HF 4366

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/25/2024 04:23pm

A bill for an act
relating to behavioral health; modifying civil commitment priority admission
requirements; specifying that a prisoner in a correctional facility is not responsible
for co-payments for mental health medications; allowing for reimbursement of
county co-payment expenses; appropriating money; amending Minnesota Statutes
2022, sections 245.4905; 246.18, subdivision 4a; 256B.0622, subdivisions 2a, 3a,
7a, 7d; 256B.0757, subdivision 5; 256B.76, subdivision 6; Minnesota Statutes
2023 Supplement, sections 246.54, subdivisions 1a, 1b; 253B.10, subdivision 1;
254B.04, subdivision 1a; 254B.05, subdivision 5; 256.969, subdivision 2b;
256B.0622, subdivision 7b; 256B.76, subdivision 1; 256B.761; 641.15, subdivision
2; proposing coding for new law in Minnesota Statutes, chapters 245; 253B;
repealing Minnesota Statutes 2022, section 256B.0625, subdivision 38.

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

ARTICLE 1

PRIORITY ADMISSIONS TO STATE-OPERATED TREATMENT PROGRAMS

Section 1.

Minnesota Statutes 2023 Supplement, section 253B.10, subdivision 1, is amended
to read:

Subdivision 1.

Administrative requirements.

(a) When a person is committed, the
court shall issue a warrant or an order committing the patient to the custody of the head of
the treatment facility, state-operated treatment program, or community-based treatment
program. The warrant or order shall state that the patient meets the statutory criteria for
civil commitment.

(b) deleted text begin The commissioner shall prioritize patients being admitted from jail or a correctional
institution who are deleted text end new text begin A person committed to the commissioner will be prioritized for admission
to a medically appropriate direct care and treatment program based on the decisions of
physicians in the executive medical director's office, using a priority admissions framework.
The framework must account for a range of factors for priority admission, including but
not limited to new text end :

(1) deleted text begin ordered confined in a state-operated treatment program for an examination under
Minnesota Rules of Criminal Procedure, deleted text end deleted text begin rules 20.01, subdivision 4 deleted text end deleted text begin , paragraph (a), and
deleted text end deleted text begin 20.02, subdivision 2 deleted text end new text begin the length of time the person has been on a waiting list for admission
to a direct care and treatment program new text end ;

(2) deleted text begin under civil commitment for competency treatment and continuing supervision under
Minnesota Rules of Criminal Procedure, deleted text end deleted text begin rule 20.01, subdivision 7 deleted text end new text begin the intensity of the
treatment the person needs, based on medical acuity new text end ;

(3) deleted text begin found not guilty by reason of mental illness under Minnesota Rules of Criminal
Procedure, deleted text end deleted text begin rule 20.02, subdivision 8 deleted text end deleted text begin , and under civil commitment or are ordered to be
detained in a state-operated treatment program pending completion of the civil commitment
proceedings; or deleted text end new text begin the person's provisional discharge status;
new text end

(4) deleted text begin committed under this chapter to the commissioner after dismissal of the patient's
criminal charges. deleted text end new text begin the person's safety and safety of others in the person's current environment;
new text end

new text begin (5) whether the person has access to necessary treatment in a program that is not a direct
care and treatment program;
new text end

new text begin (6) negative impacts of an admission delay on the facility referring the individual for
treatment; and
new text end

new text begin (7) any relevant federal prioritization requirements.
new text end

deleted text begin Patients described in this paragraph must be admitted to a state-operated treatment program
within 48 hours. The commitment must be ordered by the court as provided in section
253B.09, subdivision 1, paragraph (d).
deleted text end

(c) Upon the arrival of a patient at the designated treatment facility, state-operated
treatment program, or community-based treatment program, the head of the facility or
program shall retain the duplicate of the warrant and endorse receipt upon the original
warrant or acknowledge receipt of the order. The endorsed receipt or acknowledgment must
be filed in the court of commitment. After arrival, the patient shall be under the control and
custody of the head of the facility or program.

(d) Copies of the petition for commitment, the court's findings of fact and conclusions
of law, the court order committing the patient, the report of the court examiners, and the
prepetition report, and any medical and behavioral information available shall be provided
at the time of admission of a patient to the designated treatment facility or program to which
the patient is committed. Upon a patient's referral to the commissioner of human services
for admission pursuant to subdivision 1, paragraph (b), any inpatient hospital, treatment
facility, jail, or correctional facility that has provided care or supervision to the patient in
the previous two years shall, when requested by the treatment facility or commissioner,
provide copies of the patient's medical and behavioral records to the Department of Human
Services for purposes of preadmission planning. This information shall be provided by the
head of the treatment facility to treatment facility staff in a consistent and timely manner
and pursuant to all applicable laws.

