HF 3865

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/26/2024 03:38pm

A bill for an act
relating to human services; modifying provisions related to assertive community
treatment; amending Minnesota Statutes 2022, section 256B.0622, subdivisions
2a, 3a, 7a, 7d; Minnesota Statutes 2023 Supplement, section 256B.0622, subdivision
7b.

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

Section 1.

Minnesota Statutes 2022, section 256B.0622, subdivision 2a, is amended to
read:

Subd. 2a.

Eligibility for assertive community treatment.

An eligible client for assertive
community treatment is an individual who meets the following criteria as assessed by an
ACT team:

(1) is age 18 or older. Individuals ages 16 and 17 may be eligible upon approval by the
commissioner;

(2) has a primary diagnosis of schizophrenia, schizoaffective disorder, major depressive
disorder with psychotic features, other psychotic disorders, or bipolar disorder. Individuals
with other psychiatric illnesses may qualify for assertive community treatment if they have
a serious mental illness and meet the criteria outlined in clauses (3) and (4), but no more
than ten percent of an ACT team's clients may be eligible based on this criteria. Individuals
with a primary diagnosis of a substance use disorder, intellectual developmental disabilities,
borderline personality disorder, antisocial personality disorder, traumatic brain injury, or
an autism spectrum disorder are not eligible for assertive community treatment;

(3) has significant functional impairment as demonstrated by at least one of the following
conditions:

(i) significant difficulty consistently performing the range of routine tasks required for
basic adult functioning in the community or persistent difficulty performing daily living
tasks without significant support or assistance;

(ii) significant difficulty maintaining employment at a self-sustaining level or significant
difficulty consistently carrying out the head-of-household responsibilities; or

(iii) significant difficulty maintaining a safe living situation;

(4) has a need for continuous high-intensity services as evidenced by at least two of the
following:

(i) two or more psychiatric hospitalizations or residential crisis stabilization services in
the previous 12 months;

(ii) frequent utilization of mental health crisis services in the previous six months;

(iii) 30 or more consecutive days of psychiatric hospitalization in the previous 24 months;

(iv) intractable, persistent, or prolonged severe psychiatric symptoms;

(v) coexisting mental health and substance use disorders lasting at least six months;

(vi) recent history of involvement with the criminal justice system or demonstrated risk
of future involvement;

(vii) significant difficulty meeting basic survival needs;

(viii) residing in substandard housing, experiencing homelessness, or facing imminent
risk of homelessness;

(ix) significant impairment with social and interpersonal functioning such that basic
needs are in jeopardy;

(x) coexisting mental health and physical health disorders lasting at least six months;

(xi) residing in an inpatient or supervised community residence but clinically assessed
to be able to live in a more independent living situation if intensive services are provided;

(xii) requiring a residential placement if more intensive services are not available; deleted text begin or
deleted text end

(xiii) difficulty effectively using traditional office-based outpatient services; new text begin or
new text end

new text begin (xiv) receiving services through a program that meets the requirements for the first
episode of psychosis grant program under section 245.4905 and having been determined to
need an ACT team;
new text end

(5) there are no indications that other available community-based services would be
equally or more effective as evidenced by consistent and extensive efforts to treat the
individual; and

(6) in the written opinion of a licensed mental health professional, has the need for mental
health services that cannot be met with other available community-based services, or is
likely to experience a mental health crisis or require a more restrictive setting if assertive
community treatment is not provided.

Sec. 2.

Minnesota Statutes 2022, section 256B.0622, subdivision 3a, is amended to read:

Subd. 3a.

Provider certification and contract requirements for assertive community
treatment.

(a) The assertive community treatment provider must deleted text begin :
deleted text end

deleted text begin (1) have a contract with the host county to provide assertive community treatment
services; and
deleted text end

deleted text begin (2) deleted text end have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section,
the standards in chapter 245I as required in section 245I.011, subdivision 5, and minimum
program fidelity standards as measured by a nationally recognized fidelity tool approved
by the commissioner. Recertification must occur at least every three years.

(b) An ACT team certified under this subdivision must meet the following standards:

(1) have capacity to recruit, hire, manage, and train required ACT team members;

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

(3) ensure flexibility in service delivery to respond to the changing and intermittent care
needs of a client as identified by the client and the individual treatment plan;

(4) keep all necessary records required by law;

(5) be an enrolled Medicaid provider; and

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

(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.

