HF 3486

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/20/2024 01:15pm

A bill for an act
relating to substance use disorder treatment; modifying continuing education
requirements for licensed alcohol and drug counselors; allowing for religious
objections to placements in substance use disorder treatment programs; modifying
comprehensive assessment requirements; prohibiting courts or other placement
authorities from compelling an individual to participate in religious elements of
substance use disorder treatment; requiring a report; amending Minnesota Statutes
2022, sections 244.0513, by adding a subdivision; 245F.10, subdivision 1; 245G.13,
by adding a subdivision; 245G.15, subdivision 1; 253B.03, subdivisions 4, 10;
253B.04, subdivision 1; Minnesota Statutes 2023 Supplement, sections 241.415;
245I.10, subdivision 6; 609.14, subdivision 2a; proposing coding for new law in
Minnesota Statutes, chapters 241; 254B.

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

Section 1.

Minnesota Statutes 2023 Supplement, section 241.415, is amended to read:

241.415 RELEASE PLANS; SUBSTANCE ABUSE.

The commissioner shall cooperate with community-based corrections agencies to
determine how best to address the substance deleted text begin abuse deleted text end new text begin use disorder new text end treatment needs of offenders
who are being released from prison. The commissioner shall ensure that an offender's prison
release plan adequately addresses the offender's needs for substance deleted text begin abuse deleted text end new text begin use disorder new text end
assessment, treatment, or other services following release, within the limits of available
resources. The commissioner must provide individuals with known or stated histories of
opioid use disorder with emergency opiate antagonist rescue kits upon release. new text begin An offender
who in good faith objects to any religious element of a substance use disorder treatment
program shall not be required to participate in that treatment program as part of a prison
release plan under this section. The commissioner must document the offender's good faith
objection and may require the offender to participate in an equivalent alternative treatment
program to which the offender has no religious objection. If an equivalent alternative
treatment program is not available within a reasonable time, the offender may decline to
participate in any religious element of a treatment program to which the offender objects.
The commissioner may not use an offender's good faith refusal to participate in a treatment
program or element of a treatment program to adversely impact the offender's term of
incarceration or supervised release conditions.
new text end

Sec. 2.

new text begin [241.417] SUBSTANCE USE DISORDER TREATMENT; RELIGIOUS
ELEMENTS.
new text end

new text begin (a) No court, corrections officer, probation officer, or other placing authority, or an
organization providing services under contract with any such individual or entity, shall
directly or indirectly compel an individual to participate in any religious element of a
substance use disorder treatment program if the individual objects in good faith. If an
individual objects to the religious character or any religious element of a substance use
disorder treatment program, the entity requiring the individual to receive substance use
disorder treatment must document the individual's objection and may require the individual
to participate in an equivalent alternative treatment program to which the individual has no
religious objection. If an equivalent alternative treatment program is not available within a
reasonable time, the individual may decline to participate in any religious element of a
treatment program to which the individual objects. An individual's good faith refusal to
participate in a treatment program or element of a treatment program for religious reasons
may not adversely impact the individual's ability to receive treatment, the duration of the
individual's treatment, or requirements for discharge from treatment.
new text end

new text begin (b) For purposes of this section, "directly or indirectly compel" means:
new text end

new text begin (1) requiring an individual to receive substance use disorder treatment from a specific
type of program or treatment that includes religious elements;
new text end

new text begin (2) requiring an individual to receive substance use disorder treatment that meets
nonclinical criteria that limits the number of equivalent alternative providers available, such
as requiring the individual to have a sponsor or prohibiting the individual from receiving
medication-assisted treatment; or
new text end

new text begin (3) preventing an individual from receiving substance use disorder treatment solely
because of the individual's objection to or refusal to participate in a religious element of the
treatment program.
new text end

Sec. 3.