(e) Patients described in paragraph (b) must be admitted to a state-operated treatment
program within 48 hours of the Office of Medical Director, under section 246.018, or a
designee determining that a medically appropriate bed is available. This paragraph expires
on June 30, 2025.

new text begin (f) A panel appointed by the commissioner, consisting of all members who served on
the Task Force on Priority Admissions to State-Operated Treatment Programs under Laws
2023, chapter 61, article 8, section 13, subdivision 2, must review deidentified data quarterly
for one year following the implementation of the priority admissions framework to ensure
that the framework is implemented and applied equitably. If the panel requests to review
data that is classified as private or confidential and the commissioner determines the data
requested is necessary for the scope of the panel's review, the commissioner is authorized
to disclose private or confidential data to the panel under this paragraph and pursuant to
section 13.05, subdivision 4, paragraph (b), for private or confidential data collected prior
to the effective date of this paragraph. The panel must also advise the commissioner on the
effectiveness of the framework and priority admissions generally. After the panel completes
its year of review, a quality committee established by the Department of Direct Care and
Treatment executive board will continue to review data and provide a routine report to the
executive board on the effectiveness of the framework and priority admissions.
new text end

new text begin (g) The commissioner may immediately approve an exception to add up to ten civilly
committed patients who are awaiting admission in hospital settings to the priority admissions
waiting list for admission to medically appropriate direct care and treatment programs.
Admissions of these patients must be managed according to the priority admissions
framework under paragraph (b). This paragraph expires upon the commissioner's approval
of the exception or on August 1, 2024, whichever is sooner.
new text end

ARTICLE 2

COMMUNITY BEHAVIORAL HEALTH SERVICES

Section 1.

Minnesota Statutes 2022, section 245.4905, is amended to read:

245.4905 FIRST EPISODE OF PSYCHOSIS GRANT PROGRAM.

Subdivision 1.

Creation.

The first episode of psychosis grant program is established in
the Department of Human Services to fund evidence-based interventions for youth new text begin and
young adults new text end at risk of developing or experiencing deleted text begin a deleted text end new text begin an early or new text end first episode of psychosis
deleted text begin and a public awareness campaign on the signs and symptoms of psychosis deleted text end . First episode of
psychosis services are eligible for children's mental health grants as specified in section
245.4889, subdivision 1, paragraph (b), clause (15). new text begin The Department of Human Services
must seek to fund eligible providers of first episode of psychosis services and assist with
program establishment throughout the state.
new text end

Subd. 2.

Activities.

(a) All first episode of psychosis grant programs must:

(1) provide intensive treatment and support for adolescents and new text begin young new text end adults experiencing
or at risk of experiencing deleted text begin a deleted text end new text begin an early or new text end first psychotic episode. Intensive treatment and
support includes medication management, psychoeducation for an individual and an
individual's family, case management, employment support, education support, cognitive
behavioral approaches, social skills training, peer support, new text begin family peer support, new text end crisis
planning, and stress management;

(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinicians, on early psychosis symptoms,
screening tools, new text begin the first episode of psychosis program, new text end and best practices;

(3) ensure access for individuals to first psychotic episode services under this section deleted text begin ,
including access for individuals who live in rural areas deleted text end ; and

(4) use all available funding streams.

(b) Grant money may also be used to pay for housing or travel expenses for individuals
receiving services or to address other barriers preventing individuals and their families from
participating in first psychotic episode services.

Subd. 3.

Eligibility.

Program activities must be provided to people 15 to 40 years old
deleted text begin with deleted text end new text begin who have new text end early signs of psychosis new text begin or who have experienced an early or first episode
of psychosis new text end .

Subd. 4.

Outcomes.

Evaluation of program activities must utilize evidence-based
practices and must include the following outcome evaluation criteria:

(1) whether individuals experience a reduction in psychotic symptoms;

(2) whether individuals experience a decrease in inpatient mental health hospitalizations new text begin
or interactions with the criminal justice system new text end ; and

(3) whether individuals experience an increase in educational attainment new text begin or employment new text end .

Subd. 5.

Federal aid or grants.

new text begin (a) new text end The commissioner of human services must comply
with all conditions and requirements necessary to receive federal aid or grants.

new text begin (b) The commissioner must provide an annual report to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance, the senate Finance Committee, and the house of representatives Ways
and Means Committee detailing the use of state and federal funds for the first episode of
psychosis grant program, the number of programs funded, the number of individuals served
across all grant-funded programs, and outcome and evaluation data.
new text end

Sec. 2.

new text begin [245.4908] EARLY EPISODE OF BIPOLAR DISORDER GRANT
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The early episode of bipolar disorder grant program is
established in the Department of Human Services, to fund evidence-based interventions for
youth and young adults at risk of developing or experiencing an early episode of bipolar
disorder. Early episode of bipolar disorder services are eligible for children's mental health
grants as specified in section 245.4889, subdivision 1, paragraph (b), clause (15). The
Department of Human Services must seek to fund eligible programs throughout the state.
new text end

new text begin Subd. 2. new text end

new text begin Activities. new text end

new text begin (a) All early episode of bipolar grant program recipients must:
new text end

new text begin (1) provide intensive treatment and support for adolescents and young adults experiencing
or at risk of experiencing early episode of bipolar disorder. Intensive treatment and support
includes medication management, psychoeducation for an individual and an individual's
family, case management, employment support, education support, cognitive behavioral
approaches, social skills training, peer and family peer support, crisis planning, and stress
management;
new text end

new text begin (2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinicians, on bipolar disorder symptoms,
screening tools, the recipient's program, and best practices; and
new text end

new text begin (3) use all available funding streams.
new text end

new text begin (b) Grant money may also be used to pay for housing or travel expenses for individuals
receiving services or to address other barriers preventing individuals and their families from
participating in early episode of bipolar disorder services.
new text end