Sec. 3.

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 deleted text begin provide deleted text end new text begin ensure that new text end overall treatment supervision to the ACT
team new text begin is available new text end after regular business hours and on weekends and holidays deleted text begin . The team
leader may delegate this duty to another deleted text end new text begin , and is provided by a new text end qualified member of the ACT
team;

(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. 4.

Minnesota Statutes 2023 Supplement, section 256B.0622, subdivision 7b, is
amended to read:

Subd. 7b.

Assertive community treatment program deleted text begin size and opportunities deleted text end new text begin scores new text end .

deleted text begin (a) deleted text end
Each ACT team deleted text begin shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows: deleted text end new text begin must demonstrate that the team
attained a passing score according to the most recently issued Tool for Measurement of
Assertive Community Treatment (TMACT).
new text end

deleted text begin (1) a small ACT team must:
deleted text end

deleted text begin (i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
deleted text end

deleted text begin (ii) serve an annual average maximum of no more than 50 clients;
deleted text end

deleted text begin (iii) ensure at least one full-time equivalent position for every eight clients served;
deleted text end

deleted text begin (iv) schedule ACT team staff on weekdays and on-call duty to provide crisis services
and deliver services after hours when staff are not working;
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
deleted text end

deleted text begin (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
deleted text end

deleted text begin (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
deleted text end

deleted text begin (2) a midsize ACT team shall:
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
deleted text end

deleted text begin (iii) serve an annual average maximum caseload of 51 to 74 clients;
deleted text end

deleted text begin (iv) ensure at least one full-time equivalent position for every nine clients served;
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
deleted text end

deleted text begin (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
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (3) a large ACT team must:
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
deleted text end

deleted text begin (iii) serve an annual average maximum caseload of 75 to 100 clients;
deleted text end

deleted text begin (iv) ensure at least one full-time equivalent position for every nine individuals served;
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

Sec. 5.

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

Subd. 7d.

Assertive community treatment assessment and individual treatment
plan.

(a) An initial assessment shall be completed the day of the client's admission to
assertive community treatment by the ACT team leader or the psychiatric care provider,
with participation by designated ACT team members and the client. The initial assessment
must include obtaining or completing a standard diagnostic assessment according to section
245I.10, subdivision 6, and completing a 30-day individual treatment plan. The team leader,
psychiatric care provider, or other mental health professional designated by the team leader
or psychiatric care provider, must update the client's diagnostic assessment deleted text begin at least annually deleted text end new text begin
as required under section 245I.10, subdivision 2, paragraphs (f) and (g) new text end .

(b) A functional assessment must be completed according to section 245I.10, subdivision
9. Each part of the functional assessment areas shall be completed by each respective team
specialist or an ACT team member with skill and knowledge in the area being assessed.

(c) Between 30 and 45 days after the client's admission to assertive community treatment,
the entire ACT team must hold a comprehensive case conference, where all team members,
including the psychiatric provider, present information discovered from the completed
assessments and provide treatment recommendations. The conference must serve as the
basis for the first individual treatment plan, which must be written by the primary team
member.

(d) The client's psychiatric care provider, primary team member, and individual treatment
team members shall assume responsibility for preparing the written narrative of the results
from the psychiatric and social functioning history timeline and the comprehensive
assessment.

(e) The primary team member and individual treatment team members shall be assigned
by the team leader in collaboration with the psychiatric care provider by the time of the first
treatment planning meeting or 30 days after admission, whichever occurs first.

(f) Individual treatment plans must be developed through the following treatment planning
process:

(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.

(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.

(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.

(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.

(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.

(6) The individual treatment plan and review must be approved or acknowledged by the
client, the primary team member, the team leader, the psychiatric care provider, and all
individual treatment team members. A copy of the approved individual treatment plan must
be made available to the client.

Sec. 6. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the Office of Senate Counsel, Research and
Fiscal Analysis; the House Research Department; and the commissioner of human services,
shall prepare legislation for the 2025 legislative session to recodify Minnesota Statutes,
section 256B.0622, to move provisions related to assertive community treatment and intensive
residential treatment services into separate sections of statute. The revisor shall correct any
cross-references made necessary by this recodification.
new text end