Minnesota Statutes 2022, section 244.0513, is amended by adding a subdivision
to read:

new text begin Subd. 5a. new text end

new text begin Substance use disorder treatment program religious objections. new text end

new text begin An offender
who in good faith objects to any religious element of a substance use disorder treatment
program must not be required to participate in that treatment program as a condition of
release under this section. The commissioner must document the offender's good faith
objection and may require the offender to participate in an equivalent alternative treatment
program to which the offender has no religious objection. If an equivalent alternative
treatment program is not available within a reasonable time, the offender may decline to
participate in any religious element of a treatment program to which the offender objects.
The commissioner may not use an offender's good faith refusal to participate in a treatment
program or element of a treatment program to adversely impact the offender's term of
incarceration or supervised release conditions.
new text end

Sec. 4.

Minnesota Statutes 2022, section 245F.10, subdivision 1, is amended to read:

Subdivision 1.

Patient rights.

Patients have the rights in sections 144.651, 148F.165,
deleted text begin and deleted text end new text begin 241.417, and new text end 253B.03, as applicable. The license holder must give each patient, upon
admission, a written statement of patient rights. Program staff must review the statement
with the patient.

Sec. 5.

Minnesota Statutes 2022, section 245G.13, is amended by adding a subdivision to
read:

new text begin Subd. 2a. new text end

new text begin Staff continuing education workshops. new text end

new text begin The commissioner shall develop and
make available continuing education workshops for licensee program staff members who
are not licensed by a health-related licensing board, including recovery peers. The workshops
must include information on:
new text end

new text begin (1) statutory and regulatory requirements related to religious objections in substance use
disorder treatment programs;
new text end

new text begin (2) serving clients who object to religious or spiritual elements of substance use disorder
treatment programs;
new text end

new text begin (3) serving clients who have experienced trauma related to religion or spirituality; and
new text end

new text begin (4) offering a variety of substance use disorder treatment and peer recovery support
approaches and modalities to best serve a diverse range of clients.
new text end

Sec. 6.

Minnesota Statutes 2022, section 245G.15, subdivision 1, is amended to read:

Subdivision 1.

Explanation.

A client has the rights identified in sections 144.651,
148F.165, deleted text begin and deleted text end new text begin 241.417, and new text end 253B.03, as applicable. The license holder must give each
client on the day of service initiation a written statement of the client's rights and
responsibilities. A staff member must review the statement with a client at that time.

Sec. 7.

Minnesota Statutes 2023 Supplement, 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. An alcohol and drug counselor
may gather and document the information in paragraphs (b) and (c) when completing a
comprehensive assessment according to section 245G.05.

(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, including withdrawal symptoms,
medical conditions, and behavioral and emotional symptoms;

(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 and substance use disorder treatment;

(10) cultural influences on the client; deleted text begin and
deleted text end

new text begin (11) the client's religious preference, if any; and
new text end

deleted text begin (11) deleted text end new text begin (12) new text end substance use history, if applicable, including:

(i) amounts and types of substances, frequency and duration, route of administration,
periods of abstinence, and circumstances of relapse; and

(ii) the impact to functioning when under the influence of substances, including legal
interventions.

(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.

(3) 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; and

(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.

(g) Information from other providers and prior assessments may be used to complete
the diagnostic assessment if the source of the information is documented in the diagnostic
assessment.

Sec. 8.

Minnesota Statutes 2022, section 253B.03, subdivision 4, is amended to read:

Subd. 4.

Special visitation; religion.

new text begin (a) new text end A patient has the right to meet with or call a
personal physician, advanced practice registered nurse, or physician assistant; spiritual
advisor; and counsel at all reasonable times. The patient has the right to continue the practice
of religion.

new text begin (b) A patient has the right to refrain from any religious or spiritual exercise or activity.
A patient who in good faith objects to the religious character of a treatment facility or
program or state-operated treatment program has the right to participate in an equivalent
alternative treatment program to which the patient has no religious objection. If an equivalent
alternative facility or treatment program is not available within a reasonable time or is not
clinically appropriate, the patient may decline to participate in any religious element of a
treatment program to which the patient objects. A patient's good faith refusal to participate
in a treatment program or element of a treatment program for religious reasons may not
adversely impact the duration of the patient's civil commitment or requirements for discharge.
new text end

Sec. 9.

