06 and
245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses
(1) to (6).

(c) A county is an eligible vendor for a comprehensive assessment and assessment
summary when provided by an individual who meets the staffing credentials of section
245G.11, subdivisions 1 and 5, and completed according to the requirements of section
245G.05. A county is an eligible vendor of care coordination services when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and
provided according to the requirements of section 245G.07, subdivision 1, paragraph (a),
clause (5). A county is an eligible vendor of peer recovery services when the services are
provided by an individual who meets the requirements of section 245G.11, subdivision 8.

(d) A recovery community organization that meets the requirements of clauses (1) to
(10) and meets deleted text begin membership deleted text end new text begin certification new text end or accreditation requirements of the deleted text begin Association
of Recovery Community Organizations deleted text end new text begin Alliance for Recovery Centered Organizations new text end , the
Council on Accreditation of Peer Recovery Support Services, or deleted text begin a Minnesota statewide
recovery community organization identified by the commissioner deleted text end new text begin the Minnesota Alliance
of Recovery Community Organizations new text end is an eligible vendor of peer new text begin recovery new text end support
services. Eligible vendors under this paragraph must:

(1) be nonprofit organizations new text begin under section 501(c)(3) of the Internal Revenue Code, be
free from conflicting self-interests, and be autonomous in decision-making, program
development, peer recovery support services provided, and advocacy efforts for the purpose
of supporting the recovery community organization's mission new text end ;

(2) be led and governed by individuals in the recovery community, with more than 50
percent of the board of directors or advisory board members self-identifying as people in
personal recovery from substance use disorders;

(3) deleted text begin primarily focus on recovery from substance use disorders, with missions and visions
that support this primary focus deleted text end new text begin have a mission statement and conduct corresponding activities
indicating that the organization's primary purpose is to support recovery from substance
use disorder new text end ;

(4) deleted text begin be grassroots and reflective of and engaged with the community served deleted text end new text begin demonstrate
ongoing community engagement with the identified primary region and population served
by the organization, including individuals in recovery and their families, friends, and recovery
allies new text end ;

(5) be accountable to the recovery community through new text begin priority-setting and participatory
decision-making new text end processes that promote the deleted text begin involvement and deleted text end engagement of, and consultation
with, people in recovery and their families, friends, and recovery allies;

(6) provide nonclinical peer recovery support services, including but not limited to
recovery support groups, recovery coaching, telephone recovery support, skill-building
deleted text begin groups deleted text end , and harm-reduction activities new text begin , and provide recovery public education and advocacy new text end ;

(7) new text begin have written policies that new text end allow for and support opportunities for all paths toward
recovery and refrain from excluding anyone based on their chosen recovery path, which
may include but is not limited to harm reduction paths, faith-based paths, and nonfaith-based
paths;

(8) deleted text begin be purposeful in meeting the diverse deleted text end new text begin maintain organizational practices to meet the new text end
needs of Black, Indigenous, and people of color communities, deleted text begin including deleted text end new text begin LGBTQ+
communities, and other underrepresented or marginalized communities. Organizational
practices may include new text end board and staff deleted text begin development activities, organizational practices deleted text end new text begin
training new text end , service offerings, advocacy efforts, and culturally informed outreach and deleted text begin service
plans deleted text end new text begin services new text end ;

(9) deleted text begin be stewards of deleted text end new text begin use new text end recovery-friendly language new text begin in all media and written materials new text end that
is supportive of and promotes recovery across diverse geographical and cultural contexts
and reduces stigma; and

(10) new text begin establish and new text end maintain deleted text begin an employee and volunteer deleted text end new text begin a publicly available recovery
community organization new text end code of ethics and deleted text begin easily accessible deleted text end grievance new text begin policy and new text end procedures
deleted text begin posted in physical spaces, on websites, or on program policies or forms deleted text end .

(e) new text begin A new text end recovery community deleted text begin organizations deleted text end new text begin organization new text end approved by the commissioner
before June 30, 2023, deleted text begin shall retain their designation as recovery community organizations deleted text end new text begin
must meet the requirements under paragraph (d) by January 1, 2025, in order to be an eligible
vendor of peer recovery support services new text end .

(f) A recovery community organization that is aggrieved by an accreditation new text begin , certification, new text end
or membership determination and believes it meets the requirements under paragraph (d)
may appeal the determination under section 256.045, subdivision 3, paragraph (a), clause
(15), for reconsideration as an eligible vendor. new text begin If the human services judge determines that
the recovery community organization meets the requirements under paragraph (d), the
recovery community organization is an eligible vendor of peer recovery support services.
new text end

(g) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.