new text begin Subd. 3. new text end

new text begin Service eligibility. new text end

new text begin A grant recipient's program activities must be provided to
individuals between 15 and 40 years of age who have early signs of or are experiencing
bipolar disorder.
new text end

new text begin Subd. 4. new text end

new text begin Outcomes. new text end

new text begin Evaluation of program activities must utilize evidence-based
practices and must include the following outcome evaluation criteria:
new text end

new text begin (1) whether individuals experience a reduction in symptoms;
new text end

new text begin (2) whether individuals experience a decrease in inpatient mental health hospitalizations
or interactions with the criminal justice system; and
new text end

new text begin (3) whether individuals experience an increase in educational attainment or employment.
new text end

new text begin Subd. 5. new text end

new text begin Federal aid or grants. new text end

new text begin (a) The commissioner of human services must comply
with all conditions and requirements necessary to receive federal aid or grants.
new text end

new text begin (b) The commissioner must provide an annual report to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance, the senate Finance Committee, and the house of representatives Ways
and Means Committee detailing the use of state and federal funds for the early episode of
bipolar disorder grant program, the number of programs funded, the number of individuals
served across all grant-funded programs, and outcome and evaluation data.
new text end

Sec. 3.

new text begin [253B.042] ENGAGEMENT SERVICES PILOT GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The engagement services pilot grant program is established
in the Department of Human Services, to provide grants to counties or certified community
behavioral health centers to provide engagement services under section 253B.041.
Engagement services provide early interventions to prevent an individual from meeting the
criteria for civil commitment and promote positive outcomes.
new text end

new text begin Subd. 2. new text end

new text begin Allowable grant activities. new text end

new text begin (a) Grantees must use grant funding to:
new text end

new text begin (1) develop a system to respond to requests for engagement services;
new text end

new text begin (2) provide the following engagement services, taking into account an individual's
preferences for treatment services and supports:
new text end

new text begin (i) assertive attempts to engage an individual in voluntary treatment for mental illness
for at least 90 days;
new text end

new text begin (ii) efforts to engage an individual's existing support systems and interested persons,
including but not limited to providing education on restricting means of harm and suicide
prevention, when the provider determines that such engagement would be helpful; and
new text end

new text begin (iii) collaboration with the individual to meet the individual's immediate needs, including
but not limited to housing access, food and income assistance, disability verification,
medication management, and medical treatment;
new text end

new text begin (3) conduct outreach to families and providers; and
new text end

new text begin (4) evaluate the impact of engagement services on decreasing civil commitments,
increasing engagement in treatment, decreasing police involvement with individuals
exhibiting symptoms of serious mental illness, and other measures.
new text end

new text begin (b) Engagement services staff must have completed training on person-centered care.
Staff may include but are not limited to mobile crisis providers under section 256B.0624,
certified peer specialists under section 256B.0615, community-based treatment programs
staff, and homeless outreach workers.
new text end

new text begin Subd. 3. new text end

new text begin Outcome evaluation. new text end

new text begin The commissioner of management and budget must
formally evaluate outcomes of grants awarded under this section, using an experimental or
quasi-experimental design. The commissioner shall consult with the commissioner of
management and budget to ensure that grants are administered to facilitate this evaluation.
Grantees must collect and provide the information needed to the commissioner of human
services to complete the evaluation. The commissioner must provide the information collected
to the commissioner of management and budget to conduct the evaluation. The commissioner
of management and budget may obtain additional relevant data to support the evaluation
study pursuant to section 15.08.
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 254B.04, subdivision 1a, is amended
to read:

Subd. 1a.

Client eligibility.

(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, who meet the income standards of section 256B.056,
subdivision 4, and are not enrolled in medical assistance, are entitled to behavioral health
fund services. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.

(b) Persons with dependent children who are determined to be in need of substance use
disorder treatment pursuant to an assessment under section 260E.20, subdivision 1, or in
need of chemical dependency treatment pursuant to a case plan under section 260C.201,
subdivision 6, or 260C.212, shall be assisted by the local agency to access needed treatment
services. Treatment services must be appropriate for the individual or family, which may
include long-term care treatment or treatment in a facility that allows the dependent children
to stay in the treatment facility. The county shall pay for out-of-home placement costs, if
applicable.

(c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
(12).

(d) A client is eligible to have substance use disorder treatment paid for with funds from
the behavioral health fund when the client:

(1) is eligible for MFIP as determined under chapter 256J;

(2) is eligible for medical assistance as determined under Minnesota Rules, parts
9505.0010 to 9505.0150;

(3) is eligible for general assistance, general assistance medical care, or work readiness
as determined under Minnesota Rules, parts 9500.1200 to 9500.1318; or

(4) has income that is within current household size and income guidelines for entitled
persons, as defined in this subdivision and subdivision 7.

(e) Clients who meet the financial eligibility requirement in paragraph (a) and who have
a third-party payment source are eligible for the behavioral health fund if the third-party
payment source pays less than 100 percent of the cost of treatment services for eligible
clients.

(f) A client is ineligible to have substance use disorder treatment services paid for with
behavioral health fund money if the client:

(1) has an income that exceeds current household size and income guidelines for entitled
persons as defined in this subdivision and subdivision 7; or

(2) has an available third-party payment source that will pay the total cost of the client's
treatment.