Minnesota Statutes 2022, section 253B.03, subdivision 10, is amended to read:

Subd. 10.

Notification.

(a) All patients admitted or committed to a treatment facility or
state-operated treatment program, or temporarily confined under section 253B.045, shall
be notified in writing of their rights regarding hospitalization and other treatment.

(b) This notification must include:

(1) patient rights specified in this section and section 144.651, including nursing home
discharge rights;

(2) the right to obtain treatment and services voluntarily under this chapter;

(3) the right to voluntary admission and release under section 253B.04;

(4) rights in case of an emergency admission under section 253B.051, including the right
to documentation in support of an emergency hold and the right to a summary hearing before
a judge if the patient believes an emergency hold is improper;

(5) the right to request expedited review under section 62M.05 if additional days of
inpatient stay are denied;

(6) the right to continuing benefits pending appeal and to an expedited administrative
hearing under section 256.045 if the patient is a recipient of medical assistance or
MinnesotaCare; deleted text begin and
deleted text end

new text begin (7) the right to participate in an equivalent alternative treatment program or to decline
to participate in any element of a treatment program if the patient objects in good faith to
the religious character of a treatment facility or element of a treatment program; and
new text end

deleted text begin (7) deleted text end new text begin (8) new text end the right to an external appeal process under section 62Q.73, including the right
to a second opinion.

Sec. 10.

Minnesota Statutes 2022, section 253B.04, subdivision 1, is amended to read:

Subdivision 1.

Voluntary admission and treatment.

(a) Voluntary admission is preferred
over involuntary commitment and treatment. Any person 16 years of age or older may
request to be admitted to a treatment facility or state-operated treatment program as a
voluntary patient for observation, evaluation, diagnosis, care and treatment without making
formal written application. Any person under the age of 16 years may be admitted as a
patient with the consent of a parent or legal guardian if it is determined by independent
examination that there is reasonable evidence that (1) the proposed patient has a mental
illness, developmental disability, or chemical dependency; and (2) the proposed patient is
suitable for treatment. The head of the treatment facility or head of the state-operated
treatment program shall not arbitrarily refuse any person seeking admission as a voluntary
patient. In making decisions regarding admissions, the treatment facility or state-operated
treatment program shall use clinical admission criteria consistent with the current applicable
inpatient admission standards established by professional organizations including the
American Psychiatric Association, the American Academy of Child and Adolescent
Psychiatry, the Joint Commission, and the American Society of Addiction Medicine. These
criteria must be no more restrictive than, and must be consistent with, the requirements of
section 62Q.53. The treatment facility or head of the state-operated treatment program may
not refuse to admit a person voluntarily solely because the person does not meet the criteria
for involuntary holds under section 253B.051 or the definition of a person who poses a risk
of harm due to mental illness under section 253B.02, subdivision 17a.

(b) In addition to the consent provisions of paragraph (a), a person who is 16 or 17 years
of age who refuses to consent personally to admission may be admitted as a patient for
mental illness or chemical dependency treatment with the consent of a parent or legal
guardian if it is determined by an independent examination that there is reasonable evidence
that the proposed patient is chemically dependent or has a mental illness and is suitable for
treatment. The person conducting the examination shall notify the proposed patient and the
parent or legal guardian of this determination.

(c) A person who is voluntarily participating in treatment for a mental illness is not
subject to civil commitment under this chapter if the person:

(1) has given informed consent or, if lacking capacity, is a person for whom legally valid
substitute consent has been given; and