(h) Hospitals, federally qualified health centers, and rural health clinics are eligible
vendors of a comprehensive assessment when the comprehensive assessment is completed
according to section 245G.05 and by an individual who meets the criteria of an alcohol and
drug counselor according to section 245G.11, subdivision 5. The alcohol and drug counselor
must be individually enrolled with the commissioner and reported on the claim as the
individual who provided the service.

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 2023 Supplement, 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) those licensed, as applicable, according to chapter 245G or applicable Tribal license
and provided according to the following ASAM levels of care:

(i) ASAM level 0.5 early intervention services provided according to section 254B.19,
subdivision 1, clause (1);

(ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
subdivision 1, clause (2);

(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
subdivision 1, clause (3);

(iv) ASAM level 2.5 partial hospitalization services provided according to section
254B.19, subdivision 1, clause (4);

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5);

(vi) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6); and

(vii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7);

(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;

(3) treatment 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) withdrawal management services provided according to chapter 245F;

(6) 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;

(7) 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;

(8) ASAM 3.5 clinically managed high-intensity residential services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license, which
provide ASAM level of care 3.5 according to section 254B.19, subdivision 1, clause (7),
and are 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

(9) 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) is licensed under chapter 245A and sections 245G.01 to 245G.19; 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 9502;

(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;

(3) disability responsive programs as defined in section 254B.01, subdivision 4b;

(4) 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; or

(5) programs that offer services to individuals with co-occurring mental health and
substance use disorder problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) 25 percent of the counseling staff are licensed mental health professionals under
section 245I.04, subdivision 2, or are students or licensing candidates under the supervision
of a licensed alcohol and drug counselor supervisor and mental health professional under
section 245I.04, subdivision 2, 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;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(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;

(v) family education is offered that addresses mental health and substance use disorder
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

(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 substance use disorder facility of the child care provider's current licensure to provide
child care services.

(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).

(f) deleted text begin Subject to federal approval, deleted text end Substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services 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.

(g) 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.

(h) 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.

(i) Payment for substance use disorder services under this section must start from the
day of service initiation, when the comprehensive assessment is completed within the
required timelines.

new text begin (j) Eligible vendors of peer recovery support services must:
new text end

new text begin (1) submit to a review by the commissioner of up to 15 percent of all medical assistance
and behavioral health fund claims to determine the medical necessity of peer recovery
support services for entities billing for peer recovery support services individually and not
receiving a daily rate;
new text end

new text begin (2) limit an individual client to 14 hours per week for peer recovery support services
from an individual provider of peer recovery support services. Additional service hours
may be authorized at the commissioner's discretion; and
new text end

new text begin (3) require authorization for more than 728 hours of peer recovery support services per
calendar year for an individual client receiving services.
new text end

new text begin (k) Peer recovery support services not provided in accordance with section 254B.052
are subject to monetary recovery under section 256B.064 as money improperly paid.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 8.

new text begin [254B.052] PEER RECOVERY SUPPORT SERVICES REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Peer recovery support services; service requirements. new text end

new text begin (a) Peer recovery
support services are face-to-face interactions between a recovery peer and a client in which
specific goals identified in an individual recovery plan, treatment plan, or stabilization plan
are discussed and addressed. Peer recovery support services are provided to promote a
client's recovery goals, self-sufficiency, self-advocacy, and development of natural supports,
and to support maintenance of a client's recovery.
new text end

new text begin (b) Peer recovery support services must be provided according to an individual recovery
plan if provided by a recovery community organization or county, a treatment plan if provided
in a substance use disorder treatment program under chapter 245G, or a stabilization plan
if provided by a withdrawal management program under chapter 245F.
new text end

new text begin (c) A client receiving peer recovery support services must participate in the services
voluntarily. Any program that incorporates peer recovery support services must provide
written notice to the client that peer recovery support services will be provided.
new text end

new text begin (d) Peer recovery support services may include limited transportation or group activities
directly related to a client's individual recovery plan. Peer recovery support services may
not be provided to a client residing with or employed by a recovery peer from whom they
receive services.
new text end

new text begin Subd. 2. new text end

new text begin Individual recovery plan. new text end

new text begin (a) The individual recovery plan must be developed
with the client, and must be completed within the first three sessions with a recovery peer.
A recovery peer may bill for up to two hours prior to the client's completion of a
comprehensive assessment.
new text end

new text begin (b) The recovery peer must document how each session ties into the client's individual
recovery plan. The individual recovery plan must be updated as needed. The individual
recovery plan must include:
new text end