(g) A client who is disenrolled from a state prepaid health plan during a treatment episode
is eligible for continued treatment service that is paid for by the behavioral health fund until
the treatment episode is completed or the client is re-enrolled in a state prepaid health plan
if the client:

(1) continues to be enrolled in MinnesotaCare, medical assistance, or general assistance
medical care; or

(2) is eligible according to paragraphs (a) and (b) and is determined eligible by a local
agency under section 254B.04.

(h) When a county commits a client under chapter 253B to a regional treatment center
for substance use disorder services and the client is ineligible for the behavioral health fund,
the county is responsible for the payment to the regional treatment center according to
section 254B.05, subdivision 4.

new text begin (i) Notwithstanding paragraph (a), persons enrolled in MinnesotaCare are eligible for
room and board services under section 254B.05, subdivision 1a, paragraph (d).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end

Sec. 5.

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.

new text begin (b) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase rates for residential services subject to this section by ... percent. The commissioner
shall adjust rates for such services annually according to the change from the midpoint of
the previous rate year to the midpoint of the rate year for which the rate is being determined
using the Centers for Medicare and Medicaid Services Medicare Economic Index as
forecasted in the fourth quarter of the calendar year before the rate year. This paragraph
does not apply to federally qualified health centers, rural health centers, Indian health
services, certified community behavioral health clinics, cost-based rates, and rates that are
negotiated with the county.
new text end

new text begin (c) For payments made under paragraph (b), if and to the extent that the commissioner
identifies that the state has received federal financial participation for behavioral health
services in excess of the amount allowed under Code of Federal Regulations, title 42, section
447.321, the state shall repay the excess amount to the Centers for Medicare and Medicaid
Services with state money and maintain the full payment rate under paragraph (b).
new text end

new text begin (d) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increase for residential services provided in paragraph (b). Managed
care and county-based purchasing plans must use the capitation rate increase provided under
this paragraph to increase payment rates to behavioral health services providers. The
commissioner must monitor the effect of this rate increase on enrollee access to services
provided under paragraph (b). If for any contract year federal approval is not received for
this paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision.
new text end

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

deleted text begin (c) deleted text end new text begin (f) new text end The commissioner shall establish higher rates for programs that meet the
requirements of paragraph deleted text begin (b) deleted text end new text begin (e) new text end 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.

deleted text begin (d) deleted text end new text begin (g) new text end In order to be eligible for a higher rate under paragraph deleted text begin (c) deleted text end new text begin (f) new text end , 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.

deleted text begin (e) deleted text end new text begin (h) new text end 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 deleted text begin (c) deleted text end new text begin (f) new text end , clause (4), items (i) to (iv).

deleted text begin (f) deleted text end new text begin (i) new text end Subject to federal approval, 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.

deleted text begin (g) deleted text end new text begin (j) new text end For the purpose of reimbursement under this section, substance use disorder
treatment services provided in a group setting without a group participant maximum or
maximum client to staff ratio under chapter 245G shall not exceed a client to staff ratio of
48 to one. At least one of the attending staff must meet the qualifications as established
under this chapter for the type of treatment service provided. A recovery peer may not be
included as part of the staff ratio.

deleted text begin (h) deleted text end new text begin (k) new text end 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.

deleted text begin (i) deleted text end new text begin (l) new text end 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.

Sec. 6.

Minnesota Statutes 2023 Supplement, section 256.969, subdivision 2b, is amended
to read:

Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are available, except
that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019.
The estimated change in the average payment per hospital discharge resulting from a
scheduled rebasing must be calculated and made available to the legislature by January 15
of each year in which rebasing is scheduled to occur, and must include by hospital the
differential in payment rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and

(6) geographic location.

(k) Effective for discharges occurring on or after January 1, 2024, the rates paid to
hospitals described in paragraph (a), clauses (2) to (4), must include a rate factor specific
to each hospital that qualifies for a medical education and research cost distribution under
section 62J.692, subdivision 4, paragraph (a).

new text begin (l) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase payments for behavioral health services provided by hospitals paid on a
diagnosis-related group methodology for hospital inpatient services by increasing the
adjustment for behavioral health services under section 256.969, subdivision 2b, paragraph
(e).
new text end

new text begin (m) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increase provided under paragraph (l). Managed care and
county-based purchasing plans must use the capitation rate increase provided under this
paragraph to increase payment rates to behavioral health services providers. The
commissioner must monitor the effect of this rate increase on enrollee access to services
described in paragraph (l). If for any contract year federal approval is not received for this
paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision.
new text end

Sec. 7.

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. 8.

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. 9.

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. 10.

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. 11.

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. 12.

Minnesota Statutes 2022, section 256B.0757, subdivision 5, is amended to read:

Subd. 5.