(2) is participating in a medically appropriate course of treatment, including clinically
appropriate and lawful use of neuroleptic medication and electroconvulsive therapy. The
limitation on commitment in this paragraph does not apply if, based on clinical assessment,
the court finds that it is unlikely that the patient will remain in and cooperate with a medically
appropriate course of treatment absent commitment and the standards for commitment are
otherwise met. This paragraph does not apply to a person for whom commitment proceedings
are initiated pursuant to rule 20.01 or 20.02 of the Rules of Criminal Procedure, or a person
found by the court to meet the requirements under section 253B.02, subdivision 17. new text begin This
paragraph shall not be construed to compel a person to participate in a course of treatment
for substance use disorder to which they object in good faith based on the religious character
of the treatment or to prevent a person from transferring to an equivalent alternative course
of treatment if clinically appropriate and available within a reasonable time.
new text end

(d) Legally valid substitute consent may be provided by a proxy under a health care
directive, a guardian or conservator with authority to consent to mental health treatment,
or consent to admission under subdivision 1a or 1b.

Sec. 11.

new text begin [254B.035] SUBSTANCE USE DISORDER TREATMENT; RELIGIOUS
OBJECTIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Equivalent alternative substance use disorder treatment programs. new text end

new text begin To
ensure that an individual has equivalent alternative treatment options if the individual objects
to religious elements of a treatment program, the commissioner must license a broad range
of programs that are eligible vendors of services identified in section 254B.05 to provide
substance use disorder treatment, including programs that exclusively use secular treatment
modalities.
new text end

new text begin Subd. 2. new text end

new text begin Technical assistance. new text end

new text begin The commissioner must provide technical assistance to
all licensed substance use disorder treatment providers to ensure compliance with section
241.417.
new text end

Sec. 12.

Minnesota Statutes 2023 Supplement, section 609.14, subdivision 2a, is amended
to read:

Subd. 2a.

Alternatives to incarceration.

(a) A probation agent must present the court
with local options to address and correct the violation new text begin , new text end including deleted text begin , deleted text end but not limited to deleted text begin , deleted text end inpatient
deleted text begin chemical dependency deleted text end new text begin substance use disorder new text end treatment when the defendant at a summary
hearing provided by subdivision 2 is:

(1) a nonviolent controlled substance offender;

(2) subject to supervised probation;

(3) appearing based on a technical violation; and

(4) admitting or found to have violated any of the conditions of probation.

(b) For purposes of this subdivision, "nonviolent controlled substance offender" is a
person who meets the criteria described under section 244.0513, subdivision 2, clauses (1),
(2), and (5), and "technical violation" has the meaning given in section 244.195, subdivision
15.

new text begin (c) A defendant who in good faith objects to any religious element of a substance use
disorder treatment program shall not be required to participate in that treatment program as
an alternative to incarceration under this subdivision. The court must document the
defendant's good faith objection and may require the defendant to participate in an equivalent
alternative treatment program to which the defendant has no religious objection. If an
equivalent alternative treatment program is not available within a reasonable time, the
defendant may decline to participate in any religious element of a treatment program to
which the defendant objects. The commissioner may not use an offender's good faith refusal
to participate in a treatment program or element of a treatment program to adversely impact
the offender's term of incarceration or supervised release conditions.
new text end

Sec. 13. new text begin DIRECTION TO COMMISSIONER; RELIGION IN SUBSTANCE USE
DISORDER TREATMENT REPORT.
new text end

new text begin By January 15, 2026, the commissioner of human services shall submit a report to the
legislative committees with jurisdiction over substance use disorder treatment and criminal
justice, evaluating the prevalence of religion in substance use disorder treatment programs
and providing information on secular treatment options. The report must include:
new text end

new text begin (1) information on the number of individuals who have been required by a court or other
placing authority to participate in substance use disorder treatment programs with religious
elements, and the number of individuals who submit good faith objections under Minnesota
Statutes, section 241.417;
new text end

new text begin (2) an evaluation of the systems, processes, and barriers that result in these individuals
being required to participate in substance use disorder treatment programs with religious
elements to which they object;
new text end

new text begin (3) the statewide availability of substance use disorder treatment programs using treatment
approaches and modalities that do not include religious elements; and
new text end

new text begin (4) the status of the implementation of the requirements and prohibitions in Minnesota
Statutes, sections 241.417 and 254B.035.
new text end