new text begin (1) the client's name;
new text end

new text begin (2) the recovery peer's name;
new text end

new text begin (3) the name of the recovery peer's supervisor;
new text end

new text begin (4) the client's recovery goals;
new text end

new text begin (5) the client's resources and assets to support recovery;
new text end

new text begin (6) activities that may support meeting identified goals; and
new text end

new text begin (7) the planned frequency of peer recovery support services sessions between the recovery
peer and the client.
new text end

new text begin Subd. 3. new text end

new text begin Eligible vendor documentation requirements. new text end

new text begin An eligible vendor of peer
recovery support services under section 254B.05, subdivision 1, must keep a secure file for
each individual receiving medical assistance peer recovery support services. The file must
include, at a minimum:
new text end

new text begin (1) the client's comprehensive assessment under section 245G.05 that led to the client's
referral for peer recovery support services;
new text end

new text begin (2) the client's individual recovery plan; and
new text end

new text begin (3) documentation of each billed peer recovery support services interaction between the
client and the recovery peer, including the date, start and end time with a.m. and p.m.
designations, the client's response, and the name of the recovery peer who provided the
service.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 9. new text begin RECOVERY PEERS; TIERED REIMBURSEMENT RATES.
new text end

new text begin (a) The commissioner of human services shall develop and implement a tiered
reimbursement rate structure for recovery peers who meet the qualifications under Minnesota
Statutes, section 245I.04, subdivision 18. The rate structure must include two rate tiers, as
follows:
new text end

new text begin (1) tier one, providing peer recovery support services on a one-on-one basis; and
new text end

new text begin (2) tier two, providing peer recovery support services for a group of up to four clients,
if appropriate based on each client's individual recovery plan.
new text end

new text begin (b) The commissioner shall implement the tiered reimbursement rate structure no later
than September 1, 2024.
new text end

Sec. 10. new text begin PEER RECOVERY SUPPORT SERVICES AND RECOVERY
COMMUNITY ORGANIZATION WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; duties. new text end

new text begin The commissioner of human services must
convene a working group to develop recommendations on:
new text end

new text begin (1) peer recovery support services billing rates and practices, including a billing model
for providing services to groups larger than four clients at one time;
new text end

new text begin (2) acceptable activities to bill for peer recovery services, including group activities and
transportation related to individual recovery plans;
new text end

new text begin (3) ways to address authorization for additional service hours and a review of the amount
of peer recovery support services clients may need;
new text end

new text begin (4) improving recovery peer supervision and reimbursement for the costs of providing
recovery peer supervision for provider organizations;
new text end

new text begin (5) certification or other regulation of recovery community organizations and recovery
peers; and
new text end

new text begin (6) policy and statutory changes to improve access to peer recovery support services
and increase oversight of provider organizations.
new text end

new text begin Subd. 2. new text end

new text begin Membership; meetings. new text end

new text begin (a) Members of the working group must include, but
not be limited to:
new text end

new text begin (1) a representative of the Alliance for Recovery Centered Organizations;
new text end

new text begin (2) a representative of the Minnesota Alliance of Recovery Community Organizations;
new text end

new text begin (3) a representative of the Council on Accreditation of Peer Recovery Support Services;
new text end

new text begin (4) a representative of the Minnesota Association of Resources for Recovery and
Chemical Health;
new text end

new text begin (5) representatives from at least three recovery community organizations who are eligible
vendors of peer recovery support services under Minnesota Statutes, section 254B.05,
subdivision 1;
new text end

new text begin (6) at least two currently practicing recovery peers qualified under Minnesota Statutes,
section 245I.04, subdivision 18;
new text end

new text begin (7) at least two individuals currently providing supervision for recovery peers according
to Minnesota Statutes, section 245I.04, subdivision 19;
new text end

new text begin (8) the commissioner of human services or a designee;
new text end

new text begin (9) a representative of county social services agencies; and
new text end

new text begin (10) a representative of a Tribal social services agency.
new text end

new text begin (b) The commissioner of human services must make appointments to the working group
by July 1, 2024, and convene the first meeting of the working group by August 1, 2024.
new text end

new text begin (c) The commissioner of human services must provide administrative support and meeting
space for the working group. The working group may conduct meetings remotely.
new text end

new text begin Subd. 3. new text end

new text begin Report. new text end

new text begin The commissioner must complete and submit a report on the
recommendations in this section to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance on or before
December 15, 2024.
new text end

new text begin Subd. 4. new text end

new text begin Expiration. new text end

new text begin The working group expires upon submission of the report to the
legislature under subdivision 3.
new text end