Payments.

new text begin (a) new text end The commissioner shall deleted text begin make payments to each designated
provider for the provision of health home services described in subdivision 3 to each eligible
individual under subdivision 2 that selects the health home as a provider deleted text end new text begin determine and
implement a single statewide reimbursement rate for behavioral health home services under
this section. The rate must be no less than $408 per member, per month. The commissioner
must adjust the statewide reimbursement rate annually according to the change from the
midpoint of the previous rate year to the midpoint of the rate year for which the rate is being
determined using the Centers for Medicare and Medicaid Services Medicare Economic
Index as forecasted in the fourth quarter of the calendar year before the rate year new text end .

new text begin (b) The commissioner must review and update the behavioral health home service rate
under paragraph (a) at least every four years. The updated rate must account for the average
hours required for behavioral health home team members spent providing services and the
Department of Labor prevailing wage for required behavioral health home team members.
The updated rate must ensure that behavioral health home services rates are sufficient to
allow providers to meet required certifications, training, and practice transformation
standards; staff qualification requirements; and service delivery standards.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end

Sec. 13.

Minnesota Statutes 2023 Supplement, section 256B.76, subdivision 1, is amended
to read:

Subdivision 1.

Physician and professional services reimbursement.

deleted text begin (a) Effective for
services rendered on or after October 1, 1992, the commissioner shall make payments for
physician services as follows:
deleted text end

deleted text begin (1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
deleted text end

deleted text begin (2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
deleted text end

deleted text begin (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
deleted text end

deleted text begin (b) deleted text end new text begin (a) new text end Effective for services rendered on or after January 1, 2000, new text begin through December
31, 2024, new text end payment rates for physician and professional services shall be increased by three
percent over the rates in effect on December 31, 1999, except for home health agency and
family planning agency services. The increases in this paragraph shall be implemented
January 1, 2000, for managed care.

deleted text begin (c) deleted text end new text begin (b) new text end Effective for services rendered on or after July 1, 2009, new text begin through December 31,
2024, new text end payment rates for physician and professional services shall be reduced by five percent,
except that for the period July 1, 2009, through June 30, 2010, payment rates shall be reduced
by 6.5 percent for the medical assistance and general assistance medical care programs,
over the rates in effect on June 30, 2009. This reduction and the reductions in paragraph (d)
do not apply to office or other outpatient visits, preventive medicine visits and family
planning visits billed by physicians, advanced practice registered nurses, or physician
assistants in a family planning agency or in one of the following primary care practices:
general practice, general internal medicine, general pediatrics, general geriatrics, and family
medicine. This reduction and the reductions in paragraph (d) do not apply to federally
qualified health centers, rural health centers, and Indian health services. Effective October
1, 2009, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in
this paragraph.

deleted text begin (d) deleted text end new text begin (c) new text end Effective for services rendered on or after July 1, 2010, new text begin through December 31,
2024, new text end payment rates for physician and professional services shall be reduced an additional
seven percent over the five percent reduction in rates described in paragraph (c). This
additional reduction does not apply to physical therapy services, occupational therapy
services, and speech pathology and related services provided on or after July 1, 2010. This
additional reduction does not apply to physician services billed by a psychiatrist or an
advanced practice registered nurse with a specialty in mental health. Effective October 1,
2010, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in
this paragraph.

deleted text begin (e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
deleted text end

deleted text begin (f) deleted text end new text begin (d) new text end Effective for services rendered on or after September 1, 2014, new text begin through December
31, 2024, new text end payment rates for physician and professional services, including physical therapy,
occupational therapy, speech pathology, and mental health services shall be increased by
five percent from the rates in effect on August 31, 2014. In calculating this rate increase,
the commissioner shall not include in the base rate for August 31, 2014, the rate increase
provided under section 256B.76, subdivision 7. This increase does not apply to federally
qualified health centers, rural health centers, and Indian health services. Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.

deleted text begin (g) deleted text end new text begin (e) new text end Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.

deleted text begin (h) deleted text end new text begin (f) new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

deleted text begin (i) deleted text end new text begin (g) new text end The commissioner may reimburse physicians and other licensed professionals for
costs incurred to pay the fee for testing newborns who are medical assistance enrollees for
heritable and congenital disorders under section 144.125, subdivision 1, paragraph (c), when
the sample is collected outside of an inpatient hospital or freestanding birth center and the
cost is not recognized by another payment source.

Sec. 14.

Minnesota Statutes 2022, section 256B.76, subdivision 6, is amended to read:

Subd. 6.

Medicare relative value units.

deleted text begin Effective for services rendered on or after
January 1, 2007, the commissioner shall make payments for physician and professional
services based on the Medicare relative value units (RVU's). This change shall be budget
neutral and the cost of implementing RVU's will be incorporated in the established conversion
factor deleted text end new text begin (a) Effective for physician and professional services included in the Medicare Physician
Fee Schedule and rendered on or after January 1, 2025, the commissioner shall make
payments at rates at least equal to 100 percent of the corresponding rates in the Medicare
Physician Fee Schedule. Payment rates set under this paragraph must use Medicare relative
value units (RVUs) and conversion factors, at least equal to those in the Medicare Physician
Fee Schedule, to implement the resource-based relative value scale new text end .

new text begin (b) The commissioner shall revise fee-for-service payment methodologies under this
section, upon the issuance of a Medicare Physician Fee Schedule final rule by the Centers
for Medicare and Medicaid Services, to ensure the payment rates under this subdivision are
at least equal to the corresponding rates in the final rule.
new text end

new text begin (c) The commissioner must revise and implement payment rates for mental health services
based on RVUs and rendered on or after January 1, 2025, such that the payment rates are
at least equal to 100 percent of the Medicare Physician Fee Schedule in accordance with
paragraph (a), before or at the same time as when the commissioner revises and implements
payment rates for other services under paragraph (a).
new text end

new text begin (d) All mental health services and substance use disorder services performed in a primary
care or mental health care health professional shortage area, medically underserved area,
or medically underserved population, as maintained and updated by the United States
Department of Health and Human Services, are eligible for a ten percent bonus payment.
The services are eligible for a bonus based upon the performance of the service in a health
professional shortage area if (1) the services were rendered in a health professional shortage
area, or (2) the provider maintains an office in a health professional shortage area.
new text end

new text begin (e) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increases provided under this subdivision. Managed care and
county-based purchasing plans must use the capitation rate increase provided under this
paragraph to increase payment rates to the providers corresponding to the rate increases.
The commissioner must monitor the effect of this rate increase on enrollee access to services
under this subdivision. If for any contract year federal approval is not received for this
paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision.
new text end

Sec. 15.

Minnesota Statutes 2023 Supplement, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.

(c) In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.

(d) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

(e) Effective for services rendered on or after January 1, 2024, payment rates for
behavioral health services included in the rate analysis required by Laws 2021, First Special
Session chapter 7, article 17, section 18, except for adult day treatment services under section
256B.0671, subdivision 3; early intensive developmental and behavioral intervention services
under section 256B.0949; and substance use disorder services under chapter 254B, must be
increased by three percent from the rates in effect on December 31, 2023. Effective for
services rendered on or after January 1, 2025, payment rates for behavioral health services
included in the rate analysis required by Laws 2021, First Special Session chapter 7, article
17, section 18, except for adult day treatment services under section 256B.0671, subdivision
3; early intensive developmental behavioral intervention services under section 256B.0949;
and substance use disorder services under chapter 254B, must be annually adjusted according
to the change from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined using the Centers for Medicare and Medicaid Services
Medicare Economic Index as forecasted in the fourth quarter of the calendar year before
the rate year. For payments made in accordance with this paragraph, if and to the extent
that the commissioner identifies that the state has received federal financial participation
for behavioral health services in excess of the amount allowed under United States Code,
title 42, section 447.321, the state shall repay the excess amount to the Centers for Medicare
and Medicaid Services with state money and maintain the full payment rate under this
paragraph. This paragraph does not apply to federally qualified health centers, rural health
centers, Indian health services, certified community behavioral health clinics, cost-based
rates, and rates that are negotiated with the county. This paragraph expires upon legislative
implementation of the new rate methodology resulting from the rate analysis required by
Laws 2021, First Special Session chapter 7, article 17, section 18.

(f) Effective January 1, 2024, the commissioner shall increase capitation payments made
to managed care plans and county-based purchasing plans to reflect the behavioral health
service rate increase provided in paragraph (e). Managed care and county-based purchasing
plans must use the capitation rate increase provided under this paragraph to increase payment
rates to behavioral health services providers. The commissioner must monitor the effect of
this rate increase on enrollee access to behavioral health services. If for any contract year
federal approval is not received for this paragraph, the commissioner must adjust the
capitation rates paid to managed care plans and county-based purchasing plans for that
contract year to reflect the removal of this provision. Contracts between managed care plans
and county-based purchasing plans and providers to whom this paragraph applies must
allow recovery of payments from those providers if capitation rates are adjusted in accordance
with this paragraph. Payment recoveries must not exceed the amount equal to any increase
in rates that results from this provision.

new text begin (g) Effective for services under this section billed and coded under HCPCS H, S, and T
codes and rendered on or after January 1, 2025, the payment rates shall be increased as
necessary to align with the Medicare Physician Fee Schedule.
new text end

new text begin (h) The commissioner shall revise fee-for-service payment methodologies under paragraph
(g), upon the issuance of a Medicare Physician Fee Schedule final rule by the Centers for
Medicare and Medicaid Services, as necessary to ensure the payments rates under paragraph
(g) align with the corresponding payment rates in the final rule.
new text end

Sec. 16. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAID
REENTRY SECTION 1115 DEMONSTRATION OPPORTUNITY WAIVER.
new text end

new text begin (a) The commissioner of human services shall apply to the secretary of health and human
services for a Medicaid Reentry Section 1115 Demonstration Opportunity waiver to provide
short term medical assistance enrollment assistance and prerelease coverage for care transition
services to incarcerated individuals who are soon to be released from incarceration, consistent
with the statutory directive in section 5032 of the Substance Use-Disorder Prevention that
Promotes Opioid Recovery and Treatment for Patients and Communities Act (Public Law
115-271) and federal guidance. The commissioner's application must request coverage for
at least the services under Minnesota Statutes, section 256B.0625, subdivision 72, for at
least 30 days prior to an eligible incarcerated individual's expected release date.
new text end

new text begin (b) When preparing the application for the Section 1115 Demonstration Opportunity
waiver, the commissioner of human services must consult with the commissioner of
corrections, sheriffs, lead agencies, and individuals with lived experience of incarceration.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 17. 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

Sec. 18. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2022, section 256B.0625, subdivision 38, new text end new text begin is repealed.
new text end

ARTICLE 3

MISCELLANEOUS

Section 1.

Minnesota Statutes 2022, section 246.18, subdivision 4a, is amended to read:

Subd. 4a.

Mental health innovation account.

The mental health innovation account is
established in the special revenue fund. deleted text begin Beginning in fiscal year 2018, $1,000,000 of deleted text end The
revenue generated by collection efforts from the Anoka-Metro Regional Treatment Center
and community behavioral health hospitals under section 246.54 must annually be deposited
into the mental health innovation account. Money deposited in the mental health innovation
account is appropriated to the commissioner of human services for the mental health
innovation grant program under section 245.4662.

Sec. 2.

Minnesota Statutes 2023 Supplement, section 246.54, subdivision 1a, is amended
to read:

Subd. 1a.

Anoka-Metro Regional Treatment Center.

(a) A county's payment of the
cost of care provided at Anoka-Metro Regional Treatment Center shall be according to the
following schedule:

(1) zero percent for the first 30 days;

(2) 20 percent for days 31 and over if the stay is determined to be clinically appropriate
for the client; and

(3) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged.

(b) If payments received by the state under sections 246.50 to 246.53 exceed 80 percent
of the cost of care for days over 31 for clients who meet the criteria in paragraph (a), clause
(2), the county shall be responsible for paying the state only the remaining amount. The
county shall not be entitled to reimbursement from the client, the client's estate, or from the
client's relatives, except as provided in section 246.53.

deleted text begin (c) Between July 1, 2023, and June 30, 2025, the county is not responsible for the cost
of care under paragraph (a), clause (3), for a person who is committed as a person who has
a mental illness and is dangerous to the public under section 253B.18 and who is awaiting
transfer to another state-operated facility or program. This paragraph expires June 30, 2025.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end Notwithstanding any law to the contrary, the client is not responsible for payment
of the cost of care under this subdivision.

new text begin (d) The county is not responsible for the cost of care under paragraph (a), clause (3), for
a client who is civilly committed, if the client:
new text end

new text begin (1) is awaiting transfer to a facility operated by the Department of Corrections; or
new text end

new text begin (2) is awaiting transfer to another state-operated facility or program, and the direct care
and treatment executive medical director's office has determined that:
new text end

new text begin (i) the client meets criteria for admission to that state-operated facility or program; and
new text end

new text begin (ii) the state-operated facility or program is the only facility or program that can
reasonably serve the client.
new text end

Sec. 3.

Minnesota Statutes 2023 Supplement, section 246.54, subdivision 1b, is amended
to read:

Subd. 1b.

Community behavioral health hospitals.

(a) A county's payment of the cost
of care provided at state-operated community-based behavioral health hospitals for adults
and children shall be according to the following schedule:

(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and

(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.

deleted text begin (b) Between July 1, 2023, and June 30, 2025, the county is not responsible for the cost
of care under paragraph (a), clause (1), for a person committed as a person who has a mental
illness and is dangerous to the public under section 253B.18 and who is awaiting transfer
to another state-operated facility or program. This paragraph expires June 30, 2025.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Notwithstanding any law to the contrary, the client is not responsible for payment
of the cost of care under this subdivision.

new text begin (c) The county is not responsible for the cost of care under paragraph (a), clause (1), for
a client who is civilly committed, if the client:
new text end

new text begin (1) is awaiting transfer to a facility operated by the Department of Corrections; or
new text end

new text begin (2) is awaiting transfer to another state-operated facility or program, and the direct care
and treatment executive medical director's office has determined that:
new text end

new text begin (i) the client meets criteria for admission to that state-operated facility or program; and
new text end

new text begin (ii) the state-operated facility or program is the only facility or program that can
reasonably serve the client.
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 641.15, subdivision 2, is amended
to read:

Subd. 2.

Medical aid.

Except as provided in section 466.101, the county board shall
pay the costs of medical services provided to prisoners pursuant to this section. The amount
paid by the county board for a medical service shall not exceed the maximum allowed
medical assistance payment rate for the service, as determined by the commissioner of
human services. In the absence of a health or medical insurance or health plan that has a
contractual obligation with the provider or the prisoner, medical providers shall charge no
higher than the rate negotiated between the county and the provider. In the absence of an
agreement between the county and the provider, the provider may not charge an amount
that exceeds the maximum allowed medical assistance payment rate for the service, as
determined by the commissioner of human services. The county is entitled to reimbursement
from the prisoner for payment of medical bills to the extent that the prisoner to whom the
medical aid was provided has the ability to pay the bills. The prisoner shall, at a minimum,
incur co-payment obligations for health care services provided by a county correctional
facility. The county board shall determine the co-payment amount. new text begin A prisoner shall not
have a co-payment obligation for receiving a medication for mental health treatment in a
county correctional facility. The county board may seek reimbursement for mental health
medication co-payment costs from the commissioner of human services. new text end Notwithstanding
any law to the contrary, the co-payment shall be deducted from any of the prisoner's funds
held by the county, to the extent possible. If there is a disagreement between the county and
a prisoner concerning the prisoner's ability to pay, the court with jurisdiction over the
defendant shall determine the extent, if any, of the prisoner's ability to pay for the medical
services. If a prisoner is covered by health or medical insurance or other health plan when
medical services are provided, the medical provider shall bill that health or medical insurance
or other plan. If the county providing the medical services for a prisoner that has coverage
under health or medical insurance or other plan, that county has a right of subrogation to
be reimbursed by the insurance carrier for all sums spent by it for medical services to the
prisoner that are covered by the policy of insurance or health plan, in accordance with the
benefits, limitations, exclusions, provider restrictions, and other provisions of the policy or
health plan. The county may maintain an action to enforce this subrogation right. The county
does not have a right of subrogation against the medical assistance program. The county
shall not charge prisoners for telephone calls to MNsure navigators, the Minnesota Warmline,
a mental health provider, or calls for the purpose of providing case management or mental
health services as defined in section 245.462 to prisoners.

Sec. 5. new text begin JOINT INCIDENT COLLABORATION; DIRECTION TO COMMISSIONER
OF HUMAN SERVICES.
new text end

new text begin The commissioner of human services and the Department of Direct Care and Treatment
executive board, once operational, shall coordinate to implement a joint incident collaboration
model with counties and community mental health treatment providers to actively arrange
discharges of direct care and treatment patients to appropriate community treatment settings
when the patients are medically stable for discharge.
new text end

ARTICLE 4

APPROPRIATIONS

Section 1. new text begin CORRECTIONAL FACILITY MENTAL HEALTH COSTS AND
SERVICES.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services for services and costs for prisoners receiving mental health medications in
county correctional facilities. The commissioner must use these funds to:
new text end

new text begin (1) pay for injectable medications or neuroleptic medications used for mental health
treatment of prisoners in county correctional facilities and related billable provider costs;
and
new text end

new text begin (2) reimburse county boards for co-payment costs incurred for mental health medications
provided in county correctional facilities, pursuant to Minnesota Statutes, section 641.15,
subdivision 2.
new text end

Sec. 2. new text begin DIRECT CARE AND TREATMENT; COUNTY CORRECTIONAL
FACILITY MENTAL HEALTH MEDICATIONS.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services to create a staff position within direct care and treatment to provide education,
support, and technical assistance to counties and county correctional facilities on the provision
of medications for mental health treatment and assist with finding providers to deliver the
medications.
new text end

Sec. 3. new text begin FORENSIC EXAMINER SERVICES.
new text end

new text begin $9,230,000 in fiscal year 2025 is appropriated from the general fund to the supreme
court for the psychological and psychiatric forensic examiner services program to deliver
statutorily mandated psychological examinations for civil commitment, criminal competency,
and criminal responsibility evaluations. This appropriation must be used to increase forensic
examiner pay rates from $125 to $225 per hour.
new text end

Sec. 4. new text begin DIRECT CARE AND TREATMENT CAPACITY AND UTILIZATION.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services to increase capacity and access to direct care and treatment services for all
levels of care. The commissioner must prioritize expanding capacity within the Forensic
Mental Health Program by ten to 20 percent, and Anoka Metro Regional Treatment Center
and community behavioral health hospitals by 20 percent, through renovation, construction,
reallocation of beds and staff, addition of beds and staff, or a combination of these activities.
The commissioner must also use money appropriated under this section to examine the
utilization of beds at the Forensic Mental Health Program to identify opportunities for the
most effective utilization of secured programming and to develop and fund direct care and
treatment transitional support resources.
new text end

Sec. 5. new text begin HOSPITAL PAYMENT RATE INCREASES.
new text end

new text begin $8,785,000 in fiscal year 2025 is appropriated from the general fund to the commissioner
of human services for the hospital payment rate increases under Minnesota Statutes, section
256.969, subdivision 2b, paragraphs (l) and (m). The aggregate amount of the increased
payments under Minnesota Statutes, section 256.969, subdivision 2b, paragraphs (l) and
(m), must at least equal the amount of this appropriation.
new text end

Sec. 6. new text begin ENGAGEMENT SERVICES PILOT GRANTS.
new text end

new text begin $2,000,000 in fiscal year 2025 is appropriated from the general fund to the commissioner
of human services for engagement services pilot grants under Minnesota Statutes, section
253B.042. This funding is added to the base.
new text end

Sec. 7. new text begin EARLY EPISODE OF BIPOLAR GRANT PROGRAM.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services for the early episode of bipolar grant program under Minnesota Statutes,
section 245.4908. This funding is added to the base.
new text end

Sec. 8. new text begin FIRST EPISODE OF PSYCHOSIS GRANT PROGRAM.
new text end

new text begin $2,000,000 in fiscal year 2025 is appropriated from the general fund to the commissioner
of human services for the first episode of psychosis grant program under Minnesota Statutes,
section 245.4905. This funding is added to the base. The commissioner may distribute this
funding to fully fund current grantee programs, increase a current grantee program's capacity,
and to expand grants for programs to outside the seven-county metropolitan area. The
commissioner must continue to fund current grantee programs to ensure stability and
continuity of care, if the current grantee programs have met requirements for usage of grant
funds previously received.
new text end

APPENDIX

Repealed Minnesota Statutes: H4366-1

256B.0625 COVERED SERVICES.

Subd. 38.

Payments for mental health services.

Payments for mental health services covered under the medical assistance program that are provided by masters-prepared mental health professionals shall be 80 percent of the rate paid to doctoral-prepared professionals. Payments for mental health services covered under the medical assistance program that are provided by masters-prepared mental health professionals employed by community mental health centers shall be 100 percent of the rate paid to doctoral-prepared professionals. Payments for mental health services covered under the medical assistance program that are provided by physician assistants shall be 80.4 percent of the base rate paid to psychiatrists.